§ 3.50 p.m.
§ Mr. House (St. Pancras, North)
I beg to move, in page 24, line 29, after "practitioners," to insert "or others."
There are two issues lying behind this Amendment. The first is that nature-cure practitioners who reach a required 1889 standard of training and qualification should be recognised under the Bill. Such practitioners comprise naturopaths, osteopaths, and others. The second is that patients should have the free and unfettered right to attend the practitioner of their own choice. The first request does not rest solely on the merits of nature-cure practitioners, but, conversely, on the point that medical practice, in so far as it is based upon the application of medicine, drugs and vaccines, is undesirable. The question of quackery usually arises on the nature-cure practitioner issue, but I suggest that no class is less deserving of the taunt of quackery than are nature cure practitioners. In fact, the charge of quackery might lie with more accuracy upon medical practice to the extent that it relies upon chemistry, medicines, drugs and vaccine.
During the Debate on the Second Reading, the hon. Member for Ripon (Mr. York) referred to rheumatism, and expressed anxiety as to whether the Bill would be able to deal effectively with that serious disease. He mentioned, in relation to its seriousness, that about one-seventh of the industrial incapacity of this country arises from rheumatism. I have been prone to rheumatism, and have had considerable experience of medical practice. I have also had experience of nature cure practice, From my own experience—and I am definitely not exaggerating-1 say I have had more benefit from three days' nature cure for rheumatism, than from 13 years' treatment by medical practice. I say that without exaggeration. I speak as I find. If a practitioner of any school sticks a pin into my body, I am the person who can say whether it hurts. I am the judge also of the effects of medical treatment on the one hand and of nature cure treatment of rheumatism on the other. Recently I was in close contact with a famous hospital in this country which specialises in the treatment of rheumatism. I do not think that they claim to compete with the efficacy of nature cure practice in the treatment of rheumatism. I saw one young fellow there. He is about 30 years of age. He had been in and out of that hospital under treatment for rheumatism for some 15 years. I am satisfied that he can derive no substantial benefit from the treatment he was receiving, and that if he attends 1890 until he is as old as Methuselah he will not recover from the disease of rheumatism. Nature cure practice is the effective answer to rheumatism.
Take the question of cancer. On a previous occasion and in connexion with another Bill, I referred to the case of a lady medical practitioner in the North of England. This lady doctor contracted cancer of the breast. She had been in medical practice for many years. She was in a position to get the very best medical advice this land can provide and she obtained it. She went to eight of the leading cancer specialists of Great Britain. The sum total of their advice was that she should undergo a major operation and also radium treatment and deep X-ray therapy. She decided to accept none of that advice. Instead, she went to a qualified nature cure practitioner. One year fallowing that advice by the medical specialist, she was examined by the head of the cancer research department of Scotland and he certified that there was absolutely no trace of malignancy, or, in other words, that she was completely cured. I hope the Minister will appreciate what that means——
§ 4.0 p.m.
§ Sir Ian Fraser (Lonsdale)
Can the hon. Gentleman tell us what the principle of nature cure is? How are these persons qualified?
§ Mr. House
I hope that I shall be permitted to develop my speech. I appreciate the importance of the aspect of qualification, and I hope to deal with it. I said that I am a layman. I have no knowledge of the science of nature cure, but I speak as a layman who has experienced treatment from it. I have experienced both medical treatment and nature cure treatment over many years. As I said, the person who has a pin stuck in him is the person who can decide whether it hurts.
One of the principles underlying this Amendment is full freedom of choice for the patient to attend whichever practitioner he desires. Take the case of that lady practitioner to whom I have referred. As against that of a working-class person she was comparatively well-to-do and could afford to go to the practitioner of her choice. It may have cost her 20 to 50 guineas, but whatever it was, it was worth while to her, because it probably 1891 meant the difference between life end death. Suppose it had been a poor person. It might have been one of the colliery friends of the Minister, destitute because of disease suffered over a period of years. Facing this issue of life and death, he would have to find 20, 30 or 40 guineas. Would he have freedom of choice? Obviously he would not have. Speaking from memory, I think I have seen a statement in writing by my right hon. Friend, to the effect that this Bill will not interfere with the freedom of nature cure practice. My right hon. Friend contends, quite honestly I know, that he has the patients, and particularly the poor patients, in mind, but when he stated that there would be freedom in the practice of nature cure, he must have had in mind either the practitioners themselves, who are comparatively well-to-do, or such patients who have sufficient wealth to pay for the services of a nature cure practitioner. This question of freedom of choice is vitally serious for the working class type of individual. The Bill calls upon that person to pay into the National Health scheme 4s. 11d. per week. That is a comparatively heavy contribution for a working class man, and notwithstanding that payment, if the individual is up against the issue of life or death, he may have to go without nature cure treatment if he has not the wherewithal to pay for it. Unfettered freedom of choice for the poor person can only mean that the services of a nature cure practitioner must be paid for from the National Health Service Fund.
I now want to deal with the matter of tuberculosis. Immediately before the war I associated with a worker in a heavy manual trade—constructional engineering —in Glasgow. He had a very fine physique. I lost touch with him during the war until I heard from him about nine months ago. I was astonished to learn that he had been a victim of tuberculosis for some four or five years. A couple of months ago I met him in Glasgow, and I was astonished to find him a wreck, compared with what he was before the war. He told me that he had gone through the whole gamut of medical practice in regard to tuberculosis. He had gone to his panel doctor, to a specialist, then to hospital and sanatorium, back to work, had a relapse, and had then gone to the tuberculosis clinic, and he was still going downhill. I 1892 know a great deal as a layman about this issue of medical practice and nature cure practice. I felt quite confident that the man had no hope under medical practice, but my conclusion was that he had plenty of scope and hope under nature cure practice. I arranged for him to be treated by a qualified naturopath. That was in April last. After about three weeks, he wrote me in the most glowing terms about the progress he was making, and on 10th June he told me that he was getting along very well indeed. I read the letter this morning and noted particularly one of his statements. He said:My cough has stopped although during my nature cure treatment I have stopped taking the cough cure and emulsion.I have here a letter dated 19th June from the qualified naturopath about this man who has been treated by the naturopath since April and who, as I say, had previously had five years of medical practice treatment. It says:The only symptom at present is a slight cough. Respiration, sleep, energy and appetite are all good. However, I think that the disease condition, although greatly slowed up, is still slightly active. I intend to continue the treatment for another month at least.The Minister and medical practitioners might reply that that case is an exception, but I can assure the House that I am not exaggerating when I say that a hundred thousand cures by naturopaths in cases which were given up by medical practitioners can be quoted. I agree that there are cases of failures by naturopaths which have been cured by doctors, but the number of cures by naturopaths in cases given up by the medical practitioners would exceed comparable cures by medical practitioners I am sure by one hundred to one.
It is amazing what support this principle of freedom of choice has throughout Great Britain. It is a very serious matter. The case I have mentioned was that of a poor working-class man who had been living for the last year or so on a destitution basis. He was faced with the issue of life or death. He is paying 4s. 11d. into the National Health Insurance Fund, and the Minister, as the Bill stands, will deny that man the nature cure treatment which would bring him health and vitality. I submit that the whole principle needs very serious consideration.
§ Mr. Wilkins (Bristol, South)
May I interrupt the hon. Member for a moment? 1893 Would he tell the House whether these nature cure practitioners would be prepared to offer service to the community on the same capitation basis as that which the medical profession will be offered under the State medical service? I understand that their terms are rather expensive.
§ Mr. House
I am obliged for the question. The answer is in the affirmative. These people will be only too pleased to help. When my hon. Friend says that he understands their services are expensive, I would point out that they are only expensive in this way: when they can offer life as against death, cheque books are open, but fees in general are quite reasonable. If to-morrow I have influenza, I can cure myself without spending a penny. When I say "cure myself" it reminds me of my right hon. Friend. The reason I went in for nature cure was because I used to lose a great deal of time from my work, which I loved, owing to influenza and minor ailments. If there was an epidemic of influenza, probably the doctor himself would not come along because he himself had influenza, I would ask what sort of a person was he, to treat me? The right hon. Gentleman also loves his work, but he lost a week or more in Committee on this Bill. I know how he loves his job because he was a trade union official. He loves it even more as Minister, particularly at this time of his life, yet in that Committee he lost a week or more. Furthermore, he lost a week at the National Conference of the Labour Party.
§ The Minister of Health (Mr. Aneurin Bevan)
Does my hon. Friend suggest that a naturopath is never ill at all?
§ Mr. House
I am saying this, based on 20 years' experience as a layman, that I have been in the same position time and time again, but I have not lost time from work. I have left home many a time with influenza symptoms but by the time I have got home at night I have forgotten all about them. That is the test to the layman. Under medical treatment, if I left my home with influenza, I knew from experience that I had better get home as quickly as possible, and get into bed. My right hon. Friend has the wrong notion about nature cure. He thinks it is a question of orange juice and the necessity for cleaning out the bowels.
§ 4.15 p.m.
§ Mr. House
I am not an expert on that, but had my right hon. Friend understood nature cure, he would not have lost that time. I have seen him since with his little tins and pills and pellets. [Laughter.] It is very serious, Mr. Speaker, though I know it causes laughter. It is very serious because his lack of knowledge of the nature cure means the death of many in this country, and needless suffering for millions. I think that my right hon. Friend ought to get some understanding of this question, because a terrible price is being paid in this country for lack of knowledge.
As to qualifications, there is difficulty among the nature cure practitioners with regard to this matter. There are certain schools which are organised and they recognise a high standard of qualification. They lay down for their members a minimum four years' training, and unless the standard of qualification laid down is reached, no student is admitted into the organisation. Generally, all over he country there is an endeavour on the part of these nature cure practitioners to get their standard of qualification on an acceptable basis. I agree readily that we cannot expect the Minister to dip into the national funds for practitioners whose qualifications cannot be proved. Tae practitioners know quite well that they must reach a reasonable standard of qualification, and they are giving that every consideration. I think that my right hon. Friend should be prepared to give them some help. He cannot afford to stand aside and say, "These people are not qualified and unless and until they can show a standard of qualification, I shall leave them alone," because, while he is adopting that attitude, there are many who are suffering illness needlessly.
Two last points. First, I saw a letter from an hon. Member opposite to one of his clients, wherein he stated that these nature cure practitioners should be recognised only provided they took a medical degree.
Mr. McKie (Galloway)
May I interrupt the hon. Gentleman? He said he had seen a letter from an hon. Member on this side of the House to one of his clients. Is he accusing an hon. Member on this side of being a nature cure practitioner?
§ Mr. House
I only referred to the letter to make a point, I will make my point clear in a moment. I hope the Minister will not adopt the attitude that these naturopaths can only be recognised provided they first take a medical degree because, in my opinion, that would be a cowardly running away from responsibility. The hon. Member who said that, meant this To start with, he did not know whether nature cure was good or bad. He did not go into that at all. What he said in effect to his constituent was, "Give me, a representative of the public, the refuge of a medical degree and, after achieving that degree, the nature cure practitioner can do what he likes." I say that is a cowardly and an evasive way of dealing with the issue. Is it right that nature cure practitioners, who are most definitely opposed to medicine and chemicals, drugs, pills and so forth, should be asked to take a medical degree? Certainly it is not fair and ought not to be expected of them. They are prepared to take a degree on their basis, the basis of nature cure practice. I submit that this is a very serious issue. I submit also that my right hon. Friend cannot discharge his responsibility and stand still, at least he ought to arrange for an inquiry into this subject.
When I ask for an inquiry, I do not mean a committee made up of medical practitioners, because that would be like asking a board of devoted fishermen to decide on the ethics of fishing; their decision would be hard lines on the poor fish. An inquiry can only be fair, provided it is carried through by a lay body. I think the Minister ought at least to agree to that Incidentally, there was an inquiry into osteopathy by this House some 11 years ago, but the inquiry board was composed to a large extent of medical representatives, so the board was unfair to start with. Furthermore, the osteopaths were not ready. They conducted their case, as far as many of their witnesses were concerned, foolishly, and it would not be right for the Minister to condemn an inquiry today because of something that happened in 1935.
§ Sir Ernest Graham-Little (London University)
The hon. Member seems to be unaware that there was a second osteopath inquiry in the House of Lords by a Select Committee. They had a very large number of sessions. The fact was that in the 1896 middle of that inquiry the osteopaths threw in their hand and said they were not going any further.
§ Mr. House
I think the hon. Member for London University (Sir E. Graham-Little) is referring to the inquiry I have in mind, that in 1935. Even if it were more recent that that, I would remind the Minister that only yesterday he was defending his Parliamentary Secretary on a statement the Parliamentary Secretary made a year ago. If the Parliamentary Secretary can make one statement a year ago and be defended by the Minister for making an opposite statement today, I think an inquiry on this subject should also be allowed. The position is so serious, that I hope the Minister will, at least, see that the door is kept open. At present it is slammed against the nature cure practitioner, and against free and unfettered freedom of choice. That is a very undesirable position and should have the careful consideration of the Minister.
§ Mr. Ewart (Sunderland)
I beg to second the Amendment.
I think I have very sound reasons to advance in its favour. The question of whether patients, after the Bill has become law, shall be subject only to medical treatment, or not, is a matter of serious concern to hundreds of thousands of people. There are fields of specialised treatment worthy of consideration, such as the field of physiotherapy and massage——
§ Mr. Ewart
It is very comforting to know that, apart from ordinary treatment, there is this treatment, which can be of great assistance to men and women, now brought into the, ambit of the Health Service. I welcome the Minister's intention to bring within the hospital services medical auxiliaries and physiotherapists. But he should give some serious regard 1897 to the extension of training of physiotherapists for the benefit of the whole community. There is a serious shortage of them. Workers, particularly in Cleveland, contribute to special funds to provide for such treatment. These people will be denied, after paying their contributions in those areas, the type of treatment they need.
§ Mr. Bevan indicated dissent.
§ Mr. Ewart
They will be denied the physiotherapists in the areas, and will not get the benefit of physiotherapists in the health service. I am informed that they have to go on paying outside the Bill and outside their normal contributions, unless the Minister can extend the service. He should do something very quickly to extend the training, so as to allow the vast number of people coming out of the Forces, the Royal Army Medical Corps and so on, who have had some kind of experience and training, to fit into a scheme of this kind. I am very glad to know that the Minister will agree to that.
There is, however, a field of healing outside the purely medical auxiliaries. It is that described by the mover of the Amendment, naturopathy, osteopathy, and the various kindred therapies associated with nature cure which do not come within the ambit of the Health Service. The patient is denied the opportunity of choosing the type of health treatment he or she desires. It is not a free Health Service to people who have to contribute through the National Exchequer, if in times of sickness they are denied benefit if they refuse to subscribe to orthodox medical treatment to which they have a conscientious objection. We have to have some regard to conscientious objection in this matter.
On the question of qualification, I do not think the medical profession would claim that they have the monopoly of medical brains and scientific practice. The Minister does not claim that, for in 1941 he said:I am bound to say that it does not seem to me that quacks cease to be quacks by reason of their being given a charter. The suggestion that because doctors have to pass examinations, quackery is eliminated from the medical profession, is a suggestion that is entirely opposed to our experience." Entirely opposed to our experience." He says that there are varying grades in the British Medical Board but the health 1898 services will vary and will be monopolised by the orthodox medical practitioners. People who object to submitting themselves to treatment will be denied their right of benefit under the Bill, and denied the right of benefit given them by the National Health Insurance Act, 1936. In that Act provision is made whereby people of the type I have tried to describe are provided for as follows:Regulations made for the purpose of medical benefit shall authorise the Insurance Committee by which medical benefit is administered to require any person whose income exceeds a limit to be fixed by the Committee, and to allow any persons, in lieu of receiving medical benefit under such arrangements as are hereinbefore mentioned to make their own arrangements for receiving medical treatment and attendance and in such cases the Committee shall, subject to the Regulations, out of the funds out of which the cost of medical benefit is payable, contribute towards the cost of medical treatment and attendance for those persons sums not exceeding in the aggregate the amounts which the Committee would otherwise have expended in providing medical benefit for them.In short, it means that insurance committees up and clown the country, if perfectly satisfied that people outside the realm of orthodox medicine treat individuals, their benefit is shared and such payments as it would cost the service shall be refunded to the practitioner or the healer who treats the patient. In the new Bill he is denied that right. Knowing the Minister's broad outlook on such questions, I hope he will look very closely at this matter and give the right of freedom of choice if possible in tae new Health Bill to enable people to have the type of treatment they desire. I am not going to argue that all people outside the medical profession are fully qualified people or, for one moment, that there are no quacks. But I do say there are a number of highly trained men and women, educated people, practising the art of healing who are having magnificent results and poor people are being denied the right to the type of treatment they can give, and the benefit which accrue from such treatment, because of the restrictions placed upon them by the law.
The Minister himself said, again in 1941:No reputable doctor will claim any high percentage of science for medicine; medicine is about 25 per cent. science and 75 per cent. art; and as long as there is a body of protected citizens who cannot claim any high 1899 degree of scientific accuracy for their practice, it is very dangerous to prevent anybody else from practising the same arts.It is perfectly true that under the new Bill the legal status or the non-legal status of people outside the profession will be maintained, but the status of people within the medical profession will be that laid down by the B.M.A. in the exercise of their monopolistic attitude in this matter. Their position will be considerably stronger. The choice that exists will mean the choice of a doctor, or of being given a doctor if one makes no choice. It means undergoing medical treatment, and it is for such treatment that cash benefits will be paid from the fund.
I wish to make this simple appeal: I wish to ask the Minister to consider this matter at a very high level. The qualifications of the people for whom we are pleading are worthy of examination and consideration. I know full well that we cannot argue today that they should be included in the Bill. The fact is that they must be recognised by charter, before they can be included. I know that to argue the case today would be to argue against a closed door. But if the Minister will stick to the argument he put in 1941, if he has the same outlook and the same point of view, I am convinced that he will shed himself of all prejudice, and have an inquiry made into the qualifications, claims and demands of this vast school of healing, which is supported by hundreds of thousands of people in this country. The Minister, to quote again from his words in 1941, referring to the healers who practise their art unrestricted until they meet the opposition of the medical school, probably in the law courts, when on hopeless cases they go down, then dealt specifically with herbalists, who will be penalised by the Bill. He said:…as long as a body of people is working on a vast deal of empirical research conducted by citizens who have no legal licence, and do not need one, it would be a very bad thing for the medical profession to prevent them going on with the investigations and explorations because a very great deal of what is today described as quackery becomes the accepted practice in medicine tomorrow, as is known by anyone who is familiar with the history of medicine."—[OFFICIAL REPORT, 8th July, 1941; Vol. 373, c. 92–94.]It is argued that this type of what might be called empirical or experimental healing is costly. It might be in some cases. 1900 Medical treatment can be costly. There are the same difficulties in orthodox treatment. There are the high charge and the low charge. There is also, free of charge, a service by osteopaths. I have here a little book about Salvation Army work ha Glasgow entitled "Underworld of a Great City" in which it is stated of their clinic:To this hall comes a visiting osteopath, who carries on what has been described as the only osteopath clinic in Scotland …he has dealt with some 500 cases in the course of a year, and a number of wonderful cures have been reported.Because this service is not given in the general medical service in this country, people who want the service, men, women and children, have to submit to free treatment, to treatment given free by public spirited people, and the benefits will warrant the continuance of this free clinic, which is now in its tenth year.
I put to the medical profession this point: that the people to whom I am referring are the people who get the rejects of the medical profession after all other types of treatment and all other schools of medicine have been tried. The cures are in proportion to the type of patient they have to treat. I am not suggesting that they arc phenomenal or wonderful, but having regard to the type of case that comes to them as a last resort, the number of cures is a substantial contribution to the furtherance of this great work. I, therefore, suggest that the Minister might keep in mind, the statements he made in 1941, when he was pleading the case I am pleading today from the same benches as those from which I am now speaking. I hope that he will consider favourably the argument I have advanced.
§ The Minister of Health (Mr. Aneurin Bevan)
I do not rise with any intention of discourtesy to other Members who have also risen, but in order to continue the practice which I have followed throughout the Report stage, namely, of replying immediately when an Amendment is before the House, in order to put Members in possession of the Government's point of view on the matter. I have been rather hardly treated by both my hon. Friends who have moved and seconded this Amendment. The mover of the Amendment threw all reticence to the winds and discussed my private affairs with a candour which I found rather embarrassing. Perhaps he could discover, 1901 in nature cure, some specific for public reticence. The seconder of the Amendment has quoted against me, queerly enough, a number of observations made in 1941, which I should have thought still stood. In 1941, I was defending the right of persons to conduct experimental investigation into all forms of therapy, without any interference from anybody. I still take up that position; I still think that the heterodoxy of yesterday becomes the orthodoxy of today, and that the medical profession today normally practises many forms of therapy which it yesterday rejected. There is nothing wrong with that. It is not being interfered with and we are not discussing it at the moment. We are discussing an entirely different matter. I can assure hon. Members in all parts of the House that I do not intend to commit the indiscretion of forming a judgment as to the relative merits of one form of therapy as against another. It is not my function, nor is it the function of the House at the present time. We are discussing an Amendment which would place on the executive council of each area, the obligation of providing whatever kind of medical attention any citizen might want. That is an impossible suggestion.
§ Mr. House
My right hon. Friend knows perfectly well that that is not behind the Amendment. I agree that the words of the Amendment are wide, but I explained in my speech the narrow limit of them. Obviously, my right hon. Friend should take the narrow limit, and it is for him to provide the proper wording.
§ Mr. Bevan
The House is legislating. An Amendment is before the House and if the language of that Amendment were included in the Bill, the consequences would be that anybody, any Tom, Dick or Harry, would be able to prey upon the credulity of any citizen, and could call upon the State to provide the money for that service.
§ Mr. Bevan
If the hon. Member will permit me, I will come to that statement in a moment or two. At the moment, I am dealing with what is actually before the House. I am pointing out what 1902 would be the result if this language were adopted. The position would be chaotic. Now, I come to the point of substance raised by hon. Members. It is that one should select, from a number of forms of therapy lying outside the medical Acts, some forms of treatment which we would be prepared to give. I challenge any hon. Member to say at once where the frontier should be fixed. It is necessary if we are to provide a free health service that we should be able to identify objectively the kind of service we will give. We must stop somewhere. I have met representatives of these various bodies. Many of them are persons of dedicated zeal who I am quite certain have done a great deal of good to very many people with whom they have come into contact, although the evil they have done is not on record. That is the whole difficulty. Unfortunately, the evil done by doctors is not on record either——
§ Vice-Admiral Taylor (Paddington, South)
Under this Bill, which involves compulsory contributions, will patients be compelled to obtain only tae attention of the qualified medical practitioner?
§ Mr. Bevan
Perhaps the hon. and gallant Member will permit me to finish my argument. I will deal with the point in the course of my remarks, but at fie moment I am dealing with an entirely different matter. It is necessary that tie House, if they are going to place upon the Minister the responsibility of providing a service, should accept the obligation of defining that service. So far Parliament have decided that the kind of service which the executive councils will organise shall be the medical services within the medical Acts. Once a doctor has a qualification which entitles him to to go on the medical register, no one interferes with the kind of treatment which he gives. In point of fact, some of the best and most experienced general practitioners conceive it to be their duty merely to remove obstructions for nature to do its own remedial work. They would be described by many people as nature-paths, but they are people who have passed the examinations and acquired the right to give whatever form of treatment they conceive to be necessary. If these persons, belonging to these various creeds or bodies, believe that they have got something which is beneficial to man 1903 kind, all they need do is to acquire the necessary qualifications. No one insists upon what they should do after they have acquired the qualifications. But I am bound to say, it seems to me to be an appalling situation that the State should be called upon to provide any form of treatment, which the hon. Member himself is unable to define because one of the characteristics of what we are being asked to define is that almost all the evidence is subjective, and based upon testimony. If it was capable of systematisation, codification or verification it would become an accepted form of medical therapy. That is the whole difficulty.
§ Mr. House rose——
§ Mr. Bevan
No, I cannot give way. I have almost finished. I did not interrupt the hon. Member. Without expressing any comment upon the methods of these different forms of therapy, I say that the House ought not to place upon the Minister the impossible task of deciding between the relative merits of the different forms of treatment I come now to the question put to me by the hon. and gallant Member for South Paddington (Vice-Admiral Taylor). Individual citizens will be perfectly free. They are not compelled to accept any form of treatment. If they wish to avail themselves of a form of treatment not provided in the National Health Service, they will have to pay for it.
§ Vice-Admiral Taylor
I thank the Minister very much for that answer. It has already been pointed out that poor people cannot afford to pay both compulsory contributions to the National Health Service, and also to someone else for treatment.
§ 4.45 p.m.
§ Mr. Bevan
Mention been made of the contributions. As a matter of fact, the vast proportion of the contribution is not for medical services at all. It is for pensions, invalidity allowances, and all kinds of things. Only a very small proportion of the contribution is for the public health services. Most of the service is free. The proportion is less than 8d. and I am convinced that as time goes on far less than 8d. of the 4s. 1d. will be taken. Therefore, that point falls. The issue before us is perfectly clear. It is 1904 that we must limit the obligation placed upon the Government to what is scientifically ascertainable. I am not suggesting for a moment that that means that medicine is 100 per cent. sound. We know it is not, but it is scientifically ascertainable. A person has passed a certain examination and is on the register. Therefore, those are the persons we must organise and put at the disposal of the community.
There is one further point with reference to what was said by my hon. Friend the Member for Sunderland (Mr. Ewart). It is perfectly true that under the National Health Insurance Acts there is some provision, very rarely exercised, for the subvention of a person who wishes to have some other form of medical treatment. That, as I say, is rarely exercised and difficult to administer. Indeed, if it were extended, it would be impossible to administer. I was rather astonished by the suggestion that physiotherapy and occupational therapy, and other forms of treatment of that sort, were unorthodox and frowned upon. On the contrary, one of the most——
§ Mr. Bevan
The answer is that they are being extended. Furthermore, these forms of treatment have been fostered by distinguished doctors. One of the most distinguished physicians of our day, Lord Horder, has been President of the Chartered Society of Physiotherapists. Another distinguished doctor, Sir Reginald Watson-Jones, carried out very important experiments in remedial exercises and physiotherapy in the Royal Air Force during the war. Those have been developed. The hon. Member is perfectly correct when he says we have not enough physiotherapists. I quite agree with him. We have not enough dentists or doctors either. It does not lie against the proposal that we are short of the personnel to carry out the treatment. I have taken powers in the Bill to provide for this matter, and I look forward to the training of additional physiotherapists. I trust it will not be necessary, because it seems to me the principles are perfectly clear, to carry this discussion very far. If we are extravagant with our time so early in the day, we shall have to be parsimonious with it later in the evening.
§ Vice-Admiral Taylor
I have great sympathy with this Amendment. This Health Service is a compulsory contributory service, which has been described as providing free medical attendance, and that means free medical attendance so far as the services of a fully qualified medical practitioner arc concerned. I have had a number of letters from people who have raised this matter with me, asking whether it would not be possible, under this Bill, to do something for those people who either do not believe in, or, at any rate, do not consult the ordinary medical practitioners, but who have received great benefits from treatment by other methods of healing. They are asking whether it would not he possible for them to be allowed the fees which they pay to those who treat them, so that they will not have to pay those fees, and, in addition, pay their contributions to the National Health Service.
There is no doubt that there are a great many people in this country who have gained an immense benefit from those who are not duly qualified medical practitioners. In saying that, I am not saying anything against the medical profession. The medical practitioner has one method of curing the ills from which we may be suffering. Other methods are employed by other people, who are not duly qualified in the same way as the qualified medical practitioner, in the sense that they have not gone through a seven years course, and are not recognised by the Government. The people who go to these healers, outside this Bill, will have to pay their fees in addition to their Health Service contributions. I think it is high time something was done so that other methods of curing the ills of the body should be recognised in this country. I know that there are great difficulties with regard to qualification. It is quite right that people should possess proper qualifications when they set themselves up to cure the ills of the body. In other countries, there are certain qualifications, and some of these people go through a very extended course, while, in other cases, they do not. But these qualifications are not recognised in this country, and I very much regret the fact that osteopaths, bone setters and people like them are not recognised in this country. I know, from personal experience, and from the fact that members of my family and my friends have received the utmost benefit from what is 1906 described as unorthodox treatment, that they do a great deal of good. They have no position in this country, however, and are riot recognised by the State and do not come under this National Health Service. I know it is not possible to do it today, but I think it is time that the usefulness of these people was recognised by the medical profession and that it is not only the qualified medical practitioner, after a seven years' course, who can cure the ills of the body, but also many of these unorthodox people who have treated their patients with a great deal of benefit to them.
It is not a question of not going to a qualified medical practitioner because there is a conscientious objection to doing so, but because, in many cases, people have gone to these unorthodox healers after the medical practitioners have completely failed. Then the patient, having gone to the unorthodox healer, has been cured. Naturally people who derive benefit from such methods want to continue to be treated by these people, but, under this Bill, that appears to be impossible. The Minister has said that any method of healing will he recognised by the Government, provided that the person employing it possesses the necessary medical qualifications. That means that everybody would have to go through this course of, I think, seven years to become a medical practitioner before they are recognised as being qualified to treat not in accordance with the medical practitioner's method, but in accordance with the one which they utilise. Most of this seven years' training would be a complete waste of time, and I think that the insistence on having to go through that long medical course is a mistake. I hope the Minister will consider this matter again to see whether something cannot be done. I recognise the difficulties the Minister will have to face, but if those people who do not believe in, and will not go to, the ordinary medical practitioner can be allowed the fees which they pay to the unorthodox healer, it will give an immense amount of satisfaction throughout the country, and widen the scope of the means of healing for the community.
§ Mr. Raikes (Liverpool, Wavertree)
I have a great deal of sympathy with the idea underlying the Amendment moved by the hon. Member for North St. Pancras (Mr. House). I agree with the 1907 Minister that the Amendment, in the terms in which it is phrased, would not be practicable in this Bill, but I thought the right hon. Gentleman was a little rough on the hon. Member who moved it, because it was perfectly obvious that it was moved, not with the intention of replacing imperfect words in the Bill, but in order to give the widest freedom to those who prefer various forms of healing.
§ Mr. Raikes
I always thought that one of the objects of a Minister was to show encouragement towards ordinary Members of the House. Nevertheless, what the Minister could perfectly well do—and this was the only object behind the Amendment—would be to consider more closely what sort of qualifications should be permitted for persons outside the medical profession, who give their services in the same way that services will be given, under the Bill, by the medical profession. What the Minister has said means that a man must take a medical degree, and that that should be the way out. I suggest to him that we have today among the nature curers, homeopaths, and osteopaths, a considerable number of——
§ Sir Henry Morris-Jones (Denbigh)
The hon. Member is under a misapprehension. Homeopaths are qualified practitioners.
§ Mr. Raikes
No, hon. Members are thinking of a different Mr. Barker. I was discussing a Mr. Barker, of whose services I have made use, and he is a homeopath and not an osteopath, and I should not have made use of his services unless he was pretty good. Insistence on a medical degree, in many cases, would mean that a man who has today a very considerable practice in nature healing would have to waste time—and it would be a complete waste of time—in taking that course. It would mean that a great many of the people whom he was serving would be deprived of his assistance while he was taking a degree, which, if I may say so with respect, might be totally inapplicable to the kind of work which he 1908 was performing. Qualifications would, of course, have to be looked into, including the form and method of the studies which these people were continuing, but to come down to the rigid medical degree seems to me to be a course which would rather curtail that diversity of healing, which, in my view, and I do not pretend to be an expert, is of great importance. Sometimes some of these people fail with their cases where orthodox practitioners are more successful, andvice versa. That is not the fault either of the medical profession or of those outside bodies; certain cases are best suited to certain types of treatment. Under the Bill as it stands, people who know that they are getting the results—it is largely a question of faith —will no longer be able to get them unless they pay more than they would if they came under the ordinary State medical scheme. I know that the Minister has sufficient ingenuity to find a proper form of words to meet the case, and I hope that he will accept my challenge and show that he is more intelligent than the humble hon. Members who are speaking today and that he will accept the view that it is important that these people should be brought into the scheme. The hon. Member who moved the Amendment has served a very useful purpose.
§ 5.0 p.m.
§ Mr. Austin (Stretford)
I wish to support the Amendment because, whilst I have no animus against orthodox medical science, I quite understand the difficulties confronting the Minister in regard to definition and qualifications of unorthodox practitioners, and it seemed to me that he was at variance with himself in certain of the arguments he put forward. He said that, in the past, there were certain unorthodox practices which have now been accepted as orthodox medical science. If that is so, on that premise, why does he not encourage them, or set up a court of inquiry into the furtherance of this new science of nature cure? This science has saved the lives of many people. There may be quacks among its practitioners, but if the Minister lends his usual energy to the setting up of an examining body, or a court of inquiry, to examine the matter, such a body could confirm or otherwise the value of that science. It seems to me that the Minister's outlook today is not in accord with his usual progressive freedom of mind.
1909 The only other point I wish to make is the one touched upon by the hon. Member for Wavertree (Mr. Raikes) in regard to the recognised principle on the part of a patient of faith, either in the person who is treating him or in the treatment he prefers. It is a well known fact that if a man turns his face to the wall in despair, he is bound to die, whatever the treatment accorded him. Therefore, the stricture which the Minister is placing upon the patient, whether because he has to pay something in addition to the normal contribution of 8d. or not, is restricting a man in regard to his freedom of choice, and preventing him from achieving a better prospect of regaining his health to the full. On those grounds, those of us who support this Amendment ask the Minister to reconsider this question with a view to instituting a court of inquiry into the matter and the establishment of some joint body composed of nature cure practitioners and others who, as we know, are so widely divided on this matter of qualifications. If the Minister did that, he would be rendering a service, not only to the practitioners, but to the people with whom we are concerned—the working class people whose needs those practitioners so largely meet.
§ Sir H. Morris-Jones
While I have a certain sympathy with the arguments put forward on this matter, I look upon it impartially. I would not mind going to a nature curer if I thought he was better than another practitioner, but it is clear that no responsible Minister, either in this Government or any other, could possibly accept an Amendment of this kind. We admit that very fine cures are achieved by nature curers and osteopaths, but we do not hear very much about their failures. Their failures are strewn on the path, unknown and unsung. It is very easy to shoot at 20 birds in a tree in the hope of killing one of them, and I have no doubt that a nature curer may be able to find some obscure system by which he can cure one person out of 20. But it should be realised that a tremendous amount of harm has been done by some of these unorthodox treatments. In many cases, such treatments have delayed orthodox treatment and have resulted in a great loss of lives in this country. Curable cases have become incurable, through the time wasted in trying unorthodox treatment be 1910 fore applying orthodox means. Illnesses which could be cured in their elementary stages, are allowed to develop until they become incurable. It is no exaggeration to say that the result has been the loss of hundreds of thousands of lives in this country, mainly through sheer ignorance.
It is now being asked that these people should be recognised by the State. In this country, as in every other country, there must be some kind of yardstick by which to measure these things. If a man wants to be a solicitor he has to be recognised by the Law Society. In the same way, all the medical men in this country, to whatever class they belong, have to go through a rigid training and examination, and are strictly controlled by a disciplinary body. They are precluded from doing a large number of things which nature curers enjoy. They may not advertise a marvellous cure in the Press, as can the unorthodox practitioners, which brings in a large income. If these practitioners are recognised by Statute as legally qualified men, they will, if they like, be able to operate, to administer anaesthetics and to write certificates of death—of which a great number will be required. The hon. Member who moved this Amendment is clearly an enthusiast for nature curing. According to his premises, it can mean everlasting life without any mortality. Let us hope that he will have the advantage of a nature cure in his old age.
§ Mr. Braddock (Mitcham)
It seems to me that this is a very modest and helpful Amendment, and I am surprised at the great length of the discussion upon it. I can quite appreciate the Minister's difficulties, but it seems to me that he would be very well protected by the terms of the Clause itself because, in the first line, it states:It shall be the duty of every Executive Council in accordance with regulations…"Regulations" means regulations made by the Minister under the Bill. That, surely, safeguards all responsible people allowed to come in under this Clause.
Neither the Minister nor the opponents of this Amendment deny that there are in this country responsible people who are doing splendid work by these methods. Their qualifications and the results of what they have done can be tested. Surely if the Minister has power under this Bill to make regulations to decide 1911 who shall come into the scheme and who shall not, there is all the safeguard that can possibly be wanted. It is not denied that many people have benefited by the ministrations of these people, and unless they are allowed to come into the scheme this will not be the best possible health Bill in modern conditions.
This Amendment proposes to leave open the door for making use of the abilities of these people who have been of such tremendous benefit to thousands of our fellow citizens. We ought not to be pernicketty in excluding these people. Rather should we take every opportunity of including them if we possibly can. I suggest that the very terms of this Clause give to all who hold a responsible position an opportunity of deciding who shall come into the scheme and who shall not. Therefore, this is a perfectly safe Amendment which would be of tremendous benefit, and of great encouragement to these people with new ideas. What has been our experience of medicine in the past? It has been one of continual change. The ordinary practice of doctors today was jeered at and laughed at in the past. Do not let it he said of a Bill introduced in 1946, coming from a Government of this sort, that we failed to accept new ideas, if it is possible to bring them in safely and with benefit to the community.
§ Several Hon. Members rose——
§ Sir E. Graham-Little
I have a particular interest in this matter because just 20 years ago I asked this House to institute an inquiry into the Whole question of what I called irregular practice. I think that inquiry is very necessary. I am not in the least prejudiced in the matter, but before we can recognise one branch of irregular practice—and not a very old or very well established branch—we should know something more about its scientific background. I have studied this matter very considerably. Schools of naturopathy in this country are very few and very ill-equipped, and examinations are just puerile. I say that from my personal observations, and they ought to be much better. It is quite likely that there is something very sound in some of their theories, but I do not think that we 1912 ought to accept them on trust without knowing something more about them. One of the features of this practice today is that the best known schools which give training are not in this country. Osteopathic schools are entirely confined to America. When I brought my Motion before this House, Mr. Neville Chamberlain, who was then the Minister of Health, said that he could not possibly recognise examinations carried out in another country, and that when the osteopaths decided to follow courses of study which were recognised as suitable for medical practice in this country there would be no difficulty in getting them recognised.
I think the Minister is right to resist the recognition of this method until we know a great deal more about it. The theory and practice of osteopathy were examined with the utmost possible care in another place some seven or eight years ago. They had something like 12 or 15 sessions, and a very large number of practitioners and people who claimed to have benefited by it gave evidence. The result of that inquiry is very significant. Half way through, very unexpectedly and quite suddenly, the champions of osteopathy were overwhelmed by the evidence and threw in their hand. Nothing has been done since then to continue the investigations into osteopathy. There has been no investigation into naturopathy, and it is time there was one. Until an established scientific inquiry has been instituted there should be no recognition of any section of irregular practice. I think there ought to be a basic examination to ensure that practitioners of irregular practice should know something 'of the action of drugs, even if they do not deal with them, and of the technique of operations, etc. At present, quite properly, the qualified practioner does not consult with the unqualified practitioner. The result has been that the irregular practitioner is an isolated person—a Robinson Crusoe on his island—and he has no contact with other medical branches. He is a pariah. He is not recognised, and he does not get that immense impetus which one gets from meeting one's fellow workers. For all those reasons, I think it is premature to recognise any branch of irregular practice at the moment.
§ Sir Patrick Hannon (Birmingham, Moseley)
I suggest that the proposal by the hon. Member for Mitcham (Mr. Braddock) for further inquiry into the practice and the results of osteopathy ought to receive the sympathetic consideration of the Minister. Many of the older Members of this House will remember the inquiry to which my hon. Friend the Member for London University (Sir E. Graham-Little) referred, and which took place several years ago. At that time very widespread interest was taken in this House and outside in the practice of osteopathy. We had deputations in this House calling the attention of Members to what was happening in the United States in the practice of this side of medical activity. I think we ought to have further inquiry. I appreciate. the Minister's point of view and I am in entire sympathy with him. Nevertheless, I think more inquiry is necessary. After these long discussions to which my hon. Friend the Member for London University referred, a friend of mine endowed a clinic of osteopathy in London, with which I feel sure the right hon. Gentleman is familiar. Recently a movement has been inaugurated to establish in London a college of osteopathy. In view of these developments, and the widespread interest in the practice of this subject, mainly derived from people who have been trained in the United States, I think the Minister should make further inquiry into this practice which has conferred considerable advantage on people, and he ought to give further consideration to the possibility of including it in the ambit of the national medical service.
§ Mr. Charles Williams (Torquay) rose——
§ Mr. Deputy-Speaker
I hope the House will now be willing to come to a decision. We have had a very long discussion indeed.
§ Mr. Williams
I have not intervened in this Debate yet. I do so now for one reason, and I shall not take up much time, provided I am not interrupted. I have had a good many representations on this matter over a number of years from my constituents. I realise the great efficiency of the medical profession, but, from a number of experiences, I know that there are extensions of various treatments, which have been mentioned today. I listened with great interest to every word of the 1914 hon. Member for North St. Pancras (Mr. House) who moved this Amendment. I say, frankly, there can never he too much human knowledge in dealing with the ills of the people of this country. If there is any possibility, as I believe there is, of extending the knowledge of the medical profession in this way it would be a very good thing indeed to have a general inquiry into this matter.
§ Mr. Deputy-Speaker
The question of an inquiry, which has been mentioned, does not come within the scope of this Amendment. I have hesitated hitherto to interrupt hon. Members, but we cannot have a discussion on the advisability otherwise of an inquiry. It does not arise on this Amendment.
§ Mr. Williams
Of course, Mr. Deputy-Speaker, I willingly accept your Ruling as applied to this Debate. But from what I have heard during the Debate I am not quite happy and satisfied about the Minister's position. I sincerely hope that this Debate, which was opened by a speech of very high quality, will have some useful effect.
§ Amendment negatived.
§ Mr. Turton (Thirsk and Malton)
I beg to move, in page 25, line 16, to leave out from "them," to the end of the line.
This Amendment is short and, I believe, non-controversial. I hope the Minister appreciates that he can shorten it a good deal at any time by taking a certain course. The object of this Amendment is to provide uniformity of medical service, I hope uniformity of legibility, certainly uniformity of style, and, I think most necessary, uniformity of cost. If I were the Minister of Health the first thing I would do under these regulations with regard to medical certificates would be to enact that all of them should be written so that anybody could read them. This is a great opportunity for the Minister, and it is a pity he limits it to certificatesunder or for the purposes of any enactment.Why should not the Minister have power to make regulations regarding medical certificates under contract for service, or any other contract, or indeed any custom? It is wrong that these regulations should be limited to regulations that are required under an Act, such as regulations for medical certificates under the Education Act and under the National Health Service Bill.
1915 I will give the House an illustration of what will happen to a man who falls ill when at work. In order to qualify for his National Health Service benefit he will have to obtain a medical certificate, as required under the Bill. I presume it will be free. I imagine it will also be regulated by the Minister of Health, as before. That man will, at the same time, in many cases, also be under a contract of service, which covers him up to full wages for a period on production of a medical certificate. Unless this Amendment is accepted, it would appear that the man might well go to his doctor and have to pay a substantial fee for that medical certificate, which may not be in the same form. Therefore, it seems wrong that there should be these two different avenues of treatment. In my experience I have often found people deterred from taking the correct action, in many cases, because of the fear of these varying charges for medical certificates. Whatever the Minister does, I hope that in his reply he will tell us whether he intends to make these medical certificates free to applicants. It is desirable that such a step should be taken. If he takes that step, I suggest that, to be just and generous, all such medical certificates should be free; that is to say, certificates which are in connection with a claim for sickness benefit, whether it is under an Act, under a contract of service, or under a custom. The Amendment is really very little more than drafting. I think it would improve the Bill. I assure the Minister that it has the support of all the major local authorities in the country, and on those grounds, I hope he will consider it favourably and accept it.
§ Mr. Sidney Marshall (Sutton and Cheam)
I beg to second the Amendment.
I hope the Minister will accept this Amendment, because certificates should be available free. They are very often required by juniors obtaining jobs. In many cases a medical certificate is required, not under any particular enactment but for general purposes. It should be made quite plain that the provision of these certificates is free, and, without any question, should be given by the medical practitioner. I do not know what is in the mind of the Minister in saying in the Bill that certificates should only be issued 1916under or for the purposes of any enactment ",if certificates are required for many purposes, and not particularly under any Act. I hope the Minister will accept this very small Amendment to delete these words, and in that way ensure the giving of free certificates by medical practitioners to those who need them for very many purposes other than under any enactment.
§ Mr. Bevan
I sympathise with a great deal of what is in the minds of the hon. Members who moved and seconded this Amendment. When I have spoken I think perhaps they will realise that quite a substantial degree of their case has been met. At the present time, the issue of certificates, without charge, is limited to certificates connected with insurance work. The language of the Bill extends that very much, and further certificates will be issued for the purpose of any enactment under which certificates are required. That extends the obligation of the doctor. To go further, and to suggest that a person should be allowed to receive a certificate from a doctor whenever he wanted it, and for whatever he wanted it, is going rather too far. The trouble is, the obligation of construing the word "reasonable" is left to the doctor or to the patient. At the moment it is:reasonably required by them under or for the purposes of any enactment.That is easily capable of construction, but once the words "under or for the purposes of any enactment" are left out, then the difficulty of definition becomes insuperable. Having widened the obligation of the doctor as far as we have, it would really be most unfortunate if we widened it still further, and I am certain that it would meet with a considerable degree of resistance from the profession.
§ 5.30 p.m.
§ Mrs. Braddock (Liverpool, Exchange)
If a charge is to be made for a medical certificate, who will receive the charge if the doctors come under the State? At present no charge is made for a doctor's note when a person leaves a hospital, but charges are made in certain cases. For instance, a woman may need a special or surgical corset, but she cannot get one made unless she can produce a doctor's note. Would the Minister say that a note of that sort, concerning something which is absolutely necessary from the medical 1917 point of view, should be the subject of a charge, and who would be responsible for collecting it or keeping it?
§ Mr. Turton
The Minister has dealt very sympathetically with the Amendment, and I hope he will have another opportunity of considering the problem, perhaps in another place. With that end in view, I beg to ask leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.