§ Order for Second Reading read.
§ 4.7 p.m.
§ The Secretary of State for Scotland (Mr. Westwood)
I beg to move, "That the Bill be now read a Second time."
In inviting the House to give a Second Reading to this Bill I feel it well that we should briefly consider the background of its preparation, and the need for its introduction as the next step forward towards a positive health policy for Scotland. The beginnings of the health services in Scotland can be traced to the fear of pestilence, and this fear supplied the leading motive for nearly all health efforts in Scotland up to about the beginning of this century. It can be summed up so far as this policy is concerned in the words, "a public policy directed rather to the preservation of the untainted, than to the recovery of the sick."
A good illustration of this policy was the decision of the magistrates of Aberdeen —it is true that it is a long way back, but, still, it give? us some indication of what the policy was at that time in a particular area—in the year 1585, to erect three gibbets—one at Mercat Cross, another at the Brig of Dee, and a third at the haven mouth—so that any infected person arriving in the burgh, or any person who gave shelter to an infected person, if a man should be hanged, and if a woman should be drowned Much progress has been made since that time. [An HON. MEMBER: 996 "What is being done now?"] We have had a century of legislation, each piece of legislation carrying us forward to the health services of today—health services which are in operation for the care of the sick poor, the industrial health service, the school medical service, the maternity and child welfare service, national health insurance, and not least of all, particularly as it affects Scotland, the Highlands and Islands medical service. Arising out of the Dewar Committee's Report, Parliament in 1913 passed the Highlands and Islands Medical Service (Grants) Act, which today provides grants for doctors, nursing services, hospitals, specialists, ambulances and other means for the prevention, the treatment and the alleviation of illness and suffering in the Highlands and Islands, and recognising that an adequate medical service is an essential element for the wellbeing of the citizen, the State, so far as that part of Scotland is concerned, has been subsidising these services since 1913.
Despite the progress we have made as the result of previous legislation, there remains a large mass of sickness and defects of various kinds as revealed by the records of medical inspection of school children, sickness returns of the insured population, and other figures. The Committee on Scottish Health Services, of which I had the honour and privilege to be a member, and which reported in 1936, pointed out that:In an investigation in Glasgow about 10 per cent. of school children were found to have ailments that could not be classified as minor; in the course of a year over 20 per cent. of the insured population are incapacitated for work, and the average time lost among the insured population is more than ten days per annum. Of the men applying for enlistment in the Army and presented for medical examination, 38 per cent. were rejected on medical grounds. There is, in addition, much subnormal health and many minor defects that, although not recorded in any tables, represent diminished reserve and capacity for living and may be the precursors of manifest disease. The vital statistics of Scotland are disquietingly less favourable than those of England and Wales and several other European countries.Having all these facts before them, the Committee to which I have already referred came to the conclusion and again I quote:Changes in the size and distribution of the population, in social and economic conditions, in the habits and outlook of the people, and in the actual causes of death and ill-health require a readjustment of health 997 effort. The existing health services are not fully adapted to modern conditions and outlook, and it is inherent in their more or less haphazard and sectional growth that they do not constitute a national health policy. The first essential, in order to avoid over-lapping, to secure a full return for expenditure, to keep the services in line with changing conditions, and to secure that emphasis is distributed according to the social value of the varied services, is to integrate the separate services into a national health policy. The general aim of this policy should be to promote the fitness of the people. The need for such a policy is, among other considerations, reinforced by the fact that the people of Scotland are far short of an attainable standard of fitness, the huge communal cost of ill-health and the prospect of a declining population. Policy should be comprehensive in scope and should cover the whole field of morbidity.Now when that Committee considered the general practitioner service, it was conclusively proved that many persons, especially women and children, do not in fact receive adequate and timely attention because those responsible could not afford to pay for the services of a private general practitioner. Let me quote from evidence of the medical officer of health for Dundee. This is what he said:One of the most important criticisms of the organisation as it exists at present is that advice and treatment are not immediately accessible to every individual unless the payment of medical fees is a matter of little or no moment.This witness went on to state:This fact has been brought home to me on numerous occasions when visiting in the district for the purposes of housing. During the winter months particularly, one finds in numerous dwelling houses children who are obviously ill and in need of medical attention.He also said that no doctor was in attendance and the reason, admitted or obvious, based upon the inquiries and the work on which he was engaged, was always connected with finance. He added:Usually we find that there has been delay in sending for medical advice owing to the expenditure involved.That Committee gave me an insight into health administration in Scotland and the opportunity of getting a grounding for the work which I have to do in this House now, to get this Bill through in time. It further found that the inadequacy of general medical attendance adds to the cost, interferes with the efficiency, and prevents the sound development of many of the medical services provided by Statute. We came to the conclusion—and here I quote again from the Report— that: 998as part of a policy for the promotion of the health of the people it is necessary to secure that as far as possible all members of the community should have available the services of a general medical practitioner. On grounds of administrative expediency as well as on grounds of national policy it has become imperative for the State to frame a policy to meet the needs of—I want to emphasise the next two words—at least the dependants of insured persons and others in similar economic circumstances and to lay down the lines along which the medical services should develop.Those two words "at least" were placed in the report because there were members of that Advisory Committee who believed that it was essential to have an all-comprehensive service providing a family practitioner for all who needed his or her services. We could only get agreement, so far as that part of the report was concerned, by agreeing to the insertion of the words "at least." To put it another way, that was to be the minimum towards which we were to strive, and it certainly did not satisfy at least seven members of that Committee, who finally signed a reservation so far as the provision of family practitioner service was concerned.
A subcommittee of the Scottish Health Services Committee reported on the Highland and Islands medical service. They reported that they found it to be so satisfactory that it might provide valuable pointers for consideration of future medical service in Scotland as a whole. I mention that because they were so impressed with the success of the Highlands and Islands medical service, to which I will refer later, that they were assured in their own minds that it could give us the necessary pointers towards having a full and comprehensive service in Scotland.
As to the policy of having a free, all-embracing, family practitioner service, the Royal Commission on National Health Insurance recommended the separating of the medical service from the insurance structure, and the placing of it on public funds. Ten years later, in their reservation to which I have already referred, six members and myself out of the 18 members of the Scottish Health Services Committee recommended the abandonment of the contributory system so far as the medical side of insurance is concerned, and we further suggested that those with whom the direction of policy rests should in planning the future bear in mind that the "ultimate solution" of the Royal Commission cannot be much longer postponed 999 and that they should seek the favourable moment to bring simplicity and logic into this part of our health policy.
We found a serious shortage of hospital facilities, that the shortage militated against the ideal of early treatment, that adequate hospital service is essential for the public health, and that steps should be taken to provide it. It is true that the Scottish Health Services Committee also said that it was in the interest of the State to foster the voluntary hospital system, but this was qualified by the statement that it would be unwise to extend their financial commitments much further than at present. To secure an adequate hospital service under modern conditions —and to safeguard the voluntary hospitals—hospitals of all kinds, we went on to state, must be viewed as a whole, and over wide regions, and must be regarded as forming one service.
The Bill which is now before the House —a Bill drafted and directed towards providing for Scots people a comprehensive Health Service—places for the first time on public authorities—central and local— the responsibility for seeing to the provision of all facilities needed for the health of the whole population. The essential aims and objectives, on which I think there is general agreement, although we may disagree on how we are to attain these objects, might be summed up in this way. In the first place, it is to be the statutory responsibility of some public authority to provide every necessary form of health care—the family doctor, the specialist, the hospital, rehabilitation and convalescence, dental treatment, the care of sight and hearing including the provision of artificial aids, special priority services for expectant and nursing mothers, young children and school children, and so on. There is to be full provision, not only for the treatment of illness, but also, what is no less important, for the prevention of illness, and the promotion of health, without which we cannot have a positive health service.
In the second place, the service—or any part of it—will be available to every man, woman and child in the country. Although part of the cost is to be met from insurance funds, there will be no insurance qualifications,' nor any other kind of test based upon means, residence, or anything of that kind. In the third place, the new 1000 service is, for all practical purposes, to be free of charge. This does not mean that it will not be an expensive business to provide the service, although less expensive than to allow ill-health to continue unchecked. But the cost will be met mainly from the national Exchequer, and partly, also, from rates and insurance contributions; so that the patient will not in future have to pay in accordance with the extent to which he finds it necessary to call in the service to his aid
So much for the aims of the new Service. And now a word about the organisation which the Bill proposes to attain these aims. Central responsibility for the new Service as a whole is to rest with the Secretary of State. By his side, to give him expert advice on all aspects of the Service, there is to be a Scottish Health Services Council, with members drawn from all relevant fields of experience. Standing committees of that council will be set up in connection with particular parts of the Service, including any additional members necessary to cover particular sub-divisions of the expert field. Responsibility for the hospital and allied services is also to rest in future with the Secretary of State. For this purpose all existing hospitals, local authority, and voluntary, are to be transferred to him. The administration of these services is to be entrusted to an organisation I propose to set up under the Bill, a specially created regional and local organisation. Five regional hospital boards will act as agents of the Secretary of State, undertaking the general administration of the services in their areas. In turn, to act as agents of the regional boards for the control and management of particular hospitals, boards of management are to be set up. On these regional boards and boards of management members with all appropriate kinds of experience and local interests will find a place. For the general practitioner services, executive councils are to be established, drawn mainly from local authorities, and from representative professional committees in each area. The doctors and dentists will be encouraged to work from health centres, which will be staffed and equipped so as to enable them to carry out their work in the most effective way. Responsibility for these health centres will, in Scotland, rest in the first place with the Secretary of State. In order to improve the distribution of 1001 doctors throughout the country, there will be provision for debarring additional doctors from entering the Service in an area already adequately covered. Sale and purchase of medical practices coming within the new Service will be forbidden, and compensation will be paid. Remuneration, while mainly by way of capitation payments, will also include a basic salary dement, which can be adjusted in accordance with the different needs of particular areas
§ Major Guy Lloyd (Renfrew, Eastern)
The right hon. Gentleman is now touching on an important point. Who is to decide whether a particular area is adequately covered or not? Is the Secretary of State to have advice?
§ Mr. Westwood
The hon. and gallant Gentleman may rest assured that I will have the best and most competent advice to guide me on what is, I admit, a very important point.
§ Mr. Scollan (Renfrew, Western)
Can my right hon. Friend explain a point about compensation? General practitioners in my constituency have agreements with their assistants in which the assistants have the right, either to go into partnership, or, if the practice is sold, of first priority. Some of them have built up quite considerable assistants' practices. Is any consideration to be given to those people, now that the general practitioners are to sell out to the Government?
§ Mr. Westwood
I would prefer that these particular points should be raised in Committee, when we shall have fuller time to deal with these very important questions. That is one of the reasons why I endeavoured to keep this as a Scottish Bill, so that we shall be able to thresh these matters out in detail in the Scottish Grand Committee. The lump sum for compensation is £66 million. I shall be referring to it later in my speech. It will be available for the whole of the medical practitioner services in Great Britain, and Scottish doctors will be entitled to their fair share.
§ Mr. Scollan
The only point I have in mind, in raising the matter, is that, unfortunately, no provision is made in the White Paper, or in the Bill. These men are suffering great hardship in this respect, that if they claim the right to practise in the area where they have been 1002 practising, the General Medical Council will come down on them for a breach of the rules of etiquette.
§ Mr. Westwood
I do not want here to go into Committee points. It would be impossible for us to deal with all the points of detail on the Second Reading of the Bill. These are matters which can be discussed when we reach the Committee stage. I repeat that the sale and purchase of medical practices coming within the new service will be forbidden, and compensation will be paid As I have pointed out, remuneration, while mainly by way of capitation payment, will also include a salary element.
For a considerable range of local services, responsibility will rest, as at present, with the major local authorities, that is, the county councils and the town councils of our large burghs. In addition to their present maternity and child welfare duties, authorities will have a new duty to secure the provision of a home nursing service, and also wide powers to undertake preventive and after-care services, including the provision of domestic help needed on health grounds. The decisions, taken by the Government, were taken in the light of a great mass of information about the views and suggestions of the various interests concerned. As Secretary of State I made it my business to see that circumstances peculiar to Scotland were kept in view.
In settling the final form of the Scottish Bill we have had the advantage of many interesting and valuable discussions that have taken place on the English Measure. I have also had the further advantage of discussions with the Scottish interests concerned on the basis of the Bill introduced into Parliament last Session. The Bill now before the House owes much to the great mass of knowledge and experience that has been brought into play in recent months, and I wish, from this Box, to express my sincere thanks to those busy men and women in Scotland and elsewhere, who have been of assistance to me. On some questions we have differed. That I suppose was inevitable. But I have never looked in vain for helpful advice and comment from those whom I have consulted in Scotland. The final result of all this consideration and these discussions is now before the House. I do not propose today to go over all its provisions in detail. In the 1003 course of Debates in this House and in another place during recent months the general principles on which this Bill, like its English counterpart, is based, have been subjected to close examination and scrutiny. As a result Parliament endorsed the Government's proposals and, so far as they relate to England and Wales, has written them into the Statute Book. Scottish Members of Parliament and Scotsmen in another place took a prominent part in these Debates.
I propose therefore to devote the rest of what I have to say mainly to the points of difference between the proposals in the Scottish Bill now before the House and those which were embodied in the English Act. Conditions in Scotland are different in many important respects from conditions south of the Border. Scotland has her own legal system, her own traditions, and her own system of local government. The geographical distribution of her population is different. It is necessary, therefore, to adjust the application of general principles to suit Scotland's particular circumstances and needs. As regards the general practitioner division of the Service, the only important difference concerns health centres. In Scotland, where conditions in different local areas vary so widely, and the country as a whole is not an unmanageable unit, I thought it best that the early steps in health centre development should be undertaken directly by the Secretary of State. In this way I think that the lessons of the early years can best be learned and generally applied. The Scottish local authorities have not indicated any serious objection to this course, and the medical profession in Scotland prefer that it should be so. While the Bill enables the Secretary of State's functions in relation to' health centres to be delegated to local authorities, I personally do not intend to exercise that power in the early and experimental years of this service. I would emphasise that the family practitioner's contract, in the health centre as outside, will be with the executive council proposed to be set up by this Bill.
In Scotland, as in England, I contemplate that, although payment by capitation fees should represent the larger part of the doctor's remuneration, there should also be an element of basic salary. I see in this method of adjusting remuneration to varying conditions in different parts of 1004 the country. That the doctors in Scotland should look upon this fearfully I say quite frankly is a surprise to me, for basic salaries by another name have for the last 30 years been an essential feature of the Highlands and Islands medical service, to which so many tributes have been paid by the doctors themselves and by many committees of inquiry. I see in the basic salary element, too, a means of reducing competition between doctors for patients which, like most good things, is good in moderation but bad when carried to excess. As in England, sale and purchase of medical practices coming within the new service in Scotland will be prohibited. Doctors in Scotland who suffer loss in consequence of this prohibition will, as I have already indicated in reply to the intervention of my hon. Friend, have their share of the £66 million the Government are providing by way of compensation.
§ Mr. Westwood
If it is suggested that it is a bribe, then if doctors do not want to take any of it, they are not compelled to do so.
§ Mr. Westwood
Where everything comes from—from those who produce the wealth of this country. So much tor the family doctor. Looking at it from the patient's point of view, the next stage is when the services of a consultant specialist are needed. Generally speaking, up till now the great majority of the community have been unable to get specialist advice except by attending the out-patient department of a hospital or by going into the hospital as a patient. In the new service, for which this Bill provides, the family doctor will be able to call in a specialist whenever his opinion is required. The specialist service must be based on the hospitals and it will be the responsibility of the hospital boards, but they will make arrangements with the executive councils to ensure the close association of the specialist and the general practitioner.
This brings me to the hospital administration itself. I have already quoted the view of the Scottish Health Services Committee that it should be one service and organised on regional lines. It seems to 1005 me that while everyone accepts the need for a regional hospital system, it is not equally appreciated that no system of this kind is possible so long as there are two different forms of hospital administration and ownership. In Scotland the voluntary hospitals have always had a very prominent place. As in so many other fields, voluntary effort has blazed the trail. But is it really possible for them to continue as they have done up till now? Their costs in all directions have greatly increased and are still increasing as services become more and more elaborate and highly specialised. With any form of National Health Service, it would only be right that they should be paid for their treatment of patients who took part in chat Service. The payments for service to the State would bulk increasingly large in the revenue of the voluntary hospitals. The State could not go on handing over these large sums of money without having control.
This control, I submit, can be exercised only by the State, because the local authorities would not be a suitable instrument. Many local authorities have neither the resources nor the experience necessary to run hospitals. I do not think that we can look to local authorities any more than to voluntary bodies, to provide an efficient hospital service in the new conditions which now obtain. The very fact that there are so many independent units creates hopeless difficulties. In Scotland there are about 250 hospitals belonging to the 55 local authorities, and about another 220 voluntary hospitals, practically every one of which has a separate governing body. That means to say, we have about 250 hospital authorities, all with their own interests and ideas. With this multiplicity of authorities we get over-lapping, unnecessary competition and worst of all, gaps in the hospital service.
Hospital services are developing in such a way as to make a new and comprehensive authority with a large area and large resources behind it a practical necessity. The hospital surveyors, both in their general introduction to the survey, and in the surveys themselves, over and over again speak in terms of comprehensive units—large infectious diseases hospitals instead of small ones, and the advantages of putting large infectious diseases hospitals side by side with general hospitals, the amalgamation of special hospitals for eyes, 1006 ears, nose and throat, or cancer with the general hospitals. These are the lines on which the hospital service must develop, according to the best technical advice we can get, and there is a very striking unanimity about the recommendations of all the surveyors, both in Scotland and in the comparable surveys in England and they have not been seriously challenged. There is no possible chance, I submit, of securing all these developments so long as the general hospital is a voluntary one and infectious diseases is the responsibility of a local authority. If, in a particular area, there are two unsatisfactory and small general hospitals, one run by a voluntary body and the other by the local authority, how can one work towards a new single and comprehensive unit. It would be absolutely impossible.
To an increasing extent we are having to provide services which demand wide areas of up to half a million or a million people. The orthopædic service is an example, where it has already been necessary to set up joint regional councils. A proper cancer service, and the new branches of surgery, like plastic and brain surgery, need an organisation covering a million, or perhaps even two million people. Even in the older fields of medicine and surgery, there has been in the past too great a concentration of the specialist skill in and around the teaching hospitals. In face of all this, I have no doubt whatever that anyone beginning from scratch would come down in favour of the sort of hospital organisation that this Bill provides, with one ownership, and one administration. Why then should we bogle about making the change, provided that we can, and I am sure we can, preserve all that is essentially good from the past? These proposals are, as fax as I can judge from my discussions—and I have had many in Scotland—generally acceptable to those who have to work in the hospitals and even to some of the local authority and voluntary hospital people, whose responsibilities are being taken away. There is, as I have said, much to preserve from the past. Some of the voluntary hospitals have set a very high standard and in recent years some of the Scottish local authorities have achievements to their credit which will stand comparison anywhere. I will be told that we shall be losing the benefits of the voluntary spirit, and the freedom and enterprise that are supposed to be 1007 peculiarly associated with it. I ask the House why should we? We shall have the same doctors and nurses, the same independent medical schools, many, I hope, of the same people on the regional boards and boards of management, and the same endowments will be available, even more than they are today, for new developments and for research. Voluntary bodies have no monopoly of enterprise or freedom.
§ Mr. Westwood
I have taken great care in framing this Bill to avoid any undue concentration of authority. The maximum of independence and responsibility will be left with the Boards of Management. The Bill places definite duties on them and the regulations under it and the schemes for delegation which the Regional Board have to make will carry this process still further. In the same way, when I have appointed the Regional Boards, laid down the broad lines of hospital policy, and approved their budgets, I intend, so far as I can, consistently with my overall responsibility for the Service, to leave them to get on with their job.
Now I would deal with three features of my hospital proposals that are peculiar to Scotland. In the first place, whereas the English Act puts the responsibility for the ambulance service on the local health authorities, the Scottish Bill puts it on the Secretary of State. I am convinced that in Scotland, where the local health authorities are smaller in area and population, this is the right thing to do. The next main difference concerns the teaching hospitals. From an early stage of the Government's discussions on the National Health Service, I have been clear in my own mind, that the English arrangement was unsuitable for Scotland. Although the number of hospital beds in Scotland is only about one-tenth of the total for the United Kingdom, Scotland is training about one-third of the medical students. That is a remarkable achievement. It follows, therefore, that the teaching hospitals bulk very large in the hospital service—so large, indeed, that if they were taken out of the regional ambit, the core of the hospital service would have gone.
I have tried, therefore, to frame an alternative scheme with the same general 1008 aim, of course, of safeguarding the position of medical education. In doing so, I have had the benefit of consultations with the representatives of universities and I think they would accept generally that the provisions in the Bill will enable them to discharge their responsibilities to their own satisfaction. The Bill lays a clear duty on the responsible Minister, and through him on the regional boards and [he boards of management, to make available all the necessary facilities for clinical teaching and research. It provides that when a regional board is drawing up its scheme for constitution of boards of management for hospitals in particular groups of hospitals it must consult the university. The object of this consultation is to establish in which hospitals teaching is to be carried on, because wherever teaching is carried on, the Bill provides for the university and the teaching staff to be suitably represented by their own nominees on the board of management of that hospital. There is also provision for a medical education committee in each region consisting of nominees of the university, members appointed by the regional board and other members, who would include, for example, members to represent the medical teachers themselves and chosen after consultation with the Royal Colleges and other bodies who speak for them. This medical education committee will advise the regional board on all matters relating to the hospital service which affect medical education.
This brings me to the third point of difference. This Bill provides that in Scotland all the boards of management, whether of teaching or non-teaching hospitals, will, in the first place, retain the endowments of their particular hospital or hospitals. In the new conditions, when many endowments will not be needed for their original purposes, particularly where they were left for the general upkeep of a hospital, some review and reallocation is necessary. There are people who seem to think that it is something quite revolutionary to interfere in any way with endowments. The House may be interested to know that more than 70 years ago, in 1872, Parliament set up the Colebrooke Commission to deal with Scottish educational endowments, and the first Educational Endowments Commission was set up ten years later to review and adjust the use of endowments in 1009 accordance with the policy which it laid down. I might point out that these Commissions did not consist of members of my party. They contained between them some very well known Scottish names—Rosebery, Stirling Maxwell, Campbell of Stracathro, Elgin and Balfour of Burleigh, and I do not know that any of those took out a membership card of the Labour Party to which I belong. There is, therefore, nothing very revolutionary or particularly Socialist in what the Bill proposes.
The method of reviewing, and where necessary adjusting, the application of endowments follows very closely the precedent of the Educational Endowments Act of 1928 and the Hospital Endowments Commission is modelled closely on the Educational Endowments Commission set up under that Act, of which I myself was a member. Because of my knowledge gained there, I thought it would be quite a good thing to bring that same principle into operation in dealing with the hospital endowments in Scotland.
§ Major Lloyd
Surely, the right hon. Gentleman is not asking the House to assume that endowments for education are on a par with an endowment for hospitals given in memory of the treatment of some beloved relative? Is there not a fundamental difference between the two? If the Secretary of State is going to quote instances of endowments, why not quote the case of Henry VIII and the monasteries?
§ Mr. Westwood
I am not so interested in Henry VIII and in acts in which he participated as I am in this Bill, which I hope to see an Act of Parliament in the very near future. I gave that as an illustration, in an endeavour to prove that the principle is not a new one.
§ Mr. Westwood
I believe that these methods, which are in accordance with a well tried Scottish precedent which has worked satisfactorily for Scottish education, will be generally acceptable and will have equally satisfactory results for the hospital service. I am confident, too, that the Endowments Commission will do its work in such a way as to encourage future benefactors to give their money to the hospitals in the future, just as they have done 1010 in the past. Our experience in education has certainly confirmed this view. I might add that the first Commission, the 1882 Commission, dealt with endowments of an annual value of £200,000. The second one between 1929 and 1936 dealt with endowments of an annual value of about £750,000. The annual value of the Scottish hospital endowments is not exactly known, but it is probably about £300,000 so that experience suggests that the Commission will have no serious difficulty over the size of their task.
I am not giving, nor do I intend to give any instructions on this subject to anybody, but perhaps I might quote from a great benefactor's letter to his trustees, because what it says of the particular town of which he writes might well apply to the future use of hospital endowments:Remember you are pioneers, and do not be afraid of making mistakes; those who never make mistakes never make anything. Try many things freely but discard just as freely. As it is the masses you are to benefit it follows you have to keep in touch with them and must carry thorn with you. Not what other cities have is your standard; it is the something beyond this which they lack, and your funds should be strictly devoted to this … I can imagine it may be your duty in the future to abandon beneficient fields from time to time when municipalities enlarge; their spheres of action and embrace these. When they attend to any department it is time for you to abandon it and march forward to new triumphs. 'Pioneers always ahead ' would not be a bad motto for you.
§ Mr. Westwood
We will not argue about that. These were the words of a famous Scotsman who was a Scotsman before he was a capitalist. They were written by Andrew Carnegie with reference to the burgh of Dunfermline in the county of which I am proud to be a citizen.
The third main division in which the new service is organised comprises the clinic and domiciliary services entrusted to the local health authorities. The only important differences from England are the omission, from this field, of responsibility for health centres and for ambulances, which I have dealt with already. The transfer of hospitals away from the local authority field will, it is true, diminish the direct interest of local authorities and their medical officers of health in the treatment of disease. But this by no means implies that the local authority concern with health services has 1011 been so reduced that it is not worth while their continuing in the health field at all. The most important health function of the local authorities in future, as I see it, is the social side of health care. This is linked with their broad duties in connection with the control of infectious diseases. The medical officer who knows his district intimately, who knows the conditions under which the people live, will in future have great opportunities in the expanding field devoted to prevention of disease and promotion of health in community life.
The local authorities have another part to play in the new service. Locally they represent the consumers. For this reason, therefore, they nominate one-third of the members of the executive councils responsible for the general practitioner services. They are consulted in the appointment of regional hospital boards and boards of management, so that a link with these bodies also can be established through common membership. In this way the local authorities can do much to help in linking together the various parts of the new service.
I referred earlier to the Highlands and Islands medical service. I know that the Scottish people want me to say something in connection with that. I am often asked what will become of that service in future under proposals contained in this Bill and it might help if I explained the position now. What, in fact, is happening is that the Bill is extending to all Scotland many features hitherto operating in the Highlands and Islands only. Thus, instead of supplementing the income of general practitioners by annual grants paid under direct contracts between the practitioner and the Department, basic salaries will be paid under contracts between the practitioners and the executive councils, on which representatives of the practitioners themselves sit. In place of limited grants in aid of hospitals, of surgical and other specialists, and of ambulance services, full public responsibility for these services is taken over by the Secretary of State. To the local health authorities is given the duty of seeing that a domiciliary nursing service is provided, which I hope they will generally do by entering into financial arrangements with district nursing associations under which those associations can carry on their valuable work. But while this is so, I do not forget that 1012 there will be a continuing need for special consideration of circumstances in the Highlands and Islands, and I contemplate setting up a standing advisory committee of the Scottish Health Services Council to advise me on questions of special importance in that area. In framing the necessary regulations under this Bill, it will be our earnest desire to have full and free discussions with all the interests concerned, including the organisations of professional men and women on whose good will and cooperation the success of the Service depends.
Finally, there are two relatively important points on the Bill to which I invite the attention of the House. By Clause 76, we seek to delete from the Nurses (Scotland) Act, 1943, the provision which made it impossible for anyone starting on a course of training after 4th August, 1948, to qualify for admission to the Scottish roll of assistant nurses. The new service will make increased demands upon the services of nurses of all types, and we consider it essential that all channels of recruitment to the profession should be kept open. The position will, however, be kept under review, and if in, say, ten years time it should be considered undesirable to continue the recruitment of assistant nurses, the Government of the day will, of course, be free to come to Parliament for further legislation.
The second point is one which may have puzzled many hon. Members. In the Bill as introduced last Session, the Clause dealing with superannuation— Clause 64—included a Subsection making provision for the transfer of persons between employment in Scotland and in employment in England and Northern Ireland. That Subsection does not appear in the present Bill. The reason is that its inclusion meant that the Bill was one which did not apply solely to Scotland and so would not have automatically been referred to the Scottish Grand Committee. That is a contingency which, hon. Members representing Scottish constituencies will agree, we could not have contemplated. The Subsection has, therefore, been omitted from the Bill as introduced this Session, but it is my intention to move its insertion again at an appropriate stage in our proceedings.
When this Bill has found its way to the Statute Book, my work will not be done. 1013 Indeed, it will be just begun, because there will be a great deal to do before the machinery of the new service can be ready to operate. Therefore, I seek the cooperation of hon. Members, in the proceedings in the House and upstairs, in securing as speedy a passage for the Bill as is consistent with the proper consideration of all it implies. Of one thing I am sure, that whoever might have undertaken this great task of building a Health Service in Scotland, he would have been bound to make mistakes. I cannot hope to be an exception to that rule, and in so far as defects become apparent while the Bill is going through its various stages, hon. Members will not find me reluctant to accept improvements, from whatever source they come. In framing the proposals in this Bill, I have only one objective in mind, to provide Scotland with a Health Service that will, in years to come, be a source of strength to her own people and the admiration of all others.
§ Mr. Stephen (Glasgow, Camlachie)
On a point of Order, Mr. Deputy-Speaker. I notice that on the Order Paper there is a reasoned Amendment to the Bill, and to that Amendment there is the name of a Member of the Government, the hon. Member, for Ardwick (Mr. Joseph Henderson). I would like to ask you whether there is not something strange in the Government introducing a Bill and a Member of the Government supporting; reasoned Amendment for its rejection.
§ Mr. Deputy-Speaker (Mr. Hubert Beaumont)
I gather there must be a misprint in the Order Paper. It will be looked into.
§ Mr. John Henderson (Glasgow, Cathcart)
I was going to point out, Mr. Deputy-Speaker, that attached to the Amendment is the name of the hon. Member for Ardwick (Mr. Joseph Henderson); it should have been the hon. Member for Cathcart.
§ 5.7 P.m.
§ Mr. J. S. C. Reid (Glasgow, Hillhead)
I beg to move, to leave out from "That", to the end of the Question, and to add instead thereof:this House, while welcoming the idea of a comprehensive Health Service for Scotland, decline? to give a Second Reading to a Bill which concentrates so large a proportion of the control of the service in the hands of the Secretary of State; which permits endowments and benefactions to be diverted to purposes 1014 other than those defined by the donors; which interferes with that close personal relationship between doctor and patient which plays so great a part in achieving success in medical treatment; and which gravely threatens both the training of the student of medicine and the research upon which the future advancement of medical science depends.I think there is general agreement in all parts of the House that the time has come for a great expansion of the health services of Scotland and therefore, I do not propose to follow the right hon. Gentleman the Secretary of State for Scotland in the first quarter of an hour of his remarks further than to say that he referred at some length to the Hetherington Report of 1936. He will, of course, remember that these Committees were set up by Governments of a different complexion from that which is now in office, and their reports could have been, and would have been, carried into effect by a Conservative Government, or a Unionist Government but in a very different way from this Bill.
§ Mr. Reid
The real question which divides us is not the objective, but the form in which the machinery should be devised and the spirit which ought to underly the Bill to be introduced. I think it is not unimportant to follow the right hon. Gentleman, although on a rather different line, and to ask how has this need arisen? I was a little surprised by the right hon. Gentleman appearing to take the view that the progress of medicine in Scotland had followed on the development of legislation. Almost all his remarks about progress in Scotland in the last years related to legislative development, but I believe that for the last two centuries or more, Scotsmen, on their own initiative, have done far more than their share in developing both the art of medicine and the sciences which underlie that art. We must thank a host of men and women of past generations for their devotion and service in developing the health services of the country very much more than any legislation which has been passed during that time. The quality of their work, I am sure the right hon. Gentleman will agree, has been good, and indeed, in most cases, magnificent; but I think there are three factors which we have to bear in mind now—there may 1015 be others—when we come to expand and build upon their work. First of all, there have been great developments in medical science and the art of treatment. Secondly, there is need for a great expansion of the services. We all agree that a large number of people in the country have not, in fact, had full access to all services, and it would have been our aim, as it is the right hon. Gentleman's aim, to put that right, but in a different way. Thirdly, there is the element of ever-rising cost which here, as in so many other aspects of our national life, is leading to all kinds of unexpected and embarrassing developments.
We therefore require coordination and more expenditure. We all agree that that cannot be done without bringing the State in, for assistance. The question is, what form should State assistance take? Indeed, the question is, should it be State assistance, or State control and management? The Bill lays down control and management. I venture to suggest that the proper course would have been assistance. The great problem with which we are confronted, as the right hon. Gentleman properly said, must be considered against a background. I should have thought the proper background was the history and tradition of Scotland, and the character and past achievements of our people, and not, as in the Bill, a background of theory or of tidy paper planning. Scotsmen and Scotswomen are a very varied people, but most certainly those in responsible positions are reliable people; they do better work if they are given independence and responsibility than if they are kept subject to control, whether it be by the Government or anybody else. Therefore, the first step and the first principle of the Bill ought to have been to keep Government control at a minimum.
My first objection to the Bill is that, on the contrary, it puts far too much power into the hands of the Secretary of State. He comes in as the ultimate ruling authority in almost every Clause. The right hon. Gentleman said that the Bill avoided undue concentration; I cannot think how we could have had more concentration of authority in the hands of the Secretary of State. The Bill leaves far too little scope for initiative and responsibility on the part of those who are to run the services. So much so, that it is 1016 questionable—I hope that this will not be the result—whether what is left in this respect will attract the best voluntary service. I hope it will. I hope that the right hon. Gentleman will loosen very much the controls in the Bill, so as to attract voluntary service. The Bill does not however hold out much hope. The work will have to be done by the right hon. Gentleman following a different policy from that which inspired the wording of the Bill.
There is also far too little scope for variety of organisation and for emulation between different kinds of institutions. The right hon. Gentleman is, I think, totally wrong when he says that uniformity of planning of institutions leads to efficiency. It does no such thing. The more varied the types of institution which can be fitted into a scheme, the more likely it is that we shall get progress as time goes on. Centralisation is bound to lead to rigidity. It leads to rigidity for the reason that those who are administering at the centre, able men though they be-if they had not been able men our administration would have broken down long ago under the strain put upon it by the right hon. Gentleman—are bound to have a large measure of caution in trying out new ideas. It is true that boards are set up under the Bill, but those boards, as is made clear on every page, are merely the agents of the Minister. They have always to be looking over their shoulders to see what the Minister and his permanent advisers have in mind. We cannot get the same flexibility, the same power of progress in those circumstances as we should if we gave people more authority.
Particularly is that so within the ambit of the Bill. From what I know of the matter, medicine is a realm in which, more perhaps than in any other, new ideas and new lines of approach are being developed every year, almost every week. I am making an understatement when I say that those new ideas and proposals do not always come from people who are in authority. Too much authority is very liable to stifle at birth promising ideas and proposals before they have even been tried out. The argument which was put forward in this connection by the Minister of Health and which the Secretary of State attempted to support today, was that he cannot be responsible for adequate services unless he has direct control of those services in every respect. That argument 1017 makes complete nonsense of his responsibility for education, and for the whole of our system of local government. If that is to be the line on which future legislation is to be developed—that no Minister is willing to assume responsibility unless he has complete control—it must lead to such centralisation in London as to make all effort by local authorities nugatory. Therefore I hope that the right hon. Gentleman will try, between now and the Committee stage, to reconcile his position in the Bill with his position as Minister responsible for Scottish education. It is not a very easy thing to do.
Let me state in the broadest outline what I think should have been the underlying plan. Of course, the Government must take a hand in the general planning of the services. We are all agreed about that. It could have been done no doubt through regional planning bodies. That is a perfectly good and easy proposal. Of course, the Government must have full opportunity to get all information they want, and to be able to advise, if necessary, where there is trouble. There should be provision for remonstrance and, if necessary, for stepping in and taking control, but only in the last resort. The Government ought to keep out of the practical business of running the services. They should not pretend that they intend to have a universal grip on the services if, in fact, they do not intend to exercise that grip. Let their theory correspond with their practice. We shall see, when we come to the Committee stage, whether the Government are prepared to give additional authority to those bodies which the Secretary of State say he does not want to control.
This is the case particularly with the teaching hospitals and the universities. If there is one sphere in this field where the Secretary of State ought to keep out, it is that of medical education: Scotland has long been the home of an international school of medicine, but I see nothing in the Bill to recognise that fact. The Bill raises a whole host of important issues which could not possibly be adequately discussed between 5 p.m. and 10 p.m.—all the time that remains to us after the Secretary of State has opened the Debate. It would be quite wrong of me to take up time in discussing issues on which I have already expressed my views in this House in another connection Therefore, if I do not attempt to cover, 1018 or even to refer, to the whole ground, it must not be taken that I have abated my objection in any way to the proposals which I do not mention. I shall, therefore, restrict my remarks to two major issues, the position of the doctor, and the position of the voluntary hospitals, particularly the teaching hospitals. Those are topics, it so happens, in regard to which the position in Scotland either differs, or is to be made by the right hon. Gentleman to differ, from the position in England.
With regard to the doctors, our cardinal objection has always been that this Bill injures the patient by undermining the independence of the medical profession, and almost all the objectionable provisions which do that, centre around the Clause which makes it possible to control the distribution of doctors. If there is no need for that control, all these other irksome restrictions should go by the board. A case was made in regard to maldistribution in England, and many figures were given. We were told of an area, South Shields, I think, where there were as many as 4,100 persons per general practitioner, and of another area where there were as few as 1,200 patients per medical practitioner. We said that such a case of maldistribution could be put right in other ways, very much more easily than by the scheme in the English Bill. But we have heard nothing about any such case with regard to Scotland, and I hope that whoever replies may be able to give us some evidence to support this, the most important Clause from the point of view of the medical profession, perhaps, in the whole Bill. Such information as I have been able to get, negatives the need for any such Clause in the case of Scotland.
§ Mrs. Jean Mann (Coatbridge)
There are at present 3,000 unemployed doctors. Will the right hon. and learned Gentleman explain that system?
§ Mr. Reid
I cannot understand the relevancy of the hon. Lady's interjection because the purpose of this Clause is not to facilitate the movement of doctors, but to prevent it. If the hon. Lady is contemplating a direction, that doctors shall go to a certain place, then I must point out—to give the right hon. Gentleman the Secretary of State for Scotland his due— that that is not in the Bill.
§ Mr. Reid
Then let us leave that to the Committee stage. Let me put the facts as I understand them—they may be in-accurate—to the right hon. Gentleman. I believe figures have been produced for Scotland in relation to 31 areas. The average number of persons in Scotland per general practitioner is, as near as may be, 2,000. In England the figure is a good deal higher and, therefore, the problem is more difficult, but in Scotland we have more doctors per thousand of the population than there are in England. The problem in Scotland is, therefore, easier. I can only find three areas in the whole of Scotland which, in comparison with the others, can be said to be really under-doctored, and those are the three areas of Greenock, West Lothian and Angus. Those are not so very far away from the average. We could cure all that is wrong in those areas by adding another 50 doctors or thereabout. Where, then, is the case for restricting the movement of the medical profession in Scotland? There is none. If the right hon. Gentleman can produce figures which controvert those figures, we shall listen to them with interest.
Is this control of the movement of the medical profession in Scotland based on facts which require it, or is it based on some theory which the Government think ought to be put into operation—some form of control required not by facts but by doctrine? If it is required by doctrine, we can argue about it. If it is required by facts, let us have the facts. But let us know which it is. I am not sure that everybody realises how irksome is this control. In every area, and not only in the few areas which are under-doctored or over-doctored, according to the English system—and I suppose it is the same in this case—there is to be advertisement of every vacancy; then there will be applications to the executive council, and they will be referred to the local medical committee and to the partnership if there is a partnership. They will go back to the committee, then to the executive council, up to the medical practices committee, and ultimately there may be an appeal. All this time there will be patients waiting to be treated. There is to be all this rigmarole before a doctor can come in. Indeed, the doctor cannot even buy the house of his predecessor without going to 1020 the medical practices committee to get permission, unless he wants to risk prosecution.
§ Mr. Scollan
I am very interested in the right hon. and learned Gentleman's description of how the bureaucracy will control the movements of doctors and thus curtail their services. Would he explain how the present control keeps 3,000 of them out of work? They cannot get practices.
§ Mr. Reid
I agree with what the right hon. Gentleman the Secretary of State said in that connection. That is one of the reasons why we say we want a more comprehensive service, because in the past in Scotland there have been people who thought they could not afford medical attention when they should have had it. If under this Bill we had 100 per cent. service with capitation fees, there would be work for those 3,000, and they should be allowed to find their own work, which they very soon would. [HON. MEMBERS: "Oh!"] They are much more likely to find the right place for themselves than if they are directed by some central body. A central body will not increase the amount of money available to the medical profession. All it will do will be to pre-. vent people who want to go to certain places from going there.
§ Mr. Gallacher
If the right hon. and learned Gentleman were a doctor, I wonder if he would choose Greenock?
§ Mr. Reid
I agree with the hon. Member for Western Renfrew (Mr. Scollan) that we have not heard anything about the position of assistants, and I hope we shall do so before the proceedings on this Bill are finished. I shall not say anything about basic salary, good will or about the Highlands and Islands scheme, as these depend upon considerations which do not in the least apply in Central Scotland.
I pass on, therefore, to the other subject with which I should like to deal, namely, the hospitals. I believe that both the voluntary hospitals and the local authority hospitals could be continued under satisfactory arrangements with good results and with advantage to the community. On the subject of endowments, I see no reason why the right hon. Gentleman should take what I believe to be extremely drastic powers. Let me deal with the teaching hospitals. I am amazed that the 1021 right hon. Gentleman should treat them so much less favourably than they are treated in England, and for such flimsy reasons. I should have thought that the success and prestige of the great infirmaries in Scotland would entitle them to better treatment than is given in England, rather than worse. For practical purposes, they are being abolished as independent institutions. Let me for a moment contrast the differences between Scotland and England in this respect. In England a board of governors is in direct contact with the Minister, and is directly responsible to him. They get grants direct from the Minister. They themselves settle the conditions of service of their servants and officers. They are in direct relation with the universities and they keep all their endowments. In Scotland those who look after the Royal Infirmary or the Western Infirmary will in future be mere boards of management, mere units in a large scheme. The boards will, be appointed by the regional boards and will be answerable to them, and all the officers of the infirmaries will be officers of the regional boards. The conditions of those officers will be settled by the regional boards, and the grants will have to be applied for through the regional boards. How can it be said that there is any independence left to an institution of that character?
§ Mr. Reid
I regard with some apprehension the fact that, in future, there is to be no direct relationship with the universities. The Secretary of State, not the board of governors, is to settle the teaching facilities granted to university students. Appointments are not to be made between the board of governors and the university, but a mixed body, an appointments committee, is to be set up. I believe it will be much more difficult under this scheme to make sure that beds are allotted to the men who are wanted by the universities as professors than it would have been, even under the English scheme. The great infirmaries in Scotland are being reduced to the level of minor institutions; they will not be anything like as efficient for their patients. This may well be disastrous for their position as centres of the great schools of medicine. How are we to keep in these minor bodies that standing which we must have, if we are to retain the 1022 position which Scotland holds in international medicine?
The right hon. Gentleman said that these bodies must be taken under the wing of the regional body because they occupy such a large part of the number of beds. Does he think that in England the teaching hospitals, with their boards of governors, are not integrated in the general scheme? Has he read the English White Paper? Has he consulted with his colleagues? This is what the English White Paper says:The fact that special administrative and financial arrangements may be made for teaching hospitals does not mean, however, that these hospitals are not to form an integral part of the hospital service as a whole.If the teaching hospitals in Scotland, with independent boards of governors, can be made an integral part of the hospitals as a whole—as his colleague believes they can in England—what more does he want? Therefore, I say the right hon. Gentleman has deprived the Scottish infirmaries of their status, for no reason at all. His colleague does not seem to have much doubt about the necessity for preserving that status. Let me reads what the Minister of Health said during the Committee stage of the National Health Service Act:I was exceedingly careful to devise a scheme for the administration of teaching hospitals which would leave them with the utmost autonomy, consistent with the general hospital service.Why has not the Secretary of State done that? Then the Minister of Health said— and I think he was a bit optimistic here. but this was his view—… the transfer of the hospitals to the Ministry will not make St. Thomas's Hospital any less St. Thomas's, Bart's any less Bart's, or Guy's any less Guy's."—[OFFICIAL REPORT. Standing Committee C, 14th May, 1946: c, 215–217.]It will make the Royal Infirmary and the Western Infirmary a great deal less than they are today, if this scheme is carried out. I say Scotland has been most un fairly treated in this respect.
I now come to the endowments. Can any hon. Member in this House suspect the Minister of Health of undue tenderness to charitable institutions? It was not for that reason that he left the teaching hospitals in England with their full endowments. It was obviously because he realised that, if they are to maintain their status as teaching bodies, they must have every penny they can get, free from red 1023 tape and regulations. Under Clause 8 of this Bill, all endowments of the Scottish teaching hospitals are subject to re-allocation. The right hon. Gentleman would not have introduced that noticeable departure from the English Bill, unless he had intended it to be made full use of: he would not have done that, unless he had intended that a great deal of the endowments were to be taken away from the teaching hospitals. He would not have included that otherwise. The Bill is extremely vague on the subject, but if we look at the White Paper it is pretty clear what is wanted. The right hon. Gentleman thinks that pocket money for other hospitals is more important than the promotion of the interests of the teaching hospitals. This is what he says:In making the schemes, the Commission is to take into account the spirit of the intention of the founder of the endowment, the extent to which its original purpose is now otherwise fulfilled, and the interests of the hospital service generally. Thus it will be possible for boards to which few or no endowments are initially transferred, to receive such resources at a later stage.If that does not mean that the endowments which ought to be left for teaching purposes are to be taken away for pocket money, I do not know what it means. This Commission, which the right hon. Gentleman values so much, is not really an independent commission at all. He selects all the members; he does not need to give them instructions, because he knows who is being selected. He takes power to appoint a Member of Parliament if he wants to; he takes power to control the Commission by modifying the scheme, or, if he does not like them, remitting it; he can supersede the Commission if he - thinks they are in default, and at the end of the day he takes over all their functions himself. Is that a fair way to put forward a commission as a judicial independent body?
Does the right hon. Gentleman say that our infirmaries are less important than the English teaching hospitals? I am sure he does not. Does he say that they are better endowed? He cannot. The figures which I have—and I believe them to be accurate —are these. The teaching hospitals in London have £8 million of endowments, and the teaching hospitals in Scotland have £3½ million. That is not more than sufficient, if Scotland is to maintain its position in competition with London. But 1024 London is to keep the whole of the £8 million, and Scotland is to lose such proportion of the £3½ million as may be determined. What rhyme or reason is there in that? How can we afford to have this cut, and yet be able to maintain our position in the world? If it is necessary to divert the funds of the teaching hospitals in order to get pocket money for the others, the right hon. Gentleman should go to the Treasury. The Government are taking over, in the great hospitals in Scotland, property worth millions of pounds —worth probably a good deal more in proportion to the population than in England. If only a few thousand pounds are wanted, why not go and ask for it, rather than rob the teaching hospitals? Surely, that would have been the right course to adopt?
For years these great infirmaries will not know how much of their endowments are to be left to them. This examination by the Endowments Commission is to take a minimum of five years, according to the Bill. How can they plan ahead when they do not know how much of their funds they are to have left at the end of the day? It would be bad enough to tell them now what is to be taken away. But to leave them under this suspense for, it may be, the next five years, makes it impossible to establish a proper scheme in Scotland under this Bill.
I have taken too long already, and I close by saying that the English Bill was bad enough, but this Bill is a great deal worse. This is only another instance of the way in which Scotland is being less favourably treated by this Government than England. My objections to this Bill are summed up in the reasoned Amendment in the name of my right hon. and hon. Friends and myself, which I now move.
§ 5.40 p.m.
§ Mr. McLean Watson (Dunfermline Burghs)
We have just begun the discussion of the most important Bill to affect Scotland during this Session of Parliament. I daresay that before it reaches the Statute Book it will be very carefully examined by all who are interested in this great subject of public health. The Secretary of State, in moving the Second Reading of the Bill, expressed the hope that there would be cooperation between the Scottish Members to make it as good a Bill as we possibly could. He seemed 1025 to indicate that he would welcome suggestions to improve the Bill. It is not the first time I have heard an opinion of that kind expressed. I remember that when the last great Bill dealing with Scotland was before the House, namely, the Bill of 1929 that made such a great change in the local government system in Scotland, the same hope and belief was expressed on Second Reading; but when we got to the Committee stage we found that the Secretary of State was not prepared to make any concessions. I hope that this time the Secretary of State will be prepared to look at suggestions, no matter from what quarter they come. Personally, I want to see this Bill made as perfect as it possibly can be.
But there are certain fundamental principles that we on this side are bound to observe. I noticed in the speech by the right hon. and learned Gentleman the Member for Hillhead (Mr. J. S. C. Reid), to whom we have just listened, that we have had the Opposition's point of view very clearly expressed. They welcome the expansion of the health services in Scotland; they welcome the assistance that the Treasury is proposing to give for the development of these health services,"but while these things are welcomed there is one thing that is not welcomed, and that is public control. They never welcome public control from that side of the House. So far as we on this side are concerned, if public money has to be expended, there must be public control. It is all very well for hon. and right hon. Gentlemen opposite to say that we are curbing initiative, that we are not developing our Scottish character as we ought to do, by these Government regulations, restrictions and directions. One cannot have it both ways. If there is a demand for public money, and if public money is required for the development of these services, then there must be some public control.
I have examined the Bill very carefully, and I agree with one of the objections raised by the right hon. and learned Gentleman opposite—that there is too much of the Secretary of State in the Bill, and too little of the local authorities. From Clause 20 to Clause 29 we have a series of Clauses dealing with the local health authority, but when it comes to the setting up of the various committees that have to work this scheme, there is not so much of the local authority there. I think 1026 that the Secretary of State has gone just a little too far to conciliate the professional classes, the doctors, dentists, pharmacists and others. He has given them far more say in these committees than he ought to have been prepared to give. I am not sure whether, when we reach the Committee stage, there may not be an attempt made to have less control by the Secretary of State and more control by the local authorities. Up to now the local authorities in Scotland, the county councils and the town councils, have been our local health authorities, and it seems to me that this Bill is going to remove a very considerable amount of the control that they have exercised in the past. The proposed representation of the professional classes on the various bodies to be set up is a very much larger proportion than is justified. I dare say that the agitation that has been carried on by the doctors and others has had its effect on my right hon. Friend, and that he has gone as far as he possibly can to placate those various interests.
The right hon. and learned Gentleman dealt with the position of the doctors, and objected to their being directed here and there. But there must be some control if we are to have so much public money spent on the development of these services. After all, who will direct the doctors here and there? They are to be directed almost wholly by their own representatives, by the medical men. There is one thing that I cannot understand with regard to the medical practices committee, which it is proposed to set up. I believe there are to be a chairman and five members of the committee, who will have the responsibility for saying whether a place is over-staffed with doctors or understaffed, and of sending doctors where they will be most required. While three members are definitely mentioned as being doctors, I fail to find, in either the relevant Clause or the Schedule, who are to be the two others on the committee. Perhaps the right hon. Gentleman will look into that point and tell us exactly who are to compose the medical practices committee, which will have the job of saying how doctors are to be distributed, and what services they are to undertake
So far as the general principles of the Bill are concerned, I am heartily in support of this Measure. The powers of the Secretary of State, and the diminution of the powers of the local authorities, are 1027 matters we shall have to discuss in Committee. They are largely Committee points. But as far as the general principle of the Bill is concerned, I welcome it wholeheartedly. It is high time we had a very extensive improvement in the medical health services in Scotland.
There is another point I want to raise with the right hon. Gentleman the Secretary of State. We are proposing to shift power for dealing with public health from the local health authorities to committees, boards and commissions. When we are considering the question of regions for hospital management—and I agree that there ought to be larger areas for the control of the hospitals—what is to be the controlling factor and who are to exercise the control, I want my right hon. Friend to make sure that we shall have more harmony among the various authorities that are brought in than we have had under the Local Government Act of 1929. We have had a sort of cooperation between the small burghs and the county councils. We shall have in practically all areas where we have these regional councils set up for dealing with hospitals, county interests, large burgh interests, and small burgh interests. We may have, as a result of this Measure, the same conflict that we have had in connection with the Local Government Act. It must be known to every Scottish Member of this House that there have been a great deal of dissatisfaction, and continual bickering between the small burghs and the county councils. Is that to be the result of this forming of regions for the control of the hospitals, or are we to have an assurance that between the county councils and the large burghs— because the conflict will start between the county councils and the large burghs which will be brought into the regions for the control of the hospitals within their areas—there will be more harmony under this scheme than there was as a result of the passing of the Local Government Act of 1929?
Perhaps in the county that I come from we have had more trouble between the small burghs and the county councils than anywhere else in Scotland, for the reason that we have more small burghs than any other county in Scotland, and it may be because I am living alongside and among these difficulties that I know the feeling existing between the small burghs and the 1028 county councils. Now we are to have these local health authorities set up in which there will be at least three interests represented, and, unfortunately, the three interests are not harmonious interests; they are all out for the same thing, but they are antagonistic. When there are three interests, the county councils, the small burghs and the large burghs, all competing with each other and insisting upon having their way, I should like to feel that the Secretary of State is sure that he can obtain a more harmonious working than we have had under the Act to which I have previously referred. It will only be through getting harmonious working between the various local authorities that we shall get the best results, there is no question about that.
So far as this scheme is concerned, the need for larger areas for the control of hospitals is obvious, and I agree that in that direction there are adequate safeguards in this Measure, even for the voluntary hospitals, which I do not think have any reason to complain of the control outlined in this Measure. I agree that we should examine very closely the powers that are to be exercised by the Secretary of State for Scotland, and at the same time I should like to see greater power given to the local authorities. I know that many other hon. Members wish to take part in the Debate this afternoon, and I do not want to take up much more of the time of the House, but it is a matter of very great importance to the people of Scotland that this Measure should be brought into operation is speedily as possible. We are assured of medical and surgical grants from the Exchequer; we are to have a contribution from the National Insurance fund, but there is another contribution to which we shall have to pay some attention, and that is the contribution which will be made by the local ratepayers. The local ratepayers will be interested to a very considerable extent, and that again is one of the reasons why I should like to see the powers of the local authorities increased under this Bill.
Do not let us disguise from ourselves the fact that this scheme, when it is brought into operation, will call for very considerable increases in local rates, despite the substantial Treasury grant. Local rates have been rising for years past, and we know something of the complaints of local ratepayers about these 1029 recent increases. We must be prepared to face even the local ratepayers, and say to them that they cannot expect to get the benefits that a scheme of this kind will bring unless they are prepared to make their contribution. We require to say to our local ratepayers what we had to say to the workers of this country when the National Insurance Bill was before this House, namely, that the benefits proposed are worthy of the sacrifices that we are asking the workers to bear. We are asking them to increase their contributions to National Insurance; we shall get substantial aid in the working of this scheme, and we shall have to be prepared to face local ratepayers and tell them that this scheme is worth while if it will remove from them a great deal of the anxiety they have had in the past. I do not want to embark upon that side of it, but it is a fact that when a working class family is affected by the illness of the worker, who is laid off his work, from that moment there is anxiety in the home, and it is increased when specialists have to be brought in or when special treatment has to be given to the worker who simply cannot afford it. I know that today many families in this country are making great sacrifices in order to get facilities which ought to be provided for them, and which it is proposed to provide for them in this Bill. It is because of the benefits that will follow as a result of this Measure that I want to see it on the Statute Book, and in operation, as soon as possible.
I hope that when we come to the Committee stage we shall find the Opposition not simply referring, as the right hon. and learned Gentleman did this afternoon, to our trying to frame a scheme because of the ideas that we on this side of the House entertain. There are ideas on the other side, and I have referred to them before; there is the idea that public money should be given to develop these schemes, but that everybody is to be free and there is to be no restriction or control, no overriding authority on the part of the State. State money certainly, but no State control—if that is the attitude which the Opposition adopt in Committee, I am afraid that we shall have no more harmonious discussions on this than we had on the other Measure to which I have referred, and of which the right hon. and gallant Gentleman who has just been elected as Member for the Scottish Universities 1030 (Lieut.-Colonel Elliot) had some experience himself. I think he was in rather a subordinate position, but he was in office in 1929 when that famous Act was before the House, and he knows the part that was played by his chief and by himself, and by others on this side of the House who had ideas, just as we now have ideas. If we can get away from our doctrinaire ideas on both sides, we may be able so to frame this Measure that it will be of infinite value to the people of Scotland.
§ 5.59 p.m.
§ Sir John Graham Kerr (Scottish Universities)
The Bill now before the House is not, of course, a product of Scotland, nor on the other hand is it a product of that great host of selfless people who constitute the main health service of our country at the present time, the ordinary general practitioners. It is, in fact, a replica except in detail of the English Bill which was before the House some months ago. It is the product of diligent Bill artificers, working in the murky recesses of a Whitehall office. The right hon. Gentleman, in an eloquent speech in introducing the Measure, referred to his desire to keep the best of the past, and perhaps I may be pardoned if I say something of that great past, and something of the history of such things. Great Britain, in the past, has occupied a leading position in the progress of medical science, and some of the brightest stars that shine in the firmament of medical history have shone from universities and voluntary hospitals of Scotland. I should like to speak at some length on that glorious history of British medicine, but there would be a revolt on the part of my fellow Members if I did anything of the kind.
Perhaps I may be allowed to say a few words, and recall one or two points concerning a particular section of medical history, namely, surgery. The historians of surgery, all over the world, divide that history into two parts, firstly, the dark ages of pre-Listerian days, and, secondly, the development in the whole field of modern surgery. Scotland played its part, even in the dark ages. Was not the very first textbook, in English, upon surgery the work of Peter Lowe of Scotland; and did not operative surgery in those dark days rise to great heights under Liston and Syme of Edinburgh? These pre-Listerian workers were terribly handicapped. Even 1031 the simplest operation in those days meant a deadly danger to the individual operates} upon. All hospitals were infested by the microbes which give rise to what were called hospital diseases—hospital gangrene, erysipelas and so on. To get onto the operating table, even for a simple operation like an amputation meant a very serious probability of death. All that was changed by the work of a young professor in the University of Glasgow, working in the wards of its great voluntary hospital, the Royal Infirmary. It was that great man Lister who was able to see beyond the work of Louis Pasteur, who showed how putrefaction and fermentation were due to living microbes. He was able to see beyond that work and visualise the microbic cause of hospital diseases and indeed of all kinds of wound infection. He tackled the problem, and he worked it out with some of his great assistants like William MacEwan of Glasgow. The result was the foundation of modern surgery. Without this marvellous development, there could not have even been contemplated those complicated abdominal operations which are now an everyday occurrence, and which have jerked many persons back from the very edge of the grave. I might have gone on at length on this subject, and I might have spoken about other aspects of medical science, such as obstetrics, in which again Scotland gave a great lead; and medicine too in the restricted sense. One of the great divisions of medicine is that which comes under the name of "tropical medicine," of which the very founder is acknowledged to be Patrick Manson, who hailed from the University of Aberdeen.
What has all this to do with the Bill before the House? It has a great deal to do with it, because these great figures, these great leaders in medicine and surgery, were the inspired teachers of the generation of doctors that was to come. The success or failure of any enactment, however good or bad, is tremendously influenced by the character of the men who have to carry its provisions into effect. We have at present the very finest material coming into the science of medicine. I know something about that, because among the 7,000 or so students who passed through my laboratory, were to be found those belonging to practically every one of the faculties, except perhaps law. I have not the least 1032 hesitation in saying that it was the medical students who were the pick of the whole lot.
It is sometimes said that the young man is an idealist, and that he is attracted into a particular profession by his ideals. That is not my experience of the young student. He is a thoroughly practical young person. He is looking ahead, and he tries to feel that there lies before him something great by way of a career. This is the raw material which is coming forward, but what about training? It is the leaders of the professions who are at present doing that training in the voluntary hospitals. Why do they do it? It is because they realise that if they take a teaching post, even if it is an honorary post, in a great hospital, they will have the opportunity to inspire the students they train, and they will be paid back, indirectly, by forming a great clientele of practitioners who will come back to consult them later on. It is worth while at present for the great leaders to play that part in teaching, and it is worth while for the able young men to enter that profession. The type of man who goes into a university, or other school of medicine, and, later, into the profession, is not the type of person who is interested in a salaried service, in which promotion goes merely by seniority He is a young man who is ambitious, who has a good idea of his own capacity, and who will only go into a profession in which he thinks there is a fine future.
Before I sit down, perhaps I might correct, or modify, one point. I have been speaking of the great voluntary hospitals as being the laboratories in which leaders of the sciences such as Lister, in the Royal Infirmary, Glasgow, are carried out. But we must not forget that all over the country there is a vast amount of modest research being done by the ordinary country practitioner. The ordinary general practitioner, perhaps with the aid of his local cottage hospital, is working away quietly and modestly, doing work which, in the aggregate, is of the greatest importance. I would quote one case, that of Edward Jenner, a general practitioner in a great dairy district in Gloucestershire. He had the wit to look beyond a remarkable fact, namely, that dairymaids do not die of smallpox. He saw beyond that strange fact, and he invented vaccination, which has not only 1033 Deen adopted in every civilised country in the world, as a remarkable preventative of a disease which in the old days was so deadly but, has, in its turn led to immunisation which today protects us from such other diseases as cholera, typhoid and diphtheria. Edward Jenner made that great step in the science of medicine and public health and I would recall that he, unlike many in more recent times who have rendered great services to our people, did not go without any financial recompense from the Government of the day. He was given, I think, £30,000 for his services. I will go on no longer, except to say that in the few words I have spoken there has been perhaps the hint that I consider that if the Bill before the House is passed into law, it will become one of the greatest disasters to the health of our people.
§ 6.16 p.m.
§ Miss Herbison (Lanark, North)
I welcome this Bill, because it makes provision, for the first time in Scotland, for adequate health services for our people. The fact that these services will be available to everyone, without limitation, will prove of inestimable benefit to many people. We find that the majority of our workmen get the services of a doctor, as a panel patient, for a weekly contribution, but those services do not apply to his wife or children. Time and again, it has been found that dependants have often refrained from calling in a doctor when his services were most necessary, because they did not know where the money would come from to pay the expenses. For that reason alone, it is important that this Bill should get its Second Reading today, and get through the House as quickly as possible.
A great deal has been said about the direction of doctors. I have spoken with many young medical students, and I have gathered that the majority of them welcome this Bill. They realise that through this Measure they will have security immediately they have finished their medical studies. We have heard about the number of doctors who are unemployed. It is a disgraceful thing, when so many doctors are needed today, that even one should be unemployed, far less about 3,000. Not only should they be used, but many more doctors should be used. I know many young students, leaving school, who would have preferred to take a medical degree, but who have 1034 gone into some other faculty. They did not take a medical degree, because they knew that if they took a degree that would lead to teaching they would almost surely obtain a position, whereas they were not so sure that if they took their medical degree there would be a position for them when they had finished. It is because of that part of the Bill which applies to doctors, and their distribution in the places which need them most, that many young people will no longer be deterred from taking their medical degree. There will be a good supply of doctors in districts that badly need them, and there are many places in Scotland which need more doctors than they have today, in spite of the remarks made by the right hon. and learned Gentleman the Member for Hill-head (Mr. J. S. C. Reid).
There are one or two things I want to ask the Secretary of State. I have gone through the Bill very carefully, and I see that provision is made for doctors entering the service, for dentists, pharmacists, and opticians. But in no part of it do I find any provision at all for masseurs or masseuses, or chiropodists. Will they be part of the service? I feel that the work they do in helping to keep the nation healthy and strong is of the greatest importance. Will they be part of the service which is to be free to our people, or must our people, who need their services, pay for them? I hope the Minister will assure us that masseurs and chiropodists will be a part of the health service. In regard to the committees about to be set up under this service, I wonder what part nurses will play. Are they to have adequate representation? I have no doubt that doctors are to have very adequate representation. If my miners get as good workers' control under the nationalisation of the mines, as the doctors are to have in this service, I shall be well satisfied. We must see to it that the nurses, upon whom a great part of this health service will depend for its smooth and efficient running, are given a part to play on these committees. We find today that there is a very grave shortage of nurses in Scotland, and that not only beds but wards are empty because there are not sufficient nurses for our sick people. I am not at all surprised that that is the case. The life which a nurse has had to live has not been very comfortable. Nurses should be able to make representations so that their lives as nurses may be 1035 made very much better than they have been in the past.
I would like to make one or two suggestions on behalf of the nurses which I am sure, if they have representation, they will make very adequately themselves. I think of the case of the young probationer who ought to spend her time in training and who should not be compelled to over-study in her spare time. Her first year in hospital is spent in scrubbing and polishing. That does not happen to the doctor who is to play his part in the medical service. Why should it happen to the nurse? The nurse should be fully occupied in learning those things which are so necessary if she is to do her job well. She should be given extra time for her studies, instead of having to make herself almost a hermit, if she is to get through her examinations. Instead of having to live in a room in a hospital, there should be a home for her just as there are clubs for business women, where she can have all the comforts which she would have in her own home. She should be treated as a responsible human being who is able to look after herself instead of being surrounded by rules and regulations during her off-duty time. Those are some of the things which I think will have to be done if we are to attract into the nursing profession the women whom we must have, and I hope that on these committees the nurses will have adequate representation.
There is a part of the Bill which deals with domestic help. I would have preferred to see in this Bill, instead of the provision that a local health authority "may" make such arrangements as the Secretary of State may approve the word "must" being used in that connection. I have never liked the word "may" in our legislation. I know only too well in teaching, that when the word "may" is applied to something affecting teachers or their children, some local authorities pay no attention whatever to it. Domestic help for people, as outlined in this Bill, is of the greatest importance to the working class woman and working class home. I would like, on the Committee stage, to suggest that the word "may" should be changed to "must," so that every local authority in Scotland will set up this system of domestic help for people who are sick, particularly when the mother of a family is sick and needs domestic help so much.
1036 Under this Bill, there are to be supplied to our people spectacles, dentures and many other appliances. We are told that if someone wants something special in spectacles or dentures, they must pay extra for it. I would remind the Secretary of State for Scotland that we have to be very careful here. I had a meeting in my constituency not long ago and a woman came to me in great distress. She had needed spectacles. She was not at all well off, and she was advised to make application to the local authority for them. When she went, she said, "What kind of spectacles will you give me?" When I look round the House and see hon. Members wearing spectacles, I notice that they are nearly all like the pair which I am wearing.
This woman thought that she would get the type of spectacles which most people wear nowadays, but judge of her surprise, when she was given steel-rimmed spectacles, such as no one wears today. Every time she put them on, people would know at once that her spectacles had not been paid for by her but had been provided by the local authorities. A similar thing has happened under the present scheme for supplying dentures. I am not asking the Secretary of State to provide a man or woman with gold teeth or any such nonsense as that. But there have been very great developments in dentures so that one would scarcely know when a person was wearing a denture, and all I ask is that people under this scheme should have the best.
I have listened to the talk on voluntary hospitals and about our great Royal Infirmaries in Edinpurgh, Glasgow and elsewhere. They are indeed great but it is nonsense to suggest that when they come under the scheme, as they will, their greatness will be any less. When I was a student, I spent very cold days with boxes trying to get money for them. Time and time again, they have been unable to get the appliances which they ought to have. Under this scheme, whatever they need, they will be able to get and from being great they will become even greater
The same applies to research. I can think of some discussions which we have had on the Miners' Welfare Commission, of which I am a member. There are some diseases from which miners and miners only suffer. There has been very 1037 little research into the miners' disease of nystagma. What a little has been done to help those men who have suffered so miserably from that disease! The same is true of the pneumoconiosis. I have the spectacle, almost every week, of miners coming to me who are said by their own doctors to have this disease. The Royal Infirmary in Edinburgh has X-rayed them, and the doctors there have also said that they are suffering from this disease. Then they go before the Manchester Board and are told that they have not got it. There is no compensation for them. Their own doctor warns them that they must not work in the pit and they remain unemployed. Surely there must be some definite work of research in relation to that disease. These are only two of the many diseases on which research must be carried out. I shall never forget in Edinburgh one day, when I was paying my bill in a restaurant, seeing a box hanging up, which gave particulars of the incidence of tuberculosis in Scotland, and which said that every halfpenny helped in the fight against it. What a shocking state of affairs—that the right against tuberculosis must depend on people in restaurants putting halfpennies into a tin box. I say to the Secretary of State for Scotland that those who have been responsible for his Bill, in spite of anything which the Opposition have said against it today, will have the wholehearted support of the people of Scotland. Our people are beginning to know that this is a Bill which will give them a medical service and a health service which only the rich in Scotland can buy for themselves at the present time.
§ 6.30 p.m.
§ Lieut.-Colonel Elliot (Scottish Universities)
I would not have intervened at this early stage after my return to familiar scenes had it not been that this is a Bill in which I myself am greatly interested and in which many of my constituents are very interested indeed. In fact, if the hon. lady the Member for North Lanark (Miss Herbison) really deceives the Secretary of State into the idea that the doctors are wholeheartedly in favour of this Bill, I am afraid she is encouraging him to build upon wrong foundations.
§ Lieut.-Colonel Elliot
I know the hon. Lady said that medical students were in 1038 favour of this Bill, but I am afraid he will not find that the medical students when they graduate are any more in favour of it than are those who, by an overwhelming vote, showed their extreme dislike of the provisions that are brought forward in the Bill. That vote is not merely the university vote, but includes votes such as the plebiscite taken by the British Medical Association. Whether it is true or not, that dislike is not due to the negotiations of the Secretary of State for Scotland, who is an accomplished negotiator, but is due to what I call ramstam and buccaneering methods which have succeeded in uniting a volume of opinion against a Measure, which is almost unprecedented in negotiable working undertaken by His Majesty's Government. We welcome the Secretary of State's view that he is prepared to make concessions under this Bill, and, indeed, we remember the appeal from the hon. Member for Dunfermline Burghs (Mr. Watson) that we should treat this in a statesmanlike fashion. There will be one simple acid test of that. There was a decision come to by a Committee on the English Bill on the question of the right of appeal. That was come to purely by weight of argument. It was reversed without any discussion when it came down to the House by the weight of the majority here. If the Secretary of State for Scotland will give us a pledge that, if the Committee so decides, he will concede that principle, we would believe he was going to treat this in the way of a Council of State, but judging by the derisive laughter both from himself and from the Under-Secretary of State for Scotland, who is to wind up—
§ The Joint Under-Secretary of State for Scotland (Mr. Buchanan)
I was not laughing at that, but at a man with the record of my right hon. Friend the Secretary of State having the attentions of others forced upon him.
§ Lieut.-Colonel Elliot
I fail to see exactly what point that has in connection with the argument that has been brought forward, but if we are to take it that the Secretary of State has an open mind on this issue we shall look forward with hope to the course of argument in the Committee, because it is true, as has been said by many speakers tonight, that this Bill would be a very much better Bill if it followed the Scottish traditions instead of trailing, as it does, at the heels of the 1039 English Bill or indeed of the Welsh instigator of the English Bill. We in Scotland never had need of such great assistance from the Welsh that we needed to go on following meekly on their heels.
§ Mr. Gallacher
I do not want to interrupt a maiden speech, but the right hon. and learned Gentleman the Member for Hillhead (Mr. J. S. C. Reid) said that the Bill would be much better if it followed the English Bill.
§ Lieut.-Colonel Elliot
No, he said that, bad as the English Bill was, this Bill was worse. He said that the Bills departed entirely from the Scottish traditions, as indeed they do, and not merely from the Scottish traditions, but from the findings of important and responsible Scottish committees, and not only from that, but from the findings of a committee on which the right hon. Gentleman the Secretary of State for Scotland himself sat, as well as departing from the report of a Commission set up by Mr. Tom Johnston to consider this very problem of the postwar hospitals in Scotland, in the setting up of which the present Secretary of State for Scotland, who was then Under-Secretary of State and responsible for the health of the country, had some responsibility. Now the findings of that Commission are thrown overboard without a word of apology by the Secretary of State for Scotland simply because the powerful Welsh figure in the background has said, "If you deviate by one jot or tittle from what I have decided in this matter so much the worse for you when I get you outside in the playground." It was the right hon. Gentleman and not I or anybody on this side of the House who said this according to the Hetherington Report, which in turn quotes from the evidence of the 1936 Health Services Committee Report. This is the quotation:Nothing emerging from the present inquiry has in any way lessened the force of the assertions of the Committee of the Scottish Health Services (1936)"—that is the assurance of the right hon. Gentleman—that the hospital services shall be developed by cooperation of voluntary and statutory hospitals.This inquiry went again over these matters. It was an inquiry upon which, as one would expect from a committee appointed by Mr. Thomas Johnston, 1040 both sides were well represented, while great figures in the Labour movement like Mrs. McNab Shaw and Mr. Neil Gunn were representatives. Their unanimous finding was for a completely different system of hospital administration in Scotland from that which is introduced by the right hon. Gentleman and recommended to the House. I would ask both him and the Joint Under-Secretary of State to justify their departure from this and explain why it is that the Hetherington Report has been thrown overboard and this new parentless—I should not like to use any stronger word—institution is brought in. Not a single authority in Scotland asked for it; not a single local authority asked for it. There are protests from local authorities already. Not a single medical association and not a single county town or burgh asked for it. There is nobody the Government can quote who asked for this proposal, but the right hon. Gentleman could quote, as indeed could I, many authorities who have asked for a scheme along the lines of the Hetherington Report.
What was the essence of the Hetherington Report? The essence dealt with exactly the point which was made, I think with force, by the hon. Lady the Member for North Lanark and also by the hon. Gentleman the Member for Dunfermline Burghs, namely, that public money should involve public control. That is true. That committee draws out in detail arrangements by which public money entails public control, but to produce public control it was not necessary to take over, lock, stock and barrel, institutions which were then to be controlled. As I say, one must assume that people like Mrs. McNab Shaw, Mr. Neil Gunn and many others like Mr. Vallance, of the Scottish Department, whom I know well, were equally concerned with the public control of public money. They say without any hesitation that there should be grants to the voluntary hospitals which should be left under the control of the voluntary hospitals board. They could see no difficulty about combining that with a system of public control. The whole argument for this—and it is proved on the authority of a representative Scottish committee who were appointed to examine this very problem—is that there is no difficulty whatever about maintaining the voluntary hospitals system with adequate assistance from the Exchequer, and having public 1041 control of the kind wanted either on that side of the House or on this.
Indeed, one can take the matter further. The Secretary of State for Scotland has referred to the Highlands and the Islands system. All are agreed about that. There is nothing doctrinaire about us. If we have a better local service run by doctors wholly or in part paid a basic salary, we judge it on the merits, and if the merits are conclusive we have no hesitation in agreeing with the administration of that service. The Highlands and Islands medical service, small as it is, covers 150 doctors in all, with an intake of about six or 12 per annum, and is very well adapted to the circumstances in which it finds itself. It does not bear out the claims that have just been made by the right hon. Gentleman because to carry on that service they have not found it necessary to nationalise a single one of the hospitals. The hospitals in the Highlands and Islands are left under local control The Royal Northern Hospital at Inverness, the Lerwick hospital, those at Thurso, Fort William, Oban, Golspie, Stornoway, and the Cottage Hospital at Skye—all these are left under the control of local bodies, as indeed they should be. This suggestion that nobody can do anything unless the whole responsibility is taken over by the Secretary of State himself find no confirmation in practice.
The whole of the defects of the Bill derive from the egocentricity of the present Minister of Health—the fear of all subordinates, unless he is unable to order them about, to control them, to regulate them, to lay down the conditions under which they are to work, to resign, and to be remunerated, and those under which the payment of expenses, if any, is to be made. He lays down all these as things to be settled by him. Unless he can do this he fears his fellow men so much that he dare not undertake the responsibility. That never was our idea in Scotland, nor was it ever the idea of the hon. Gentleman the Member for Gorbals (Mr. Buchanan)—
§ Lieut.-Colonel Elliot
It may be that the hon. Gentleman has learned a great deal from me, and I hope he will learn still more. I have come back here with a fairly representative backing for the 1042 purpose of pressing these points upon him, and I hope to be able to press them yet further, and, it may be, to convince him, although I must say that as a true Scotsman he likes argument better than conviction so far as I have found up to now. The whole of the proposals which are brought forward can be summed up in the words "the taking over of a hospital not only from the voluntary bodies, but from the local authorities". It is nonsense to say that a serious inroad is not being made by this Bill into the duties of local authorities under a process which, of course, is going to be continued under other Bills brought forward by this Government with the same tendency to remove authority from the local body and transfer it to boards and commissions appointed wholly by the Minister. The same tendency may be seen in the provisions with regard to doctors, and there I would beg the right hon. Gentleman and the Under-Secretary of State to devote their attention, if they will, to the point that they are here erecting orthodoxy into a system into which it will be impossible for unorthodoxy to break through.
The hon. Lady the Member for North Lanark referred to defects in the tuberculosis service, but the tuberculosis service is a State service. She referred also to defects in the provisions for the investigation of pneumoconiosis and other miners' ailments, but she was complaining against actions which were being carried on by public bodies. The hon. Gentleman, my colleague in the representation of the Universities (Sir J. Graham Kerr) referred to the great advance which had been made in the University of Glasgow, with which the hon. Member for the Gorbals is also well acquainted—his own brother being a distinguished student. In those wards experiments were carried out by Lister in the teeth of medical opinion of the time. When Lister came to London he was greeted with every kind of abuse and contumely. That is the history of advance. I read a speech by Lord Moran pointing out that when he took official bodies round his hospital they were frozen and cold shouldered when they came to Almroth Wright's laboratories because Almroth Wright was a man of very independent views which he had no hesitation in ventilating. Yet, said Lord Moran. 1043 the discovery of penicillin, one of the greatest advances of our time, came as the result of Wright's work. This has raised the uneasiness of no less an authority than George Bernard Shaw— and when Mr. Shaw becomes alarmed about the progress of Socialism, then the rest of us may reasonably feel that there is cause for uneasiness.
§ Miss Herbison
I am afraid that the right hon. and gallant Gentleman is again misrepresenting what I said. When I spoke of those diseases peculiar to miners I was suggesting that in this Bill there would be much more money given for research. I was not complaining of what other voluntary institutions had done at all.
§ Lieut.-Colonel Elliot
It was certainly not my intention to misrepresent the hon. Lady. It is true that she said that more money would be given, but her examples where the case of the subscriptions for tuberculosis in a restaurant and the treatment of men who were told by their private doctors to keep out of the pits and then, going before some public body, were told that they were not suffering from the disease in question at all. The danger in all those cases is not that we shall not have research. We shall, but we may get differing interpretations of research and certainly the orthodox interpretation is not always the right interpretation but is very often the wrong one. That is the danger of frozen systems such as that which we are clamping upon medical education and medical practice in Scotland. It has been mentioned by more than one hon. Member—and by the right hon. Gentleman himself—that the hospitals of Scotland train a third of the doctors of this island—one of our greatest invisible exports, medical skill. But then the right hon. Gentleman says that because of that it is difficult to fit our hospitals into this scheme. "Well, then," he said, "so much the worse for the hospitals. Let the scheme go through; we will jam the hospitals into it." Might he not have thought of the other thing? If the hospitals are difficult to fit in because of their very orthodoxy his case for—
§ Mr. Westwood
In my consultations I have reached complete agreement with all the authorities I have consulted— universities, doctors, local authorities 1044 —and that so far as that side of my hospital proposals are concerned, the only objectors have been the representatives of voluntary hospitals.
§ Lieut.-Colonel Elliot
The right hon. Gentleman is proving my case He says that all the orthodox people agree with him, but it is the rebels he has to consider. Where are they? That is the question of officialdom and bureaucracy in every age.
§ Dr. Morgan (Rochdale)
Is the right hon. Gentleman now pretending to say that unorthodoxy is found in the voluntary hospitals? Is it not rather the case that the voluntary hospitals have become absolutely the home and basis of orthodox medicine?
§ Lieut.-Colonel Elliot
Surely, the hon. Member for Rochdale (Dr. Morgan), who himself has been a rebel in his time, knows that it is not to the people at the top that one looks for rebellion, but to the people below. I am saying that the Government are making an arrangement by which it will be impossible for the rebels to find any space or any access to the great systems of medicine or treatment which this Bill purports to set up. I know that many other hon. Members wish to speak on this Second Reading, and I do not wish to take up too much time, but let me simply quote as my last word the provisions under which the distribution of doctors is to be effected, and under which some people seem to think more doctors will be provided although, as the Secretary of State has rightly said, these are not provisions for producing more doctors but for putting a brake upon the distribution of those who are already here. Read the Seventh Schedule of the Bill, which says:1. The Scottish Medical Practices Committee shall consist of a chairman, who shall be a medical practitioner, and five other members of whom three shall be medical practitioners actively engaged in medical practice.2. The chairman and members shall be appointed by the Secretary of State after consultation "—"consultation," let it be noted, not "agreement"—with such organisations as the Secretary of State may recognise as representative of the medical profession.3. The Secretary of State may make regulations—
- (a) with respect to the appointment, tenure of office and vacation of office of the members of the Committee;
- (b) for the payment to members of the Committee of remuneration or travelling and subsistence allowances.4. The Secretary of State may provide the services of such officers as the Committee may require5. The proceedings of the Committee shall not be invalidated by any vacancy in the membership of the Committee or by any defect in the appointment or qualification of any member thereof.We might add to that final statement that there shall be no appeal from a decision of the Secretary of State. The hon. Member for North Lanark said she would be very happy if our miners got as much control as was laid down in this Bill. Would she be happy, or would any hon. Members opposite be happy, if any of their professional unions were to be overridden by a body of which the members are chosen by the Secretary of State—and he will not always be a Socialist Secretary of State—
§ Lieut.-Colonel Elliot
I understand that hon. Members below the Gangway have strong objections to some aspects of Government policy and that they very successfully did their best to prevent the return of a Member supporting the Secretary of State in favour of the hon. Gentleman the Member for Camlachie (Mr. Stephen). The present Secretary of State will not always be the Secretary of State for Scotland. The hon. Member for West Fife (Mr. Gallacher) "glowering frae him," as they say in Scotland, no doubt dreams of the day when he will sit in that place and when he will have the nomination of the chairman and members after consultation with such organisations as he may recognise as representative of this profession. From what I have seen of Soviet Russia, under his regime the rebels will have a pretty thin time. The proposals laid down here are proposals, first of all, which go directly contrary to the trend of Scottish thought, as it has been brought out over many years by many committees of inquiry. They go counter to that because of arguments which do not hold water. The recommendations of all these committees, representing labour as well as conservatism, have been examined and turned down. These proposals enforce a rigid system which will be of the utmost disadvantage to the patient and will go very far to militate against the future prosperity of the great schools of medicine for which Scotland has been 1046 famous. For these reasons alone—others would be unnecessary—I hope very much that the House will not accept the Second Reading of this Bill.
§ 6.54 p.m.
§ Dr. Morgan (Rochdale)
We have just listened to a speech which was no doubt meant to be a serious contribution to the Debate but was simply a frivolous, attempted-facetious speech which did not really ring true. The right hon. and gallant Member for the Scottish Universities (Lieut.-Colonel Elliot) rather taunted me with being a rebel. I remember the days when he was a rebel as a member of the Glasgow University Fabian Society, and that was not very long ago either—
§ Lieut.-Colonel Elliot
I thank the hon. Member for that. I felt that it was long ago, but if he feels that it was not long ago, I am all the more flattered.
§ Dr. Morgan
Perhaps my measurement of 20 years is not long, but I remember the right hon. and gallant Gentleman being associated with the Fabian Society and he was a greater rebel than I was. Apart from the personal issue, what really has he said tonight? He talked about appointments by the Secretary of State. Did he not, when Secretary of State, appoint medical officers to his Departments? Were they always orthodox members of the profession, did they never have unorthodox or rather unusual views which he accepted as professional advice given to his Department, and did he not act on that advice? Surely every Secretary of State and every departmental officer has to take the advice of his expert and sometimes professional advisers. What is wrong about that? The right hon. and gallant Gentleman, who has had a period of meditation and contemplation and whom one would have expected in those days of quietude to have examined what took place on the Debates on the English Health Bill, comes here and talks about something which happened in Committee when the Government were defeated by one vote—and that vote was mine. He also says that on the question of the appeal to the courts, there was a vote but practically no discussion later in this House. Not only was there discussion in Committee but there was discussion here in which I was privileged to take part, and it was only after a very full discussion in the House on the Report stage that a vote was taken and, 1047 as I intended, I abstained from voting on the particular issue on the right of appeal to the court—
§ Lieut.-Colonel Elliot
Perhaps the hon. Member did not hear me say that, totally against the weight of argument, the decision was taken by the weight of the majority, and I am perfectly sure of that because I read very carefully every line of those Debates—in the period of meditation which was terminated by the 18,000 majority which I was happy to collect in Scotland last week.
§ Dr. Morgan
That is getting away with a minor point. The question as to the weight of the argument, is a matter of personal interpretation of the argument. I think—although I was against them— that the hon. Members who put up the arguments against the appeal to the courts put up a good case—
§ Dr. Morgan
One can recognise a fine contribution when one has a stronger case. This Bill is a very good Bill in spite of what the right hon. and gallant Gentleman said. It is better than the English Bill. There are finer things in this Bill—
§ Dr. Morgan
The doctors do think so. Many of the doctors are more intelligent than other professional men and even the right hon. and gallant Gentleman after his leisurely period of temporary oblivion. Certain things now come directly under the aegis of the Secretary of State for Scotland under this Bill. Health centres instead of being left to local authorities will be directly under the responsibility of this House through the Minister. It will be in his hands to see that the experiments that are made as to the ideal health centre are to be done with coordination, and good planning, design, personnel and work. I am particularly glad that, as in the case of the English Bill, he will have medical research in his own hands. I was afraid that Scottish research would fall 1048 under the patronage of the English Research Medical Council. Talk about orthodoxy—if one wants to see orthodoxy in excess, and sometimes in extremis, one must go to medical research in England —the Medical Research Council and so on. The unorthodox man scarcely has a chance. The rebel has not a chance of expressing his views or of getting into the inner councils of medical research—
§ Dr. Morgan
It is not a State organisation, as the right hon. and gallant Gentleman knows. The State provides the money and allows free rein to the professional bodies and appointed experts. The right hon. and gallant Gentleman knows that as well as I do.
§ Lieut.-Colonel Elliot
This is a terrible attack on the Lord President of the Council, under whom that Committee worked.
§ Dr. Morgan
It is not an attack on him. He is not an expert in medical research. To indulge in these playful contributions in a serious discussion does not help. Let me have a chance to say why I like this Bill. The Scottish mind does its research mainly on deductive lines as Buckle pointed out in his classic on Civilisation. I am not pretending that all Scotsmen have deductive minds and that none has an inductive mind, but in bulk and in appropriate proportion the tendency is that the predominance of their mind when considering a question of research or a difficulty under dispute is to do it on deductive lines rather than inductive lines. The right hon. Gentleman knows that quite well. In Great Britain now the great tendency in medical research is to do inductive research, to base theories and practical diagnosis and treatment on facts. Take the question of immunity. Immunity is that peculiar biological property by which not only large organisms, animal or vegetable, mainly animal, have the power of building up protective substances, but even those microscopic organisms, one cell of which we have to magnify 1,200 times under the microscope, have the same peculiar property—practically unexplored territory from the point of view of research—of protecting themselves against drugs which are inimical to their well being.
1049 Penicillin, that exaggerated drug which has not yet found its level, is an instance. It is known that in certain diseases these organisms, when first treated, disappear like a flash under penicillin treatment but, as the treatment is tried again or repeated they acquire the power of being resistant to penicillin or to the new drugs like sulphanomides, so that after treatment, when a patient gets a second attack, he is in a worse position than before, if treated on the same lines as previously, because these drugs are then practically useless, the casual microbes having built up a resistance. There are other questions. Why should a man be peculiarly sensitive to certain forms of disease? Why should certain men have hay fever? Why should certain men be allergic to certain things? Why should certain men be unable to eat certain types of fish? Why should certain men react to the touch of certain plants? Why should they get reactions? Medical research in Great Britain has practically not touched those problems.
Very excellent work is being done in the laboratory referred to—the Sir Almroth Wright Institute of Research attached to St. Mary's Hospital, London. Dr. Freeman there is an absolute marvel, working on Wright's lines, though Sir Almroth himself is getting old now. He is one of many. We want to spend not a half million but millions on the question of why certain people are protected against certain diseases and others not, so that the whole thing can be built up from the preventive point of view. My former tutor, the excellent professor who now shares the representation of the Scottish Universities with the right hon. and gallant Gentleman who has just spoken, referred to Jenner and vaccination as an immunising agency against smallpox. We immunise against diphtheria. We are only on the fringe of the great problem of immunity, and it is because the Scots have this peculiarly deductive mind that I am so glad the Secretary of State will have under his aegis the right to prosecute medical and biological research by a method and on a subject which is so peculiarly suited to the brilliant development of the Scottish mind. This is a subject which is one of great fascination, for research is a marvellous thing, and the basic, problem of immunity and its therapeutic application is vitally important.
1050 With regard to the ambulance service, instead of leaving it to the local authorities to make perhaps private arrangements, the responsibility is now placed in the proper quarter, on the Minister's shoulders, so that ambulances will be able to go wherever the patient is to receive treatment instead of there being a demarcation of boundaries. All that is to be the direct province of the Minister, so I feel this Bill is a good Bill. I know that certain people are pretending that the doctors are against it; I know that peculiarly-worded plebiscites are being taken, to ask doctors to oppose this Bill. There is not an argument that has not been put up by the doctors that cannot really be answered. No one who is opposed to a State medical service, or a full time salaried service, has ever been able to answer the point I made in the last Debate: why, if the doctors object to a full-time State medical service, do they employ their own assistants for years or decades on a full time salary basis attached to their practices?
May I make this further point? Many assistants under contract to doctors are now in a quandary because doctors are to be compensated for the goodwill of their practices. Will the assistant be allowed to remain in that district and practise? The General Medical Council still has the right of ethical professional supervision over those doctors, and can tell the assistant, "You signed a bond and, in the ethics of the profession, you cannot break that bond. Although the doctor has received compensation for the loss of his goodwill, according to your bond you cannot be allowed to remain in this district and practise." That is a point which I hope will be cleared up in the Bill.
There are other problems which this Bill will engender, but I feel sure it is a finer Bill than the English Bill. It has made special provision for the institutions for which I pleaded on the last occasion, the denominational hospitals, the Jewish and Quaker hospitals. That is a tribute to the broadmindedness of the Scottish intellect, as fine as Buckle's reference to their fine deductive minds. I hope my contribution has been a little more serious than the rather playful, academic and somewhat boyish speech which we heard from the right hon. and gallant Gentleman the Member for the Scottish Universities.
§ 7.8 p.m.
§ Mr. Thornton-Kemsley (Aberdeen and Kincardine. Western)
Of course, this being a Scottish Bill it is a better Bill than the English or the Welsh Bills, but it is not good enough, and in spite of the reinforcements which the Government have called up, including the hon. Member for Rochdale (Dr. Morgan) who, I suspect was born in Wales, represents Lancashire in this House, but had the sense to be educated under the hon. Gentleman the Member for the Scottish Universities (Sir John Graham-Kerr)—in spite of that fact, we on this side of the House, though completely in favour of a comprehensive health service with free treatment for every man, woman and child in Scotland—
§ Dr. Morgan
I am sorry to interrupt the hon. Gentleman, but I had better correct him at once. He said he thought I was born in Wales. My name happens to be Welsh, but I really come of Irish parentage. I was born in the West Indies, educated at a Scottish University, and all my subsequent appointments have been English, so I am a regular mongrel.
§ Mr. Thornton Kemsley
Force is given to my point that reinforcements are called up by the Government from all corners of the Empire in support of their not very good Bill—[An HON. MEMBER: "It is not the first time"]—and in spite of those reinforcements and the arguments that have been adduced in favour of the Bill, we feel on these benches that there are far too many unsatisfactory features about the Bill for us to be able to recommend it to the people of Scotland. Of course, we accept the desirability of regional organisation; indeed, we agree that Scotland is peculiarly suited to such an organisation, much more suited, in fact, than is England, because in Scotland you have the great teaching hospitals of Edinburgh in the South-East, of Glasgow in the South-West, of Aberdeen way up in the North-East, and Dundee in association with St. Andrew's University to cover the centre of Scotland, with the possibility that gives you of having your teaching hospitals in the centre with the cottage hospitals around the periphery.
If we had been in the position occupied by His Majesty's present advisers, we certainly should not have placed the teaching hospitals under the regional organisation. 1052 I desire to support everything which was said in that connection by the right hon. and learned Member for Hillhead (Mr. J. S. C. Reid). There can be no adequate justification for placing these great teaching hospitals in an inferior position to that in which they have been placed under the English Bill, both in regard to administration and the conservation of their endowments. The repeated reference to rules and regulations made by the Secretary of State or by the regional hospital boards, make it clear that the day-to-day actions of those boards of management which will control the hospitals under the proposed organisation will make them subject to a system of remote and impersonal control which is quite unwarranted in the case of the teaching hospitals, and which is vastly different from the intimate and personal contact which today exists between the management, staffs, patients, and subscribing public in the case of the voluntary hospitals.
Reference has been made to the powers the Secretary of State is taking upon himself. May I remind the House that the Bill proposes to set up a health service council with 35 members appointed by the Secretary of State. It sets up a hospital endowments commission which is appointed for five years by the Secretary of State. It sets up five regional hospital boards, the members of which are appointed by the Secretary of State, who even in this case appoints the chairmen.
§ Mrs. Jean Mann
If the hon. Member will look at the Second Schedule to the Bill, he will find that the appointments are only made "after consultation."
§ Mr. Thornton-Kemsley
I am grateful to the hon. Lady. I was coming to that point. I have noticed she frequently intervenes but, if I may say with respect, if she allowed the speaker to develop his argument it would be better, because in nearly every case the Member is not foolish enough to have omitted a point such as that. The Bill sets up executive councils in each county for the provision of personal medical services. In this case again, the chairman and 24 other members are appointed by the Secretary of State.
§ Dr. Morgan
No, the hon. Gentleman is quite wrong. If he reads the Bill he will see that it says: 1053An Executive Council shall consist of a chairman appointed by the Secretary of State and 24 other members of whom—(a) eight membersand so on.
§ Mr. Thornton-Kemsley
I will leave this list for the moment and accept the fact, of which I have been reminded, and of which I was aware, that provision is made for consultation with various bodies. But the principle is exactly the same. These bodies are to comprise appointed members, and not elected members. In this country we are a democracy, and believe in democratic methods, and in elections. Yet, in not a single instance in this Bill, either in the cases I have mentioned, or in other cases I might have mentioned, is provision made for the election by people of the locality of representatives they wish to represent them on the boards.
§ Dr. Morgan
I am sorry to interrupt, but we had better get this perfectly clear. The Sixth Schedule says quite distinctly:An Executive Council shall consist of a chairman appointed by the Secretary of State and 24 other members of whom—(a) eight members shall be appointed by the local health authority.appointed by the Secretary of State and the other members shall be appointed by the Secretary of State, the local medical committee, the local dental committee and the local pharmaceutical committee. So the Secretary of State does not appoint all the members of the Executive Council.
§ Mr. Thornton-Kemsley
The hon. Member for Rochdale was fortunate in catching your eye, Mr. Speaker, in the English Debate, and he has now ventured to intervene in the Scottish Debate. But I cannot give way any further because so many other Members on this side—
§ Mr. Thornton-Kemsley
The point the hon. Member has made in intervening makes not the slightest difference to my argument, which is that those members are appointed, and not elected. This is a point worthy of consideration that the appointment of members by the Secretary of State, on by any other body, is no substitute for the elected representatives of the districts concerned.
I want to say something about the six specific responsibilities laid on the local authorities. Of these six, at least four— 1054 the responsibility for the care of mothers and young children, the responsibility for the midwifery services, responsibility for home nursing and responsibility for after care—are at present, in part at any rate, carried out by the district nurses. I want to pay tribute to this splendid body of women, so many of whom are members of the Queen's Nurses, with 60 years of selfless service behind them. These women play a great part, particularly in the rural areas, in looking after the health of the people of Scotland and, of course, of England, too. I have been glad to see that the local health authorities, of whom, in the country districts, the county councils will be the organisaions responsible, are empowered to work through voluntary organisations. If need be, they may contribute financially to the maintenance of these voluntary organisations. I hope they will do this, for here, at least, is an opportunity for the local voice to be heard.
Voluntary hospitals are to be transferred to the Secretary of State. By definition in Clause 78 of the Bill this includes nursing homes which are not run for profit. But the Secretary of State need not take over these nursing homes if they are not required for providing hospital or specialist services. It is quite clear that there is likely to be difficulty in finding enough pay-bed accommodation, and I urge that the existing facilities for the treatment of private patients, particularly in mental institutions, and in nursing homes run by organisations such as the Officers' Association, which has such a splendid nursing home in Edinburgh, should be interfered with as little as possible. I know that there may be a strong temptation for the Secretary of State to take them over. Some of them may be richly endowed. Therefore, I ask for an assurance from the Joint Under-Secretary, who will be replying to this Debate, that when he comes to look at things like this, the question He will put to himself will be this: Is it desirable and necessary to the successful working of the scheme that I should take over this or that institution?
The points I have made are rather of an administrative nature. I want to add a point which I think is really of an ethical character. Side by side with what, for want of a better term, one might describe as the technical approach of a doctor to his patient, there is a deeper relationship which rests upon a shared confidence, and 1055 upon the responsibility which the respect and trust of the patient imposes upon the doctor. The doctor is far more than a mere technician. He shares with the pastor, and to a lesser extent, I suspect, with the schoolmaster, the privilege and the responsibility of entering the inmost recesses of the hearts and minds of his patients. There is in old people and in sick people a sense of dependence which amounts, in greater or lesser degree, to an instinctive longing 10 be regarded as some one who is human, and therefore precious in the sight of God, and worth helping. All Divine teaching and human experience go to show the sovereign importance of the human will, and only a doctor knows how much the will to get well or the will to live depends upon a doctor-patient relationship which rests upon mutual confidence and trust. It follows that the doctor should undertake full responsibility for the care and the welfare of his patient without outside interference, and with full freedom of judgment in professional matters.
That ideal cannot be achieved in full. It is not achieved in full at the present time. The medical officer in the Armed Forces or the doctor in the Emergency Medical Service are cases in point. But side by side with the State servant there has hitherto been the stimulus of a widespread and virile private practice. That balance is now to be upset. It may indeed disappear altogether, for the hazards of competition with the State medical service may be such as to make it unlikely that many doctors will be able to take the risk of remaining outside the scheme. If that is the case throughout Scotland, which has rejoiced in its liberty and grown great because of its rugged independence, the vast majority of doctors will owe their first allegiance to the State instead of to the patient. The pressure of subservience will tend to blur the ideals and to dull the enterprise of the State servant, as it always has done down the ages. If I may put it more bluntly, the doctor-patient relationship will suffer when the doctor's prospect of advancement depends not upon his care of his patient, not even upon his skill in medicine, but upon the impression he can make upon his lords and masters in the hierarchy of the State medical service.
§ 7.25 p.m.
§ Mr. Carmichael (Glasgow, Bridgeton)
I wish first to express my appreciation of 1056 the introduction by the Government of a Bill to establish a comprehensive health service for Scotland. I think the two main principles associated with the Bill are, first, the granting of the best possible medical service to every member of the community, irrespective of the size of the purse; and secondly, a proper allocation of the medical skill of the country, so that we can have an organisation that will bring the patient close to the medical chiefs, without the haphazard gambling that goes on at the moment. Therefore, I say that I appreciate the introduction of a Measure of this kind. Having said that, I want to be quite frank. I wish to be critical of certain of the administrative aspects of this Measure. A previous speaker proceeded on the lines I had intended to develop myself in criticising the number of boards that are to be appointed.
There are two main criticisms. The first is against the idea that the responsibility should rest entirely on the Secretary of State for Scotland. I speak with some little experience of a local authority. For many years I served on a number of important committees. One disturbing feature in recent years has been the tendency to hamper or cripple the local authority unless it has received sanction from the Secretary of State for Scotland. There is a strong democratic argument put forward for the Secretary of State for Scotland, but on examination that argument does not hold. The strong democratic argument is that the Secretary of State has to come before the House of Commons; in other words we have the complete expression of democracy in that the Secretary of State is answerable to Parliament. On a superficial examination that is the position, but on a closer examination the Secretary of State for Scotland today—there is no personal point in this —is shown to be responsible for the health services, for education, for the police, for agriculture and for fisheries. What is the position so far as ordinary Scottish Members are concerned? We have the opportunity on rare occasions to deal with Scottish affairs, and even then we have to face up to the intervention of Rochdale pioneers. Over a long spell we get one or two days. That, to me is, in the modern age, far from being democratic.
What actually happens is that the Secretary of State for Scotland is compelled, by the difficult problems he has to face, 1057 to draw round him a great team of permanent officials. He has to be guided very largely by the permanent officials. Whatever value that has, it has tremendous weaknesses, if it encroaches upon the control of democratically elected bodies. To take this Bill, it starts off with a Scottish Health Service Council, with 35 appointed members. There is also an Executive Council. My only suggestion to the medical profession is that, apart from their natural objection to change, they will, in the long run, have much more say in the development of the medical service in Scotland than they had in the past. But I wish to make the point that there are too many committees, all working under the guidance of the Secretary of State, right down to the one that deals with the localities. The regional boards will precede the local authorities in many directions. To whom are the regional boards responsible? To the Secretary of State for Scotland. They can submit reports to him, he can examine them, and if they are considered suitable or desirable by the Secretary of State, they will be published. But under the Bill he has power to refuse to publish any of the reports.
Who elects this body? It is true that the medical profession, the local authorities and other people will be consulted, but the members elected are responsible to nobody but the Secretary of State for Scotland. If a member of a local authority were elected to the body, he would not be responsible to that local authority; he would be responsible to the members of the Board and to the Secretary of State for Scotland. In addition, we have the hospital boards. I do not want to enter into a discussion on voluntary hospitals. Therefore, I will deal with the boards as such. The hospital board is responsible to the regional board. It has a certain autonomy and it can appoint and dismiss people and make certain purchases. There is, however, no permanent link that indicates the constant movement forward in unison of the hospital board and the regional board. Between these bodies come the local authorities who are responsible for many of the home services. The local authorities are responsible for watching the development of tuberculosis in the home and attempting to check it. The local authorities in the big areas are responsible for infectious diseases—
§ Mr. Carmichael
I say that the local authorities will be responsible for watching in the district for the danger of infectious diseases. I do not put tuberculosis in the category of infectious diseases though we know it is an infectious disease. The local authorities are responsible for watching tuberculosis in the homes of the people. I say, therefore, that we have a link, which is not a very healthy link, between the local authority, the regional board, and the hospital board in trying finally to get the patient from the home into hospital. That is my reading of the Bill and I should be more than happy to be corrected. Why are the local authorities being set aside? Is it not admitted by anyone who has studied the history of social development that it sprang, first of all, from the small community? In cities like Glasgow and Edinburgh the development of the hospital services was not primarily the outcome of legislation. It arose from the work of far-sighted local reformers.
All that is being thrown to one side. I know from experience that if we hand this over to the regional boards, even the right of knowing what is happening in the hospitals will be difficult to enforce. Everyone of us knows that, even in local authorities, we find it necessary to complain not against bad management, but against institutions which are not properly managed, where there is haphazard administration. Perhaps the medical superintendent has not sufficient courage and capacity to handle his staff, with the result that the healthy development of the institution is impeded. As one of my hon. Friends says, as an aside, that remark also applies to the matrons. I would not like to be unfair to matrons, though I agree that they can be very hard, not only to the patient but to the staff. The only point I wish to make is that matters of that kind can be checked up by the local authority through the medical officer and the health committee. Under the regional board, I want to know how they will be able to check these things. I do not see any opportunity provided for that in the Bill. If the Joint Undersecretary could help us, I would be very happy.
I should have thought that in the extension of the health services greater responsibility would be placed on local 1059 authorities. The strong case against the local authorities comes from the Treasury. As soon as the Government hand out money, they must have some Minister responsible to the House of Commons. I do not understand that line of reasoning when it concerns the development of a democratic country. The Government appoint auditors to examine the books of local authorities and nobody else can do it but Government appointed auditors. The very people who are elected to this House of Commons, who feel they are capable of carrying out a responsibility on behalf of the community as a whole, surely should have some respect for the people appointed to local authorities by the same electors. I hope that if we cannot get any assurance tonight, at least the interjection of some of our complaints may cause the Minister to give the matter closer examination before we reach the Committee stage.
I know the difficulties which will arise in Committee. With the Government on one side, and the Opposition on the other, it does not matter very much what reasons are put forward. It is the weight that matters. Certain people will say, "We have already framed the Bill and we do not like the idea of amending it." As I said, in the only other speech which I have made in this House, I want to see this Government score a great success. I then uttered what I thought was a warning from an ordinary member of the community, that in the desire to develop State enterprise, there was a danger of encroaching unduly on the democratic machinery established down the generations. It is my fear in connection with this Bill that there will be an encroachment on local authorities in a manner which is not justified by our knowledge of the past. I ask the Joint Under-Secretary of State for Scotland to correct me on my point about infectious diseases and tuberculosis, if he so wishes. I hope he will not destroy the very fine machinery set up by local authorities, at least in the big cities. I think the local authorities have been of great value to this community, and that their work can be enlarged upon without encroaching upon the democratic rights of the electors.
§ 7.37 p.m.
§ Mr. Niall Macpherson (Dumfries)
The hon. Member for Bridgeton (Mr. Carmichael) has spoken with great cogency. 1060 I trust that hon. Members opposite will have listened to him, for he speaks as one who has much the same approach as they have, but he happens to be free and not dominated by the Government Front Bench. I wish to approach the Bill as an ordinary citizen, not from the point of view of the doctors, from whom we have had several distinguished speeches today, nor from the point of view of the Front Bench. I want to approach the matter from the point of view of one who is responsible ultimately, as an elector, for the provision of these services. There is no difference of opinion in the House on the question that there should be a comprehensive health service. The question is how it should be provided. It is a matter of control.
The Secretary of State said the State should not go on handing out large sums of money without having control. Hon. Members opposite have echoed that remark. I would point out that the State does hand out large sums of money every day without having complete control. The State exercises supervision. It hands out large sums of money in subsidies to agriculture but it does not run the farms itself It hands out large sums of money to industry but it does not run the whole of our industry.
§ Mr. Macpherson
The party of which the hon. Gentleman the Member for West Fife (Mr. Gallacher) is a member may hope to do so, but the Government say they do not intend to do that. I want to consider the matter from the point of view of the elector who has to provide these services, to use them and to pay for them. In Clause 1 (2) of the Bill there is the phrase:The services so provided shall be free of charge.There is, however, a risk of there being a considerable over emphasis on the word "free." Surely, emphasis should rather be placed on the fact that all citizens are contributing, in one way or the other, to these services, and that it is in relation to their own effort that they will get good services. Everybody wants the services to be provided as sympathetically, as efficiently and as economically as possible. But what control does this Bill give to the elector over those services? What encouragement is there to him to exercise that control?
1061 First of all, let us take the hospitals. Some are under the control of local authorities, and, when those local authorities are conscientious, the services are good. When those local authorities are less conscientious, or provide bad services, it is always open to the local authority elector to turn them out and to put in people who are prepared to spend more on those services. Then there are the voluntary hospitals which are financed by, bequests or gifts, or are maintained by public subscriptions from people who wish to get something for themselves a little better, perhaps, than their neighbours enjoy. That is a manifestation of robust and honest rivalry between districts. In my own constituency there are two small hospitals in two different burghs— Langholm and Moffat. One is entirely endowed and the other is supported by public subscription. Those hospitals are now to pass under the control of regional boards constituted and appointed by the Secretary of State, and working subject to his regulations and such directions as may be given by him. These regional boards have no representative element on them whatever, apart from the members appointed after consultation with the local health authorities. Then, the local hospitals are to be ran, either separately or in groups, by boards of management appointed in accordance with the scheme to be prepared by the regional hospital boards and approved by the Secretary of State. The Bill does not prescribe the proportion of local authority representatives on the boards, but I doubt very much whether they will be in a majority judging by the constitution set forth in the Schedule.
Perhaps it may be said that this set-up is essential in the interest of efficiency, and of the health of the people. If the right hon. Gentleman compares the state of health of this country 100 years ago with its state of health today, would he say that the present system has not worked? Have the Members of the Government so little confidence in the good sense of our people, and has the right hon. Gentleman the Secretary of State so much confidence in himself, that he must assume that he alone can provide hospital and specialist services? Could not a scheme for voluntary cooperation between hospitals have been worked out which would have commanded support?
1062 In his speech, the right hon. Gentleman referred to the fact that one third of the students trained in Great Britain are trained in Scotland. He then went on to say that he wished to safeguard that position. But, surely, the greatest safeguard is the continuance of the system whereby out of the individual efforts in the country we have managed to reach a state where we produce one third of the doctors in the Kingdom? I believe that it would have been possible to have followed one of the schemes worked out, for example, by the British Hospitals Association. If the alternative had been given of having this Bill or of having such a scheme then, undoubtedly, the hospitals would have opted for the scheme which they themselves suggested. It is only because they have seen the progress of the English Bill through this House that by a kind of attrition they have come to the conclusion that they had better give way. But that is not their real view at all.
Perhaps the right hon. Gentleman took his cue from his right hon. Friend the Minister of Health who, according to a report in "The Times" of Monday, 28th October, told the British Medical Students' Association on 26th October:The scheme could not be articulated through self-motivating voluntary hospitals.He went on to say, on a slightly lower level:I could not provide a service through institutions which were able to deny my ultimate authority.So, right or wrong, the Minister's dictates must prevail. He who pays the piper calls the tune. But is the Secretary of State so sure that he knows the local needs better than do the local electors themselves?
I will now turn to a special topic which has not so far been mentioned—that of mental hospitals. I believe that there are more beds in mental hospitals in Scotland than in general hospitals. If there is one thing which is quite clear it is that it is essential that the independence of these mental hospitals should be maintained. There must be elasticity in their management, and a large measure of freedom must be given to them. The constituency which I represent is internationally famous for two things; firstly, its connection with Burns, and secondly, the fact that it contains the Crichton Royal Hospital. That 1063 hospital was founded about 100 years ago, and has an international reputation. About 58 per cent, of its patients are private patients. It is not because I think that our best services should not be reserved for Scotland that I mention this, but only 35 per cent, of those private patients come from Scotland. The point is that it is essential in the case of mental hospitals to allow the patients to choose where they will go. For obvious reasons, mental cases do not want to go for treatment just round the corner. It is essential for such patients to have the kind of life to which they have been accustomed and, in the case of the treatment of neurosis and various psychopathic conditions, it is essential that there should be no psychological shock in the way they are treated. I hope that the hon. Gentleman who is going to reply will deal with the mental hospitals' freedom of management, their elasticity as to which hospitals patients are sent, and the extent to which reservations are to be made for private patients in mental hospitals in comparison with other kinds of hospitals.
Local authorities are left with many duties. Among them they have the care of expectant and nursing mothers, sick visiting, home nursing and the after-care of the sick. All these services are under the direction of the Secretary of State in order to fit in with hospital and specialist services. That is nothing but an insult to local authorities. Surely, they would be anxious to fit in without directions or regulations. Whatever the hon. Member for Dunfermline Burghs (Mr. Watson) may feel about his own very independent county, given the problems, the local authorities will be anxious and willing to solve them in cooperation. If real responsibility is taken away from local authorities, that will to cooperate will be taken away.
I turn now to the question of the private citizens' approach to his medical practitioner. What are the ordinary citizen's, requirements of his doctor? First, I should say is availability of doctors; secondly, sympathy; thirdly, skill; and fourthly, privacy. With regard to availability, the Bill will not increase the number of doctors or dentists. The White Paper states that the Bill imposes no limits upon availability, but, in fact, it imposes very practical limits, and I want to mention some of them. It reduces 1064 the doctor's time for attending to patients. There will be an immense number of regulations, and forms to fill up, and there will be many more doctors engaged on administrative duties.
§ Mr. Baird (Wolverhampton, East)
There will not be so many doctors practising in wealthy residential districts, like Bournemouth.
§ Mr. Macpherson
On the whole, the distribution of doctors throughout Scotland is far more even than it is in England. There will be a great deal more routine work for doctors. Far more will be employed in administrative duties. Let hon. Members look at the Schedules and see how many doctors will be involved in executive councils, boards of management, and so on. Moreover, a salaried service is being set up. I would like to quote from a letter that I received from a doctor, which says:The Bill takes away all incentive to become a good, or even a conscientious doctor. A wholetime salaried doctor, being a human being, will be no better and no worse in the matter of work than any other wholetime salaried officer. There is no doubt that he, too, will demand his eight-hour day and will down tools when the clock strikes the eighth hour each day. At the worst, he will not bestir himself to answer an emergency call out of hours; at the best he will not bestir himself mentally, and the standard of medicine throughout the country will fall to that of other totalitarian countries.
§ Mr. Macpherson
That is a doctor's opinion on this matter. He is not a very old doctor, and has not very long been out of the student stage. Let us now consider the question of sympathy. With regard to the very important point about the choice of doctor, I would like the Joint Under-Secretary of State to say something about that in his reply, since it is not clear in the Bill and the White Paper. It is obvious that the doctor can choose his patient, just as the patient can choose a doctor, and there is also, of course, an arrangement with the executive council whereby a patient may be directed to a particular doctor. What is not said is whether the doctor is then obliged to take that patient.
§ Mr. Gallacher
Does the hon. Gentleman suggest that a poor working-class resident in the East End of London can choose the doctor he wants?
§ Mr. Macpherson
I do not see the relevance of that interruption. A poor working-class man can change his doctor, and I doubt very much whether, under this Bill, that will be possible. There seems, to be no provision for it. There is a prevailing idea—and it is a very good one—that medicine is a calling and not a career, but once it is made a salaried service, there is bound to be all the normal wirepulling of a career. There will be doctors place-hunting and seeking promotion, and this will destroy the relationship between the family and the doctor.
There is also the very important question of privacy. Health centres are to be set up. There is a great deal to be said for clinics in which doctors may be in partnership and each of them specialise in some aspect of medicine. Perhaps, in Scotland, we are not quite as advanced in that respect as other parts of the country, although I believe that Aberdeen, in this as in many other things, is very well advanced. Surely, the privacy of the patient will be mightily affected in several ways. He will go to the health centre, which incidentally will not be under the local authority, but one of the services provided by the Secretary of State. Probably he will have a medical history card filed away, with no guarantee that it cannot be seen by eyes that he would not wish to see it. The only eyes that he would wish to see his medical history card would be those of his own doctor, but once there is a medical history card, it may be called for on all kinds of occasions. Surely, it is a natural instinct, when one is sick, to crawl into a corner rather than to go round to a great public place for health services.
Lastly, with regard to the executive councils, I agree fully that there is far too much control throughout by the medical profession. The person who is really interested, and should have the control, is the patient, through his local authority, and, if you like, through an advisory council. But the executive council is only half local health authority, the other half being doctors, dentists and pharmaceutical experts. Surely, that is entirely wrong. There are two separate considerations. First, there is the control by the profession, from the disciplinary point of view, of its own members, and that should be in the hands of the profession, as it is, for instance, in the case of 1066 solicitors. At the present time, doctors have control. The hon. Member for Rochdale (Dr. Morgan) would not entirely agree with me if he were present, but surely, that control ought to be entirely in the hands of the profession, whereas if it really is necessary—I do not think it is—for there to be any control over the number of doctors in any given area, from the point of view of allowing them to come in or not to come in, it should be for the citizens, through the local authority, to say whether the medical services are being adequately manned or not. There should be, of course, medical advisers to give expert advice. I understand that is the way the Highlands and Islands scheme works, and I do not see why there should be any deviation from that system in this Bill. In conclusion, I would point out that we are being asked to surrender all our great teaching hospitals to a Secretary of State for Scotland whom we might describe as our first foreign citizen, and who is anxious to give us a health service which—
§ Mr. Buchanan
Would the non. Member tell us what he means by the expression "first foreign citizen"?
§ Mr. Macpherson
The Secretary of State for Scotland speaks with the accents of Scotland, but I believe he comes from across the Border.
§ Mr. Buchanan
A Member of his party was Secretary of State for Scotland for some time before my right hon. Friend occupied that position. He was the first foreign one. The first foreign citizen was, therefore, my right hon. Friend's former leader.
§ Mr. Macpherson
I accept that interruption in good part. The fact remains that Scotland takes note of it. The Secretary of State for Scotland is anxious to give a health service to Scotland. It is easy enough to give it with other people's money. I can assure the right hon. Gentleman that what he gives us is nothing to what he is taking away in spiritual values. He is depriving Scotland of that feeling of individual responsibility in the professions and of responsibility of local authorities towards private citizens. The right hon. Gentleman said in his speech that he is incorporating all that is best into the Bill. On second thoughts I think he would agree that that is not so. There are aspects of voluntary effort on the part of doctors 1067 in the voluntary hospitals and we can ill afford to do without them. They have built up the great medical services of Scotland to the pre-eminent position that they occupy today. I trust that when we come to the Committee stage there will be a considerable revision of some of these points in the Bill.
§ 8.2 p.m.
§ Mr. Hector Hughes (Aberdeen, North)
I wish to make one point in reply to the argument of the hon. Member for West Aberdeen (Mr. Thornton-Kemsley). I am sorry that he is not in his place at the moment. His argument was thoroughly pedantic, and was based upon a strained meaning of the word "appointed." He sought to prove that the executive councils contemplated by the Sixth Schedule would not be democratic bodies because the word "appointed" is used in the Schedule. Therefore, they were appointed bodies and not democratic or elected bodies.
The hon. Member's argument will not bear a moment's examination. In the Sixth Schedule we find it provided that executive councils shall consist of 24 members. Of that number, five will be appointed in the true and proper meaning of the word. They will be appointed by the Minister. The other 19 will be elected. The executive council is to consist of a chairman appointed by the Secretary of State and 24 other members,of whom—(a) eight members shall be appointed by the local health authority.How does a local health authority appoint any persons? Surely, by electing that person by a majority of its members. Any person so appointed is, in fact, elected. Therefore, the eight members in sub-paragraph (a) will be elected members.
Sub-paragraph (b) says:four members shall be appointed by the Secretary of State.They will be appointed in the proper sense of the word, and not elected. Sub-paragraph (c) says:seven members shall be appointed by the local medical committee.What is the local medical committee? It is a committee of medical men appointed by local medical men. How does the committee appoint anybody? By electing them by a majority of its own mem- 1068 bers. Therefore, under sub-paragraph (c) the seven members who are to be appointed by the local medical committee will be elected members, though the word "appointed" is used.
I pass to sub-paragraph (d) which says:Three members shall be appointed by the local dental committee.The same line of reasoning applies here. Sub-paragraph (e) says:Two members shall be appointed by the local Pharmaceutical Committee.Exactly the same argument applies.
Therefore, we find that of the 24 members of the executive council, 19 are elected, although the word "appointed" is used. They are elected in the true meaning of the word "elected." The word "appointed" in those sub-paragraphs means "elected." Therefore, of the executive council, 19 will be elected and five will be appointed in the true meaning of the word. Therefore, the argument propounded by the hon. Member for West Aberdeen falls to the ground. It is, as I said, a thoroughly pedantic argument, based upon a strained meaning of the word "appointed," and is thoroughly unsound.
§ 8.7 p.m.
§ Colonel Gomme-Duncan (Perth and Kinross, Perth)
I agree heartily with the provision of a comprehensive health scheme for Scotland, but I also agree with hon. and right hon. Gentlemen on this side of the House that the Bill is not the way to bring it into effect. I wish to emphasise most particularly, as did my right hon and learned Friend the Member for Hillhead (Mr. J. S. C. Reid) and other speakers, that the Bill gives the Secretary of State for Scotland quite remarkable powers. I am not being personal, but am referring to the holder of the office at any time. The Minister will have at his disposal powers, responsibilities, and patronage on a vast scale. The best proof of the powers which he has under the Bill is the fact that his title appears, as taking some form of power or responsibility, no fewer than 279 times in the Bill. That is a pretty fair show of the power which he is taking to himself. I maintain that to put such power into the hands of the Minister is a travesty of democratic government. Such action is becoming more and more frequent on the part of this Government, as Bill after Bill 1069 goes through the House. It is a process that must inevitably lead to totalitarianism, which is ultimately the end of all Socialist governments. Nobody can argue about that.
I would turn to Clause 22, which deals with dental priorities. I think that nursing and expectant mothers and young children should have priority of dental treatment. As a matter of principle, it is regrettable that this Bill does not deal with the adolescent, who is normally considered to be between 15 and 18 years of age, because I am informed on very re-liable authority, by dentists and others qualified to speak, that the biggest dental problems of today lie in that age group. If we must have this Bill, I cannot see why adolescents should not be included in this very important provision. I hope when the Joint Under-Secretary replies that he will have something to say about that point. I understand that in the case of the English Bill the Minister of Health said it could not be done because there was such a great shortage of qualified dental practitioners. I think it is a fact, although I am open to correction, that in Scotland we are very much better off in that respect, and I hope the Secretary of State will consider that point because it is very important. Although it may be said that under this Bill, children's teeth having been well treated earlier, the situation will improve, which is quite true, that state of affairs will not come about for a considerable number of years, and there is a vast task awaiting dental officers in connection with adolescents.
I would like to turn to Clause 37, which also deals with the question of dental services. It lays down that the area executive councils shall prepare lists of dental practitioners who shall undertake to provide general dental services. In view of the fact that Subsection (2), paragraph (c) says that regulations shall include provision.for conferring a right on any person to choose in accordance with the prescribed procedure the dental practitioner from whom he is to receive general dental services",I do not see why in a country like Scotland there should be lists of dental practitioners confined to the areas covered by these executive councils. Why should not there be one for the whole of Scotland? Why should a man living in Perth, for instance, who, perhaps, may have always been to a Glasgow dentist for 1070 treatment all his life, not continue to do so merely because it is said that that area does not come under the same executive council as Perth? If we are going to have dentists who are prepared to serve in this capacity, the patient concerned should have a choice of where he goes, anywhere in Scotland, and I cannot see that it would interfere with the Bill if he did. It is merely another niggling attack on the liberty of the subject.
I wish to turn to Clause 41, which deals with the tribunal set up to deal with complaints against doctors or dentists. This is a most glaring example of the immense powers of the Secretary of State. He appoints the chairman and members, admittedly after consultation with certain bodies, but from past experience we also know what little notice is taken, in practice, of advisory bodies by Ministers. I think it is a very great danger that the Secretary of State should appoint not only the chairman but also the members of this tribunal. Supposing I, as a medical officer, have appeared before this tribunal and I consider that I have been wronged by the tribunal, I am allowed to appeal. But to whom may I appeal? To the Secretary of State. I can never get away from him. There is no hope of getting beyond the Secretary of State. It is a fundamental right of every citizen of Scotland that he shall ultimately have the right of appeal to a really independent body which is a court of law. But under this Bill a medical officer can never get beyond the Secretary of State who will be judge, jury, prosecuting and defending counsel and everything else rolled into one. I cannot see why we should be denied what is our fundamental right in our country.
There is one other objection to this tribunal. That is that the members have what is tantamount to the power to strike from the roll of his profession a doctor or a dentist. That is a very great power, and I maintain that such a tribunal needs strengthening very considerably on the professional side, because only men of the same profession can decide whether a member of that profession has been guilty of undesirable conduct or inefficiency from the professional point of view. For one man—say, a dentist—to sit with other people who are not dentists in trial on a defaulting dentist is far too great a responsibility for that one professional 1071 man, and I think that such a tribunal should be very much strengthened.
I would now like to turn to Clause 67, and to the Tenth Schedule which is related to it, on the question of inquiries. I understand there is no equivalent Schedule in the English Act in the matter of inquiries. I hope the right hon. Gentleman or the Joint Under-Secretary will tell us a bit more about these inquiries; what is their object, and why they are necessary in Scotland and not in England. We have no indication of the powers of these inquiries; we have no indication what action may be taken following their deliberations; and there is nothing to show that there is any appeal against the decision of the inquiries. I would like to know—I am assured by people for whose opinion I have the greatest respect that I am wrong in this, but I would like it cut and dried in the House—whether it is possible for one man to come up before the tribunal already mentioned, and also before an inquiry for possibly the same offence. As I say, I am assured that that is not the case. But frankly, I do not like the look of it, and I hope that the Secretary of State will assure the House and the country that the situation of one man coming up before two bodies and being tried for one offence cannot possibly happen under this Bill, and that it will be put in the Bill in writing. If that were done I should feel much happier.
§ 8.17 p.m.
§ Mr. Malcolm MacMillan (Western Isles)
The one main thing which several hon. Members on both sides have said is that it is desirable to have a comprehensive health service, that it is the thing which has been lacking. It did rather astonish me that, with his reputation on the "Brains Trust" and in past Debates in the House, that the right hon. and gallant Gentleman the Member for the Scottish Universities (Lieut.-Colonel Elliot) did not appear to put forward any suggestion of his own, except a reversion to the admittedly unworthy past, or a maintenance of the status quo in place of what is proposed in this Bill. I thought that at times he became almost frivolous, in the funny philosophical way which they have at times on the "Brains Trust." He certainly did not measure up in any constructive way, in our view, to the requirements of a serious Debate of 1072 this kind, on a matter of fundamental importance to all the people of Scotland. The hon. and gallant Member for Perth (Colonel Gomme-Duncan) did us the honour of joining in this desire to establish a comprehensive national health service. But he did not tell us a different or better way of doing it, than by the method suggested in this Bill. He differed on details, which I think would be much more appropriately dealt with during the Committee stage of the Bill. He did not appear—because he concentrated on those details—to differ with us at all on principle, except on a few exceptional points.
§ Colonel Gomme-Duncan
I very much regret that I must differ with the hon. Gentleman. I mentioned matters of very great principle, such as the right of appeal, and various things of that kind. If the hon. Gentleman will go into it more carefully, he will find there are many matters of principle and not of detail.
§ Mr. MacMillan
On the matter of legal principle, I quite agree that point he made in the case of appeal is important. I am talking of the general principles of establishing and administering a national health service, which is a different and wider matter altogether.
The Highlands and Islands Medical Service has been drawn in by both sides of the House. It was generally approved by hon. Members on the other side who thought that nothing in this Bill should cause it to be altered in any way, and nothing else should be substituted for it in any service on a national scale. Hon. Members on this side have expressed pride, and I think justifiable pride in it. But we do know this—and, nobody is more conscious of it than the people in the Highlands and Islands, and the doctors there—that that service, good as it is does not measure up to the requirements of today. There is no possible gainsaying that. At least two years have passed since I had discussions with the representatives of all the doctors of the Western Isles, who were unanimously in support of the principles of a Bill improving and extending these services; and the principle of a national health service; and they were most anxious that the State should be in control of it, and not the local authorities, or some mixed dual control. They were completely relieved to know at that time that it was projected that, instead of dual 1073 or county council control, there would be direct control by the Secretary of State and the Department of Health. I cannot say how relieved they were. They knew that there would have to be administrative freedom, and through the use of that freedom there would be established throughout Scotland a vastly improved medical service including an improved Highlands and Islands Medical Service. I should like to pay this tribute to the men and women who run this magnificent service, for they have done magnificent work, and the men and women of the Highlands and Islands have great faith in their work, and have had great benefit from it. The extension and improvement of that service is one of the things that is most necessary if the health of the people of Scotland is to be maintained and built up, as hon. Members on all sides want it to be.
Those who have criticised this Bill have suggested nothing better to put in its place. I take it that the right hon. and gallant Member for the Scottish Universities who is an ex-medical practitioner of some distinction, was put up as the main spokesman against the Bill today. I must honestly say that he failed in his criticisms of the Bill, and he had nothing at all constructive in his criticism to suggest as an alternative scheme. I compliment the Secretary of State for Scotland and those who drafted this Bill, and those who have taken part in drafting it behind the scenes, on producing as nearly a perfect an instrument of legislation for the end in view as possible. I do compliment them for having brought forward a Measure which will give great satisfaction to the doctors and nurses and the people of the Highlands and Islands, which will improve the conditions of those in the service and enable them to give greater service in better conditions, improving as time goes on.
There was one principle laid down—an astonishing one—by the right hon. and gallant Member for the Scottish Universities, when he tried to flay verbally the Secretary of State for Scotland because he had not bound himself for all time, and bound Parliament with him, to the findings and report of the Hetherington Committee. It is a thing which Parliament has always defended itself against, being bound by a previous Parliament, or, at all events, by any report of an outside body. I resented, and I am sure 1074 the House as a whole resented, the implications of this attack upon the right hon. Gentleman the Secretary of State. After all, there was another great event that took place, a much greater one than this report by that committee, however important it may have been. There has been the General Election since then. The right hon. and gallant Member for the Scottish Universities did not happen to come in on the small flood of Opposition at that time. He has had the consolation of coming back here since. He should realise that we have a mandate from the people of Scotland and of this country to carry through this service. It is part of the programme we laid before the people of this country.
If I may refer to the result of the by-election in the Scottish Universities as being of some consolation to hon. Members opposite, the result at the Kilmarnock by-election is a really good stiffener to the Scottish Opposition by the people of this country. It ill becomes the right hon. Gentleman and his friends to criticise us on the grounds on which he criticised the right hon. Gentleman the Secretary of State. After all, the right hon. and gallant Member for the Scottish Universities advocated things himself in his day. and so did the leader of his party, which they have never implemented. The right hon. Member for Woodford (Mr. Churchill) advocated nationalisation of many things in his Liberal day. He advocated destruction of the Tory Party, and never carried any of his promises out.
§ Mr. MacMillan
He did his best, but he did not quite succeed. He is still trying.
Since the Highlands and Islands service has been brought so much into the picture tonight, I want to say that that service is indeed as gallant a venture as has been described on all sides of the House. It is a picture of men and women doing their best against difficulties of transport and climate, inadequate buildings, lack of accommodation and specialist services and the rest, but still doing their best. It is also a picture of men and women doing their best while waiting hopefully, expectantly, that this new service will give them an incentive to do greater work still. They are not 1075 concerned primarily with profit, as are so many of the vested interests which are against this Bill—the newspaper advertisers, and. therefore, some of the newspapers themselves, the usurers—the sellers and buyers of practices—all the people who sell patent medicines, and all the other racketeers in the background of this opposition. It is not genuine opposition at all, but is organised by them through the most powerful vested interest instrument, the British Press, which they could possibly have for their destructive advocacy—an advocacy which admits nothing whatsoever except the status quo—which even hon. Members on the other side know must not be allowed to remain— in place of what we are trying to propose in this Bill.
Emphasis has been laid on this side of the House on the value of one provision in support of which I wish to join, and that is the provision for research in this Bill. I think everyone of us looks forward to the time when we shall be able to give our overworked medical men a little freedom from the drudgery of fee-grubbing, which occupies them in the present free enterprise competitive system which is advocated on the benches opposite, to the time when they can have a little real freedom, if they have a capacity or a special bent for research, to go ahead with it, to the time when we shall finance them so that in their work will not be continually worried with sending out students to collect pennies in tin cans every year as they have to do from the universities which the right hon. Gentleman represents. We look forward to the time when we shall see the State backing to the full a real attempt at fundamental research into the causes and prevention of those terrible afflictions, tuberculosis, cancer, the diseases of the miner, and the other industrial diseases which cause suffering—much of it unnecessarily, I believe—to hundreds of thousands of the people of this country. We on this side welcome this Bill, and we welcome it sincerely, not simply on the principle of counting heads behind the Government to which we alleged always to say "Yes"—though not in every case. We genuinely welcome it on behalf of our constituents, who are, after all, the consumers of the services we are trying to improve against the opposition of thoughtlessness and selfishness.
§ 8.28 p.m.
§ Lieut.-Colonel Sir Thomas Moore (Ayr Burghs)
I will not comment on either the last speech or a number of its predecessors, although there is ample scope for comment; the time is limited, and I would therefore concentrate on the Secretary of State and his proposals in this Bill. As the House probably knows, I had the temerity recently to criticise the Secretary of State and his colleagues in office for their inability, or fear, to stand up sufficiently for Scotland, and I pointed out that they were rather apt to be dominated by a ruthless and unsympathetic English Chancellor of the Exchequer—even thwarted at times—in what otherwise might have come out of their friendly and good hearts. My criticism has apparently borne some fruit.
§ Sir T. Moore
At any rate, we have got our own Health Service Bill, and not merely an uninspired paragraph or Clause in the English Act, saying that the Act applied to Scotland. Unhappily, however, my main criticism still holds good. I am sorry to have to say so, because the Bill that we are discussing—and I hereby disagree with my right hon. and learned Friend the Member for Hillhead (Mr. J. S. C. Reid)—follows much too slavishly the many objectional characteristics of the English Act. I want to make it clear that I think it is high time that Scotland had this comprehensive National Health Service, but at the same time, as our newly elected Member for the Scottish Universities (Lieut.-Colonel Elliot) pointed out, the Hetherington Report made it perfectly clear how this health service could be brought about without resorting to what I have stated to be the objectionable characteristics of the English Act.
The hon. Lady the Member for North Lanark (Miss Herbison) mentioned that many young doctors would welcome this Bill, and I suppose that was also in the mind of the Secretary of State. But, is it wise to offer nothing but security to our young men coming into this wonderful profession, turning them into civil servants who are only eager and anxious for security, instead of offering them the great challenge of an adventurous career? I do not think that we shall get the best health service in that way. I believe that the Government are clamping down the lifeless hand of bureaucracy on what might 1077 be and should be our greatest healing agency—
§ Sir T. Moore
I am not going to give way, because I promised to finish my speech within a certain time. In any case, as the hon. Member knows, it might not be worth my time to deal with his query although I have no doubt it would be interesting to himself. I should like to refer to an extraordinary statement made in the Financial Memorandum. It says:The service will be free for all who care to use it.That is a lot of misleading nonsense. Of course the service is not free; it is paid for by those who use it, and by those who do not use it. We have to recognise that the taxpayer is still the milch cow for every Socialist experiment. With all that shrewd honest sense and genial bonhomie of the right hon. Gentleman, it is not yet realised by him that the Scots are a race of individualists, and that is demonstrated throughout the Bill to all who read it.
§ Sir T. Moore
I am not going to be led away. I do not apologise for the Irish blood in me, nor take credit for my Scottish blood. I thank God that it is half-and-half, and that I am more than qualified, therefore, to speak in a British House of Commons. With all good will, I would point out to the right hon. Gentleman that the Scots have taught the English practically all the sciences, education and medicine they know. If that is so, it is obvious that Scotland will not sit down and have English methods of administering these great arts foisted upon them, for the Scots have always been creative and not imitative. I realise the position in regard to this Bill and its withdrawal last Session, but I want to register in the mind of the right hon. Gentleman that he must be prepared to accept a vast number of Amendments before Scotland will accept the Measure.
In deference to your wishes, Mr. Deputy-Speaker, I pass very rapidly over the many convincing attacks I would have otherwise made against this Bill. However, I must refer to that time-honoured, —no, not time-honoured but moth-eaten— statement by the hon. Member for the Western Isles (Mr. M. MacMillan) about 1078 their mandate—it is becoming so boring, and it is also so untrue. I once again state the facts. The party opposite got a 48 per cent. party vote out of a 76 per cent. national poll, or slightly under 40 per cent. of the total electorate. Therefore, they have a mandate for nothing, except to guide this country as smoothly as possible from a war-time economy to a peace-time prosperity. Until hon. Members opposite begin to remember that, and realise their responsibility to the people as a whole, and not to one section, they will not get the popularity to carry them through another General Election. In any case, they certainly have not a mandate to interfere with the fundamental characteristics and attributes of the Scottish people. This Bill, however, is different from most other nationalising Bills that we have been up against, in that it deals with the affairs of life and death. The life of even one Scot is much more important to Scotland —and to England, as we know—that all the theoretical dogmas of an uninspired Socialist philosophy. So, we are determined, during the whole of the Committee stage, to resist, so far as possible, this lifeless control by the State over the means and methods by which the life and health of Scotland are determined.
We do not believe that regional boards can adequately replace the intimate contact and personal association of the local management boards, which hitherto have so happily functioned. We do not agree that individual endowments should be handed over to an impersonal endowments commission, with little or no appreciation of local requirements. This Bill may make that legal, but it will not make it moral. It is just as if a will were declared invalid as soon as the corpse was safely tucked into the coffin. That is the attitude of the Secretary of State in regard to endowments. He may make it legal, but he will never make it moral in the eyes of the Scottish people. Now I come to the Scottish doctor, known in the city slum, and in the Highland croft, as always the friend and kindly adviser. He is always welcome; he is always reliable. I ask the House and the Government whether the State servant can be acceptable as that man's successor, as successor to the man who is willing to turn out at any hour of the day or night, and go over rough country to serve his patient? Can the State servant take his place? Will 1079 the State servant carry out the intimate and never-ending services so closely associated in the minds of every Scottish person with their local doctor? Answering my own question, I would say that the medical profession as a whole must be free. The doctor must be free to serve his own patients in the district of his choice. The doctor and patient may have to subscribe to, and comply with, certain unwanted State regulations, but this fundamental freedom must remain.
I do agree that it is advisable, despite the wastage of doctors in administrative posts, to associate doctors as much as possible with local affairs, with which their work is so closely allied and interlocked. Under the Bill, there are created 10 different commissions, councils and committees. We remember the late Mr. Ramsay MacDonald's Government, with all their Royal Commissions, which cluttered up the whole process of Government. Do not let us clutter up this Bill with more committees or commissions than are absolutely necessary. Most of my speech has been directed towards the Secretary of State, because I believe that he is capable of absorbing good ideas. Whether he is capable of carrying them out is a different matter. But let him be prepared, in a friendly frame of mind, to accept the many Amendments that will have to be proposed during the Commitee stage, for he must remember that the Scots may be led but certainly will never be driven.
§ 8.40 p.m.
§ Mr. Rankin (Glasgow, Tradeston)
I think that the issue which faces us tonight has been somewhat overclouded by the diversity of speeches that have been made. To me it is a fairly clear-cut issue as to whether or not this Government is to allow a system of laissez faire in the practice and organisation of medicine in this country to continue, or whether it is to introduce into that practice and organisation a planned system. Members on the opposite side, both above and below the Gangway, have sought tonight to evade that issue. The right hon. and learned Member for Hillhead (Mr. J. S. C. Reid) faced it in a half-hearted way by suggesting a "greater expansion." That was from the Tory Opposition. Below the Gangway, confronted with the same problem, the hon. Member for Dumfries (Mr. Macpherson), from the National 1080 Liberal point of view, suggested "voluntary cooperation." Neither of them rejected the idea of a comprehensive medical scheme, but both of them—and I presume that they represent their parties —rejected the idea of a definitely planned system of medical practice. They took whatever sort of funk-hole they could find in order to dodge the issue.
Some rather lurid pictures were painted, especially by the hon. Member for Dumfries, who suggested that when a person was ill, rather than go to a great public clinic for treatment, he would "prefer to creep into a corner." I think those were his exact words. That is exactly how my dog behaves when he becomes ill—he wants to creep away into a corner. That, I submit, shows exactly the type of mind that has been shown in the past with regard to other problems which we have had to face up to. It is sought to treat a human being as if he is a type of dog who, when he becomes ill, creeps away into a corner.
I suggest what will actually happen is that an individual when he reaches that stage in health, will not be allowed to be without a doctor, as he often is now. Under the system we propose to introduce, instead of having to creep into a corner, he will take to his bed, and a doctor will be brought to see him. The hon. Member for Dumfries suggested that we should have a terrible inquisition— medical certificates and so on. I wonder if he realises that that sort of thing is going on now very circumspectly. It goes on every day in our schools and all the records are kept circumspectly. There is no divulging by private doctors of the troubles of individuals. For six years, millions of young men and women were subjected to medical inspection, their records documented and carefully kept and there was no revelation. I believe that now, in the interests of the working population, it is going on in industrial establishments on Clydeside under the impulse of a public authority and not private enterprise. I refer to diagnosis by radiography. We were told of the dangers of uniformity creeping into our services. That took my mind back to those age-old arguments that any attempt to get the State to raise the level of human well-being was bound to lead to uniformity, and, therefore, was a setback.
I remember when the Carnegie grants were first introduced into Scottish educational 1081 life the boys and girls of the working classes, who were receiving a chance free which they never had before, were looked down upon when they accepted these grants, and those of them who went to universities were sneered at as "Carnegie students." Today, it is a definite part of our educational life, and no one can deny that the action on the part of those trustees contributed directly to raising the artistic, scientific and medical education of Scotland. I remember, too, when the 1911 Act was brought in by Lloyd George, almost the same re-mark's were used against it, as are being used against this present Bill tonight. I am certain that those arguments are present in the minds of many doctors today. I can remember rather vaguely that at that time, nearly every doctor in the city of Glasgow lived in rooms above his consulting room. His residence was upstairs and his consulting rooms were downstairs. Perhaps he lived even downstairs and his consulting rooms were there also. The Joint Under-Secretary of State for Scotland perhaps can remember that 1911 Act a little vaguely like myself. [An HON. MEMBER: "What age were you?"] We were just boys. It made the medical profession free as it had never been free at any time in its history. In a little while every doctor in Glasgow areas like Gorbals, Crosshill, Tradeston and other industrial areas, had moved out into the suburbs, where they acquired a suburban home with a motor car and only their consulting rooms in Glasgow were retained.
§ Mr. Rankin
The medical profession have nothing to fear under this Bill. I should really like, Mr. Deputy-Speaker, to go on, but unfortunately coming on at this stage of the proceedings I have had to enter into a secret treaty. [HON. MEMBERS: "Shame."] If that is out of Order I beg to withdraw, substituting that I have made a voluntary conformity to a certain ritual and I must draw my remarks to a close. Before doing so, I should just like to say that I have gone to the trouble of making my own inquiries. I have not found one doctor opposed to the scheme unless the general practitioners, who more or less are a sort of reactionary lot, not as individuals but because they have an interest to preserve. Among young medical students coming out, among the young 1082 doctors and among specialists whom I have consulted, I have not found one to oppose this scheme. I should like to ask any Member of the Opposition to tell me why the British Medical Association is tonight refusing to publish the figures of the vote which it recently took with regard to the attitude of doctors to this scheme. I am told that the support given to it was so strong, that the B.M.A. received figures which they never anticipated, representing considerable and unexpected support for this Measure.
I must leave the other half of my speech for another occasion, but I am very sorry to do so because it strikes a slightly critical note. I hope that my right hon. Friend the Secretary of State, who looks round somewhat alarmed when he hears a critical note behind him, will forgive me. but I want to say that this Bill is striking in what it is going to do for the welfare of the people of our country. It is equally striking—in fact, this is its most striking feature—in that it separates the health services of the community into more or less watertight compartments where the question of coordination is left to cooperation between individual units. On that cooperation will depend the success or failure of this Bill.
§ Mr. Westwood indicated assent.
§ Mr. Rankin
I am glad that my right hon. Friend agrees with me on that, and it is just because I believe that, in spite of the opposition, there is sufficient intelligence in the medical community of this country to ensure that they will cooperate in making this Bill a success, that I welcome it and assure my right hon. Friend that it will have every support from this side of the House.
§ 8.52 p.m.
§ Mr. John Henderson (Glasgow, Cathcart)
I extend my sympathy to the hon. Gentleman the Member for Tradeston (Mr. Rankin) for having entered into a vow to finish speaking at a certain time. If he has only delivered half his speech, the vow I have entered into prevents me from delivering any speech at all. Only a matter of minutes has been allocated to me.
I think it was the hon. Member for the Western Isles (Mr. M. MacMillan) who showed some feeling with regard to the criticism which was made against the right hon. Gentleman the Secretary of 1083 State for Scotland. I do not in any way wish to associate myself with that kind of thing. I feel that when the Secretary of State for Scotland comes to bid farewell to his public life—whether it be compulsorily or voluntarily—if he should be allowed sufficient time to throw back his mind to the part he has played, both for his party and as Secretary of State for Scotland, he will derive a tremendous amount of satisfaction from having submitted this Bill for its Second Reading and from having, with overwhelming support from his party, placed it on the Statute Book. After all is said and done, there is nothing so intimate to any of us, apart from our political views or outlook, as health. If we have not good health we have nothing at all. I am sure that we are all deeply and sincerely anxious to play our part in promoting the health of the community at large.
The Secretary of State said that Scotland had its own traditions, and the only regret I have in connection with this Bill is that the policy is running right across some of the best of those traditions. Take, for instance, the question of voluntary hospitals. I have not time to develop my argument but I was for 15 years a member of the governing body of the Victoria Infirmary, Glasgow, and for 17 years a member of the health committee of the corporation of Glasgow. In my work as a manager of the Victoria Infirmary, one of the great voluntary hospitals in that city, I was perfectly amazed at the work which these voluntary institutions did.
Every Scottish Member knows something of our great infirmaries, whose staffs and boards of management are imbued with one aim only—to contribute towards bringing health to suffering humanity. There are the Samaritan hospitals, and the cancer hospitals: the people in the eye infirmaries manfully battling against the midnight darkness of blindness; the hospitals for sick children in which men and women strive to allay and check the crippling of little boys and girls. Think of what is to happen to all these on the appointed day. What is to happen to all those 220 voluntary hospitals to which the Secretary of State paid tribute? These men and women are to be displaced. They are going to be sacked overnight—men and women who have built up one of those traditions of which I am sure the Secretary of State is 1084 extremely proud—the great traditions of the Scottish health services.
I want to say a word about the choice of patients and the direction of doctors. There is a peculiar relationship between the patient and the doctor. I cannot define it. When illness occurs in the home the doctor takes over, like the captain of a great ship. The husband who would perhaps very seldom take good advice from his wife, will take it from the doctor. The doctor controls, because of the peculiar relationship that exists between patient and doctor. I ask the Joint Under-Secretary when he replies to clear up a doubt which exists in many of our minds, as to whether the patient still has the right to nominate his own family doctor. I ask him also to tell the House whether, when that doctor retires, the doctor who takes his place will be a directed doctor and whether the patient will have the opportunity of transferring from him to another doctor should he so desire. I believe the patient should have the right to choose his own doctor, and if that is not allowed in this Bill it is a violation of the principles of liberty and freedom which have been cherished by Scottish people in the past. At the same time I would express my appreciation for all the splendid work the Secretary of State for Scotland has done in producing this Bill.
§ 8 59 p.m.
§ Commander Galbraith (Glasgow, Pollok)
In view of the great deal of fog which has now come into this Chamber— [An HON. MEMBER: "A Tory Scotch mist."]—it is as well that the Debate is drawing to an end or presently we shall be unable to see one another across the Floor of the House. As is natural, there have been many references to the same arguments that were used when we debated the similar Measure for England and Wales. I am afraid it may be necessary for me to refer to some of these arguments again. It does not seem to me from the trend this Debate has taken that there has been any narrowing of the gulf that existed between the Government and the Opposition on matters of principle when we had that previous Debate. As a result of that, some hon. Members may consider that this Debate today has not served any very useful purpose. I myself would demur from any such opinion, because today we are debating legislation for 1085 the Scottish people. We have been reminded by the Secretary of State himself that the view and the outlook and the habits of our Scottish people are in many ways different from those of our English neighbours, and in a matter which concerns so very intimately every man, woman and child in the country, as does this legislation, I think it well that the views of the Scottish people should be made known in this House.
I have no doubt at all that everyone is in general agreement as to the need for a more comprehensive medical service, and I could not very well understand the querulous tone which crept into the voice of the hon. Member for the Western Isles (Mr. M. MacMillan). I do not know whether the fog has been affecting him, but I was extraordinarily surprised that he seemed altogether to have forgotten the White Paper of the Coalition Government. He seemed also to have forgotten—and likewise the hon. Member for Tradeston (Mr. Rankin)—that all the parties to the Coalition Government gave an undertaking that they would introduce this comprehensive scheme.
§ Commander Galbraith
But I had hoped that the hon. Member had probably read or heard of the Debate that then took place. In these circumstances of agreement as to the need of a comprehensive Measure, it is unfortunate indeed that the Government could not have introduced a Bill which would have met with far more general acceptance. And I believe it would have been possible for that to have been done but for one fact, that the Socialists always like to pursue their theories although they well know that these theories cannot help the individual's health or increase the efficiency of any of the services which this Bill sets up.
§ Mr. M. MacMillan
Would it be very inconvenient if I interrupted the hon. and gallant Gentleman? What I was pressing there was resistance to the idea that a Parliament of the future should be bound by a previous Parliament, or a committee appointed by that Parliament, or by any body of that kind. I think this House has always insisted that that is most undemocratic and unconstitutional.
§ Commander Galbraith
I can only reply to the hon. Gentleman that all the parties to the Coalition were bound to introduce a comprehensive medical service.
§ Commander Galbraith
If any proof is required as to the assertion I have just made, I think it may be found in the opposition which comes from the medical profession. They have been pressing for many long years now for a greatly extended medical service, and many of the constructive proposals contained in the Bill come from them. It has even been suggested in the course of this Debate that that opposition arises from selfish or unworthy motives, but I believe that any such opinion is a profound mistake, for I know of no other body of people who have served the community so selflessly as has the medical profession. I believe that their opposition arises from a feeling that the best has not been made of a great opportunity, and that while this Bill may give a service of wider scope, it will be far from producing the better service which the people desire, and that it will also be far from producing medical men of greater skill, of greater sympathy or of greater understanding and indeed, that its provisions may have the reverse effect.
Anyone who practises an art, and is to practise that art to the best advantage, must be free. After all, the practice of medicine is an art, and, therefore, it seems to me that the doctor must be free if he is to practise his art to the best advantage, to act in accordance with his conscience and in what he believes to be the best interests of his patient. His whole responsibility and loyalty should be to his patient and to his patient alone. In other words, he must be independent, and in that connection I regret very much indeed that under this Bill there is to be abolished the sale and the purchase of the goodwill of medical practices. Doctors are human beings; they have all the human instincts, and I believe one of these instincts is that when one has expended money on the purchase of anything, one endeavours to retain it and, if possible, to enhance its value.
If that is so, and so long as our people are free to go where they will for their medical advice, it seems to me that a doctor who has purchased his practice will desire to retain it, and he can only do so if he exercises his utmost skill and 1087 gives his most sympathetic care and consideration to his patients. If he does these things, he will gain and retain their confidence, and, once he has done that— he is in an impregnable position—he need fear no one whatsoever. That is something of very great value to the public, because they know that their doctor can fight their case against any authority, no matter how powerful, without any fear whatsoever of the consequences. As my right hon. and learned Friend the Member for Hillhead (Mr. J. S. C. Reid) said, this Bill goes a long way to destroy that independence. No longer is the doctor to be the servant of his patient; he becomes the servant of his local executive council, and that is something very different when the whole population is insured to being in contract with his insurance committee. The doctor no longer looks to his patient for his livelihood because, as the right hon. Gentleman told us earlier this afternoon, it is the Government's intention that he shall be remunerated partly by a fixed salary, and partly by capitation. No longer can a doctor of right serve where he will, perhaps in a part of the country where he knows the people and will give his best service. No longer can he serve in partnership with those with whom he would desire to serve and, with whom, in my opinion, he might again give his best service, for he may be prevented from doing so by the medical practices committee. And no matter whether he retains the confidence of his patient or not, his name can be struck off the list of his local executive council, and also off the list of all other executive councils, not because he has committed any breach of etiquette, not because he is not a good doctor, but merely because it is decided that his retention in the service might be prejudicial to the efficiency of the service.
§ Commander Galbraith
What an extraordinarily wide ground of charges that introduces. Surely it opens the door wide to the possibility of victimisation. Particularly so when his case will be heard by a tribunal of three persons, none of whom need have any judicial experience whatsoever, appointed by the Secretary of State, who is the sole court of appeal. I can see one of these rebels of whom the right hon. and gallant Gentleman the 1088 Member for the Scottish Universities (Lieut.-Colonel W. Elliot) told us, worrying and nagging his local executive council until they came to the conclusion that his retention is prejudicial to the efficiency of the service. I can see that tribunal supporting it. I can see a very harrassed and worried Secretary of State saying, "A plague on this man who is always worrying people. Let him go." I think it is shameful that any man should be denied the right of earning his livelihood in his chosen profession, under a procedure such as that.
Like my hon. and gallant Friend the Member for Perth (Colonel Gomme-Duncan), I cannot understand why, when the punishment is so great, he should be denied the right of appeal to the courts of justice. There at any rate, his case would be heard by men experienced in the sifting of evidence, men entirely independent, men against whom a charge of partiality could not be brought. This Bill, as I have said, is undermining the independent status of the doctor. I believe that the provisions to that end, are really a step toward the fulfilment of the declared policy of the Socialist Party, which is to set up a rational, full-time, salaried and pensionable service. That is a policy from which, we were told by the Lord Privy Seal during a Debate on 2nd May, the party had no intention of retreating.
It may be useless for anyone standing at this Box to warn, or endeavour to warn, hon. Gentlemen opposite where the pursuit of that policy may lead the country, because many of them are blind to anything but their own doctrinaire ideas. But I believe that it is right that the remainder of the House and the nation should be warned. So I propose to quote to the House the words spoken in another place by Lord Moran on 22nd October last. The noble Lord, having said that he had been invited by the medical service of the Navy and the Royal Army Medical Corps to advise them on how to get keen men into those services, and keep them keen, used these words:The results of one's investigations came to this. It was impossible, with many brilliant exceptions, to keep the men as keen in a whole-time salaried service of that nature as in general practice, where the competition stimulant is present all the time.This Bill goes far to reduce the competition stimulant, and under the policy 1089 of the Socialist Party it would be removed altogether. In consequence of that, I say, let the country be warned that with the rejection of that stimulant they need not expect, in the future, the same good service they have had in the past. Further than that, let them be warned that this Bill goes far to destroy that intimate, sympathetic, personal relationship which has hitherto existed between a doctor and his patient, and which plays such a great part in the success of medical treatment.
My right hon. and learned Friend the Member for Hillhead dealt at some length with the treatment which had been meted out to the Scottish teaching hospitals. He pointed out that while the English teaching hospitals were to retain their individuality and independence, the Scottish teaching hospitals were to be reduced to the same level as all other hospitals, and placed under the control of the regional board. I think that is a great and profound mistake. I hope that when the Joint Under-Secretary replies, he may give us a fuller explanation of the reasons for the Government's decision in this connection than we received from the Secretary of State when he opened this Debate. This is a matter of the greatest importance, not only to Scotland but to the United Kingdom and to the Dominions, for the prestige of the Scottish doctor, as the result of his training, has, up to now, been such that there has been a world-wide demand for his services. Here I will use the figures which were used by the Secretary of State. In 1938–39, the last normal year, out of 13,000 medical students in the United Kingdom, 4,300 were in Scotland. That was, in part at least, due to the fact that the prestige of Scottish training in medicine stood so high. Why then interfere with the status of these great institutions, whose prestige is so high throughout the entire world? Before that is decided upon, I think we should have from the hon. Gentleman some definite proof that the change of status will be beneficial, and will give us more highly trained and skilled doctors.
There are two other matters in connection with the teaching hospitals to which I would refer very briefly. One of them has already been touched upon. I do not think that it is possible to get the best service unless we have something with which to compare that service. I am certain that, unless we have something 1090 with which to make a comparison, a service of this kind finally falls to a low and mediocre level. It may be that when the hon. Gentleman replies, he will say that this scheme allows for a great diversity through the regional boards and the boards of management, but I have spent long years in public service and I have always found that what eventually happens is that one gets down to an official pattern. Therefore, I suggest for that reason alone, so that a comparison may be available, the teaching hospitals should be retained in their present independent position.
There is another aspect. The teaching Hospitals have been the pioneers of medical research. However, it does not appear that they are to be allowed, in future, the same range or opportunities for conducting independent research. [AN HON. MEMBER: "Why not?"] If the hon. Gentleman will have the courtesy to wait while I develop my argument, he will find out. To a large extent, research depends on sufficient funds being available. That state of affairs has never existed in Scotland. It is proposed now that the endowments shall be reallocated, and in the White Paper we are told—I remind hon. Gentlemen of this and though my right hon. and learned Friend the Member for Hillhead has already used the words, I wish to repeat them—that it will be possible for the boards to which few or no endowments have initially been transferred to receive such resources later on. In other words, endowments are to be reduced and spread over the whole hospital system. I believe the teaching hospitals at present have the greater part of them. This, action is much more serious than appears at first sight. I would like to be corrected if I am wrong but if I understand correctly Clause 17 of the Bill, the Secretary of State has no power to make grants to the teaching hospitals. He has power to conduct research on his own account, and to make grants to persons and as a result of Clause 17 (2) it would not appear that he has power to make these grants to the regional boards or the boards of managements.
If that is so, then it would appear that research in the future will fall more or less under the control of the right hon. Gentleman and those whom he may choose. Research will only be undertaken into such matters as he may desire. I cannot see the Treasury allowing him to 1091 use public funds for independent research such as has hitherto been carried out. Surely the most curious of all the curious provisions in this Bill is that which is contained in Clause 8 (2) where it is laid down—
§ Mr. Scollan
I have been reading Clause 17 with regard to research and I think the hon. and gallant Gentleman has got it wrong. That Clause says:… the Secretary of State may conduct, or assist by grants or otherwise any person to conduct, research into any matters relating to the causation …Does not that give him power to leave it in the hands of the people at present engaged, and to give them financial aid?
§ Commander Galbraith
I have asked that question, in order that I may be given an explanation of the meaning of both Subsections of that Clause by the hon. Gentleman who is to reply. The hon. Member will no doubt notice, if he reads the following Subsection, that it specifically mentions the regional boards and the boards of management. It appears to me that that might well cut out the provisions of the first Subsection, but, in any case, I will wait for the hon. Gentleman to reply.
I was saying that one of the most curious provisions of this Bill is that contained in Clause 8 (2) where it is laid down that the Endowments Commission, composed of people of whom we have no knowledge whatever, are to frame and submit schemes to the Secretary of State for the transfer and for the application of the capital or income of such endowments. The following are the words which I would like the House to note:to such purposes as the Commission think fit.It seems to me that not only are we taking away research from those experts who have hitherto carried it out, but that we are passing it over to an unknown body to lay down the conditions under which the endowments are to be used. That is a matter of very great importance, and I submit that, unless we have some real assurance tonight, that this provision will be very drastically altered when we come to the Committee stage, this Bill should not be given a Second Reading.
Further, with regard to endowments— and I am again putting a question put by my right hon. and learned Friend—is it 1092 really anticipated that the endowments commission are going to take five or more years to get out their schemes because, if so, no hospital authority will know their financial position until the schemes have been finally worked out, and that will be highly detrimental to the whole hospital system. Is it really anticipated that the endowments commission will revoke or vary these schemes and introduce new ones from time to time? Because, if that is to happen, no regional board or board of management will know, when they undertake to make alterations or carry out some desired scheme, whether they will have the financial ability to carry it through. That policy will be very detrimental to the service.
When one reads this Bill for the first time, it appears to allow for a very large measure of independence, of initiative and of freedom to doctors, to patients and to the general public. But the more one looks into it, the more one sees that that is merely a facade, and truly, as hon. Members have said in the course of this Debate, at the end of everything, there is the Secretary of State controlling and directing, either through the provisions in the Bill itself or else through the orders and the regulations which he is authorised to issue. The Bill is a very wonderful example of bureaucracy at work. It is purely a bureaucratic scheme, and it leaves the machine entirely under official control. It may be tidy and it may be neat from the official point of view, but I do not believe that it takes human nature sufficiently into account, and it is with human nature that medicine has to deal. That is not only my own personal view; it is the view of my hon. and right hon. Friends. We are, accordingly, going to decline to give this Bill a Second Reading for the very good, detailed, and conclusive reasons that are stated in the Amendment which was so ably moved by my right hon. and learned Friend.
§ 9.25 p.m.
§ The Joint Under-Secretary of State for Scotland (Mr. Buchanan)
We have had, as I think will be agreed by hon. Members on all sides of the House, a very well conducted and thoughtful Debate. I think all hon. Members will join with me when I say that the contributions which have been made by hon. and right hon. Members who have taken part in the 1093 Debate have had both force and thought behind them, whether or not we agreed with them. I can hardly take exception to a single word that has been said, apart from a remark by the hon. Member for Dumfries (Mr. N. Macpherson), who mistook a sneering lemark for cleverness. If the hon. Member were present now, I would advise him, being a much older Parliamentarian than he is, not to indulge again in that personal form of criticism. It is something which anyone could use against him, at any time, if they so desired, with much greater force. It is something that does not make for the better conduct of our affairs.
§ Mr. Maclay (Montrose Burghs)
May I say, in defence of my colleague, that he made a remark in passing which was of a sort that could be taken in a dozen different ways? I think the Under-Secretary of State is taking it much too seriously.
§ Mr. Buchanan
I am stating my own view, and I thought that the remark was rather unbecoming. With regard to the Debate generally, what is the difference of opinion between us? On both sides of the House hon. Members are in favour of a comprehensive National Health Service. That was accepted by the right hon. and learned Member for Hillhead (Mr. J. S. C. Reid), who moved the Amendment for the rejection of the Bill, and it was accepted also by the hon. and gallant Member for Pollok (Commander Galbraith), who wound up the Debate for the Opposition. It is a view which most people accept. Therefore, the common ground is that all of us accept the need for something other than the present system. Whatever else is to go on, we start by agreeing that the one thing which cannot go on is the present system. The Debate, therefore, takes the form, not of arguing in defence of the present system, but of arguing about what is to take its place. I am certain that I do the right hon. and learned Member for North Croydon (Mr. Willink), who occupied the post of Minister of Health in a previous Government, no injustice when I say that he had plans for the reform of the present system. The argument is not an argument in favour of the present system, with the panel doctor, the voluntary hospital, the local authority hospital, and so on. That is the present system, and we are all agreed that we will 1094 end that system. That has been said by the party opposite.
The clash now is not between those who defend the existing system and those who want to change it, but arises over the form which the change should take. So far, I have heard no proposal from hon. Members opposite for any change; all they have said is that our proposals are wrong. Indeed, hon. Members opposite have contradicted themselves in that, after saying that they want a change and an alteration, they have proceeded to argue in defence of the present system. On the general issues that have been raised, the hon. and gallant Member for Pollok spoke about the rebel doctor and his dismissal. His view is not my view about rebels. If ever there was a rebel in this place it was me, and look where I have landed. The general feeling I have always had about rebels is that if a rebel is sagacious enough in his work far from his being punished, the plums of office are usually held out to him.
§ Major Lloyd
I interrupt the Minister because I wondered whether it had occurred to him that one of the reasons for his appointment might have been to keep him quiet in opposition.
§ Mr. Buchanan
The hon. and gallant Member, too, is a rebel. I would only say to him that I would urge him to be a little more sagacious in his rebellion. There is the position. I am not afraid of the rebel. The short answer on this question of dismissals in the present case is that it is not a dismissal on grounds of professional misconduct. It is the right of dismissal that everybody has over any employee. The voluntary hospitals have the right to dismiss any doctor.
Who are these voluntary boards? Let us examine this matter. We have had an argument about voluntary hospitals. It may be as well to look at the matter. What is the voluntary hospital? We are being charged here with creating a body which is less democratic than the present system. I doubt very much whether there is such a thing as a voluntary hospital. Most of these hospitals have received grants from the State. When the right hon. and learned Member for North Croydon was in office, engaged in making general improvements in the system, as I am sure he would have done, it is estimated that the grants in question would 1095 have gone up to nearly 70 per cent. Therefore, where is the voluntary principle?
Let me take this matter further. I know the hospitals of my city. I agree that the great hospitals of my city—the Royal, the Western and the Victoria-have great records, but let not any man say that even they are voluntary. Every man, in every shipyard and factory, has to suffer a deduction from his wages each week. A sum is deducted willy-nilly from him, and woe beside the man who should try to refuse to allow it to be deducted. In theory he may be able to say "No," but in actual practice not one man could do so. If trade were bad, and he dared to say "No," it would end his contract, not only between him and the firm but with the rest of the men. This idea of voluntary running of the hospitals is considerably far fetched.
§ Commander Galbraith
On this side of the House we are not concerned really with the voluntary side of the matter. We are concerned with the teaching hospital.
§ Mr. Buchanan
The hon. and gallant Member does not need to be frightened. I am coming to the teaching side of it, but at the moment I am dealing with the voluntary hospitals. They have ceased to be voluntary because of compulsory deductions and State grants. Who runs these hospitals? They are run by boards. There has been some criticism of the Secretary of State, but at least he is responsible to Parliament and he has to answer questions. Who compose the boards of voluntary hospitals? When I was a young man there were no workers' representatives upon most of the voluntary boards. I took part in an agitation in Glasgow in connection with one of the most afflicted sections of the community, the blind. In my native city, treatment of the blind was by voluntary institution, but we never had any representation on the board. The doctors connected with a voluntary institution could be dismissed by the board any day, any night without even an appeal to the Secretary of State for Scotland.
What does happen in fact? It happens in practice, and will happen, that the men who get elected to these boards will be decent, kindly men and, on the whole. 1096 capable men. They would never do that kind of thing, unless they had a sound case on which to answer if they were challenged. That is really the answer to the point about dismissals. It is not a defiance of the courts of law but an answer that, on these boards of public-spirited men people do their duty, and rarely cherish vindictiveness or wrongdoing in their relations with other human beings.
Let me now deal with the teaching hospitals. I am told, "You propose to place these great teaching hospitals under some form of State control." There are two or three answers to that suggestion; but first of all, it is as well to define what we mean by a teaching hospital. I am not a very orthodox Minister, and I hope my English colleagues in the Ministry of Health will not object if I say that I see in their Bill certain difficulties which we have sought to avoid, in that they have taken out teaching hospitals. The trouble starts when one tries to define a teaching hospital, and no one knows it better than the right hon. and learned Gentleman the Member for North Croydon. Let me take my own native city, for example, because the Royal and the Western hospitals have been quoted more than any others. Let me also refer to two other great hospitals, Stobhill and Mearnskirk hospital for tubercular treatment. I suggest there are none better in the length and breadth of the country, from the point of view of treating patients or teaching. Stobhill hospital, which has the very latest appliances, is linked- up with teaching and consulting specialists. Who is to say that even in the country hospitals, far from our cities, there is no capacity for teaching? But they are not only teaching hospitals; they are practising hospitals as well. We maintain that to leave out of this great new experiment 230 hospitals—almost half the total—would make a sham of the whole scheme.
In a State scheme or a local authority scheme, from every point of view it would be wrong to leave out the best hospitals. If we wish to make a success of the scheme we must not do what used to be done in the old days of the Poor Law, and leave out the best and only take on the worst. In enabling this scheme to succeed, the teaching hospitals are valuable not merely from the point of view of teaching, but from the point of view of raising the status of every other hospital concerned. We have not taken the teaching hospitals out. 1097 We have given them a status which, in most respects, will meet the requirements. From every angle the teaching hospitals will now play an active and capable part in the scheme.
I now come to other questions which have been raised in the course of the Debate, and I will deal, first of all, with the question of endowments. Hon. Members opposite have said that what we propose to do is a terrible thing. In fact, one hon. Member went so far as to put his hand on his heart and say that it was unethical and immoral. That leaves me cold. Most of these arguments leave me cold, because during my time in this House I have known Governments do much worse, without being charged with immorality or with acting against their Christian consciences.
What is the position about endowments? Endowments are left to hospitals of all kinds—teaching hospitals and others. What do we propose? In this Bill we say it may well be that some of the endowments may have ceased to have the same force and effect as the original donors wished, through passage of time, change of circumstances, and alterations in the treatment of disease. For instance, in our new set-up we may say to a hospital which now treats, say, partly cancer, or partly ear, nose and throat diseases, "There is another hospital charged with this work. We prefer, in the interests of everybody, instead of having this work spread over three or four different hospitals, to have it charged to one." The endowment may have been given to that hospital for that purpose. Surely, in that case, there is nothing wrong with an Endowment Commission, a neutral body? It is a body which will almost certainly—and this must bring joy to the heart of the right hon. and learned Gentleman the Member for Hill-head—include members of his profession, of at least equal status to himself.
I turn to the committees which the Secretary of State appoints. Here, however, we are talking of the medical profession, and its rights. Maybe I am touchy on these matters, but I do get rather annoyed with hon. Members in this connection. It may well be that the Secretary of State appoints them. But we have done nothing in this Bill to take away the responsibility of the Secretary of State to this House. I do not want to harp on the past too much, but I remember when we were dealing with the 1098 poor law people—the poorest people in this country, almost overnight we passed a Bill abolishing, or at least reducing, their rights—giving no poor person even the right of an appeal to the Secretary of State in many cases. At that time a commission was appointed, which was entirely out of the control of Parliament. For hon. Members to complain now about something, against which we have taken a great deal of care to safeguard, is, I think, stretching things too far.
Let me now deal with the case of the doctor. If ever there was a man who had a right to be neutral about the medical profession, it is myself. I have been looking around, and I think I have more connection with the medical profession than almost any hon. Member in this House. The other night I had six of my relations in the House, and I was the only one who had escaped being a medical man; they were all in it. I remember that my eldest nephew wanted to be a captain on board ship, but he looked around and said to me, in his broad Glasgow dialect, "Geordie"—because he is called after me—"no man ever made money by going to sea. My uncle Johnny is making money at medicine. Medicine for me"—and to medicine he went He went into regular medical practice with a State salary; he is doctor to the Clyde Trust. I say to hon. Members that the idea that a doctor will not perform his duty because he receives a salary is not becoming, or even fair, to the medical profession. Take the teacher. There is no more devoted public servant than the average school teacher, inside or outside his work. As to the doctor, give him a salary or give him a capitation fee, I say his love of his profession and his love of his work will not be dimmed because of either.
Let me turn now to the sale of practices. I want to be perfectly frank. I want to see the sale of practices abolished. What is this business of the sale of practices? Let me use another family illustration. I remember my young brother starting in practice in a working class district, putting up his plate on the door. He had a fearful struggle for years and years without any income. It was a life we should never ask a lad to go through. My niece was a doctor and married a doctor. Both wanted a practice. They bought a practice, yes; but they had no freedom of choice as to the place where 1099 the practice was. They had to buy a practice within the means at their disposal, and though they wanted to buy a practice in Scotland, and were natives of Scotland, the cheapest practice they could get, and what they thought was the best value, was situated in Hull. They settled in Hull, and every week they had the load round their necks of paying for the practice. It may not be flattering to my colleagues in the medical profession, but it is true that the sale of practices has not always redounded to the credit of the medical profession.
The right hon. and gallant Gentleman the Member for the Scottish Universities (Lieut.-Colonel Elliot) knows this. I almost called him the right hon. and gallant Gentleman the Member for Kelvin-grove. I must not say that I welcome him back, for had he fought for any constituency other than that of the Scottish Universities, I should have done my best to keep him from coming back. But if we must have a Tory from the Scottish Universities, he is as good a representative as I can get, and from that point of view I wish him well in the House; and I am sure that, from the personal point of view, I shall always be pleased both to listen to him and to learn from him. May I tell him what he probably knows; if he does not know it he probably knows there is something in it. One of the most disgraceful things I have known has been to see young doctors begging, getting up the money with which to buy practices; and then, when they have paid for them, very frequently they have found that they are not what they thought they were. After all; if a doctor buys a panel of 2,000 patients he does not know that all the 2,000 will remain to him. So I am glad to end the sale of practices. But I am glad to end it for another reason. I hope that young men entering the medical profession in the future will be entering on a great career in which they are as free as they can be to practice their calling, and will not be prohibited from being free by poverty or any other reason. On this question, the Government take the stand that a salary and a capitation fee is the best way of securing freedom for doctors, and allowing them to work at their calling in the best possible way.
The hon. Member for Bridgeton (Mr. Carmichael) criticised us for not giving as much power to local government as we 1100 ought. That is a valid criticism from some angles, but, on the other hand, we have to make an experiment. The medical profession had to be consulted in the matter. Nobody has asked more than he in his last speech that there should be some form of workers' control. The doctors are the workers here, and they must be given some rights. Therefore, the doctors were consulted, and on the whole they did not want the local authority setup. We took this as the best means we could devise of working a national scheme.
In reply to my hon. Friend the Member for Dunfermline Burghs (Mr. Watson), so far as the working of the Bill is concerned, it is our duty and our right to try to bring the local authorities into cooperation with us on every possible occasion, and so far as we can we will harness them to the work. The hon. and gallant Member for Perth (Colonel Gomme-Duncan) raised a question about dentists. I do not mean to be flippant towards him, but I think he has read the wrong part of the Bill. I think he has read the first Bill; there were two Bills, the one we produced before and this one Which we have re-introduced, and in this one we have altered only two words of the original language about dentists. It was put to us that dentists were rather unlike doctors in that their patients often came from some distance away. They might come from Auchterarder to Perth, or from say Greenock to Glasgow, and that meant that the dentists ought to be on the list of every committee. We have so altered the words in the Bill that one entry by a dentist will cover all local committees, so that people will have the choice of going from one place to another for a dentist.
It has been said by hon. Gentlemen opposite that this is a doctrinaire business. I say it is not doctrinaire. There are certain questions to which my hon. Friends on this side are devoted. One of them is education, and I would point out that it has not always been the practice of medicine that has attracted the Scottish doctors to the profession, but the opportunity the profession offered of a university education. How well I remember the scrounging and scraping that used to take place; people used to walk round Jamaica Bridge to save the penny for the ferry towards getting to Glasgow University. That was the spirit that was abroad; it was not merely the doctoring 1101 which attracted them, and in every field that spirit is still prevalent. I say it is not a doctrinaire matter at all. If we took away education, what would be the next subject in which our people are wholeheartedly interested? Public health—in the local councils, in their approved societies, in their trade unions, it is public health. They feel that the State in some form or another should play a more active part, both financially and in the coordination of the services, to see that everything is flowing freely and openly.
We have fought a great struggle in Scotland to get our universities free, and in the main we have won it. It is not wholly won, but partly won. We want, in the field of health, to make free every available resource to the humblest sections of the community. On this side, it is not a question of doctrine, but a genuine feeling that the sick ought to be cared for as never before. No one can defend the present state of affairs, in which a man who is unemployed cannot get spectacles or teeth in order to work. It is entirely wrong. The Secretary of State for Scotland has applied his mind to this Bill. He has met the doctors, and he has com-
§ promised. He has met the voluntary hospitals, the great teaching hospitals, the universities and the local authorities, and of course he has made adjustments. That is the way of British public progress. I have compromised, and in my public life I hope to continue to compromise. We have set out on a great adventure in Scotland, and I would sooner go out tonight on this great adventure and fail, than never have tried at all. In a great adventure, mistakes will be made, and in a year or two we shall find out things which are wrong. We have set out on one of the noblest of adventures, that of coordinating the health services and making them free to all, irrespective of wealth or position. Far from Members on the other side of the House dividing against this Measure, they might have reserved their points and challenged us in Committee, while giving a hand in this great adventure for Scotland.
§ Question put, "That the words proposed to be left out stand part of the Question."
§ The House divided: Ayes, 273; Noes, 123.1105
|Division No. 36.]||AYES||9.58 p.m.|
|Adams, Richard (Balham)||Champion, A. J.||Farthing, W. J.|
|Adams, W. T. (Hammersmith, South)||Clitherow, Dr. R.||Field, Captain W. J.|
|Allen, A. C. (Bosworth)||Cluse, W. S.||Fletcher, E. G. M. (Islington, E.)|
|Allen, Scholefield (Crewe)||Cobb, F. A.||Follick, M.|
|Anderson, F. (Whitehaven)||Cocks, F. S.||Foot, M. M.|
|Attewell, H. C.||Coldrick, W.||Forman, J. C.|
|Austin, H. L.||Collick, P.||Fraser, T. (Hamilton)|
|Awbery, S. S.||Collindridge, F.||Freeman, Peter (Newport)|
|Bacon Miss A||Collins, V. J.||Gaitskell, H. T. N.|
|Baird, J.||Colman, Miss G. M.||Gallacher, W.|
|Balfour, A.||Comyns, Dr. L.||Ganley, Mrs. C. S|
|Barstow, P. G.||Cooper, Wing-Comdr. G.||Gibson, C. W.|
|Battley, J. R.||Corbet, Mrs. F. K. (Camb'well, N.W.)||Gilzean, A.|
|Bechervaise, A. E.||Corlett, Dr. J.||Glanville, J. E. (Consett)|
|Belcher, J. W.||Cove, W. G.||Gooch, E. G.|
|Benson, G.||Daggar, G.||Greenwood, A. W. J. (Heywood)|
|Berry, H.||Daines, P.||Grenfell, D. R|
|Bing, G. H. C||Dalton, Rt. Hon. H.||Grey, C. F|
|Binns, J.||Davies, Edward (Burslem)||Grierson, E.|
|Blenkinsop, A.||Davies, Ernest (Enfield)||Griffiths, D. (Rother Valley)|
|Blyton, W. R.||Davies, Harold (Leek)||Griffiths, W. D. (Moss Side)|
|Boardman, H.||Davies, Hadyn (St. Pancras, S.W.)||Gunter, R. J|
|Bowden, Flg.-Offr. H. W.||Davies, S. O. (Merthyr)||Guy, W. H.|
|Bowen, R.||Deer, G||Haire, John E. (Wycombe)|
|Bowles, F. G. (Nuneaton)||Delargy, Captain H. J.||Hale, Leslie|
|Braddock, Mrs. E. M. (L'pl, Exch'ge)||Diamond, J.||Hall, W. G|
|Braddock, T. (Mitcham)||Dobbie, W.||Hamilton, Lieut.-Col. R|
|Brook, D. (Halifax)||Donovan, T.||Hardy, E. A.|
|Brooks, T. J. (Rothwell)||Driberg, T. E. N.||Harrison J.|
|Brown, George (Belper)||Dugdale, J. (W. Bromwich)||Hastings, Dr. Somerville|
|Brown, T. J (Ince)||Dumpleton, C. W.||Haworth, J.|
|Bruce, Maj. D. W. T.||Durbin, E. F. M.||Henderson, A. (Kingswinford)|
|Buchanan, G.||Ede, Rt. Hon. J. C.||Henderson, Joseph (Ardwick)|
|Burden, T. W||Edwards, Rt. Hon. Sir C. (Bedwellty)||Herbison, Miss M|
|Burke, W. A.||Edwards, N. (Caerphilly)||Hobson, C. R.|
|Butler, H. W. (Hackney, S.)||Edwards, W. J. (Whitechapel)||Holman, P.|
|Callaghan, James||Evans, E. (Lowestoft)||Holmes, H. E. (Hemsworth)|
|Carmichael, James||Evans, John (Ogmore)||House, G.|
|Castle, Mrs. B. A.||Evans, S. N. (Wednesbury)||Hoy, J.|
|Chamberlain, R. A||Ewart, R.||Hubbard, T.|
|Hudson, J. H. (Ealing, W.)||Mort, D. L.||Sparks, J. A.|
|Hughes, Hector (Aberdeen, N.)||Moyle, A.||Stamford, W.|
|Hutchinson, H. L. (Rusholme)||Murray, J. D.||Steele, T.|
|Hynd, H. (Hackney, C.)||Nally, W.||Stephen, C.|
|Irving, W. J.||Nichol, Mrs. M. E. (Bradford, N.)||Stewart, Capt. Michael (Fulham E.)|
|Jay, D. P. T.||Nicholls, H. R. (Stratford)||Stross, Dr. B.|
|Jeger, G. (Winchester)||Noel-Baker, Capt. F. E. (Brentford)||Symonds, A. L.|
|John, W.||Noel-Buxton, Lady||Taylor, H. B. (Mansfield)|
|Jones, D. T. (Hartlepools)||Oldfield, W. H.||Taylor, R. J. (Morpeth)|
|Jones, Elwyn (Plaistow)||Orbach, M.||Thomas, I. O (Wrekin)|
|Jones, J. H. (Bolton)||Paget, R. T.||Thomson, Rt. Hon. G. R. (Ed'b'gh, E.)|
|Jones, P. Asterley (Hilchin)||Paling, Rt. Hon. Wilfred (Wentworth)||Thorneycroft, Harry (Clayton)|
|Kenyon, C.||Palmer, A. M. F.||Tiffany, S.|
|King, E. M.||Pargiter, G. A.||Timmons, J.|
|Kinley, J.||Parker, J.||Titterington, M. F.|
|Lang, G.||Paton, Mrs. F. (Rushcliffe)||Tolley, L.|
|Layers, S.||Paton, J. (Norwich)||Tomlinson, Rt. Hon. G.|
|Leslie, J. R.||Pearson, A.||Turner-Samuels, M.|
|Levy, B. W.||Perrins, W.||Ungoed-Thomas, L.|
|Lewis, A. W. J. (Upton)||Piratin, P.||Usborne, Henry|
|Lewis, J. (Bolton)||Porter, E. (Warrington)||Vernon, Maj. W. F.|
|Lewis T. (Southampton)||Porter, G. (Leeds)||Viant, S. P.|
|Lindgren, G. S.||Proctor, W. T.||Walkden, E.|
|Lipson, D. L.||Pryde, D. J.||Walker, G H.|
|Lipton, Lt.-Col M.||Randall, H. E.||Watkins, T. E.|
|Logan, D. G.||Ranger, J.||Watson, W. M.|
|Longden, F.||Rankin, J.||Weitzman, D.|
|McAdam, W.||Rees-Williams, D. R.||Wells, W. T. (Walsall)|
|McAllister, G.||Reeves, J.||West, D. G.|
|McEntee, V. La T.||Reid, T. (Swindon)||Westwood, Rt. Hon. J.|
|McGhee, H G.||Rhodes, H.||White, C. F. (Derbyshire, W.)|
|Mackay, R. W. G. (Hull, N.W)||Ridealgh, Mrs. M.||White, H. (Derbyshire, N.E.)|
|McKinlay, A. S.||Robens, A.||Whileley, Rt. Hon. W.|
|McLeavy, F.||Rosters, G. H. R.||Wigg, Col. G. E.|
|MacMillan, M. K. (Western Isles)||Royle C.||Wilcock, Group-Capt C.A.B.|
|Macpherson, T. (Romford)||Sargood, R.||Wilkes, L.|
|Mallalieu, J. P. W.||Scollan T.||Wilkins, W. A.|
|Mann, Mrs. J.||Segal, Dr. S.||Willey, O. G. (Cleveland)|
|Manning, Mrs. L. (Epping)||Sharp, Granville||Williams, D. J (Neath)|
|Marshall, F. (Brightside)||Shurmer, P.||Williams, J. L. (Kelvingrove)|
|Mathers, G.||Silverman, J. (Erdington)||Willis, E.|
|Medland, H. M.||Silverman, S. S. (Nelson)||Wills, Mrs. E. A.|
|Mellish, R. J.||Simmons, C. J.||Wise, Major F. J.|
|Messer, F.||Skeffington-Lodge, T. C.||Woods, G. S.|
|Middleton, Mrs. L.||Skinnard, F. W.||Wyatt, W.|
|Mitchison, Maj. G. R.||Smith, C. (Colchester)||Yates, V. F.|
|Monslow, W.||Smith, H. N (Nottingham, S.)||Young, Sir R. (Newton)|
|Montague, F.||Smith, S. H. (Hull, S.W.)||Zilliacus, K.|
|Moody, A. S.||Snow, Capt. J. W.|
|Morgan, Dr. H. B.||Solley, L. J.||TELLERS FOR THE AYES:|
|Morris, P. (Swansea, W.)||Sorensen. R. W.||Mr. Hannan and|
|Morrison, Rt. Hon. H. (Lewisham E.)||Soskice, Maj. Sir F.||Mr. Popplewell.|
|Agnew, Cmdr. P. G.||Duthie, W. S.||Kerr, Sir J. Graham|
|Aitken, Hon. Max||Eccles, D. M.||Lennox-Boyd, A. T.|
|Amory, D. Heathcoat||Elliot, Rt. Hon W. E.||Lloyd, Maj. Guy (Renfrew E.)|
|Barlow, Sir J.||Fox, Sir G.||Lucas-Tooth, Sir H.|
|Beamish, Maj. T. V. H.||Fraser, Sir I. (Lonsdale)||MacAndrew, Col Sir C.|
|Bennett, Sir P.||Fyfe, Rt. Hon Sir D. P. M.||Macdonald, Sir P. (Is of Wight)|
|Boles, Lt.-Col. D C (Wells)||Gage, C.||Maclay, Hon J. S.|
|Bower, N.||Galbraith, Cmdr T. D.||Maclean, Brig F. H. R. (Lancaster)|
|Boyd-Carpenter, J. A.||Gates, Maj E. E.||Macmillan, Rt. Hon. Harold (Bromley)|
|Braithwaite, Lt.-Comdr. J. G.||Glossop, C. W H.||Macpherson, Maj N. (Dumfries)|
|Bromley-Davenport, Lt.-Col. W.||Gomme-Duncan Col. A. G.||Maitland, Comdr. J. W.|
|Buchan-Hepburn, P. G. T.||Grant, Lady||Manningham-Buller, R. E.|
|Butler, Rt. Hon. R. A. (S'ffr'n W'ld'n)||Gridley, Sir A.||Marlowe, A. A. H.|
|Challen, C.||Grimston, R. V.||Marples, A. E.|
|Clarke, Col R. S.||Hannon, Sir P. (Moseley)||Marshall, D. (Bodmin)|
|Clifton-Brown, Lt.-Col. G.||Harvey, Air-Comdre A. V.||Marshall, S. H. (Sutton)|
|Conant, Maj R. J. E.||Headlam, Lieut -Col. Rt. Hon Sir D.||Maude, J. C.|
|Cooper-Key, E. M.||Henderson, John (Cathcart)||Mellor, Sir J.|
|Corbett, Lieut.-Col U. (Ludlow)||Hinchingbrooke, Viscount||Molson, A. H. E.|
|Crookshank, Capt Rt. Hon. H. F. C.||Hollis, M. C.||Moore. Lt.-Col Sir T.|
|Crosthwaite Eyre, Col. O. E.||Hope, Lord J.||Morrison, Mai J. G. (Salisbury)|
|Crowder, Capt. John E.||Howard, Hon. A.||Morrison, Rt. Hon. W. S. (Cirencester)|
|Darling, Sir W. Y.||Hudson, Rt. Hon. R. S. (Southport)||Mott-Radclyffe, Maj. C. E.|
|Davidson, Viscountess||Hulbert, Wing-Cdr, N. J.||Neven-Spence, Sir B.|
|Digby, S. W.||Hurd, A.||Nield, B. (Chester)|
|Dodds-Parker. A. D.||Hutchison, Lt.-Cm. Clark (E'b'rgh W)||Noble, Comdr. A. H. P.|
|Dower, E. L G. (Caithness)||Hutchison, Col. J, R. (Glasgow, C.)||O'Neill, Rt. Hon Sir H.|
|Drewe, C.||Joynson-Hicks, Lt.-Cdr. Hon. L. W.||Orr-Ewing, I. L.|
|Dugdale, Maj. Sir T. (Richmond)||Keeling E. H.||Peto, Brig C. H M.|
|Pickthorn, K.||Spearman, A.C.M.||Wakefield, Sit W. W.|
|Poole, O. B. S. (Oswestry)||Spence, H. R.||Walker-Smith, D.|
|Prescott, Stanley||Stanley, Rt. Hon. O||Ward, Hon, G. R.|
|Price-White, Lt-Col. D.||Stoddart-Scott, Col. M.||Wheatley. Colonel M. J.|
|Prior-Palmer, Brig. O||Strauss, H. G. (English Universities)||White, J. B. (Canterbury)|
|Raikes, H. V.||Stuart, Rt. Hon J. (Moray)||Williams, C. (Torquay)|
|Rayner, Brig. R.||Taylor, C. S. (Eastbourne)||Williams, Gerald (Tonbridge)|
|Reid, Rt. Hon J. S. O. (Hillhead)||Teeling, William||Willink, Rt. Hon. H. U.|
|Renton, D.||Thomas, J. P. L. (Hereford)||Winterton, Rt. Hon Earl|
|Ross, Sir R.||Thornton-Kemsley, C. N.||York. C.|
|Sanderson, Sir. F.||Thorp, Lt.-Col. R. A. F.|
|Scott, Lord W.||Turton, R H.||TELLERS FOR THE NOES:|
|Snaddan, W. M.||Vane, W. M. F.||Sir Arthur Young and|
Bill committed to a Standing Committee.
§ Bill accordingly read a Second time.