NATIONAL HEALTH SERVICE BILL

HC Deb 04 November 1946 vol 428 cc1067-167

Order read for Consideration of Lords Amendments.

Ordered: "That the Lords Amendments be now considered."—[Mr. Aneurin Eevan].

Lords Amendments considered accordingly.

CLAUSE 4.—(Accommodation available on part payment.)

Lords Amendment: In page 3, line 34, leave out "prescribed" and insert "determined in the prescribed manner."

4.3 P.m.

The Parliamentary Secretary to the Ministry of Health (Mr. Key)

I beg to move, "That this House doth agree with the Lords in the said Amendment."

Our intention was not to prescribe the actual fees which will vary from one institution to another, but to prescribe the method of arriving at the fees.

CLAUSE 5.—(Accommodation for private patients.)

Lords Amendment: In page 4, line 4, at end, insert: "whether in an honorary or paid capacity."

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

It was our intention that this point should be covered. We thought that it was covered, but this makes it clear that service in an honorary capacity qualifies.

CLAUSE 6 .—(Transfer of hospitals to the Minister.)

Lords Amendment: In page 4, leave out lines 40 and 41, and insert: the purposes of those hospitals or any of them or for the purpose of securing accommodation for persons in the area at any hospital not vested in the authority.

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

This Amendment safeguards the position of local authorities who may have acquired land for the purposes of development for hospitals. It preserves the land for the local authorities instead of transferring it to the Minister.

CLAUSE 7.—(Endowments of voluntary hospitals.)

Lords Amendment: In page 6, leave out lines 28 to 30.

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

This Amendment and two following Amendments are for the purpose of securing that the endowments of the hospitals should, as far as possible, be definitely transferred for the purposes for which they were given. A later Amendment in page 7, line 37, deals with the question so far as the boards of governors of teaching and hospital management committees are concerned, and the Amendment in page 6, line 46, has reference to the observance of the conditions when the gifts take the form of memorials and things of that sort. Broadly, the purpose of the Amendments is to put on all the bodies or persons to whom endowments are transferred the onus of ensuring that the objects are fulfilled. That applies to memorials and things of that sort. If the ultimate cost of the provision of the services is to be borne by the Exchequer, the object of the endowment will still be preserved as the result of these Amendments.

Mr. J. S. C. Reid (Glasgow, Hillhead)

I am not clear to which group of Amendments the Parliamentary Secretary is referring. I desire to make some observations on the next Amendment, but I do not think it comes within this group.

Mr. Key

The other Amendments concerned are the Amendment in line 46, and the Amendment in page 7, line 37.

Mr. Reid

In that case, I think I may at this stage offer my remarks on the next Amendment—in page 6, line 46, at end, insert: 'Provided that, where an endowment is given after the passing of this Act and before the appointed day whether to the governing body of the hospital or to trustees, upon trusts which provide either— (a) for the administration of the property as a capital fund separate from the general funds of the hospital; or (b) for the application of the property for some specific object distinct from the general purposes of the hospital and involving expenditure of a capital nature; the endowment, instead of being transferred to the Minister and the Hospital Endowments Fund as aforesaid, shall on the appointed day, by virtue of this Act, be transferred to and vest in the Hospital Management Committee constituted under the following provisions of this Part of this Act for the hospital or for the group of hospitals in which it is comprised, and shall vest in that Committee free of any trust existing immediately before the appointed day, and shall be held by the Committee on trust for such purposes relating to the hospital services or to the functions of the Committee under this Part of this Act with respect to research as the Committee think fit, and the Committee may dispose of any property comprised in any such endowment and hold the proceeds thereof on trust for any of the said purposes. I think it requires a little bit of examination. It is extremely narrow in its terms. Let us see what it does. It permits an endowment, in other words, a sum of money given to a hospital between now and April, 1948, to be retained in that hospital or group of hospitals, only subject to rather strict conditions, otherwise the money will not be retained, but will be scooped into the general pool. I think it is important that the public should understand how stringent are the conditions which they must observe, if the money which they give to a hospital between now and April, 1948, is to remain in the locality. It will be observed that the money is allowed to remain in the hospital or group of hospitals only if it is given upon trust— for the administration of the property as a capital fund separate from the general funds of the hospital; or for the application of the property for some specific object distinct from the general purposes of the hospital and involving expenditure of a capital nature; Those who give large sums of money normally take competent advice before they do so, and they will of course be advised, if they desire to benefit a particular locality, that they should make quite certain that one or other of these purposes is expressly mentioned in the deed of trust or in the deed of covenant. Therefore, provided generous donors, on advice, have their attention drawn to these matters, these large sums will probably be saved for the purposes intended. The position of the small donor is very different. I shall be glad if the Minister will correct me on this if I am wrong. The small donor, giving a few pounds, cannot give the money upon a trust for the administration of the property as a capital fund separate from the general funds of the hospital. That is quite inappropriate for a gift of a comparatively small amount. Secondly, he can hardly give the small amount of money for some specific object distinct from the general purposes of the hospital and involving expenditure of a capital nature. Therefore, as I say, this Amendment, in effect, says that big donors who are wide awake will be able to see that the money is ultimately devoted to the purpose they intend, but donors who are not wide awake or small donors, whether they are wide awake or not, will see their money taken away from the purpose they intend, and put into the general pool, whether they like it or not. We criticised the terms of the Bill on the ground that it would make hospital finances, during the next year or two, a very difficult proposition. This Clause goes a little way towards meeting that criticism, and, as such, we welcome it, but I think that the House should realise what a small improvement it is, and what a small number of charitable gifts it will cover. The greater part of the small gifts, and a certain number of the big ones, will not be covered by this Amendment, but will be taken away in the manner to which we have objected so often. I rather hope that we have interpreted it wrongly, but I hope the Minister will explain what is behind the strict limitations of this Amendment.

The Minister of Health (Mr. Aneurin Bevan)

The right hon. and learned Gentleman the Member for Hillhead (Mr. Reid) has. I think, put the correct interpretation on the Amendment, but I think he was less generous in assessing the value of its language. It is true that these words were intended to exclude from endowment funds subscriptions which ordinarily would be paid for the general administration of the hospital. Members must have regard to what I, and also public funds, must guard against. It will be realised that after April, 1948, all bequests of this nature will go to the fund of the hospital itself. We are really dealing with the interim period. It was suggested to me, in the earlier stages of the Bill, that we ought to allow hospitals to receive money in the meantime. There are very considerable objections to that, because in 1948 we take over not only the assets of hospitals, but their liabilities as well. Unless I carefully guarded myself, and also the Exchequer, it would be possible for a hospital to accumulate an artificial deficit on its general hospital fund, and a very considerable increase in its endowment fund. I wish to secure that where a capital sum is given for a special purpose it must be regarded as part of the endowment of the hospital. Other income must be considered as part of the general income.

Sir Hugh Lucas - Tooth (Hendon, South)

The Minister talks about capital being given for a special purpose, but there is no reference to that in paragraph (a).

Mr. Bevan

But there is in paragraph (b). It must be a capital sum, or a sum prescribed for a specific purpose. The destination of the money must appear, on the face of it, to be the endowment fund, and not the general expenditure fund, otherwise, unless we have safeguards of this sort, ordinary weekly subscriptions paid for the maintenance of the hospital could easily be transformed, by a very simple form of words, into a contribution to the endowment of the hospital. At the end of 15 months, in that event, I would find myself faced with an enormous deficit. We have gone a substantial way to meet the points which have been raised while, at the same time, safeguarding the Exchequer and the public purse against what might otherwise be attempts to enrich the funds of a hospital at the expense of the Exchequer.

Lords Amendment: In page 6, line 46, at end, insert: Provided that, where an endowment is given after the passing of this Act and before the appointed day, whether to the governing body of the hospital or to trustees, upon trusts which provide either— (a) for the administration of the property as a capital fund separate from the general funds of the hospital; or (b) for the application of the property for some specific object distinct from the general purposes of the hospital and involving expenditure of a capital nature; the endowment, instead of being transferred to the Minister and the Hospital Endowments Fund as aforesaid, shall on the appointed day, by virtue of this Act, be transferred to and vest in the Hospital Management Committee constituted under the following provisions of this Part of this Act for the hospital or for the group of hospitals in which it is comprised, and shall vest in that Committee free of any trust existing immediately before the appointed day, and shall be held by the Committee on trust for such purposes relating to the hospital services or to the functions of the Committee under this Part of this Act with respect to research as the Committee think fit, and the Committee may dispose of any property comprised in any such endowment and hold the proceeds thereof on trust for any of the said purposes.

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

This Amendment is one of those to which I referred earlier.

Lords Amendment: In page 7, line 3, after "Minister," insert: or any person authorised to act on his behalf, and for defraying out of the Fund such expenses incurred for the purpose of the control and management of the Fund as may be prescribed.

4.15 p.m.

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

This Amendment, and the next two Amendments, go together, and are necessary to make it possible to do what we have always intended, namely, to enable the National Debt Commissioners to act on behalf of the Minister as agents in the holding and managing of any investment that forms part of a hospital's endowment fund. Without this Amendment, it is doubtful whether that could be done without complicated transfer arrangements. The second part of the Amendment clears up another doubtful point by ensuring that expenses of management of these funds, for instance, in connection with any property involved, should be chargeable to the funds themselves.

Lords Amendment: In page 7, line II, leave out "from the governing body," and insert "in connection with the transfer."

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

This is largely a drafting Amendment. As the Bill left this House, the Minister was empowered to meet, from the hospital endowment fund, only those liabilities which had been transferred to him by the governing body. Others that might have been transferred, belonging to trustees and so forth, were left out, and that error is put right by this Amendment.

Lords Amendment: In page 7, line 37, at end, insert: '(7) Every Board of Governors and Hospital Management Committee shall, in the case of any endowment transferred to them under this section, and the Minister shall in the case of any endowment transferred to him and the Hospital Endowments Fund under this section, secure, so far as is reasonably practicable, that the objects of the endowment and the observance of any condition attaching thereto, including in particular conditions intended to preserve the memory of any person or class of persons, are not prejudiced by the provisions of this section.

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

Lord Willoughby de Eresby (Rutland and Stamford)

I gather that this Amend, ment is to cover the case of the local war memorial which is embodied in the local hospital and, that being so, I should be ungracious if I did not give thanks although, perhaps, only lukewarm thanks, to the Minister for meeting the point which I raised in Committee. In successive stages of the Bill we are getting nearer to the points which I raised earlier, and I wish there were a few more stages so that some of us could achieve, or partially achieve, what we desire. I appreciate the difficulty in which the Minister found himself. Having accepted the principle that endowments should go into the general fund—which we did not accept—it is always dangerous to start making exceptions. Having said that, in special cases, money will be used for the object intended, it is difficult for a war memorial hospital to differentiate between money originally given for the war memorial, and money which has been subsequently given for the general upkeep of the hospital. I think that the right hon. Gentleman has tried to meet that point fairly. I thank him for doing so, and I hope that the general direction which has been given to the Boards of Governors and the Hospital Management Committees will be carried out.

Mr. Bevan

I would like to make it clear in respect of this Amendment—and the same observations will apply to a number of others—that what the Amendment does is merely to write into the Bill what I have explained throughout was the intention of the Government. It is put in general terms because, eventually, if we put it in specific terms we should have to have a long catalogue of instances to which it would apply. It is merely putting language in the Bill to give expression to the intention which we have had in our minds throughout.

Mr. Henry Strauss (Combined English Universities)

This new Subsection (7) is, in our view, undoubtedly a considerable improvement. It is, so far as the voluntary hospitals are concerned, very similar to what I and other hon. Members asked for at an earlier stage. So far as it applies to hospitals other than the teaching hospitals, I welcome it. In so far as the teaching hospitals are concerned, the words which we are now putting in take the place of lines 28 to 30 on page 6, which we have just left out. It seems to me that, in the case of the teaching hospitals, we are making the proviso a little less strict than before, because the words in the proviso which we are leaving out are: So far as practicable, the board shall secure that the objects of the endowments are not prejudiced. We are now putting in So far as is reasonably practicable. I cannot say that I have looked into all the implications, but perhaps the right hon. Gentleman can tell us whether, on the advice given to him, we are not making the proviso, so far as the teaching hospitals are concerned, less strict than before.

Mr. Bevan

I think that I can give that assurance. "Reasonably practicable," I think, is rather a better form of words. It would be "practicable" to do a large number of things, but it would not be "reasonable" to do them. I think that the form of words does not make it easier for the teaching hospitals. In any case, their funds are not being touched at all.

Lords Amendment: In page 8, line 2, at end, insert: '(b) if the endowment is transferred to and vested in a Hospital Management Committee by virtue of this Act, be transferred to and vest in that Committee on that day by virtue of this Act.

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

This Amendment is to make provision for the transfer to the management hospital committees of any rights or liabilities attaching to endowments transferred to them.

Lords Amendment: In page 8, line 14, after "hospital," insert: or (in the case of an endowment which would be transferred to a Hospital Management Committee) that Committee.

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

This Amendment is consequential and deals with the apportionment of the endowment.

Lords Amendment: In page 8, line 18, at end, insert: and for the apportionment of any rights and liabilities acquired or incurred for the purposes of managing the property and of any liabilities charged thereon

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

This makes good an accidental omission in the Bill as it left this House, in the Sub- section which deals with the apportionment of property between the hospital endowment fund and for other purposes, the Amendment secures that not only the funds are apportioned but the rights and liabilities are similarly apportioned.

CLAUSE 12.—(Functions of Boards and Management Committees.)

Lords Amendment: In page 15, line 19, leave out Subsection (2), and insert: (2) It shall be the duty of the Hospital Management Committee of any hospital or group of hospitals, subject to and in accordance with regulations and such directions as may be given by the Minister or the Regional Hospital Board, to control and manage that hospital or group of hospitals on behalf of the Board and for that purpose to exercise on behalf of the Board such of the functions of the Board relating to that hospital or group of hospitals as may be prescribed.

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

This Amendment makes clear on the face of the Bill what has always been our intention, namely, that the hospital management committee shall be responsible for the running of the hospital or group of hospitals under their control. This Amendment merely inserts words to say that it is their duty to control and manage these hospitals on behalf of the board, according to the prescriptions, etc., which are made.

Mr. J. S. C. Reid

This Amendment, in carrying out the purposes which the Parliamentary Secretary has stated, has one very good feature. It requires these matters to be done by regulation, which means, if I understand the matter aright, that this House will have a chance of seeing and criticising a scheme for delegation of authority. That is all to the good. In line 3 of the Amendment are the words: and such directions as may be given by the Minister. I trust that the Minister can assure us that, so far as the general scheme is concerned, it will be done by regulation, so that we can see and criticise, as we should in this House, the general scheme, and that the directions will be limited to matters of minor or local importance, which would not be appropriate for regulation. I hope that the Minister can assure us that all topics which would be appropriate for regulation will be done by regulation and not by direction.

Mr. Bevan

The language of the Bill refers to "direction," as well as "regulations," because it may be necessary, from time to time, to give directions to hospitals in respect of specific services. For example, supposing it were decided that a particular hospital should engage in research into a particular matter—it may be cancer, or rheumatism or asthma —it would not be necessary to have a special regulation for that purpose, but it would be necessary to give directions to the hospital to provide facilities in order that that might be carried out. It is not the intention of the Government—and I hope that no sensible Government would do it—to try itself to discharge the responsibility of the management committee. I have always emphasised—and 1 take this opportunity of doing so once more—that I regard the management committees as extremely important bodies, which will have complete control over the internal administration of the hospitals in their charge. All that this Amendment does is to write on the face of the Bill what we have always declared to be the intention. It is not intended that the management committees should be merely passive instruments of the Board, but administrative organs in their own right, discharging their responsibilities from day to day, and, so far as can be done, developing in the hospitals under their control an esprit de corps which will give very much more enthusiastic and zealous service to the hospitals concerned.

Lords Amendment: In page 15, line 31, at end, insert: (a) to provide for the university with which the hospital is associated such facilities as appear to the Minister to be required for clinical teaching and research.

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

This, again, makes plain on the face of the Bill what quite obviously has to be done normally—that the teaching hospitals shall provide the universities with which they are connected, with opportunities for teaching and research.

CLAUSE 13.—(Legal status of Boards and Management Committees.)

Lords Amendment: In page 15, line 41, after "Minister," insert: and a Hospital Management Committee shall notwithstanding that they may be exercising functions on behalf of the Regional Hospital Board.

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

This makes the management committee liable to be sued in the same way as the regional board.

CLAUSE 14.—(Conditions of service and appointment of officers.)

Lords Amendment: In page 16, line 4, leave out Subsection (2), and insert: (2) A Regional Hospital Board, Board of Governors or Hospital Management Committee shall not be entitled to claim in any proceedings any privilege of the Crown in respect of the discovery or production of documents, but this subsection shall be without prejudice to any right of the Crown to withhold or procure the withholding from production of any document on the ground that its disclosure would be contrary to the public interest.

4.30 p.m.

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

The omission of the present Subsection (2) is consequential, but the new Subsection introduces a matter which was not in the Bill before, namely, a power to compel the production of documents by the authorities concerned.

Mr. J. S. C. Reid

The first part of the new Subsection makes clear what might have been thought to be implicit in the Bill before. The second part is in line with other parts of the law. I think it is desirable that we should have from the Minister a specific assurance, which I am sure he will give, that he will use this power to withhold the production of documents on the ground of public interest very sparingly and only with great care, because there can be very different views outside and inside an office as to what the public interest means. Accordingly, I think this is a matter which ought always to come within the personal knowledge of the Minister before a certificate of this kind is given. If that is done, I am sure the Minister will take the view that he should exercise this power only in the most clear cases. If he can give that assurance. I think this power will be all right.

Mr. Bevan

I can give that assurance without the slightest hesitation. It ought always to be possible to have the relevant documents produced in any action whatever, and they ought to be withheld only in very exceptional circumstances.

CLAUSE 16.—(Research.)

Lords Amendment: In page 17, line 39, after "1919," insert: and the duties imposed on the Committee of the Privy Council for Medical Research under the said Act.

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

The purpose of this Amendment is to make clear that the conferring of research powers upon the Minister does not in any way prejudice the position of the Medical Research Council. It was pointed out that the specific mention of the functions of the Minister under the Ministry of Health Act, 1919, which also confers powers on the Medical Research Council, might lead to the inference that their powers have been interfered with. This Amendment makes certain that is not the case.

CLAUSE 19.—(Local health authorities.)

Lords Amendment: In page 18, line 44, at end, insert: (4) The application of this Section within the Administrative County of London shall be subject to the following provisions:— (a) The Council of the Administrative County of London (in this subsection referred to as the county council) shall delegate to the Common Council of the City of London as respects the City of London, and the councils of the metropolitan boroughs as respects the respective areas of those boroughs, their functions under this Part of this Act in relation to the services hereinafter mentioned, and the Common Council and the councils of the metropolitan boroughs shall discharge the functions so delegated. (b) The following services shall be the services to which this Subsection refers:— (i) arrangements for the care of expectant and nursing mothers and of children who have not attained the age of five years and are not attending primary schools maintained by a local education authority; (ii) provision for the visiting in their homes of such mothers and children as are mentioned in the foregoing paragraph for the purposes mentioned in Section twenty-four of this Act; (iii) the arrangements for vaccination and immunisation mentioned in Section twenty-six of this Act; (iv) such arrangements for providing home nursing and domestic help for households as are mentioned in Sections twenty-five and twenty-nine of this Act; (v) the services relating to notification of births and child-life protection to which Subsection (3) of Section twenty-two of this Act applies; and (vi) the provision, equipment and maintenance of premises for the foregoing purposes. (c) Before submitting proposals to the Minister in pursuance of section twenty of this Act the county council shall, in respect of the services to which this subsection applies, consult with the Common Council as respects the provision of such services in the City of London and with the council of each metropolitan borough as respects the provision of such services within the area of the borough, and the provisions of Subsections (2) and (5) of Section twenty of this Act shall apply as if the Common Council and the council of the metropolitan borough were a voluntary organisation for the purposes of those Subsections. (d) The county council shall pay to the Common Council and the councils of the metropolitan boroughs one-half of the cost incurred by them in discharging the functions delegated in pursuance of this Section.

Mr. Key

I beg to move, "That this House doth disagree with the Lords in the said Amendment."

One of the major weaknesses in the provision of personal health services in this country in the past, apart from the fact that mainly they were of an optional character, has been a lack of real coordination, because of divided responsibility among the different types of authorities, in their provision. One of the major reforms proposed in this Bill is the concentration of responsibility for these personal services in one authority in each area concerned, either the council of the county or the council of the county borough. That concentration is as desirable in the London area as it is in any of the county areas; but what this Amendment does is to destroy that coordination and concentration in London, while leaving it operative in the remainder of the country. Londoner as I am, I claim that that would be a great disservice to the people of London, and therefore, it is unacceptable to us.

I know it will be said that in the past, many of the metropolitan borough councils have managed and controlled quite a good maternity and child welfare ser- vices, and that because they have done that, it is a reason for leaving them with the power in future; but I would point out that there are non-county boroughs and urban district authorities in the rest of the country which have done equally well as any metropolitan borough council, and in quite a number of cases have maintained services superior at any rate to those of some of the metropolitan borough councils to which I could draw attention. But it is not proposed that those very successful authorities should go on maintaining their maternity and child welfare services, and it seems to me that there can be no really sound reason for making this distinction. Concentration is as important in the metropolitan area as it is in the rest of the country.

I want to draw attention to one or two of the specific proposals in the Amendment. Subsection (4, b) deals with arrangements for the care of expectant and nursing mothers and children under the age of five. That involves not merely that the care of the under-fives would remain with the borough councils and the care of the over-fives go with the London County Council, but it means further that the under-fives who would be taking advantage of the services of nursery schools which the London County Council will develop would be under the control of the London County Council, but the under-fives taking advantage of the day nurseries provided by the borough councils would be under the control of the borough councils. I want to know what justification there can be for maintaining a dual service for children requiring the same sort of care and the same sort of treatment.

The Amendment would also continue; in London alone, a serious break in child welfare work caused by their passing from the care of one authority to that of another at a very critical stage in the child's development, the period when it is first beginning to attend school. As a London schoolteacher with 40 years' experience, I can testify that that break in care and welfare work at that age has been a real evil from the children's point of view. While it is possible, in transferring from one organisation to another, to pass on case papers with regard to each child that changes over, one cannot pass on personal knowledge and experience if there are two separate organisations, be- cause there is a real break in the people who are maintaining the control.

I would point out also that, under the same provision in the Amendment, while it would be the duty of the metropolitan borough councils to maintain prenatal and postnatal services, it would be the responsibility of the London County Council, if the Amendment were accepted, not only to provide the midwives' services that are necessary in between the prenatal and postnatal period, but it would be the duty of the London County Council, under Clause 23 of the Bill, to secure that the service of maternity nurses during childbirth and from time to time thereafter during a period not less than the lying-in period, is adequate for the needs of the area. I want to know what justification there can be for the break in the continuity of these maternity services, and why it is that it is expected that some benefit can come from divided responsibility, apart altogether from the fact that there would be overlapping in the administration of the services. In Subsection (4, b), paragraph (iv), of the Amendment there is placed upon borough councils the duty of providing home nursing and power to provide domestic help in times of illness, but under another part of the same Clause, that still leaves services of a preventive character, and the aftercare services in cases of illness, to be dealt with by the London County Council. Again, I should like to know how it can be a wise administration of a health service that says that one authority is to provide the nurse during the period of sickness, and another authority to be responsible for providing the after care in the very place where the original nurse has been attending.

Paragraph (vi) says: the provision, equipment and maintenance of premises for the foregoing purposes. In other words, the borough council are to be given power under this Amendment to maintain maternity and child welfare centres for their functions as well as for the purpose of the organisation of home nursing and home helps. But this leaves with the London County Council the development of the necessary health centres from which are to operate the medical, dental, pharmaceutical, and midwifery services. Surely this is a wrong method by which to approach the problem—provid- ing two separate centres dealing with parts of what is really one health service. What we have to aim at is the development of health centres in the areas where there can be common knowledge among the people serving in them with regard to the particular cases which are being dealt with, in order that they may give better service to the individuals concerned. By the development of the common health centre for this purpose we shall avoid duplication and, at the same time, effect an economy which will lead to a fuller and richer development of the service.

The set-up that is envisaged in this Amendment is bound to lead to greater possibilities of administrative friction in the carrying out of the services, while it will inevitably mean a loss of efficiency through lack of real coordination. There is, however, another aspect of this same problem which really distresses me as a representative of one of the poorest areas of this great metropolitan district. It is the problem of finance. The unified service envisaged in the Bill would mean that a service of common standards would he provided for all areas in London, irrespective of the poverty or wealth of the particular area in which the service was to he given. The Amendment says the exact opposite—that 50 per cent. of the cost of the services is to be provided by the borough council concerned. This means, in areas such as that which I represent, either an overwhelming and unbearable burden will be placed upon the local ratepayers of those already overburdened authorities, or, as the result of their poverty, the people in those areas will have to put up with a service which is less efficient than would otherwise be the case.

In the interests of the general body of the people of London we must see that unification is brought about. That does not mean to say that there cannot be real cooperation between the borough council and the London County Council in the management of these services. Nor does it mean that we have excluded the possibility that the particular value of the local information of the borough councillor shall be brought into these services. We have secured, under Part II of the Fourth Schedule of the Bill, that there shall be an opportunity for that knowledge to be brought into use so far as these services are concerned, because while we have laid it down that any subcommittees necessary for the purposes of carrying out these services which are set up by the local health authority must have a majority of public representatives, we have said that the majority need not consist entirely of representatives of the local health authority itself but may include representatives of any other local authority in the area that is covered by the local health authority. In other words, we have given to the London County Council and the borough councils power to cooperate through the sub-committees that will be necessary for carrying out these services in the various areas, and to enable the representatives of the borough council to share with the County Council in their management and control.

4.45 p.m.

I should like also to point out that Section 166, Subsection (1, b) of the London Government Act of 1939 is still in existence and will not be repealed by this Bill. It enables the borough councils and the London County Council to get together and to put forward schemes to the Minister for the purpose of dealing with services in which they want to share or to delegate powers one to the other. I say, therefore, that we have made provision in the Bill for these authorities to cooperate in carrying out the services, but from the point of view of the efficiency of the services, their proper coordination, and the convenience and welfare of the inhabitants, as well as from the point of view of financial ability to provide the service for the poorest as well as the wealthiest, we maintain that this Amendment takes entirely the wrong line. As a Londoner, I am very proud to have the privilege of asking the House, in the interests of London, to disagree with the Lords in their Amendment.

Mr. Richard Law (Kensington, South)

We on this side of the House have listened with great disappointment to the speech which has been made by the hon. Gentleman the Parliamentary Secretary, and I think it would probably not be an exaggeration to say that, while we disliked hearing the hon. Gentleman making that speech, he, for reasons with which he and the House are perfectly familiar, must have disliked having to make it even more. The hon. Gentleman does not appear to know what I mean, but I think that if he reflects he will probably find the meaning of my remarks. I may possibly enlighten him later on. We are familiar in this House with the Amendment and its background, and I can therefore see no necessity for going into any detailed record of the various transactions of which it is the result. Nevertheless, it is important that we should just refresh our minds on the general background of the picture which we are considering.

The House is aware that in 1944, after the Coalition White Paper was published, the Metropolitan Boroughs Joint Standing Committee, under the chairmanship of the Parliamentary Secretary to the Ministry of Health, came to an agreement with the London County Council. It was clear when the Coalition White Paper was published that there would have to be some division of responsibilities as between the L.C.C. and the metropolitan boroughs and without any pressure from my right hon. and learned Friend the Member for North Croydon (Mr. Willink), who was then Minister for Health, but with his good will, these two bodies got together to see whether they could reach an agreement, and in fact they did. The tenor of that agreement was that the maternity and child welfare work at present undertaken by the borough councils should be delegated by the L.C.C. to the borough councils. That, broadly and generally speaking, is what is done by the Amendment which we are considering.

It is all very well to say that that was in the days of the Coalition Government, and that nothing that was valid then is valid now in new conditions when we have a Labour majority in the House. In fact, this agreement, which was come to in 1944, in the days of the Coalition, was reaffirmed by the L.C.C. after the defeat of the Conservative Government and after the present Government assumed office.

Mr. Bevan

Was the agreement ever confirmed by the Coalition Government?

Mr. Law

I did not say it was. The agreement did not have to be confirmed by the Coalition Government. I said that the agreement was come to without any pressure from my right hon. Friend who was then Minister of Health but with his good will. I am certain that if the Coalition Government, or if we, had continued in office we would, in fact, have embodied in the National Health Service Bill the agreement which was come to.

Mr. Key

Were not the proposals which were then being dealt with vitally different from the proposals made in the Bill?

Mr. Law

That is a very difficult question to answer, for the reason that hon. Gentlemen opposite, including the hon. Gentleman who has just addressed that question to me, were continually saying that the Conservative Government, which succeeded the Coalition Government, had deserted the principles of the White Paper, and that the present Government were going back to the principles of the White Paper. The hon. Gentleman cannot have it both ways.

That is a side issue. As the House knows, the Parliamentary Secretary was chairman of the Metropolitan Boroughs Standing Joint Committee. As its chairman, he exerted, I have always understood, great influence and used great persuasion in order to bring about such a division of powers as is embodied in the Lords Amendment, and as he is rejecting this afternoon. I do not want now to go into the reasons for the Parliamentary Secretary's complete volte face. I will say only in passing that I think they were extraordinary and that I think they were discreditable.

Mr. Key

Is it not possible for the right hon. Gentleman to understand this, that a person can serve his team even although the second team that he gets into has a different attitude to that of the first; that whilst he uses his powers of persuading the metropolitan borough councils to do this, that and the other, when he goes to speak as their chairman he is bound to voice their opinion, irrespective of whether it is his own or not; and that the essence of Democracy, which quite obviously the right hon. Gentleman will never understand, is that the person who goes to speak on behalf of a body gives expression to their wishes and not to his own?

An Hon. Member

The hon. Member has changed his mind.

Mr. Law

The interjection of the Parliamentary Secretary has shown at least one thing quite clearly, that he did understand something I said at the beginning of my speech, although he professed not to. It has shown that, but I must say that I did not altogether follow him in his new definition of the team spirit—[An HON. MEMBER: "You would not"]—and of democracy. I would rather, for my own part, say that anyone who changes his mind, as my hon. Friend said in an interruption just now, because he changes his job, is, in fact, doing a great disservice to democracy.

Mr. Goodrich (Hackney, North)

I would not intervene were it not that I feel that an injustice has been done to the Parliamentary Secretary. It so happens—

Mr. Deputy-Speaker (Sir Robert Young)

The hon. Member can rise only to a point of Order or to put a question to the right hon. Gentleman who is addressing the House. Unless the hon. Member has either a point of Order or a question, he is not in Order in speaking.

Mr. Goodrich

I wanted to make this point to the right hon. Gentleman—

Mr. Deputy-Speaker

The hon. Member must make his point of Order to me, and not to the right hon. Gentleman.

Mr. Law

I assure the hon. Gentleman opposite that I have no wish to do injustice to the Parliamentary Secretary. As I have said, I do not propose to go into the reasons which underlay the volte face. It was the hon. Gentleman's interjection which brought all this to the surface. It was not my speech. I certainly do not wane to delve into the workings of the Parliamentary Secretary's mind on this point. What I want to do is to put before the House the kind of argument that must have weighed with the Metropolitan Boroughs Standing Joint Committee, with the L.C.C. and with the hon. Gentleman himself, at the time the agreement was come to. They must have had solid arguments. Although I was not a member of either body I can imagine very well what those arguments were.

In the first place, both bodies must have agreed that the services which the Amendment proposes to delegate were essentially personal services, that they demanded the closest possible contact between the individual citizen and the authority concerned and that therefore they were much better handled by a relatively small metropolitan borough council than by the L.C.C., which has the care of between 3 million and 4 million citizens of London. That must have been the first argument that weighed. The second argument no doubt was that those services had, in fact, been discharged for many years by the metropolitan boroughs, and had been discharged very well indeed. Another argument, which I dare say weighed with them, was that the L.C.C. from its very size was not fitted to handle those essentially personal services.

The final argument which I can imagine weighed very heavily, especially with the Parliamentary Secretary, who has such clear principles of democracy, was that if those services which we are discussing now were removed from the purview of the metropolitan boroughs, it would result in a very great weakening of local government in London. We should not get the same class of people to go into local government and offer themselves for election to their local councils if the main part of the job of the local authority, a job which they are doing extremely well, was removed from the purview of the metropolitan boroughs. It would be very difficult also to get medical officers of the calibre that many of the metropolitan boroughs have, of the calibre that my own borough, for example, has, to serve, if the powers of the authority were to be truncated in this kind of way.

I suggest to the House and to the Minister that those arguments, if they were arguments which weighed with the people concerned at that time—they are certainly arguments which weigh very much with us on this side of the House—are extremely weighty and weightily supported. If those arguments are swept aside, they can only be so swept aside by arguments even more weighty and solid. Anybody who listened to the Parliamentary Secretary this afternoon, or who listened to or read the Debates in another place, or that we had in this House and in the Committee upstairs, must in his heart know that the arguments which have been used by the Government on this matter are not really solid and weighty at all. I would like the House to consider for a moment what those arguments are.

5.o p.m.

A few moments ago the Parliamentary Secretary said that this Amendment introduced into the Bill a degree of lack of uniformity and lack of coordination and so on which struck across the whole principles of the Bill. I could understand that argument if in fact the Bill was based on these principles of absolute uniformity all through, but we know that it is not. We know, for example, that a woman who is going to have a baby will come under her own doctor, responsible to the executive committee; will go to a prenatal clinic under the local authority and come under a doctor responsible to the local authority; and then will go to hospital to have the baby and will come under yet a third kind of doctor, one responsible to the regional board. This Bill is full of apparent discrepancies of that kind, and it is rather absurd for the Minister to offer to the House as a reason for rejecting this Amendment the fact that it introduces some kind of lack of uniformity into the whole structure of the Bill. It is not only a question of expectant mothers. There is the question of the health centre itself. When the health centre is set up, doctors will be working under the local executive committee; local authorities will be working there under Part III of the Act; and consultants will be working there under the regional board. Again there will be the same kind of division of function and division of responsibility. If there is anything in the Minister's argument on this point, it is simply that the whole Bill is unworkable, not that this Amendment by itself is unworkable.

The Minister went on to say that if this Amendment were accepted it would perpetuate great inequality as between one borough and another. I must declare my own interest in this matter because I am the representative in Parliament of the Royal Borough of Kensington which, I suppose, has as fine a record in these matters as any borough throughout the length and breadth of the country. What Kensington has done in this field—and I have no hesitation in saying so—is very remarkable indeed. Since 1900 the infantile death rate has been reduced from 150 per thousand to 102 per thousand in 1919 and 49 per thousand last year. The maternal death rate was reduced from 3.5 per thousand in 1925 to under 2 per thousand in 1945. In 1935 the borough council inaugurated a diphtheria im-munisation service. In 1935 367 diphtheria cases were notified in the borough, and 19 deaths. In 1944, after a few years of this immunisation service, 29 cases only were notified and there was not one death.

That is a very remarkable record of which no borough need be ashamed, but the Minister's argument on that, as I understand it, is that because Kensington is a wealthy borough, it is putting other boroughs at a disadvantage and it is, therefore, necessary to bring all the boroughs under the L.C.C. so that there shall be an equal distribution of funds. The Minister referred to that part of the Amendment which deals with the 50 per cent. paid by the local authority and the 50 per cent, paid by the L.C.C. If that argument were valid, I agree that it would be extremely forceful. If it were a fact that under this Amendment Kensington as a wealthy borough would be able to provide services that, say, Shoreditch, would not be able to provide for financial reasons, there would be something in the Minister's argument. But surely that is not the case at all because we could get round that difficulty quite easily by a readjustment of the block grant to the local authorities? It does not seem to me that there is a great deal of force in that argument.

Again, we have been told that if the Government made a distinction between metropolitan boroughs and non-county boroughs outside London, they would expose themselves to unending and continuous pressure from the non-county boroughs, many of whom, as the hon. Gentleman said in his speech, are excellent, to be treated in the same way, and a hole would be opened in the dam through which the local authorities would flood and the whole structure of the Bill would be wrecked. Surely, there is nothing in that argument because London has always been treated as something separate and distinct from the rest of the country. There is any amount of legislation which treats metropolitan boroughs differently from non-county boroughs and gives the metropolitan boroughs special treatment. There are the London Building Act, the London Public Health Act and the London Government Act, and so on, and to say that we cannot treat London differently from the rest of the country because it creates a precedent is just saying something which is not true. The precedent already exists. and nobody has ever yet objected to it.

The last argument I have seen directed against this Amendment was not stressed by the Minister just now but it was used in another place. It is that at the time this agreement was made the proposals of the Government differed in one very vital respect from this Bill as it now comes before us for the last time. It differed in that the hospital services are being taken away from the L.C.C., and the argument runs that because the L.C.C. is losing its hospital services, it would therefore be convenient and suitable that the health services at present being discharged by the local authorities should be taken over by the L.C.C. I ask the House to examine that argument for a moment. If it meant that the taking away of the hospitals from the L.C.C. resulted in the L.C.C. being better equipped to deal with these local services, I could follow that argument, but it cannot mean that. Even though the hospital services are taken away, the L.C.C. is still a vast organisation and is still remote from the people of London in the sense that the metropolitan boroughs are not. It is still a body which is not fitted to undertake these essentially personal services.

At the present time in any of these services, if a citizen wants help he goes to his own town hall. He knows where it is—probably a few hundred yards from his house—and sees his own councillor or the medical officer of health. It is all intimate, on the spot and convenient. But under the Bill, if the House rejects this Amendment, all that will be swept away. The citizen will have nothing to do at the town hall in these matters. He will have to go to the County Hall. He will have to write to his L.C.C. member. That, again, is a matter which really ought to give us serious thought.

At the present time there are, I think, 120 elected members of the London County Council and they have to deal with the entire needs of the administrative area which comes under the L.C.C. These health services are still part of it. They are a terribly overworked body of men. If the recommendations of the Boundary Commission are made effective, the number of elected members on the L.C.C. will be reduced from 120 to something like 80, and those 80 men are bound to be still more over-burdened. I suggest to the House that we ought to consider very carefully before taking away from the local authorities in London these services which they are performing well, and have performed well for such a long time, and putting them on to the plate of a much vaster body that is already terribly over-burdened. I know that the misgivings with which we on these benches regard the attitude of the Government on this matter are shared by a number of hon. Members opposite. I know there are hon. Members opposite who represent London constituencies, and who feel just as strongly on this matter as we do, and I hope very much that, if the Minister remains unaffected by anything that we say, and any arguments that we put up from this side of the House, his heart may be melted by arguments that will be put up to him from the benches opposite.

Mr. Somerville Hastings (Barking)

May I first deal with some of the points raised by the right hon. Gentleman the Member for South Kensington (Mr. Law) regarding the London County Council, because I have been a member of that body for some years and know something of what happened previously and what is happening today. First, as to the suggestion that the attitude of the Council has changed completely. It has changed, but it has changed because circumstances have changed. When, under the terms of the White Paper, the London County Council supposed that it would be the sole health authority for London, it considered that it would have a little too much on its plate, and made the suggestion that the maternity and child welfare services, tuberculosis services, and the control of infectious disease might usefully be transferred to the London boroughs. What is happening to-day? Conditions are entirely different. Under the new Bill the control of infectious disease is to be retained by the boroughs, and tuberculosis is no longer in the power of the London County Council to offer to any authority because it is to be dealt with by the regional hospital boards. I suggest, therefore, that conditions have entirely changed and that, therefore, an offer made under certain conditions cannot possibly be expected to hold good under, the terms of a Bill which is as superior to the White Paper as white is to black.

There are one or two suggestions which the right hon. Gentleman made about the London County Council. First, he said that we were very remote from our constituents. I, for one, deny that. Many of us go to our constituencies once a week or once a fortnight, and see all and sundry who wish to come and see us.

Mr. Law

May I make this clear to the hon. Gentleman? I certainly did not intend to suggest that he or any of his colleagues were negligent in their duties. The point I was trying to make, but perhaps did not make clearly, was that the L.C.C. as an institution is remote from the ordinary citizen in the same sense as the Ministry of Health is remote from the ordinary citizen. It is not as close to the ordinary citizen as the local authority proper in the metropolitan borough, in its own town hall, is accessible every day to the citizen.

5.15 p.m.

Mr. Somerville Hastings

I suggest that the right hon. Gentleman is not correct. We are constantly in touch with our constituents. They come to see us for many reasons and we are very glad to give them all the advice within our power. I am not sure that there is not some danger in people being in too close contact with their representatives. I agree that in case of difficulty or complaint, the individual concerned should be able to get to his representative at once and explain matters to him, but for individuals who are supporters, or supposed friends of representatives, to come to them as sometimes happens, and ask for special favours is not a very desirable thing. Then the right hon. Gentleman went on to suggest that we who are on the L.C.C. are very much over-worked. I have held most offices in that Council, including the chairmanship of the Council, but nevertheless I have been able all the time to carry on a hospital and consultant practice as a doctor. No, we work hard but we do our work easily because we have an excellent machine, and I do not think any individual who takes office on the London County Council as a member should regard himself as unable to deal with his duties efficiently.

I object to this Amendment mainly for this reason: that instead of being three health authorities in London, there would be four. Let me take maternity, for example. Under the Bill, maternity, as regards its hospital side, would be dealt with by the Regional Hospital Board; in regard to the care of the mothers in their own homes by the general practitioner, and under the authority in charge of that service. Under the Amendment, however, what would happen would be that the midwife employed by the L.C.C., who would deal with the mother during the birth of her child, would not be under the authority of the Committee that deals with the ante-natal and also the post-natal care of that same woman. I think that would be a very great disadvantage.

It would not matter so much, or at any rate, one could regard this Amendment as intelligible, if under it all the health functions were to be transferred to the metropolitan borough council. But that is not the case. A great many of them are still to be left with the London County Council. For my sins, or otherwise, for the last 16 years I have been a member of the Hospitals and Medical Services Committee of the London County Council, which deals with some of the health functions of London, whereas some are dealt with by the metropolitan boroughs. Through practical experience, I have learned the difficulties which may arise. In cases where a health function, such as vaccination, is dealt with only by the metropolitan boroughs, all is well, but in other cases where the function is divided, as for instance in the case of tuberculosis, all sorts of difficulties may occur. I quite agree that there is every possible attempt at good will between the two authorities, but all sorts of difficulties arise because there are two authorities dealing with the same subject. For instance, the London County Council has had to pay some of the costs of the dispensaries for tuberculosis, and is, therefore, interested in them. A claim comes from a borough for an X-ray apparatus. There may be an excellent apparatus in a London County Council hospital round the corner, and the question arises as to whether that X-ray apparatus shall be provided, or not. That is bound to give rise to difficulties between the two authorities. Whatever we do, do not let us increase the authorities, which are already quite numerous enough under this Bill.

Under the Bill, and no one suggests that the Amendment would change it, the London County Council is to be the authority for health centres. It has to provide them. I know it is the Minister's desire that as many doctors as possible should see their patients in the health centres, and I am in entire agreement with that, if the doctors are willing so to do. One of the objects of getting the doctors to work in the health centres is to associate them as closely as possible with preventive services. In the past we have had doctors who were treating declared disease only and had nothing to do with prevention. I am sure it is in the Minister's mind to associate all the doctors in the new health service with the prevention of disease. One way to do that is to get them to work in health centres where preventive services are being carried out, and to get them to work in the closest possible contact with the health visitors, maternity and child welfare clinics, home nursing services, etc. And yet this Amendment wants to put these services under the borough councils which would have nothing to do with the health centres. To make this state of affairs even more difficult than it would be, the Amendment suggests that, so far from these services being closely associated with and worked through health centres, the authorities in charge should have the power to provide and maintain premises for the services. The Amendment therefore would separate much more than should be separated, and much more than is necessary, the preventive and curative sides of the treatment of disease. I was very glad to hear the Parliamentary Secretary say that the Government do not intend to agree with this Amendment.

Mr. Howard (Westminster, St. George's)

I regret that the Government should be asking the House to reject this Amendment. I express this regret not only on my own behalf with some knowledge of the health services of London, but on behalf of the citizens of Westminster as a whole. I have been requested by the authorities to do what can be done to get this position reversed, even at this late hour, and I would be neglecting my duty to my constituents if I failed to do so. I particularly regret that the present Parliamentary Secretary, of all people, should be asking the House to take this line today. I remember, as many others must remember, who have had a long association with London metropolitan government, the noble fights he has put up for the metropolitan boroughs on many occasions. I fully understand the reasons why he is in a different sphere now, and I have congratulated him on that. But it is very regrettable to find that the man who fought battles so nobly on one side, is now trying to find arguments which run entirely counter to those he put forward not very long ago.

I think it is also unfortunate that in his reference to the services which have been, and are still being, provided—as far as they are permitted7—by the metropolitan boroughs, he should use the phrase that some of them were "quite good." I think that, on reflection, he will admit that that was a little less than just, and that some of these services are at least as good as services in any other part of the country. I think he will agree that it was an understatement to say that some of them were "quite good."

The Parliamentary Secretary based practically all his arguments in support of the rejection of the Amendment on matters of administrative convenience. It may be that the arguments of administrative convenience lie on his side. But, this Bill is not coming forward for the benefit of administrators. It is coming forward for the benefit of the health of the people as a whole. The real point behind the Amendment is that it was considered that, in particular circumstances, the closest and most intimate administration was desired. In no part of his speech did the Parliamentary Secretary put forward a single argument to show that the individual nursing mother or child would get better service as a result of rejecting this Amendment. He referred to the provision in the Fourth Schedule, Part II. I think he probably advanced these arguments with his tongue in his cheek. It is very well to say that we are providing in a Schedule for powers of joint consultation between different people, but we are also providing in the Bill that under no circumstances shall those people have any power to carry out the work. As the whole point of the Amendment is to secure powers of delegation, it is something of a red herring suggesting that because powers of consultation are obtained it is ridiculous to suggest that there should be any powers of delegation. I do not intend to go over all the ground of the merits of this Amendment, but I maintain that delegation of these particular services is desirable in the interests of those for whom they are designed.

5.30 p.m.

Mr. Goodrich

Listening to the hon. Member for St. George's (Mr. Howard), I came to the conclusion that he objected to the Government's objections to this Amendment because of his fear that the citizens will not get the same service as they have always had under the present system. I have been a member of the L.C.C., and I was vice-chairman of the Metropolitan Boroughs Standing Committee, serving with the Parliamentary Secretary. In addition to that, as chairman of the largest municipal hospital in London, I knew just what happened, and the amount of midwifery and of welfare work that was and is being done in that hospital. In my 21 years' association with that hospital, I never heard one complaint with regard to the service. There were many suggestions brought to to me, as a member of the L.C.C., which were forwarded to County Hall, and dealt with by the appropriate committee there. In like manner, all other persons in need of treatment, who wanted to contact their representatives, had exactly the same privilege and power as they have even at this day. I do not feel that that fear of non-contact between the patient and the representative, whoever he or she may be, is a justification for asking the Government to withdraw their objection.

The other point I wish to make is this: It is not easy for one to sit on these benches and hear accusations made against one's colleagues when one knows perfectly well that they are untrue. The answer given by the Parliamentary Secretary was perfectly correct. He did speak for the Metropolitan Boroughs Standing Joint Committee on that particular occasion, and he was voicing the opinions of the majority members of that Committee. But it does not necessarily follow that he was in favour. I leave the House to make its own mind up on this issue, when I say that he did his job exceedingly well, but that it was not his proposition. As vice-chairman on that particular occasion, and as one who had gone on that deputation, I knew precisely what his views were but his views were withheld in favour of the decision of the Standing Joint Committee.

Mr. Keeling (Twickenham)

As the hon. Member was vice-chairman, could he say whether the Parliamentary Secretary, in fact, tried to persuade his colleagues on the Metropolitan Boroughs Standing Joint Committee to adopt the view he had previously held, or not?

Mr. Goodrich

I hope that I shall not be drawn into answering that question. The hon. Member for Twickenham (Mr. Keeling) knows quite well what goes on at the Metropolitan Boroughs Standing joint Committee. He knows there is a party system there, and he knows how the party whip operates, and the fact that the Parliamentary Secretary was at that time chairman of the committee meant that he was asked to do something which, as has already been said, he did exceedingly well.

I am convinced, at this stage, although I was not convinced at first, that it would be better for the maternity and child welfare services to be administered by the London County Council, in order that the services shall be carried out and the financial arrangements, as explained, should be suitable for all purposes.

Mr. Marlowe (Brighton)

As one who is in no way connected with any metropolitan borough, and has never been connected with the L.C.C., I am perhaps able to take a more detached view of this matter than others who have spoken in this Debate. I feel that the Government's objection must be opposed, because although the Parliamentary Secretary made a formidable speech on the ground of administrative convenience, that is not the only thing with which one is concerned in a national health service. It was an extremely strong case on the ground of administrative convenience, and if that were the only issue, I should support him. But there is a good deal more in this Bill, and particularly in this Amendment, than that. The Parliamentary Secretary made his case in three ways. First, he said that this would create a dichotomy, and would cut across the L.C.C. and the metropolitan boroughs; secondly, that it would be too expensive for the metropolitan boroughs; and thirdly, he asked, more than once, what was the justification for this Amendment? I think that that fairly summarises the case put by the Parliamentary Secretary.

So far as the first point is concerned, it is really no argument against accepting this Amendment. If one believes in the principle of delegation to local authorities, the answer to that argument is not to create one set of conditions for the bigger authority and another for the lesser, and then say that we cannot have them cutting across each other. The answer is to dele- gate still more to the local authority. Some of us are concerned to see—and this applies not only to the metropolitan boroughs—an alarming tendency to remove more and more powers from the local authority. One becomes increasingly concerned about it. Therefore I cannot see that the argument that the L.C.C. have certain functions to do has any force at all. The answer is to take away those functions from the L.C.C. and delegate them to the local authorities.

Mr. H. Hynd (Hackney, Central)

Is the hon. and learned Member seriously suggesting that each of the metropolitan boroughs should have one of the first-class hospitals of the L.C.C.?

Mr. Marlowe

Really, the hon. Member must know that I am not suggesting that at all. There is no reason why the metropolitan boroughs should not exercise certain functions and share hospitals with other boroughs.

The Parliamentary Secretary's second point was on the ground of expense. He knows the degree of support which this Amendment has among the metropolitan boroughs. It is for them to decide what expense they can undertake and what they cannot. His argument is not a sufficient answer, because if the Parliamentary Secretary is in sympathy with the general sense of the Amendment, he knows perfectly well that that point could be met by providing that a higher percentage of the cost should be paid by the L.C.C. than the 50 per cent. suggested in the Amendment. If the general sense of the Amendment were accepted, there would be no difficulty over that.

The Parliamentary Secretary's third point—one that be put more than once to those who support this Amendment—was "What was the justification for it?" In circumstances like these it is, of course, not for us to show the justification; it is for him, who is creating the new state of things, to justify his case. But I am perfectly prepared to accept his challenge and to justify it, on one ground, and one ground alone. It is that the whole purpose of this Bill is to do good for the individual. The hon. Gentleman is creating by the Bill, as he would have it, a vast organisation responsible for millions of people in the London County Council area. I cannot help feeling that that area contains too many people to have the necessary contact between the authority and the individual. Hon. Members opposite have referred to the discharge of their functions as members of the London County Council. I entirely accept what they say, but that is not the point. The point is that the individual has to deal not with a member of the London County Council but with an official. It is a far more intimate and personal matter, in the service with which we are concerned, if one is able to go to someone at the local town hall rather than to County Hall. Another justification which I can put forward to the Parliamentary Secretary is that this is a humanitarian Measure and that in a matter of this kind one should avoid, as far as possible, the use of large units and should break down the organisation into units as small and convenient as possible. The Parliamentary Secretary made a perfectly good case on the question of administrative convenience If the matter rested there, I should be on his side, but the humanitarian issue convinces me that he is wrong and that we ought to accept this Amendment.

Mr. Sparks (Acton)

I am very pleased to have the opportunity of supporting my right hon. Friend in asking the House to reject this proposition from the other place. I support him largely because he could not advise or ask us logically or practically to take any other course of action. The argument put forward by hon. Members opposite is entirely out of date. They assume that one can argue only on a restricted basis that this Amendment should be confined solely to the County of London area and seem to forget that they are including only a part of London. They leave completely outside the ambit of their argument that part of London which is known as Middlesex. To adopt the idea that London is restricted to the County of London boundaries is fallacious — it stretches far beyond the circumference of the County of London boundaries.

Mr. Keeling

Was not that equally true when the Parliamentary Secretary accepted the proposal?

Mr. Sparks

I think things have moved a little bit since those days. I represent a constituency in Middlesex which has very up-to-date services. We regret very much that we shall lose them to the County Council but we believe that by centralising the responsibility for these services with the county councils throughout the country it will result in an improved standard in the rural areas where these services are badly needed. Although we regret the passing of 50 per cent. of our public health functions, we shall not adopt a dog in the manger attitude and try to prevent others. by better administration, from being uplifted and enjoying a higher standard of service. At the same time, I believe my right hon. Friend will have to watch very closely some county councils. I have the utmost confidence in the London County Council and I know they will be as progressive in the administration of this Measure as any of the metropolitan districts. I am concerned that my right hon. Friend should see that the very high standard of service already administered by county district councils shall not deteriorate as a result of the transference of control. If my right hon. Friend replies to this discussion, I ask him to give us a little more information about this. The Measure provides for the local health authority, which is the county, to delegate some of the functions, such as the care of mothers and young children, health visiting, and home nursing, to voluntary organisation. We feel a little sore that some of these services are to be delegated or, at least, placed in the control of voluntary organisations and withdrawn from our control. I suppose my right hon. Friend has a good argument to advance in support of that and I hope he will tell us what is in his mind. I also ask him to explain further in regard to linking up the county district councils with the county council in the administration of these services. I am not clear whether he said it was the intention—

Mr. Keeling

On a point of Order. Surely the hon. Member is aware that there are no district councils in the metropolitan area to which alone this Amendment refers?

Mr. Sparks

I am aware of that, Mr. Deputy-Speaker, but obviously it will follow under the terms of this Bill that there will be some connection.

Mr. Keeling

Not under this Amendment.

5.45 P.m.

Mr. Sparks

The Parliamentary Secretary, in opening the Debate on this matter, said that there would be some provision for bringing the borough councils into this scheme in conjunction with the county council. I am anxious to find out on what basis it is proposed to operate. I may be wrong, but I understood the Parliamentary Secretary to say that local authorities and other bodies will have an opportunity of taking part in the work of these county health committees. What I am anxious to know is whether my right hon. Friend proposes to co-opt members to these county health committees or whether he will consider giving to the borough councils an opportunity of electing representatives themselves to serve upon them, thereby preserving that little connection between the borough council and the local health authority in carrying out this function. I believe that the borough council, and even the county district council, can help very considerably the county councils in carrying out this job. If there could be some degree of clarity as to whether the Minister has in mind asking the borough councils to elect a proportionate number of their members to serve upon the committees of the county council, or whether he proposes that there should be co-opted membership from the local organisations to serve on the county council health committees, it would be helpful. I think this is most important. It is important to try to link up in London the borough councils, and in the country the county district councils, in a direct way with the work of these services. I think it will redound to the interests of the locality itself and it will help to make this Bill as perfect, competent and efficient as we all hope that it will be.

Mr. Henry Strauss (Combined English Universities)

I share the regrets which have been expressed from so many quarters that the right hon. Gentleman has decided not to recommend the House to accept the Lords Amendment on this point. We pressed him strongly during earlier stages but the arguments which we advanced were reinforced in another place by some who have great experience of local government in London. I think the case for the Amendment is very strong indeed. I assure the right hon. Gentleman that I wish to be brief and, therefore, I call attention to two or three points which strike me as very important. I put in the very forefront the point which I feel most important of all and which has scarcely been mentioned. What do the people of London, living within the area of the L.C.C., desire? That is, of course, a matter on which we can all draw our own conclusions, and I do not suppose that it is susceptible of absolute proof, but, speaking for the district in which I live and from conversations which I have had, I believe that the desire of the people of London who live within the area of the L.C.C. is overwhelmingly in favour of these services remaining where they now are. They would rather, when they have to go to see an official, go to some place in their own borough, and not to County Hall or anywhere else not so familiar to them. I do not say that I very often go either to my own town hall or to County Hall, and I am, I hope, on good terms with those in both places. I am not going to say anything against the London County Council where it is exercising its proper functions, but there is no doubt whatever that the people of London regard their own town hall far more intimately than County Hall, and it is also very much more convenient for them to go there in respect of those services that are rather intimately connected with their daily lives.

The argument of the convenience of the people is very strong, but what about the wishes of the metropolitan boroughs themselves? Those boroughs which have passed resolutions have passed them in favour of retaining these powers quite irrespective of whether they happen to have a Tory majority or a Labour majority. Their opinion reflects the wishes of their constituents, and it is the same opinion, reflecting the convenience and the wishes of their constituents, whether they are Socialist councils or Tory councils. I say, therefore, that the people of London wish this Amendment to succeed.

My second point concerns the question of efficiency. Why on earth should it be supposed that the London County Council, which has never exercised these functions, will exercise them more efficiently than the metropolitan boroughs; which have hitherto exercised them, and, by the admission of the Ministers themselves, have, on the whole, exercised them well? On the argument of efficiency, apart from administrative convenience, there has not been a single valid argument advanced to negative the suggestion that the argument Of efficiency is in favour of the Amendment and not in favour of the Government's view.

The third point that I wish to make is that of the influence of this proposal on local government. It will affect the willingness of good citizens to serve on the metropolitan boroughs if some of their most important functions, which attract some of the best people to serve the boroughs, are taken away without any reason. The right hon. Gentleman, when this matter was last before the House, mentioned the fact that London government was in a state of flux, and that various changes were taking place and would take place in future. In so far as that statement is correct, it seems to me to be an overwhelming argument against the view he is now taking. If the government of London is in such a state of flux, why is there this attempt, on a side issue, to murder the metropolitan boroughs? [Laughter.] I do not know why that should cause amusement. The Parliamentary Secretary, I think, by way of showing that there would be some coordination between the L.C.C. and the boroughs, even if this Amendment were rejected, mentioned Part II of the Fourth Schedule, and I suppose that what he had in mind were the provisions of paragraph (6), which may make it possible for some sub-committee of the L.C.C., if the L.C.C. so wish, to have some representatives of the metropolitan boroughs upon it. I do not think it is seriously suggested that this is an adequate substitute for the powers which they have hitherto exercised and which this Amendment seeks that they should retain.

On the personal question of the Parliamentary Secretary, I would only say that I have always myself held, and I hold today, a high view of the character and abilities of the Parliamentary Secretary. The only thing that troubles me so much is the statements put forward by people who believe themselves to be his friends which always seem to me to cast so much doubt on his efficiency both now and in the past. I am not clear myself whether the hon. Gentleman, on the former occasion, was acting in a representative capacity or whether, in what he said today, he is acting in a representative capacity.

Mr. Key

Both.

Mr. Strauss

On both occasions, but, in neither case, apparently, are we allowed to know which are his true views.

Mr. Key

The true views of Charlie Key do not count in this; it is the proposal that matters.

Mr. Strauss

We should be very much interested to know the hon. Gentleman's views. He has had considerable experience both of local government and of national Government, and he has put forward, in the two capacities, opposite views. It would give me great pleasure to know in which of these the hon. Gentleman really believed. My own view of this purely personal question is that an hon. Member may sometimes speak in a representative capacity, but when he does so, he should make that fact clear. To sum up, I say, first, that the scheme embodied in this Amendment is that desired by the overwhelming majority of people living within the area of the L.C.C., whether they are Socialists or Tories or have no party at all. Secondly, I say that, on the argument of efficiency, we know that the metropolitan boroughs have discharged well the functions they have hitherto held and we have no reason to think that the L.C.C., which has no experience of them, will do any better. Thirdly, I say that we have no right, on a side issue, to make so vital a change in the whole future of local government. For these reasons, I hope that, when we come to a division, hon. Members, no matter to what party they belong, will vote upon this question on the merits.

Mr. Eric Fletcher (Islington, East)

May I reply to the three points which have been put by the hon. and learned Gentleman the Member for the Combined English Universities (Mr. Henry Strauss) in support of the view that the House should agree with this Amendment? Before dealing with those points, may I say that I was very sorry that the hon. and learned Member, at the end of his speech repeated what I regard as an entirely unfair attack on the Parliamentary Secretary? I think that any hon. Members who sits on this side of the House must realise that the conditions which existed in 1944, when the Parliamentary Secretary was chairman of the Metropolitan Boroughs Standing Joint Committee and when fie expressed certain views—whether in a representative capacity or not matters not the slightest —were conditions quite different from those of today. In those days, under the scheme propounded in the White Paper, it was contemplated that the London County Council would be the regional health authority for London, owning hospitals and having to provide all other kinds of health services, and, therefore, necessarily having to delegate some of those health services for which it was regionally responsible. What was more natural or more fitting than that it should delegate to the metropolitan borough councils some of the functions which, indeed, they had been performing for a number of years? But today the situation is entirely different. London is part of a region—or, for all I know, it may be a part of several regions which will radiate radially from London. The London County Council is a local health authority. Although it is no longer responsible for the hospital services, it is responsible for a great deal of other matters affecting the health and wellbeing of the people of London. Those services will have to be organised on the basis of local health centres, and the essential matter in considering the merits of this Amendment proposed in another place—the real test that hon. Members ought to apply—is which scheme is best and most likely to produce the best results for the citizens of London.

6.0 p.m.

This House has already expressed itself once on that subject after a very full Debate The hon. Member asks what the people of London wish in the matter. He goes on to admit that he has not the slightest means of finding out what they wish. But one thing is certain—I speak as a member of the London County Council, of which body I have had the honour to be a member for several years —they have expressed their view about it. It is not so very long ago—at the L.C.C. elections of March last—that that body was elected. We know what the views of the democratically elected representatives of the people of London are on this subject, and they are entitled to be heard with respect. They are against the proposed Amendment. Everybody has sympathy with the metropolitan borough councils in losing the maternity and child welfare services which they have built up with such success during the last 25 years or more and for which they have just reason to be proud.

The right hon. Gentleman the Member for South Kensington (Mr. Law) referred to the Borough of Kensington and gave figures showing the improvements that have taken place in child welfare and the reduction in the mortality rate. My own Borough of Islington yields to none in the success it has achieved in this field. I know from my own intimate association with Islington for a great number of years what a loss it is to that council to give up these powers. It is not, unfortunately, the case that every one of the 28 boroughs in London can point to the same efficiency and the same excellent standard which has been attained in Islington, and, I have no doubt, Kensington and elsewhere. One of the troubles about this subject is that there are 28 boroughs in London of very unequal size, both as regards area and population. In the nature of things, it follows that some are not as efficient as others, although the general standard is very high. But the real question that arises on this Amendment is whether these services are now to be organised on a rational basis in London, under a scheme to be prepared by the London County Council, or whether we are going to distribute them among the 28 boroughs. That is the issue which has to be faced, regardless of sentiment and regardless of the justifiable pride which borough councils have had in their maternity and child welfare services.

Everybody knows that the logical practical method of organising these services in London—'which is not unlike the way education services are organised, again by the London County Council, and the educational services call for just as much intimate association with the people of London as the health service—is through some eight or nine areas. I am confident that, under the scheme which the London County Council will propound in due course, many of those people, who for a long period have been intimately associated with the task of administering the child welfare and maternity centres in London, will have the same opportunity for and the same interest in carrying on the work which they have been doing in the past.

That brings me to the last point on which the hon. and learned Member criticised this Bill. He asked what influence it would have on local government in London. In my last few remarks, I have dealt with the question of efficiency. I now wish to address a remark to my right hon. Friend who is going to reply. The circumstances in which we are discussing this matter today are different from the circumstances in which we discussed it when it was last before the House because, during the interval, my right hon. Friend, in a recent answer given to the hon. Member for Kennington (Mr. Gibson), announced that the Reading Committee, which was concerning itself with the problem of London Government, had been relieved of its responsibilities owing, I gather, to the very limited terms of reference under which it was appointed by the right hon. Gentleman the Minister of Health in the Coalition Government. The Reading Committee was doomed to sterility in any event. However, in my opinion, that does not render it less necessary or less urgent that my right hon. Friend the Minister of Health should take the earliest possible opportunity of dealing with the problem, not only of London government, but also, as he has already pointed out in another connection, with the problem of Greater London government. In view of the fact that that problem has to be dealt with anyhow, and will, I hope, be dealt with in the near future, the right course in considering how now to deal with these health services is, surely, not to perpetuate a system —however well it has served in the past —to which changes must inevitably come, but to deal with the health services on their merits as a whole, and to entrust them, as this House has already decided, to the local health authority for London, namely the L.C.C., relying upon the provisions which will enable those powers to be administered by areas in cooperation with representatives of the metropolitan borough councils.

Mr. Bevan

I think the House will agree that we have had a fairly long discussion on this matter and, also, that we have heard nothing new about it. Indeed, we had been going on in very amiable mood until we started this discussion and, therefore, I very much regret that the right hon. Gentleman the Member for South Kensington (Mr. Law) should have introduced a note of acerbity by making references to my hon. Friend the Parliamentary Secretary. We have heard those before. I thought he was going to think up something new, but evidently the right hon. Gentleman's irascibility has not increased his inventive genius. As I say, we have heard the same speech so often before The right hon. Gentleman and hon. Members opposite will pardon me if I am somewhat controversial, but it is they who have started it this evening.

In the first place, what has the agreement which was reached between the metropolitan boroughs and the County Council got to do with this issue? It has nothing at all to do with it. If my hon. Friend the Parliamentary Secretary has departed from the agreement, so have hon. Members opposite. If my hon. Friend is to be charged with lack of integrity because he departs from his position, I must point out that hon. Members opposite have departed from theirs. This document which I have in my hand is not the agreement reached between the London County Council and the metropolitan boroughs. Why is it different? Because the Bill is different. Why does my hon. Friend now take a different attitude? For the same reason—because the Bill is different. Why should hon. Members opposite say that the new text should be regarded as dishonesty on the part of my hon. Friend? Hon. Members are not thinking very clearly about this subject. They are supporting a proposition of an entirely different kind. I do not blame anybody, because it is different. It is different because the scheme now before the House with respect to the health services is radically different from the scheme that my predecessor had to put before the metropolitan boroughs and the London County Council. Therefore, hon. Members opposite and my hon. Friend have shown a reasonable clarity in adapting themselves to the different circumstances. Let us get away from that absurdity.

Mr. Law

I do not want to add to any exacerbation there may be. Of course, the hon. Gentleman or anybody else is entitled to change his mind in altered circumstances. What I animadverted on this afternoon was not so much the fact that the hon. Gentleman had changed his mind, as the reason he gave for his change of attitude. The reason was not that he had changed his mind, but that he had not changed his mind. Therefore, on a previous occasion he was arguing something in which he did not believe.

Mr. Bevan

The right hon. Gentleman, and, with respect, the hon. and learned Member for the Combined English Universities (Mr. H. Strauss), ought to realise that the House of Commons is not a confessional. What we are expected to do at this Box or in any part of the House is to put forward what we consider to be sound reasons for the proposition that we are supporting. We are not giving testimony; we are not unburdening our souls; we are not alienists.

Mr. W. J. Brown (Rugby)

We are not saved.

Mr. Bevan

Not yet, but the hon. Gentleman need not despair. There is hope for him yet. Therefore, this attempt at probing the psychological processes of my hon. Friend has no relevance to this discussion. I would like to point out that the alteration which is proposed by the Amendment gives rise to as many anomalies as it seeks to correct. One of the difficulties facing any Minister in entrusting any task to a particular category of local authority in the present structure of local government is that anomalies are bound to exist. There are in this country some rural councils with very large urban populations. There are some urban councils with very large agricultural areas. There are ancient and proud boroughs which are hardly bigger than hamlets. Therefore, when one picks a particular category of local authority and says, "It is to that category that we shall entrust a particular function," it must inevitably follow that a whole series of anomalies will arise. It is obvious to everyone who has looked at this problem that before very long we shall have to face a further overhaul of local government structure. Let us take, for example, Harrow in the county of Middlesex. It has a population of 211,000. But that does not wring the withers of hon. Members opposite. These functions are to be entrusted to the Middlesex County Council, but nobody says a word for Harrow. Yet hon. Members are speechless with indignation about Holborn with a population of something over 22,000. With regard to the proposition which is before us at the moment, in dealing with the anomaly of having a large aggregation of population in London—

6.15 p.m.

Sir H. Lucas-Tooth

On a point of Order. May I ask if the right hon. Gentleman is in Order in going into this? I could have made a speech embodying this point, but I apprehend that had I done so, you would have ruled me out of Order. Mr. Deputy-Speaker.

Mr. Deputy-Speaker (Major Milner)

I think the Minister is in Order.

Mr. Bevan

If hon. Members wish me to be directly pertinent, what about the City of London with a population of 4,490? I do not blame the devisers of this proposed scheme, but, because of the very nature of local government in London, they find themselves faced with exactly the same anomalies as those with which I meet in the country as a whole. By selecting the metropolitan borough as a unit to which to entrust the health services, they have the anomalous position of entrusting them to the City of London with a population of 4,490. In other words, the fault is not in us; it is in our stars. Wherever the anomalies or difficulties arise, they do not arise out of the scheme. They arise out of the fact that in selecting a particular category of local authority we are bound to have anomalies. This scheme which is before us at the moment is as open to objection on that ground alone, apart from the others, as is the general scheme itself. Therefore, I hope hon. Members will not press the point.

Concerning accessibility of the local authority to the population, I attach the utmost importance to this point. I believe that the local authority ought to be capable of being approached by the citizens, but if, in the future, a citizen has any difficulty about his health he will go to the health centre and not to the town hall. He will get medical treatment not at the town hall, but at the health centre. He will not consult the officials at the municipal buildings. He is going where clinical facilities are available, at the health centre. Hon. Members have forgotten the health centre, which is a very essential part of these proposals. Under this proposed scheme, the metropolitan boroughs would be encouraged to have buildings of their own in which they would give certain health services, and alongside in another building the L.C.C. would provide other services. That would not only be bad administration; it would be bad for the citizens. They ought to be able to get their wants attended to at the same place by the same organisation; they should not have to go to one building to have their teeth photographed or X-rayed, and to another building to have them extracted. This is what hon. Gentlemen opposite call good administration. The fact is, they have not looked at this matter closely at all.

These schemes have been carefully devised and carefully integrated, and I beg and pray of the House at this stage not to make a radical alteration like this. Frankly, I am not impressed by the concern expressed by certain institutions over the representative character of the metropolitan borough. I would be moved it the House of Commons were concerned about the representative character of the institutions to which we are entrusting these services; but when a non-elected chamber calls attention to it I feel slightly ironical. We have proceeded very far in this matter; we have made certain alterations, and I had hoped that the spirit in which those alterations had been made would have allowed us to have made far more progress than we have done in this matter. In all the circumstances, I am bound to resist it and to ask the House, if they could, to give a unanimous rejection.

Several Hon. Members

rose—

Mr. Deputy-Speaker

I hope the House is now willing to come to a decision.

Mr. J. H. Hare (Woodbridge)

I am sorry to take up the time of the House, Mr. Deputy-Speaker. A number of statements were made by hon. Members opposite which were all in the same tune—the tune of the necessity of rejecting this Amendment because it would be administratively impossible to accept it. I had hoped the Minister would have realised there was a certain monotony in that argument put forward by his own supporters, and I had hoped that he would have given us some human argument why this Amendment should be rejected. It is on human grounds that we suggest that the taking away of these services from the boroughs and handing them over to the L.C.C., should be opposed. Why is it that every proposal which the Government put forward is proceeded with, as long as it looks good on paper, without reference to the people whose lives will be affected by the proposal? More and more, in all types of legislation, we are beginning to see that from day to day—As long as a thing is tidy on paper let us proceed with it."

This is the most human of all the matters with which we deal in this House. Take maternity and child welfare alone. To whatever political party we belong, we must agree that the administration of those services should be as personal and as intimate as possible. There is no question but that the people of London would agree with what my hon. and learned Friend the Member for the Combined English Universities (Mr. H. Strauss) has said. The hon. Member for East Islington (Mr. E. Fletcher) said that in the last L.C.C. election, this issue was raised, and the people of London knew about it. [HON. MEMBERS: No."] That is not true at all.

Mr. E. Fletcher

The hon. Member must not misquote me. I did not say anything of the kind. What I said was that the London County Council was an elected body, elected by the people of London, and that their elected representatives were at least as likely to know what the people of London wanted as the hon. and learned Member for the Combined English Universities (Mr. H. Strauss).

Mr. Hare

The hon. Member definitely led the House to believe that the people of London had so recently given a mandate to their representatives, that they would have approved this action. However that may be, that again is typical of the type of argument to which we have had to listen from the other side of the House. [Laughter] I say to the hon. Members who are laughing: What is wrong with these services as we now have them? Nobody in this House has raised his voice to say that they are administered in any but an excellent way. What are we proposing to do by rejecting this Amendment? We are proposing to try out a new system, a system of which we have no previous knowledge, and we are going to abandon a system which we know works. That is, in fact, what we are going to do. Surely it is a matter of common agreement that the town hall—perhaps more especially as the result of the war—has become in England a centre to which the ordinary individual likes to go with his troubles and cares. That is a submission which I suggest is a true one. People know that at the town hall they will find, not only the borough officials but also their elected representatives; they can put their troubles to them, and those troubles can be dealt with in that way. [Interruption.] Again hon. Members seem to disapprove of that, but I am willing to guarantee that in their constituencies the people will echo every word I say.

I also agreed with my hon. and learned Fried the Member for the Combined English Universities that refusal to accept the Amendment would be a grave disaster to local government. I am certain he is entirely correct in that view. I am certain that if hon. Members went to borough councils in London they would find that, irrespective of party, in their heart of hearts the councils strongly fear the result of the removal of these services to their status as boroughs, and to the service they can give to their fellow citizens. This is a mortal blow to London borough government, and that is something which cannot be laughed at, or got round. I feel the Government are making a big mistake in yielding, as they are, to the god of administrative efficiency, and failing to consider the human feelings of ordinary people.

Vice-Admiral Taylor (Paddington, South)

As I represent a London borough I propose to detain the House for a short time, in view of the fact, of which I am convinced, that the great mass of the population in all these boroughs desire to have the maternity and child welfare services carried out by the borough authorities in close association with them, easy of approach, at a place to which they are accustomed to go with their troubles, rather than having the services under the remote control of the London County Council, whose officials are completely out of touch with the people in the borough. Hon. Members opposite say, "Oh well, we are representatives of the London County Council. They come to see us." That has nothing to do with it at all. The people want to go to the borough authorities, to the authorities who administer the maternity and child welfare services. I know they would be delighted to go to the London County Council representative as well, but it is chiefly the people who administer these services whom they want to see. I endorse the very strong argument put forward by my hon. and right hon. Friends. I regret very much that the Government have decided to reject this Amendment. In my view, the case should be decided, not as was said by the Parliamentary Secretary, the gist of whose argument was that because of administrative difficulties—

Mr. Key

indicated dissent.

Vice-Admiral Taylor

The hon. Gentleman shakes his head, but that was my impression, and I think the impression of most hon. Members. Of course, he has changed his views. I do not deny that at all.

Mr. Key

What, again?

6.30 p.m.

Vice-Admiral Taylor

In my opinion, that is not the basis on which this Amendment should be decided. It should be decided entirely on what procedure will render the most efficient services to the individual in the borough. There has not been a single argument put forward from the Government benches to show why the London County Council will give greater efficiency in their services than the people get at present under the borough councils. Moreover, not one word has been said to suggest that these services carried out by borough councils have not been extremely proficient. Of course, some are better than others. Can anybody suggest any service in which some people do not do things better than others? But, in general, the services have been extremely well carried out, so far as maternity and child welfare are concerned—

Mr. Messer (Tottenham, South)

May I ask the hon. and gallant Member a question? He is referring to maternity and child welfare. Does he not know that maternity and child welfare goes to the divisional executives under the Education Act?

Vice-Admiral Taylor

I am extremely sorry, but I really could not hear what the hon. Member said.

Mr. Messer

I wanted to know, seeing that the hon. and gallant Member was referring to maternity and child welfare, whether he knows that maternity and child welfare will be dealt with by the divisional executives under the Education Act.

Vice-Admiral Taylor

That may or it may not be so, but that is not the point at all. My whole argument is that maternity and child welfare services are essentially personal services and as such should be carried out by the borough council which is in the closest personal touch with the people in the borough. It is on those grounds that I support the Amendment, and I hope that the Government will change their mind, and that the Parliamentary Secretary will change his mind, as regards this Amendment. There is one other point. I take it that it is an acknowledged fact that for really efficient administration one cannot have

an area of more than a certain size. In this case the London County Council is to have the administration of an enormous area with millions of people in it, and it is quite impossible for the L.C.C. to carry out its administration as efficiently as the borough councils can administer the smaller areas. For these reasons I shall support this Amendment, and I very much regret that the Government should reject it.

Question put. "That this House doth disagree with the Lords in the said Amendment."

The House divided: Ayes, 296; Noes, 134.

Middleton, Mrs. L.	Rankin, J.	Thomas, I. O. (Wrekin)
Mikardo, Ian	Rees-Williams, D. R.	Thomas, John R. (Dover)
Millington, Wing-Comdr. E. R.	Reeves, J.	Thomas, George (Cardiff)
Mitchison, Maj. G. R.	Reid, T. (Swindon)	Thorneycroft, Harry (Clayton)
Monslow, W.	Ridealgh, Mrs. M.	Thurtle, E.
Montague, F.	Robens, A.	Tiffany, S.
Moody, A. S.	Roberts, Emrys (Merioneth)	Titterington, M. F.
Morgan, Dr. H. B.	Roberts, Goronwy (Caernarvonshire)	Tolley, L.
Morley, R.	Rogers, G. H. R.	Tomlinson, Rt. Hon. G.
Morris, Lt.-Col. H. (Sheffield, C.)	Scollan, T.	Turner-Samuels, M.
Morris, P. (Swansea, W.)	Scott-Elliot, W.	Ungoed-Thomas, L.
Morris, Hopkin (Carmarthen)	Segal, Dr. S.	Vernon, Maj. W. F.
Moyle, A.	Shackleton, Wing-Cdr. E. A. A.	Viant, S. P.
Murray, J. D.	Sharp, Lt.-Col. G. M.	Wallace, G. D. (Chislehurst)
Nally, W.	Shawcross, C. N. (Widnes)	Wallace, H. W. (Walthamstow, E.)
Naylor, T. E.	Shinwell, Rt. Hon. E.	Warbey, W. N.
Neal, H. (Claycross)	Shurmer, P.	Watkins, T. E.
Nichol, Mrs. M. E. (Bradford, N.)	Silverman, J. (Erdington)	Webb, M. (Bradford, C.)
Nicholls, H. R. (Stratford)	Silverman, S. S. (Nelson)	Wells, W. T. (Walsall)
Noel-Buxton, Lady.	Simmons, C. J.	West, D. G.
O'Brien, T.	Skeffington, A. M.	White, H. (Derbyshire, N.E.)
Oldfield, W. H.	Skeffington-Lodge, T. C.	Whiteley, Rt. Hon. W.
Oliver, G. H.	Skinnard, F. W.	Wigg, Col. G. E.
Orbach, M.	Smith, C. (Colchester)	Wilcock, Group-Capt. C. A. B.
Palmer, A. M. F.	Smith, Ellis (Stoke)	Wilkins, W. A.
Parker, J.	Smith, H. N. (Nottingham, S.)	Willey, O. G. (Cleveland)
Parkin, B. T.	Smith, S. H. (Hull, S.W.)	Williams, D. J. (Neath)
Paton, Mrs. F. (Rushcliffe)	Snow, Capt. J. W.	Williams, J. L. (Kelvingrove)
Paton, J. (Norwich)	Solley, L. J.	Williams, W. R. (Heston)
Pearson, A.	Sorensen, R. W.	Williamson, T.
Pearl, Capt. T. F.	Soskice, Maj. Sir F.	Willis, E
Perrins, W.	Sparks, J. A	Wills, Mrs. E. A.
Platts-Mills, J. F. F.	Stamford, W.	Wilmot, Rt. Hon. J
Poole, Major Cecil (Lichfield)	Steele, T.	Wise, Major F. J.
Popplewell, E.	Stewart, Capt. Michael (Fulham, E.)	Woods, G. S.
Porter, E. (Warrington)	Stross, Dr. B.	Wyatt, W
Porter, G. (Leeds)	Stubbs, A. E.	Yates, V. F.
Pritt, D. N.	Summerskill, Dr. Edith	Zilliacus, K.
Proctor, W. T.	Swingler S.
Pursey, Cmdr. H.	Symonds, A. L.	TELLERS FOR THE AYES:
Randall, H. E.	Taylor, H. B. (Mansfield)	Mr. Joseph Henderson and Mr. Hannan.
Ranger, J.	Taylor, R. J. (Morpeth)

NOES.
Agnew, Cmdr. P. G.	Gomme-Duncan, Col. A. G.	Maude, J. C.
Amory, D. Heathcoat	Gridley, Sir A.	Medlicott, F.
Astor, Hon. M.	Grimston, R. V.	Mellor, Sir J.
Barlow, Sir J.	Hannon, Sir P. (Moseley)	Molson, A. H. E.
Beechman, N. A.	Hare, Hon. J. H. (Woodbridge)	Moore, Lt.-Col. Sir T.
Bennett, Sir P.	Harvey, Air-Comdre, A. V.	Morris-Jones, Sir H.
Birch, Nigel	Haughton, S. G.	Morrison, Maj. J. G. (Salisbury)
Boles, Lt.-Col. D. C. (Wells)	Head, Brig. A. H.	Morrison, Rt. Hon. W. S. (Cirencester)
Boothby, R.	Hinchingbrooke, Viscount	Mott-Radclyffe, Maj. C. E.
Bower, N.	Hollis, M. C.	Nicholson, G.
Boyd-Carpenter, J. A.	Holmes, Sir J. Stanley (Harwich)	Noble, Comdr. A. H. P.
Braithwaite, Lt.-Comdr. J. G.	Hope, Lord J.	Nutting, Anthony
Bromley-Davenport, Lt.-Col. W.	Howard, Hon. A.	O'Neill, Rt. Hon. Sir H.
Buchan-Hepburn, P. G. T.	Hudson, Rt. Hon. R. S. (Southport)	Orr-Ewing, I. L.
Bullock, Capt. M.	Hurd, A.	Peake, Rt. Hon. O.
Butler, Rt. Hon. R. A. (S'ffr'n W'ld'n)	Hutchison, Lt.-Cm. Clark (E'b'rgh, W.)	Peto, Brig. C. H. M.
Carson, E.	Hutchison, Col. J. R. (Glasgow, C.)	Pickthorn, K.
Challen, C.	Joynson-Hicks, Lt.-Cdr. Hon. L. W.	Pitman, I. J.
Clifton-Brown, Lt.-Col. G.	Kerr, Sir J. Graham	Ponsonby, Col. C. E.
Conant, Maj. R. J. E.	Lancaster, Col. C. G.	Poole, O. B. S. (Oswestry)
Corbett, Lieut.-Col. U. (Ludlow)	Law, Rt. Hon. R. K.	Prescott, Stanley
Crookshank, Capt. Rt. Hon. H. F. C.	Legge-Bourke, Maj. E. A. H.	Raikes, H. V.
Crowder, Capt. John E	Lennox-Boyd, A. T.	Rayner, Brig. R.
De la Bère, R.	Lipson, D. L.	Reed, Sir S. (Aylesbury)
Digby, S. W.	Low, Brig. A. R. W.	Reid, Rt. Hon. J. S. C. (Hillhead)
Dodds-Parker A. D.	Lucas, Major Sir J.	Renton, D.
Donner, Sqn.-Ldr. P. W.	Lucas-Tooth, Sir H.	Roberts, H. (Handsworth)
Dower, Lt.-Col. A. V. G. (Penrith)	Lyttelton, Rt. Hon. O.	Robertson, Sir D. (Streatham)
Drayson, G. B.	MacAndrew, Col. Sir C.	Ross, Sir R.
Eccles, D. M.	Macdonald, Sir P. (Isle of Wight)	Sanderson, Sir F.
Eden, Rt. Hon. A.	Mackeson, Brig. H. R.	Shepherd, W. S. (Bucklow)
Fleming, Sqn.-Ldr. E. L.	Maclay, Hon. J. S.	Smiles, Lt.-Col. Sir W.
Fletcher, W. (Bury)	Maclean, Brig. F. H. R. (Lancaster)	Smith, E. P. (Ashford)
Fraser, Sir I. (Lonsdale)	Macmillan, Rt. Hon. Harold (Bromley)	Snadden, W. M.
Fyfe, Rt. Hon. Sir D. P. M.	Maitland, Comdr. J. W.	Stanley, Rt. Hon. O.
Gage, C.	Manningham-Buller, R. E	Strauss, H. G. (English Universities)
Galbraith, Cmdr. T. D.	Marlowe, A. A. H.	Stuart, Rt. Hon. J. (Moray)
Gammans, L. D.	Marples, A. E.	Sutcliffe, H.
George, Maj. Rt. Hon. G. Lloyd (P'ke)	Marshall, D. (Bodmin)	Taylor, Vice-Adm. E. A. (P'dd't'n, S.)
Glossop, C. W. H.	Marshall, S. H. (Sutton)	Teeling, William

CLAUSE 20.—(Proposals for provision of services by local health authority.)

Lords Amendment: In page 19, line 25, at end, insert: and shall. not later than the day on which such recommendations are made, serve a copy thereof on the local health authority.

6.45 p.m.

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

It imposes on those people who send comments to the Minister upon the proposals of local health authorities—those bodies will be the regional hospital boards, voluntary organisations and so on—the obligation, when they send their comments to the Minister, to serve a notice also on the local authority, not later than the day on which the recommendations are made.

CLAUSE 23.—(Midwifery.)

Lords Amendment: In page 21, line 36, after "with", insert: Boards of Governors of teaching hospitals, Hospital Management Committees or

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

This and another Amendment enable the local health authority to make arrangements with hospitals for certified midwives.

CLAUSE 26.—(Vaccination and immunisation.)

Lords Amendment: In page 22, line 29, after "may", insert: with the approval of the Minister.

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

This remedies an accidental omission which it was necessary to correct because ministerial approval should be given to the extension of powers for vaccination and immunisation to other diseases besides smallpox and diphtheria.

CLAUSE 33.—(Arrangements for general medical services.)

Lords Amendment: In page 26, line 16, at end, insert: () The remuneration to medical practitioners undertaking to provide general medical services in pursuance of the provisions of this Act shall be fixed by the capitation method except in any cases where the Minister on the recommendation of the Medical Practices Committee considers that exceptional circumstances necessitate remuneration on a different basis.

6.45 p.m.

Mr. Bevan

I beg to move, "That this House doth disagree with the Lords in the said Amendment."

This is a topic which has been given a good deal of publicity and concerning which we have had a number of discussions both on the Floor of the House and when the Bill was in Committee. It gives rise to a lot of misunderstanding as to what is in the mind of the Government. I resist the Amendment because it is undesirable to have in the Bill, when it becomes an Act, the method of remuneration. It was never in the National Health Insurance Acts, it has never been in any other Act, and I believe it is unduly restrictive. Indeed, I think the profession itself is not enthusiastic about having it in, because every alteration of the basis of remuneration would need the passing of an amending Act of Parliament. It would be a departure from our usual procedure to put scales and methods of remuneration into a Statute. I have heard no arguments so far, either here or anywhere else, which justify this provision. There are arguments for and against having an element of basic salary in the remuneration of the general practitioner, but I have not yet heard an argument, and I should have listened eagerly to hear one, as to why we should at this moment put it in the Bill. Perhaps I shall hear one now, but whether it will be a sound one or not is another matter. I suggest at the outset that it is not desirable for future negotiations with the medical profession about their remuneration to start with a statutory inhibition. In this field, as in every other when we are dealing with remuneration, we ought to be free to have as much elbow room as possible in the negotiations. It would be extremely bad, if, in the course of negotiations, a point arose on which there could be mutual agreement, but which we could not implement without an Act of Parliament. Everyone knows that, in these days of congested Parliamentary menus, it would be very difficult to get Parliamentary time. I therefore seriously suggest to hon. Members in all parts of the House that, whatever their views about having a basic element in the remuneration, they ought not to insist upon its going into the Bill, but should leave it open.

However, I am not seeking to escape a discussion of the main issue. I am only seeking here to prevent us from being put into a statutory strait waistcoat. When we come to discuss the merits of the issue, I want to face them forthrightly. It has always been the contention of hon. Members on this side of the House that the doctor should have a certain degree of security. Remember that a doctor is starting in general practice fairly late, and that he has had a very long and expensive training. Very often, when he starts in general practice, he is already married. We are easing his burdens in one respect, because we are delivering him from the hands of the moneylender. He will no longer have to borrow money or serve long years of assistantship with a principal, before he can establish himself in a practice of his own. We have relieved him of that by abolishing the sale and purchase of practices. At the same time, we have not provided him with a positive means of livelihood. We have relieved him of the burden, but not at that stage enabled him to work.

Therefore, it was our intention that the young general practitioner should have a certain measure of security, and that he should start off his general practice in the area where the Medical Practices Committee says he may start, and whilst he is building up his practice, building up his lists, and establishing himself in the area, he should have some remuneration by way of a salary. I do not accept the view that a doctor examines his patients any better if his heart is gnawed with financial anxiety. I believe that the doctor's mind should, as far as possible, be serene and unhampered by any worries. I know of no field of activity where, having struggled for a livelihood, that could have a worse effect than for a doctor and his patient. Therefore, it seems to me that the element of a basic salary in the remuneration of a doctor is justified, if only on that ground alone.

But there are other grounds. It would reduce, to some extent, competition for patients. It has been assumed that competition is always a desirable thing, but competition for patients has been attended by undesirable elements. The build-up of panels has not always been done by methods which commend themselves to the best elements of the profession. I know of some instances, of which I have given one or two illustrations during the Committee stage, where the credulity of people has been preyed upon by the doctors giving huge prescriptions; we are still living, to some extent, in an era where people think that a large number of elements in the medicine bottle makes the medicine much better. This applies to a very small proportion of doctors, and 1 would not have it assumed that I am levelling a general charge, because the doctors as a whole have a very high standard. There are some doctors, however, who we know have built up their panels in this and other ways which are not congenial. Therefore, it does not necessarily follow that competition selects the best doctor, or that the most successful have the largest panel; it often selects, or sometimes selects, a man who has far better advertising methods.

The third reason—and I attach some importance to it—is that the remuneration of a doctor ought to contain an element to which we can attach special inducements for special training and qualifications, inducements to take refresher courses, and for special qualifications received after the general practitioner has started. The basic salary enables that to be done quite easily, because you can add to it. It has been suggested that we should add to the capitation fee, but that would be very untidy—it would almost be impossible. If we have a basic element in salary, we have something to which we can attach additional remuneration for special attainments. Those are three special reasons.

Some doctors have expressed fear that this is merely the beginning of establishing a full-time salaried service. I cannot read into the mind of any future Minister, or prophecy what may be done by future Governments, but that is not our intention. Our intention is that the main source of a doctor's remuneration shall be by capitation, and that for a number of very excellent reasons. There is an argument for having a full-time salaried service, and some of my hon. Friends believe in it. There is an argument for having full capitation, but there is no argument for having a very high basic salary and a small capitation, because the higher the basic element becomes, the more it becomes concealed capitation, because after the lists have reached the point where they absorb the basic element, the basic element from that time on is merely another form of capitation payment.

We are unable to carry out, or we find it difficult to carry out, the recommendations of the Spens Report if we have the basic element too high, because we would not be able to achieve the level of salary which the Spens Committee recommend that some successful general practitioners should achieve. If we have too high a basic salary, obviously the capitation rate would then have to be lower, and the higher salaries could not be achieved without enormous lists, which would be larger than those to which we would agree. And so the fears of some members of the medical profession are unfounded. I repeat that it is not proposed that the basic element should be the main part of the remuneration. The main part of the remuneration will be by capitation and the basic element a smaller part. I hope that with these assurances, and for these reasons, the House will agree with me that this Amendment should be resisted, and that on this occasion I shall have the unanimous support of the House.

Mr. J. S. C. Reid

The issue raised by this Amendment is one of the most important in the whole of the Bill. It was discussed in a general way, along with a number of other issues, in the course of the Second and Third Reading Debates, and it was discussed in Committee, but not at inordinate length. It has never been discussed before in the House as a separate issue on which Members could cast their votes, and I trust that Members will bear with me if I take a little time in dealing with the arguments in some details, although I do not propose to elaborate them. I think it is necessary that the arguments should be stated from both sides with some particularity, in view of the great importance of this topic for the whole future of medicine in this country. One of the main objections, and in some people's view the main objection, to the whole Bill is its tendency to undermine the independence of the medical profession. I do not think it will be doubted that if there is any truth in the charge, this Amendment is crucial upon that point.

At present, a doctor depends entirely on winning and keeping the confidence of his patients. He is their servant, and he is the servant of no one else. The Government can neither harm nor benefit him in any way. But as soon as you introduce the element of salary you inevitably tend to produce Government control. Inevitably, there arises a divided loyalty on the part of the doctor. Indeed, the whole object of the basic salary, according to the Labour Party's policy, has been to get control of the individual doctor. It is with that in mind that one must examine, very particularly, this Amendment.

7.0 p.m.

Labour Party policy on this matter has been quite clear. I do not know whether the right hon. Gentleman has been authorised to intimate a departure from it this evening, but, on the Second Reading of the Bill, the Lord Privy Seal stated, quite clearly, that Labour Party policy still persisted in spite of the terms of the Bill. The right hon. Gentleman said that the party had never repealed any of their policy and that they would continue to march on in the light of that policy. Has the Minister of Health the authority of his colleagues to contradict that statement because, if not, let us see what that policy is. There are a number of citations, but let me take one. Having said, on page 12 of their Election pamphlet, that unless a doctor has a salary and a prospect of a pension which frees him from economic dependence, he cannot devote his full energy to the prevention and cure of ill-health, the statement goes on: Unless the community provides that economic security it cannot direct where a doctor's work would best be used in the national interest. Only a salaried medical staff as part of the national health service can meet the need. Is that, or is it not, still Labour Party policy? If it is, we must regard this Amendment in the light of that fact. The Minister has given us calming assurances, and no doubt he will do his best so long as he remains Minister, but what he has said will have no value in regard to any other Minister unless we are assured that Labour Party policy has been radically altered in the last three or four months.

This Bill contains no limitation on the proportion of remuneration which is to be by way of salary. Therefore, if the House passes the Bill in the shape in which it would be if this Amendment were rejected the Government would have a free hand to go ahead and make alterations, as time goes on, to bring things nearer to their official policy. The right hon. Gentleman and the Parliamentary Secretary have shown in our Debates that they have realised the unwisdom of their party's policy. Not merely have they stated that the medical profession is not yet ripe for its introduction, but each has stated that their party's policy is inconsistent with the free choice of doctors. This Bill is admittedly a compromise. The right hon. Gentleman claimed that there had been an ingenious compromise on this matter, but the compromise is between him and his followers, he knowing something and they knowing very little. It is clear that they are at variance on this point and that, again, we must bear in mind in considering whether the Bill can be left in the shape in which it was when it left this House.

Let us look at the arguments for taking out these words. The arguments for a basic salary were only two. The first was that there are a number of scattered areas where men could not make a reasonable livelihood merely off capitation fees. We all agree. Nobody suggests that there should not be a salary in that case. The second argument was that, in the case of young men, a certain degree of security was required. I am much more dubious about that. I think the right hon. Gentleman will agree that a great number of young men ought to begin as assistants, and proceed to be partners. Therefore, the argument about security does not apply in those cases; at least, its application is very small. We have been told that there are areas in the country which are seriously under-doctored. Now that everybody will be subject of a capitation fee, if there is such an area there will be no difficulty in a young man, who feels he requires immediate financial gain, acquiring a practice there very quickly. If an area is seriously under-doctored any competent person who goes there will get a practice in next to no time. Therefore, there is no argument about the young man. But even supposing that I am wrong in that, young men are a small proportion of the medical profession, and so are doctors in scattered areas. We have heard no argument why the great majority of general practitioners who have established themselves in normal areas should have a salary. There has been no argument at all, except party policy.

We were told today two further points which I do not think were brought out earlier. First, that special qualifications ought to be specially recognised. I hold no strong view about that. It would be easy to provide that without a general basic salary anyone who has particular degrees or qualifications should be entitled to an extra £50 or £100, or whatever it may be.

Mr. Bevan

That would be at once a fixed amount.

Mr. Reid

We on this side have never said that in no circumstances ought a doctor to have a fixed payment. We agree that he ought to have if he is in a scattered area. The right hon. Gentleman may agree that there ought to be a fixed payment of a small amount for special qualifications. That is a matter which does not affect a large proportion of the profession, and would not have the effect, on the men of the profession as a whole, that a basic salary would have.

Then, we are told that it reduces competition. I do not see how that squares with the right hon. Gentleman's next point, that the basic salary is to be comparatively small and the capitation fee is to be comparatively large, because —taking the right hon. Gentleman's view of certain members of the medical profession, which I am not endorsing, but which I accept just now for the purpose of the argument—so long as the capitation fee remains substantial, the motive for competition remains, whether you have a basic salary added or not. Therefore, it seems to me that if the right hon. Gentleman is in earnest in his argument about competition—and I know that that appeals to many hon. Members opposite —that points directly to the basic salary becoming very soon a major part of the doctors' remuneration, otherwise the competition argument is not made out. What the right hon. Gentleman has said about competition this afternoon, certainly sharpens my suspicious that this small basic salary will be a very temporary matter if the party opposite remain in power, and it will not be long before the right hon. Gentleman's scruples, based upon a certain amount of knowledge which he has acquired, are brushed aside, and we have the party policy in full progress again.

How is this salary to work? We are told that the salary is to be sufficient to produce "a serene mind" among practitioners. Does that mean that the salary will be paid to all doctors who have more than a very small minimum number of patients? With regard to the young doctor, that minimum must be very small if the right hon. Gentleman's object is to be achieved. I do not know and I think that we have not heard about that, except, I believe, that at one stage the right hon. Gentleman was inclined to take the view that some comparatively substantial minimum number of patients on the list would be required before any saalry was paid. Of course, if he does not take that view, the Government will be paying a salary for nothing. As he very well realises, and as he has told us in these Debates: If one pays a substantial salary, one must couple with that power to direct unwilling patients to that doctor. The Government are not going to pay a substantial salary of £500 or £600 a year to a man who has only 200 or 300 patients. Therefore, I say that they must put the minimum number of patients fairly high, if the basic salary is to be fairly high, or pay away money to people who do not deserve it.

Mr. Bevan

The right hon. and learned Gentleman uses words that may be misinterpreted. I do not recollect having said that "unwilling patients would be directed to a doctor." I think that I must ask him to quote my words or withdraw his statement.

Mr. Reid

I think that that is the necessary implication. I am not professing to quote the right hon. Gentleman's exact words. The first thing that happened was that the Parliamentary Secretary made it perfectly clear that the free choice of a doctor was inconsistent with a full-salaried service. I understand that the right hon. Gentleman endorsed that in Committee, and said the same thing, though not quite so emphatically. He said: I found it very difficult to reconcile the free choice of doctor with the complete abolition of capitation." —[OFFICIAL REPORT, Standing Committee C; 18th June, 1946, col. 595-6.1]

Mr. Bevan

That is not what the right hon. and learned Gentleman said just now. What he said was that I myself recognised that if the basic salary was substantial—in other words, there is still capitation—I would find it necessary to direct unwilling patients to particular doctors. I never said that. It really is a little lawyer's logic, at the moment, to twist my words.

7.15 p.m.

Mr. Reid

Let us get this matter straight. Take first the position in which it is all salary and no capitation. The right hon. Gentleman has, I think, admitted that, if one has a service in which it is all salary and no capitation, it necessarily follows that one must have power to direct unwilling patients to a doctor who does not attract them. Certainly, the Parliamentary Secretary said that in so many words, and I think that the right hon. Gentleman endorsed it. If he says "No", then I will listen to him. If one gets to the stage when the basic salary is the greater part, and the capitation is only a small proportion of the total earnings, the same result must necessarily follow. If one pays a basic salary of £500 or £600, one must ensure that the doctor has a reasonable number of patients. One must, therefore, say to the doctor, "Unless you attract 500 or 600 patients, or whatever is the minimum, you will not get any salary at all "—in which case the security argument is completely gone—or else you say, "I cannot afford to pay a doctor £600 a year if he only attracts 200 patients, and, therefore, I must send him some more patients." There seems to be a complete dilemma. [Laughter.] I have often noticed that when an argument is getting difficult for hon. Members opposite, their uniform reaction is to laugh. I know how well drilled they are, and I cannot help feeling that they have had some instruction from a laughter leader as distinct from a cheer leader. Let me restate the position. Hon. Gentlemen seem to think that it is a difficult argument. Supposing one says, "I am going to pay a doctor a minimum basic salary of £600 a year," one or other of two things necessarily follows: Either one says, "I will only pay £600 a year to a doctor who has, say, 600 patients on his panel," or one must say, "I will pay it to all doctors who are in the scheme; but, of course, the Government cannot afford to pay, unless they have 600 patients on the panel, and, therefore, if a doctor has only attracted 300, we will send a further 300." No Government can say, "We will pay a large basic salary for a small panel of patients."

Mr. Robens (Wansbeck)

In the teaching profession, teachers are not paid on the basis of the number of scholars they have in their class.

Mr. Reid

I have always understood that scholars have very little choice of teacher.

Mr. Robens

They have a choice of school.

Dr. Segal (Preston)

If a doctor found himself being paid a basic salary with only 200 or 300 patients, would not that area automatically be an over-doctored area, which is one of the things this Bill seeks to prevent?

Mr. Reid

Of course not, because there are many people who say, "I would rather have no doctor than have Doctor X." It does not in the least follow that because one doctor in an area is unable to attract patients, the area is under-doctored or over-doctored. One finds in all areas doctors who either are not able or do not care to trouble to attract a large number of patients. What will happen, of course, is that if the right hon. Gentleman has any basic salary of any great magnitude as a proportion, he will have to deal both with doctors who are unable to attract, and with doctors who do not want to attract, a very large number of patients. Therefore, I think the right hon. Gentleman realises quite clearly that the scheme will be completely unworkable unless the basic salary is kept down to a very small sum, but his followers do not realise that. What I am apprehensive about—and I am sure a great many Members of the medical profession are appre- hensive about it—is that once the door is opened and a start is made with a small salary, it will not be long before the salary begins to mount, and then the damage will be done. If one could be certain that the salary would never exceed £100 or £200 a year, it might be all right. That might not do much harm, although it would not do any good. It would not give the security for which the right hon. Gentleman is looking. All these arguments about security and competition necessarily imply ultimately a large salary, and it is with that in view I hesitate to accept the right hon. Gentleman's assurances as likely to cover more than his own tenure of office.

The argument has been put forward that at present a certain number of doctors are in receipt of salary and no harm is done, and therefore, why should not all doctors be in receipt of substantial salaries? I believe there is such a thing as a general atmosphere in a profession. Those who enter a profession and advance in it are immersed and become steeped in that atmosphere. The atmosphere depends to a very large extent on the conditions in which the large majority of members of the profession do their work. At present, the large majority of members of the medical profession are free and independent, and as a result the atmosphere in the medical profession, as far as I can judge it, is an atmosphere of freedom and independence, in spite of the fact that a number of doctors have a secure, salaried and pensionable job. That does not affect the general feeling in the profession.

However, as soon as the great majority in the profession are put on a salary, I believe that atmosphere will change fairly rapidly, and I believe it will change very much for the worse. I do not think it is in the interests, and certainly it is not according to the wishes, of the doctors that the atmosphere or the conditions should so change. But I am much more concerned about the patients. I believe that the result of any change of atmosphere of this kind will be a most serious diminution in the quality of the services which the doctors afford, not because they will deliberately want to scamp their services in any way, but because those services depend upon what is at the back of the minds of the people rendering them. If a man is free and independent, and regards the patient as the person to whom alone his loyalty is owed, a different quality of service will be offered from that offered by a man who is brought up in a different atmosphere. It is with that in view as the likely ultimate result of rejecting this Amendment that I ask the House to support the Amendment.

Sir H. Lucas-Tooth

The right hon. Gentleman the Minister of Health, in asking the House to disagree with the Lords in this Amendment, based his case largely on the contention that the Amendment would put him in a strait waistcoat. There is something less in the way of clothing than a strait waistcoat. If the Bill goes through without the Amendment, not only will the right hon. Gentleman have no strait waistcoat; he will have no clothes of any sort, because the Bill as drafted is entirely silent on the method of remuneration of doctors, and it will be open to the Executive Councils, subject to regulations made by the Minister, to employ any method of regulation whatever. All that the Amendment does is to lay down that the capitation method is to be employed except in exceptional circumstances. The Amendment does not preclude payment by way of salary. It simply lays down the general principle that capitation is to be preferred, and unless there are special circumstances, capitation only is to be used.

I submit that the principle raised by the Amendment is one of the utmost importance. It is important not only in connection with this Measure and doctors; it has the widest possible importance to all branches of life. The principle involved concerns not only doctors: it concerns men and women of all professions who serve the public. If the general principle is to be agreed that a basic salary is desirable for doctors, then precisely that principle and precisely the same arguments must be accepted in regard to all other professions, and certainly those that serve the public as a whole. Surely, it is the duty of Parliament, when changing policy in the way in which this Bill does, to give some guidance to the Minister, who will have to carry out the policy, as to the extent to which Parliament is prepared to go in a matter of this great importance. If this Amendment to rejected, it will be left in the hands of the Minister to decide whether doctors are to be paid wholly by piece work or wholly by time work, or by some combination of the two.

I would most willingly accept what the right hon. Gentleman has said as regards his own intentions and those of the Government in this matter. I am quite certain that he is sincere and that, as long as he occupies the office of Minister of Health, he will strive to see that his undertakings are carried out, but if the Amendment is not inserted in the Bill, the road will be left wide open, without any impediment, for a gradual and steady change to be made from the capitation to the salary method of remuneration. I do not believe that any hon. Member has any doubt that if we leave that road open, we shall inevitably move steadily from capitation to salary. Indeed, the rejection of the Amendment is supported by hon. Members opposite, who remain, very wisely, silent, because if they got up and had to argue, they would argue for the method of salary as a whole. I think I shall be in Order in quoting what was said in another place by the Lord Chancellor regarding the Government's policy in this matter. In the Third Reading Debate in another place, the case for the Government was based by the Lord Chancellor on the evil of a few doctors competing for patients by lax certification. Indeed, that case has been put here again by the right hon. Gentleman the Minister. In another place the Lord Chancellor said: If you had abolished this per capita payment altogether and made it a straight out and out salary, of course that temptation— that is to say the temptation to compete for patients— would have gone. I do not for a moment suggest that. It is true that the Government may be sincere in not suggesting the out and out abolition of capitation and the introduction of a whole-time salary, but it is quite certain to my mind that if this House lays it down as a general principle that the Minister has power to provide by regulation that all doctors shall be wholly paid by salary, that must be ultimately what occurs. After all, the policy in this matter will be worked out at the Ministry of Health. There will be constant pressure on the part of that Department to encourage and enlarge the salary element in remuneration. From the point of view of the civil servant the salary has everything to commend it, and I am certain that the Minister will constantly find pressure being put upon him from his own Department to enlarge, vary and encourage the salary element in the doctor's remuneration. I believe that if we once introduced the salary element it would be increasingly popular with doctors themselves. I know that that is not so at the present time but, after all, as the right hon. Gentleman has said in the course of his speech, security is by no means a bad thing to have. Although I fully recognise the right of some Members of this House to speak more feelingly on the subject of the absence of security than myself, I can nevertheless say without fear of contradiction that while security may be a good thing it is also a terrible opiate. If once we begin to introduce this security element, we shall have a demand for more and more of it until the whole thing is security, and the whole profession a State salaried service.

Dr. Morgan (Rochdale)

What is wrong with that?

Sir H. Lucas-Tooth

It will require a very strong Minister indeed to resist the combined tendency of his own Department and of the medical profession both of whom will, I am certain, continue to want an increase in the salary element once it is let in. Although the present Minister may be well able to look after himself in resisting that sort of pressure, I have grave doubts whether that resistance will be kept up in the period of years and with the constant changes of Minister—whether drawn from that side of the House or this—

Dr. Morgan

The hon. Gentleman is arguing as if a salaried service would lead —as one hon. Member has suggested—to a great deterioration of medical practice and in the relations between the doctor and the patient. If this is so, may I ask the hon. Gentleman whether it is true now of all those medical officers who are paid full time salaries in various institutions, both voluntary and local authority—the Indian medical service, the Colonial medical service, local government employees and so on, especially, that is, in voluntary hospitals?

Sir H. Lucas-Tooth

I am obliged for that interruption. The answer is that there are no grades of general practitioners in this country, and for my part I do not see how one could introduce them. Secondly, I believe that, with many exceptions, the doctors in ordinary general practice in this country are on the whole better than those one finds in salaried positions. There are many notable exceptions, but 1 am considering the whole of each section and my own belief is that the private practitioner comes out well ahead on average.

Dr. Morgan

rose—

Sir H. Lucas-Tooth

There is a third point in answer to the hon. Gentleman's interruption. In order not to take up too much time I have not argued against the general principle of a full time salaried service, and I take it from the Minister's statement that he is as strongly opposed to that as I am. I think, however, that the interruption coming from behind the right hon. Gentleman shows very clearly indeed the kind of pressure that is going to be upon him by his own supporters if once Parliament lets that kind of thing in.

I would conclude my remarks by saying that I certainly would not wish the House to tie up the right hon. Gentleman in a strait waistcoat. He is going to have a very difficult time indeed and I have every sympathy with his desire for a great deal of flexibility. On the other hand, where a matter of first class importance such as this is raised, it is the duty of Parliament to indicate in the Measure which introduces the change of principle how far they think that change should be allowed to go. We ought not to give carte blanche to a Government Department to change overnight, if it wishes, the basis of pay of the medical profession as a whole from a capitation to a salary basis. Unless we have an Amendment of this kind in the Bill we are giving that completely free hand, and leaving the matter entirely at large, and I believe that that is an abrogation of our duty as the House of Commons.

Mr. Gage (Belfast, South)

I should like to say a word about the difference in effect upon the standard of the medical profession of a basic salary and a capitation fee respectively. I am quite certain that for medical practitioners who are practising today it will not make the slightest difference to the standard of their services whether they are paid a private fee, a capitation fee, a salary, or even if they are not paid at all. I think they will continue to give patients exactly the same services that they always have. That is, after all, the tradition of their profession. But when one considers this matter one has to envisage the position as it will be in 40 years' time, and I feel strongly that if an element of salary is introduced into a profession which, up to now, has always depended for its remuneration on the services which it has performed, that will result in a lowering of the standards. There are many things that attract people into the medical profession, and I do not think that this very important one should be ignored—that many good men are attracted to a profession where they feel they will obtain reward for their industry and where idleness is punished. There are, of course, people who prefer salary and the possibility of promotion over a period of years, but they are not normally the type of person from which the medical profession —indeed my own profession—obtains its best recruits.

One can, of course, give examples. In the early part of 1939, it was my misfortune to become a patient. I make no apology for giving such of my experience as may be interesting, particularly as almost every hon. Member who has spoken has said that the views of the patients should be treated with the utmost sympathy. Heaven knows, if the intentions of all hon. Members in that respect were to be carried into effect, there would be very little that the unfortunate patient could do except to fold his hands and expire. I was a patient when I came into my first contact with the Army Medical Service as a very humble member of the Army. As we sat about, shivering and waiting for our medical inspection—the Army had no idea of the health centres of the right hon. Gentleman—the matter that was canvassed among us was on these lines: Is the medical officer who is coming to see us a regular member of the R.A.M.C. or is he—we were irreverent enough to say —a proper doctor who was coming in from outside? It was noticeable throughout the Army that the confidence given to the doctor who came into the Army from outside was much greater than was accorded to the regular R.A.M.C. doctor.

One might have been quite wrong in that attitude. When I got to know the Service better I found very many admirable and devoted officers in the R.A.M.C. Nevertheless, one must say that the general confidence of patients—we were all patients then—was not to give nearly so much confidence to the doctors of the salaried service as it was to doctors who came from outside. There was no getting away from it. It is no use trying to escape that fact, which was the common experience of almost everyone in the Army. I feel that if salary is imported, even though it is only a part-time salary, there will be a falling off of public confidence in the medical profession and eventually there will be a falling off in the standards of the profession.

The argument of hon. Gentlemen opposite, so far as I can understand it, in favour of the salary is that you must give to young men coming into the profession a measure of security. It was my fortune when I started reading for the Bar to live in rooms in company with four medical students, also young men at the outset of their profession, and I got to know them quite well. They were all impecunious, but not one of them worried about questions of security once they were qualified. They were naturally unsettled while they were unqualified and earned nothing at all, but they were all encouraged by the knowledge that once they were qualified they could stand on their own feet.

It is from that type of young man that the medical profession has drawn its members. It will be a sorry day for that profession when young men come into it to seek security. The medical profession has many great things to offer, integrity, high standards and ideals—but it does not offer at present a sheltered and secure life. I am sure hon. Members will agree with me that in that fact lies its strength. If the Minister gives it security he may take away from it something which is far more valuable, and that is its exceedingly high standards.

7.45 p.m.

Sir Henry Morris-Jones (Denbigh)

I am sorry that the Government have decided not to agree with the Lords in this Amendment. I think there is no doubt that the capitation fee system is much better than the payment of a salary. In isolated areas, where the population is too small for the doctor to be properly remunerated on a capitation basis, possibly there might be a case for salary, as in other special cases. I am sure that the majority of members of the medical profession would prefer a capitation system. It is to their credit that they prefer it. It would be easy for them to accept a salary, which would give them a much easier life and much more security. It would abolish all competition and the doctors would be well paid. Whatever the figure was, it would be a fixed salary or emolument, and the doctors could do as much or as little as they liked. It would be very difficult for any Government to turn any of them out. If a doctor is not entirely conscientious, it is not impossible for him to give the impression that he is conscientious. Which profession can do that better than the medical profession?

The personal interest which exists in the relationship between doctor and patient cannot be taken away. It is no use for any Socialist doctrine or theory to try to abolish fundamental laws of human nature relating to personal interest. Hon. Members have asked what about doctors who are salaried today. I am not casting any reflection upon medical officers of health or doctors in any of the Services, but I must say that in the course of their lives the personal element does not enter into it to the same degree as it does between a sick individual in his own house and his medical attendant. I think it has been proved that the list built up by a doctor under the capitation fee system is a reflection of his ability. I do not doubt that some doctors are able to achieve this result by their very good bedside manner. Others do it by personality although their knowledge, academic and practical, might not be quite so strong or well developed as in other individuals who may have much smaller lists. The point is—and it is the foundation of the whole matter—that the man who builds up a successful list on which he gets capitation fees does so on a basis of confidence.

That is the very basis on which a person expects to get well. An individual cannot get well so easily in the majority of cases unless he has confidence in the doctor who is looking after him. A patient has confidence in the doctor who puts him on his list. That medical man is paid individually for that person, and no amount of doctrine—I do not care if this Government were in office for 20 years in succession—will alter that. But one day the Government will be altered. If all doctors are paid by salary, what will happen is that we shall get a dull uniformity of service which will take all the glamour out of the profession, and if we take all the glamour out of the profession, we shall get only dull people in it. Doctors of that kind will make one worse instead of better. We want to get some colour and picturesqueness in a doctor. We all know large numbers of medical men who have most brilliant academic qualifications and yet their patients have no confidence in them at all, not because of their lack of knowledge but because they lack the capacity to inspire confidence.

Mr. Sparks

Will the hon. Gentleman tell me whether that doctor, if he is paid a capitation fee, will take more interest and inspire more confidence in the patient than if he were in receipt of a salary?

Sir H. Morris-Jones

Of course he will. Everybody acquainted with the medical profession knows that. The doctor will have a much more personal interest in his list—

Mr. Messer

May I interrupt the hon. Gentleman? This is a very important matter. Does he mean that the general body of the public have no confidence in the hospitals which are staffed by salaried doctors?

Sir H. Morris-Jones

No, my general argument was in the main that those concerned in branches of public service like medical officers of health, do not come into the same contact or intimacy with the patient.

Mr. Gallacher (Fife, West)

The more money is offered to them, the more confidence there is.

Sir H. Morris-Jones

If the capitation system is adopted in the main, with a proviso that the salary can be introduced in certain special instances, the medical profession will be much more inclined to look favourably at this scheme, not because some of them are likely to make any more money out of it, but because it will give that element of competition which is vital if one is to make a success of any health scheme in this country. The salary basis should be abolished because it reduces the whole thing to a dull level of uniformity, as a result of which the profession loses the colour and characteristics which are the foundation of medicine.

I am sorry that I did not hear the arguments of the Minister at the beginning of the discussion on this Amendment, but I understand that his main argument was much the same as that which he used in Committee—that by providing a salary, security will be given to young men coming into the profession. I do not think there is any fear on that score, because for many years the supply of doctors will be much less than the demand. Not one young medical practitioner who has left the Services or the colleges or universities, need have any fear that in this country, for many years, he will not be fully employed at a fair remuneration.

Dr. Morgan

I did not want to intervene because I think the whole discussion is a sheer waste of time and is partly the result of the obstructive tactics adopted by the other side, but certain things which have been said from the medical point of view need to be answered. The Amendment as proposed seeks to insert in the Bill provision that doctors giving service under this Act shall be paid by capitation fee and in no other way—[Hon. MEMBERS: "No."]—with certain exceptions. There was also the Minister's assurance that he will pay them partly by basic salary and partly by capitation fee. The suggestion behind the Amendment is that the payment should be by means of capitation fee—

Mr. Willink (Croydon, North)

The Minister said so himself.

Dr. Morgan

What does that mean? Even if the Minister says it, may I not state my own case? The right hon. and learned Gentleman is capable of stating his own case later on. The hon. Member who spoke last said that if doctors were paid by salary and not by capitation fee there would be disadvantages associated with any form of medical service and that the relationship between doctor and patient, the giving of certificates, diagnosis and other treatment would be hampered by the fact that the doctor was paid by salary. Is that the case in the Indian Medical Service and the Colonial Medical Service and in the laboratories of this country where salaries are paid?

Commander Galbraith (Glasgow, Pollok)

What are the conditions in the Colonies and India? Would any doctor ever receive an adequate salary in some of the Colonies on the basis of capitation fees?

Dr. Morgan

I thought that a human being was a human being no matter where he lived. A doctor should give him the same attention no matter whether he lived in the Colonies, in India, in Timbuktoo, in Great Britain or in Tredegar—

Sir H. Morris-Jones

The hon. Gentleman asked a question in regard to the Indian Medical Service. Is he aware that in referring to that service he is dealing with a largely disciplined service? Surely, he is not suggesting that the people of this country should be under a rigid discipline as the result of this scheme?

Dr. Morgan

I deny the thesis that we are dealing with a disciplined service. The ordinary Indian receiving attention from the Indian Medical Service is not under discipline. The ordinary Colonial receiving attention from the Colonial Medical Service is not under discipline. To come to this country, what about the doctors in the voluntary hospitals and assistants in general practice who are paid whole-time salaries by general practitioners? Are they rendering a bad service? Can the hon. Gentleman tell me whether the doctors in the prison service, the police service and all these other services are rendering bad service? One minute it is said that it is necessary to make these payments by capitation fee because the doctors will otherwise be tempted to indulge in lax certification, and then hon. Gentlemen opposite prophesy with a whole series of jeremiads that if a man is paid a salary for his work his service to his patient will not be as good just because of that fact.

8.0 p.m.

Is that the way the insurance companies pay their doctors to do work—to give reports deliberately against the medical interests of the man who is fighting for his workman's compensation? Is it argued that the industrial medical officers of insurance firms do not do an adequate job? The doctor does his job if his, heart is in his work. If that is his line, the doctor will do his job, by comparison with other professions, as well as his human nature will allow him and he will do it better, in my opinion, if he is paid a salary and knows exactly where he is, than if he has to indulge in all sorts of little tricks in order to get his patients to come to him, patients who do not know the value of real medical service and real medical skill. The whole idea of the argument that a man who is paid a salary necessarily loses contact with his patient is perfectly ridiculous. The hon. Member for South Belfast (Mr. Gage) referred to the R.A.M.C. Has he ever heard of Manson, of Ross, and the brilliant work which the American Army Medical Service did in clearing the Panama Canal of yellow fever? Did they lose any of their skill by being in a full salaried service? I have worked in every branch of medicine, not only in general practice, and I worked temporarily in the last war for the R.A.M.C. I know that in the R.A.M.C. we gave as fine and devoted service as any general practitioner.

Mr. Gage

I am sorry to interrupt the hon. Gentleman, but of course I did not put it in that way. I said that when I got to know the R.A.M.C. better, I realised that there were many outstanding people in the Service. My argument was that, as private soldiers, when we came under the R.A.M.C. we had not the same confidence in the regular R.A.M.C. officer as we had in the private doctor. Anyone who has been in the Army knows that to be the fact.

Mr. Messer

The hon. Member is a victim of ignorance then.

Dr. Morgan

Of course medical men do different types of work, and the R.A.M.C. regular officer tends to do administrative work, but I am talking about the man who comes in direct contact with the patient. The whole theme of the arguments coming from the other side is that if a man is paid a salary in any service, under any conditions, he will not be so public spirited in his work as he would be if he received a capitation fee. That I want to deny. The whole argument is thoroughly ridiculous and is not meant to be constructive. No one has ever yet put up a decent case that a man will do better work for his patients if he is paid a capitation fee instead of being paid a regular salary, especially in a good service with superannuation and study leave and foreign study leave as well. Let us consider this Bill with good will and benevolence. It will need all our assistance. Under the present system the people of this country have a chaotic service, an uncoordinated service. This well thought out, brilliant Bill is deserving of every support and assistance from every politician in this House. Instead of frittering away our time on puny points, let us get down to the bedrock of the medical service itself, which we hope will be of benefit to every citizen in this country.

Mr. Marlowe

I rather resent the hon. Member for Rochdale (Dr. Morgan) suggesting that if we make suggestions to improve this Bill, we are necessarily being obstructive. Considering that the germ of this Bill was born in the Coalition Government, in which this party was in a majority, it seems fanciful to suggest that we are trying to obstruct it. We are putting forward ideas which we believe would improve the Bill. The hon. Gentleman also said that he wanted to tend more and more towards a salary, and less and less towards capitation. That entirely confirms what was said by my right hon. and learned Friend the Member for Hillhead (Mr. Reid), that that would be the inevitable result of the present Government scheme—that we would move further and further towards a salary.

I think the hon. Member for Rochdale completely misunderstood the argument when he put forward examples of those doctors who are now on a salary basis. It is agreed, of course, that many of them do good work, but my hon. Friend the Member for South Belfast (Mr. Gage) dealt with that. It has been pointed out that they do so at the moment, but the more you tend towards salary, the more you alter the profession and lower its standards. All experience has shown that a salary is an inappropriate basis for a professional man. The spur of competition is what makes for success in a profession, and where all are equal, and on the same basis of salary, that competition disappears. The right hon. Gentleman the Minister of Health referred to the question of security for the young practitioner. The right hon. Gentleman has never been in a profession, but I can assure him that the greatest road to success in a profession is not to have security when you are young and when you start.

Mr. Janner (Leicester, West)

Would the hon. and learned Gentleman forgive me for interrupting? I want to ask only one question out of curiosity and that is, whether the highest profession in this land, the profession of judge, is made less worthy by the fact that he accepts a salary.

Mr. Marlowe

The hon. Gentleman is really taking an absurd example—[Horn. MEMBERS: "No."] A judge is not a professional man at all.

Mr. Janner

Oh, is he not?

Mr. Marlowe

To suggest that a judge is engaged in a profession, is really quite absurd.

Dr. Morgan

Surely he does professional work?

Mr. Marlowe

I do not suggest, for instance, that a Cabinet Minister, who receives the same salary, is a professional man.

Mr. Edward Evans (Lowestoft)

What about the Church?

Mr. Deputy-Speaker (Sir R. Young)

I think we had better get back to the Bill.

Mr. Marlowe

I agree, Mr. Deputy-Speaker. The point I was making when I was interrupted was on the question of security for the young man. I think the Minister of Health is on the wrong path altogether if he thinks that it is necessary to provide security to attract the right type of young man into the profession. The type of man required in any profession is the man who is prepared to undergo hardship in his youth and make his mark by his own personality, ability and individuality. The more you tend towards a salary, the more you tend to attract, not the type that will adventure and will do his best in order to achieve success in his profession—and thereby do best for the profession—but the type that is looking for security and a comfortable life, and that is quite the wrong type for any profession.

Dr. Segal

I must apologise for intervening in this Debate at this somewhat late hour, but certain points have been raised by hon. Members opposite which I feel call for an answer. The hon. and learned Member for Brighton (Mr. Marlowe) said that insecurity is an incentive. I think he fails to realise that there are many doctors who are born into this world in a state of security. Very often these are the doctors who are able to specialise and achieve the highest positions in the medical profession. Because they happen to be born of wealthy parents, that does not necessarily mean that they are the best fitted. It means they have opportunities of specialis ing after they qualify. Let us admit that some are born into security, and are often the least deserving elements in the community. What the Bill seeks to do is to make sure that some of the deserving elements of the community shall not be deprived of rendering their services in the field of medicine because of lack of security. What I hope the Bill will achieve, ultimately, is that whereas many doctors when they qualify have to spend years and years in the drudgery of serving as assistants and locum tenons they will be much better qualified to go on and specialise. I know of many instances in which this has happened. In my own case, I had to go immediately as an assistant as soon as I qualified in order to pay for my diploma of qualification, and such instances could be multiplied of people who are far more deserving to render service to the community in the field of medicine.

The right hon. and learned Member for Hillhead (Mr. J. S. C. Reid) asked why we should attach so much importance to the younger elements within the profession. He said that, after all, young men are only a small proportion of the total in the profession. That is true now but they will form by far the majority of the profession in 10 or 20 years' time. Because we want to look ahead and to create a medical service worthy, in the fullest sense, of the community, and of the art and practice of medicine, we mean to get the best elements in our community and to give them every opportunity to develop their skill. Apparently the Opposition are agreed on the principle of fixed payment as part of remuneration but they dispute what proportion of remuneration shall consist of basic salary as distinct from capitation fee. The right hon. and learned Member for North Croydon (Mr. Willink) shakes his head, but apparently from the trend of the Debate the Opposition are opposed root and branch to the whole principle of a basic salary. We are in favour of the principle of basic salary because we believe that, to some extent, it will assist in laying less emphasis on the commercialisation of medicine and tend to emphasise the pure art and science of medicine, so that the doctor will be able to throw himself heart and soul into his profession without having his attention distracted by day to day financial worries.

The right hon. and learned Member for Hillhead spoke about a free and inde- pendent profession "as it exists today." I very much doubt if that is so. Many of our youngsters now in elementary and secondary schools long to go into the medical profession, but, because of the enormous costs of qualifying today—at least £1,500—many of those who would be the best doctors are denied an opportunity of qualifying. I urge on the Minister that the necessary corollary to his standing by this principle of the basic salary, is to ensure that the State will make provision for those students best qualified to enter the medical profession, to see that they can not only qualify as doctors but that they will have the opportunity after qualification of going into post graduate work, doing research and developing their faculties to the utmost possible extent to the benefit of medicine, and to the benefit of the community.

8.15 p.m.

Why, then, do we on this side of the House support the principle of a basic salary? The hon. Member for Denbigh (Sir H. Morris-Jones) says, "Of course, a doctor must think in terms of what salary he is to receive." I refute that suggestion as emphatically as I can. The hon. Member himself knows of innumerable instances in which a doctor is summoned to a street accident, and renders the best service he can to a patient who may not be in a position to reward him at all. He knows in his own case how often he has rendered service to Members of the Opposition, who may have needed assistance, without any question of whether he was paid on a capitation basis. In fact, as long as he has sat in this House, I believe he has been paid a basic salary. I believe in the principle of a basic salary because I am convinced that, through it, the quality of our doctors will be improved. I believe it is a principle which is fundamental to this Bill, and I sincerely hope not only that the Minister will not yield, if it comes to a Division, but that he will assert this point as strongly as he can, when it comes to negotiating with the medical profession, in order to secure as large a proportion of remuneration through a basic salary as he can.

What do we hope this principle will ultimately achieve? First we hope that ultimately it will prevent the farming of practices to assistants. Secondly, we hope that it will abolish the buying and selling of practices. On the other hand, what do we hope that this basic principle will not achieve? We hope that it will in no way damp the spirit of initiative and adventure in the medical profession. We hope that adequate incentives will be provided to every doctor to develop his qualities to the fullest possible extent, but we must make sure that these incentives which the Bill lays down will be incentives which are fully deserved, that will not be acquired on the basis of the doctor's commercial instincts, but will be gained on the actual qualifications of the doctor himself. We hope that this principle will not allow a doctor with capital to cash in on the patients in this country, and we hope, furthermore, that the acceptance of this basic principle will especially not allow the moneylender to cash in on the young doctor's financial difficulties.

It may be said, and it has been asserted during various stages of this Bill, that fully 95 per cent. of the medical profession are totally opposed to this principle of a basic salary. All of us will remember that exactly the same situation happened in 1911. Then the doctors were actually opposed to the principle of the capitation fee. Now we find that they have come round to that principle. Not only have they done so, but they actually want to extend it to cover not only insured persons but the dependants of insured persons. Just as the doctors now realise how it was to their advantage to come into the National Health Insurance scheme, and accept the capitation fee, so I am absolutely convinced that in years to come the medical profession as a whole will come round to the view that it was in their own interests and in the interests of medicine itself that they should come round to this principle of a basic salary as part of their remuneration.

I hope that in this Bill we shall be able to combine all the best elements of Service medicine without its obvious disadvantages. The hon. Member for South Belfast (Mr. Gage) spoke of how much greater was the confidence he felt during his Army service when he was attended by a doctor who was not a regular Army doctor. It is a matter of one's own personal inclination. I would like to ask him when he was being attended during his Army service by a temporary doctor, did he ask that doctor whether he had been paid on a capitation basis in civilian life or on a basic salary? Many of the finest temporary doctors we had in the Services were people who were accepting full time salary from hospitals. Many of them formed the finest elements in medical service during the war in the fields of both surgery and medicine. I hope this Bill will achieve the synthesis of all the best elements in service medical practice with all the best elements of medical initiative, originality and research in civilian practice combining the advantages of the one with those of the other. Finally, I believe it will be in the best interests of the people of this country that the money motive in our profession should become less and less insistent and that much more emphasis should tend to be laid on the art and practice of the science of medicine itself.

Lord Willoughby de Eresby

I do not wish to detain the House for many minutes, but, having taken part in all the stages of this Bill, I did not—rather, I suspect, like the hon. Member for Rochdale (Dr. Morgan)—want to let this last battle go by without entering into the fray for a few moments. This question of the remuneration of general practitioners is one of the most controversial and—let us face the fact—one of the most suspect parts of the whole of this Bill. Unfortunately, we can only argue on general grounds because, as the Minister said, we do not know the rate of remuneration that will be paid, and the ratio as between salary and payment of capitation fees. I feel that on an important question like this the House should give some general direction of their intention. I did not agree when the Minister said that we should not put whatever the tribunal is that decides this matter into a straitjacket. This House should make its mind known on a question of this nature and give a general direction. On general grounds possibly this is the old political fight between those like the hon. Member for Preston (Dr. Segal) who believe that the greatest blessing a Government can confer on doctors or mankind is that of security and those who believe that the greatest blessing is that of freedom. Unfortunately, we always find that the people usually want both. That is something which it is very difficult for Parliament to provide. No doubt that is the reason why the people usually are dissatisfied with whatever Government is in power.

There is no question but that we all agree that a basic salary, or an element of basic salary, gives a greater measure of security but in accepting even a small element of security the medical profession or the general practitioner gives up some part of his independence.

Mr. Ungoed-Thomas (Llandaff and Barry)

Why?

Lord Willoughby de Eresby

The hon. Member asks why. One would have thought that one would not have had to explain to hon. Members opposite the difference between payment on results and payment for fixed hours on a fixed salary. I do not wish to overstress the point. I think it can be overstressed. Security does not at all times go hand in hand with hard work, extra effort, or even progress. The doctors, as we know, do value their independence to a very high degree, and they are suspicious, possibly wrongly suspicious, of what are the Government's intentions in this matter. They think this element of a basic salary may be the thin end of the wedge, and I do not think that we can altogether blame them. There have been statements and speeches from the other side of the House which leave no doubt in many people's minds that the intention of the party opposite is towards a whole, full-time salaried service. I know this has been denied by the Minister in this House and also in another place, but suspicion, unfortunately, still remains.

I cannot see that there is this great insecurity today for a young man entering the medical profession. Certainly, in my own part of the world, it is not a question of insecurity for the doctor, but one of insecurity for the patients, because there are not enough doctors to do the great amount of work which has to be done. When the Bill is passed, that position will be aggravated, and an increasing amount of doctors' time will be taken by administrative work. I feel that we would be well advised to accept the Lords Amendment in this particular case, as it can always be altered if the position changes at a later date.

Mr. Willink

I am very sorry that I was not able to hear the right hon. Gentleman's arguments today, but I have heard him twice upon the subject before, and I think I have got an accurate note of the grounds on which he proposed that the House should disagree on this occasion. I think it is time now that I should attempt to express what I feel is the essence of this matter, and what I believe are the views of hon. Members behind me. The Debate has ranged rather widely, and I think it is desirable that we should clear up one or two points which were stressed, for example, by the hon. Member for Rochdale (Dr. Morgan). Nobody is arguing here today that none of those who are remunerated by salary in this world work as well as those who are remunerated in other ways. We all know there are many occupations in which the only possible form of remuneration is by salary, and we all know, too, that there are many civil servants who work as devotedly as many other people in the country. But there are many distinctions between the life and the work of a general practitioner and the life and work of a civil servant, or an officer of the Royal Army Medical Corps or a member of the staff of what used to be the voluntary hospitals which are to be local authority hospitals in the future.

Many of the considerations that have been advanced are really quite beside the point in connection with the issue we are discussing. For example, any comparison with any occupation, in which there are recognised grades of promotion and recognised appointments carrying higher status and higher remuneration, is entirely beside the point when considering the proper remuneration for general medical practitioners as a whole. I gather that no new arguments have been put forward, and that the position is as it has been for some months; that the right hon. Gentleman, to our relief, has disowned, for the present at any rate, the official policy, as it was admitted to exist by the Lord Privy Seal; that he is not applying that policy for the present, because the medical profession is not ripe for it, and that it is admitted that the official policy of the party opposite is to deprive the people of this country of freedom of choice of their own doctor, because their official policy of a wholetime medical service is inconsistent with freedom of choice. While we have, for the moment, that very valuable admission, the question is whether there are any solid grounds, or merely grounds of political compromise, for the Government's refusal to exclude the ubiquitous element of salary in the general practitioner service.

8.30 p.m.

We are not so much concerned with the doctors; we are concerned with the interests of the patients. I am convinced that the patients of this country will be less happy and, in many cases, less satisfied with a service which is a salaried service, whatever is the proportion of that salary. There is all the difference in the world between what a sick person thinks of the medical officers in a hospital, the medical officers of a local authority or what a Territorial soldier thinks of the R.A.M.C. officer in his battalion, and what the average family thinks of their own family doctor. It is an entirely different relationship. We have not heard one argument from the Minister inducing us to believe, or to begin to think, that the people of this country will like their family doctor being a salaried officer or a salaried servant, whatever one likes to call it, of a Government organisation. We believe that they will not like it, that it will reduce their confidence and that it will, in fact, lead to a lessening of the warmth of feeling which there has been in the past between doctor and patient in the general practitioner field.

Mr. Scollan (Renfrew, Western)

I have listened with great interest to many hon. Members speaking about the family doctor and the relationship between the family doctor and the family. Would the right hon. and learned Gentleman be good enough to say how many families, in his estimation, could afford the luxury of having a family doctor?

Mr. Willink

I am grateful for the interruption. Of course, that is the basic advantage of this Measure in the medical practitioner field. There is going to be no difficulty for any family, in having a family doctor, but we want the relationship to be that of the family doctor, even if it is without expense. Our objection is to the Minister's expressed intention to make every doctor, in part, a salaried man just at the moment when we believe that the whole of this House and the whole country desire that there should be a general practitioner service available to everyone without charge; we believe that he is quite unnecessarily, and without any substantial argument, destroying a great deal of the relationship between those who could afford a family doctor, a relationship which we want to see established between all persons who require a doctor in the future.

Mr. Scollan

But what is the proportion?

Mr. Willink

There is no question of proportion. All people are going to be enabled to have a general practitioner service free of charge, and the only issue on this Amendment is, Is that service to be one received from a doctor who is in part a salaried person, or from somebody who derives his income in relation to the zeal and skill which he shows with regard to his patients? We are convinced that it is an injury to the general practitioner service that the Minister should obtain from Parliament the power to administer what we believe is a compromise with the policy of his party containing this element of basic salary.

What are the arguments for it? They are those which we have heard in the past. There is another argument which has been developed—I do not know whether it has been developed by the Minister today but it has certainly been developed by Ministers in another place—that the bringing in of a basic salary will get rid of the difficulty of swollen lists. I cannot understand that argument at all. It is most necessary that any doctor in this service should be limited as to the number of patients he can take, but he is no more and no less limited because he receives a salary. What is clear is this: The larger the amount of salary, the less must be the incentive to get his list up to its allowed limit, because if he is a lazy fellow he will say "The salary is all I really want; I will not have anything more." I would have thought that at the moment when we are undoubtedly short of doctors, it is most desirable that all the doctors should be as keen as possible to get lists of a size which the Ministry of Health regard as suitable.

Then we have these old considerations which I have never been able to understand, namely, that the medical practitioner must have a basic salary in order to have something to which he can add something else, for a special qualification, or a refresher course, or because an area is difficult. I have never understood why one must have X, in order to add Y to it. The Minister has said this on several occasions, and it appears to be one of his best arguments but I have never been able to understand it, and I do not believe anybody else can, neither do I believe the right hon. Gentleman can really have put forward the argument seriously. So far as difficult areas are concerned, that matter is covered by the Amendment which the Minister is asking the House to reject.

The point concerning the Minister's intentions as to how the Bill will work is a serious matter. The hon. Member for Rochdale said this was a puny point. The question whether the general practitioners are to be salaried or not is far from a puny point. I am not affected by the question whether in a few years time the doctors are to receive £300, £l400 of £500 a year. Our whole interest is whether it is to the advantage of the patients whom it is sought to benefit under this Bill. We can see no ground whatever for believing that the patients will be advantaged in any way by this reduction of incentive to the doctors. We believe that the patients will come to feel that their doctors are not their doctors in the same way as they were in the past. We recall—and I would respectfully call the attention of hon. Members opposite to this point—the stress that was laid by the Webbs in their books about Socialism, on the value to any community of the professions being wholly independent of the State, not answerable to the State for their remuneration, and certainly not salaried. We believe that the theories of the Webbs with regard to Socialism have suffered a sad decline in this attempt to bring everybody in this direct relationship with the State, and we believe this is a grievous blemish on the Bill. The Minister has announced his intentions in regard to working the extremely wide provisions of the Bill. We believe that the Bill is shocking in the freedom that it gives to the Executive. We believe that the way in which it is proposed to be applied is dangerous, both to the profession and to the people, and we shall be bound to object to the Motion.

Question put, "That this House doth disagree with the Lords in the said Amendment."

The House divided: Ayes, 303; Noes, 128.

Division No. 293.]	AYES.	6.35 p.m.
Adams, Richard (Balham)	Corvedale, Viscount	Herbison, Miss M.
Alexander, Rt. Hon. A. V.	Daggar, G.	Hewitson, Capt. M.
Allen, A. C. (Bosworth)	Daines, P	Hicks, G.
Allighan, Garry	Davies, Clement (Montgomery)	Hobson, C. R.
Alpass, J. H.	Davies, Edward (Burslem)	Holman, P.
Anderson, A. (Motherwell)	Davies, Ernest (Enfield)	Holmes, H. E. (Hemsworth)
Anderson, F. (Whitehaven)	Davies, Harold (Leek)	Horabin, T. L.
Attewell, H. C.	Davies, S. O. (Merthyr)	House, G.
Austin, H. L.	Deer, G.	Hoy, J.
Awbery, S. S.	de Freitas, Geoffrey	Hudson, J. H. (Ealing, W.)
Ayles, W. H	Delargy, Captain H. J.	Hughes, Hector (Aberdeen, N.)
Ayrton Gould, Mrs. B.	Diamond, J.	Hughes, H. D. (Wolverhampton, W.)
Bacon, Miss A.	Dobbie, W.	Hutchinson, H. L. (Rusholme)
Baird, J.	Dodds, N N.	Hynd, H. (Hackney, C.)
Balfour, A.	Donovan, T.	Irving, W. J.
Barnes, Rt. Hon A. J.	Driberg, T. E. N.	Janner, B.
Barstow, P. G.	Dugdale, J. (W. Bromwich)	Jay, D. P. T.
Barton, C.	Dumpleton, C. W.	Jeger, G. (Winchester)
Battley, J. R	Dye, S.	Jones, Rt. Hon. A. C. (Shipley)
Bechervaise, A. E.	Ede, Rt. Hon. J. C.	Jones, D. T. (Hartlepools)
Bellenger, Rt. Hon. F. J.	Edelman, M.	Jones, Elwyn (Plaistow)
Benson, G.	Edwards, A. (Middlesbrough, E.)	Jones, P. Asterley (Hitchin)
Bevan, Rt. Hon. A. (Ebbw Vale)	Edwards, Rt. Hon. Sir C. (Bedwellty)	Keenan, W.
Bing, G. H. C.	Edwards, John (Blackburn)	Kenyon, C.
Binns, J.	Edwards, N. (Caerphilly)	Key, C. W.
Blackburn, A. R.	Evans, E. (Lowestoft)	Kinley, J.
Blenkinsop, A.	Evans, John (Ogmore)	Kirby, B. V.
Blyton, W. R.	Evans, S. N. (Wednesbury)	Lang, G.
Boardman, H.	Ewart, R.	Lavers, S.
Bowdon, Flg.-Offr. H. W.	Fairhurst, F.	Lee, F. (Hulme)
Bowles, F. G. (Nuneaton)	Farthing, W. J.	Lee, Miss J. (Cannock)
Braddock, Mrs. E. M. (L'pl, Exch'ge)	Fletcher, E. G. M. (Islington, E.)	Leslie, J. R.
Braddock, T. (Mitcham)	Follick, M.	Levy, B. W.
Brook, D. (Halifax)	Forman, J. C.	Lewis, J. (Bolton)
Brooks, T. J. (Rothwell)	Freeman, Maj. J. (Watford)	Lewis, T. (Southampton)
Brown, George (Belper)	Gaitskell, H. T. N.	Lindgren, G. S.
Brown, T. J. (Ince)	Gibbins, J.	Lipton, Lt.-Col. M.
Brown, W. J. (Rugby)	Gilzean, A.	Longden, F.
Bruce, Maj. D. W. T.	Glanville, J. E. (Consett)	Lyne, A W.
Burke, W. A.	Gordon-Walker, P. C.	McAllister, G.
Byers, Frank	Greenwood, A. W. J. (Heywood)	McEntee, V La I
Callaghan, James	Grey, C. F.	McGhee, H. G.
Castle, Mrs. B. A.	Grierson, E.	Mack, J D.
Chamberlain, R. A.	Griffiths, D. (Rother Valley)	McKay, J. (Wallsend)
Champion, A. J	Griffiths, Rt. Hon. J. (Llanelly)	Mackay, R. W. G. (Hull, N.W.)
Chater, D.	Guest, Dr. L. Haden	Maclean, N. (Govan)
Chetwynd, Capt. G. R.	Gunter, Capt. R. J.	McLeavy, F.
Clitherow, Dr. R.	Guy, W. H.	MacMillan, M. K. (Western Isles)
Cobb, F. A.	Haire, Flt.-Lieut. J. (Wycombe)	Macpherson, T. (Romford)
Cocks, F. S.	Hale, Leslie	Mainwaring, W. H.
Coldrick, W.	Hall, W. G. (Colne Valley)	Mallalieu, J. P. W.
Collick, P.	Hamilton, Lieut.-Col. R.	Mann, Mrs. J.
Collins, V. J.	Hardman, D. R.	Manning, Mrs. L. (Epping)
Colman, Miss G. M	Hardy, E. A.	Marquand, H. A.
Comyns, Dr. L.	Harris, H. Wilson	Marshall, F. (Brightside)
Cook, T. F.	Harrison, J.	Mayhew, C. P.
Cooper, Wing Comdr. G.	Hastings, Dr. Somerville	Medland, H. M.
Corlett, Dr. J.	Henderson, A. (Kingswinford)	Messer, F.
Middleton, Mrs. L.	Rankin, J.	Thomas, I. O. (Wrekin)
Mikardo, Ian	Rees-Williams, D. R.	Thomas, John R. (Dover)
Millington, Wing-Comdr. E. R.	Reeves, J.	Thomas, George (Cardiff)
Mitchison, Maj. G. R.	Reid, T. (Swindon)	Thorneycroft, Harry (Clayton)
Monslow, W.	Ridealgh, Mrs. M.	Thurtle, E.
Montague, F.	Robens, A.	Tiffany, S.
Moody, A. S.	Roberts, Emrys (Merioneth)	Titterington, M. F.
Morgan, Dr. H. B.	Roberts, Goronwy (Caernarvonshire)	Tolley, L.
Morley, R.	Rogers, G. H. R.	Tomlinson, Rt. Hon. G.
Morris, Lt.-Col. H. (Sheffield, C.)	Scollan, T.	Turner-Samuels, M.
Morris, P. (Swansea, W.)	Scott-Elliot, W.	Ungoed-Thomas, L.
Morris, Hopkin (Carmarthen)	Segal, Dr. S.	Vernon, Maj. W. F.
Moyle, A.	Shackleton, Wing-Cdr. E. A. A.	Viant, S. P.
Murray, J. D.	Sharp, Lt.-Col. G. M.	Wallace, G. D. (Chislehurst)
Nally, W.	Shawcross, C. N. (Widnes)	Wallace, H. W. (Walthamstow, E.)
Naylor, T. E.	Shinwell, Rt. Hon. E.	Warbey, W. N.
Neal, H. (Claycross)	Shurmer, P.	Watkins, T. E.
Nichol, Mrs. M. E. (Bradford, N.)	Silverman, J. (Erdington)	Webb, M. (Bradford, C.)
Nicholls, H. R. (Stratford)	Silverman, S. S. (Nelson)	Wells, W. T. (Walsall)
Noel-Buxton, Lady.	Simmons, C. J.	West, D. G.
O'Brien, T.	Skeffington, A. M.	White, H. (Derbyshire, N.E.)
Oldfield, W. H.	Skeffington-Lodge, T. C.	Whiteley, Rt. Hon. W.
Oliver, G. H.	Skinnard, F. W.	Wigg, Col. G. E.
Orbach, M.	Smith, C. (Colchester)	Wilcock, Group-Capt. C. A. B.
Palmer, A. M. F.	Smith, Ellis (Stoke)	Wilkins, W. A.
Parker, J.	Smith, H. N. (Nottingham, S.)	Willey, O. G. (Cleveland)
Parkin, B. T.	Smith, S. H. (Hull, S.W.)	Williams, D. J. (Neath)
Paton, Mrs. F. (Rushcliffe)	Snow, Capt. J. W.	Williams, J. L. (Kelvingrove)
Paton, J. (Norwich)	Solley, L. J.	Williams, W. R. (Heston)
Pearson, A.	Sorensen, R. W.	Williamson, T.
Pearl, Capt. T. F.	Soskice, Maj. Sir F.	Willis, E
Perrins, W.	Sparks, J. A	Wills, Mrs. E. A.
Platts-Mills, J. F. F.	Stamford, W.	Wilmot, Rt. Hon. J
Poole, Major Cecil (Lichfield)	Steele, T.	Wise, Major F. J.
Popplewell, E.	Stewart, Capt. Michael (Fulham, E.)	Woods, G. S.
Porter, E. (Warrington)	Stross, Dr. B.	Wyatt, W
Porter, G. (Leeds)	Stubbs, A. E.	Yates, V. F.
Pritt, D. N.	Summerskill, Dr. Edith	Zilliacus, K.
Proctor, W. T.	Swingler S.
Pursey, Cmdr. H.	Symonds, A. L.	TELLERS FOR THE AYES:
Randall, H. E.	Taylor, H. B. (Mansfield)	Mr. Joseph Henderson and Mr. Hannan.
Ranger, J.	Taylor, R. J. (Morpeth)
NOES.
Agnew, Cmdr. P. G.	Gomme-Duncan, Col. A. G.	Maude, J. C.
Amory, D. Heathcoat	Gridley, Sir A.	Medlicott, F.
Astor, Hon. M.	Grimston, R. V.	Mellor, Sir J.
Barlow, Sir J.	Hannon, Sir P. (Moseley)	Molson, A. H. E.
Beechman, N. A.	Hare, Hon. J. H. (Woodbridge)	Moore, Lt.-Col. Sir T.
Bennett, Sir P.	Harvey, Air-Comdre, A. V.	Morris-Jones, Sir H.
Birch, Nigel	Haughton, S. G.	Morrison, Maj. J. G. (Salisbury)
Boles, Lt.-Col. D. C. (Wells)	Head, Brig. A. H.	Morrison, Rt. Hon. W. S. (Cirencester)
Boothby, R.	Hinchingbrooke, Viscount	Mott-Radclyffe, Maj. C. E.
Bower, N.	Hollis, M. C.	Nicholson, G.
Boyd-Carpenter, J. A.	Holmes, Sir J. Stanley (Harwich)	Noble, Comdr. A. H. P.
Braithwaite, Lt.-Comdr. J. G.	Hope, Lord J.	Nutting, Anthony
Bromley-Davenport, Lt.-Col. W.	Howard, Hon. A.	O'Neill, Rt. Hon. Sir H.
Buchan-Hepburn, P. G. T.	Hudson, Rt. Hon. R. S. (Southport)	Orr-Ewing, I. L.
Bullock, Capt. M.	Hurd, A.	Peake, Rt. Hon. O.
Butler, Rt. Hon. R. A. (S'ffr'n W'ld'n)	Hutchison, Lt.-Cm. Clark (E'b'rgh, W.)	Peto, Brig. C. H. M.
Carson, E.	Hutchison, Col. J. R. (Glasgow, C.)	Pickthorn, K.
Challen, C.	Joynson-Hicks, Lt.-Cdr. Hon. L. W.	Pitman, I. J.
Clifton-Brown, Lt.-Col. G.	Kerr, Sir J. Graham	Ponsonby, Col. C. E.
Conant, Maj. R. J. E.	Lancaster, Col. C. G.	Poole, O. B. S. (Oswestry)
Corbett, Lieut.-Col. U. (Ludlow)	Law, Rt. Hon. R. K.	Prescott, Stanley
Crookshank, Capt. Rt. Hon. H. F. C.	Legge-Bourke, Maj. E. A. H.	Raikes, H. V.
Crowder, Capt. John E	Lennox-Boyd, A. T.	Rayner, Brig. R.
De la Bère, R.	Lipson, D. L.	Reed, Sir S. (Aylesbury)
Digby, S. W.	Low, Brig. A. R. W.	Reid, Rt. Hon. J. S. C. (Hillhead)
Dodds-Parker A. D.	Lucas, Major Sir J.	Renton, D.
Donner, Sqn.-Ldr. P. W.	Lucas-Tooth, Sir H.	Roberts, H. (Handsworth)
Dower, Lt.-Col. A. V. G. (Penrith)	Lyttelton, Rt. Hon. O.	Robertson, Sir D. (Streatham)
Drayson, G. B.	MacAndrew, Col. Sir C.	Ross, Sir R.
Eccles, D. M.	Macdonald, Sir P. (Isle of Wight)	Sanderson, Sir F.
Eden, Rt. Hon. A.	Mackeson, Brig. H. R.	Shepherd, W. S. (Bucklow)
Fleming, Sqn.-Ldr. E. L.	Maclay, Hon. J. S.	Smiles, Lt.-Col. Sir W.
Fletcher, W. (Bury)	Maclean, Brig. F. H. R. (Lancaster)	Smith, E. P. (Ashford)
Fraser, Sir I. (Lonsdale)	Macmillan, Rt. Hon. Harold (Bromley)	Snadden, W. M.
Fyfe, Rt. Hon. Sir D. P. M.	Maitland, Comdr. J. W.	Stanley, Rt. Hon. O.
Gage, C.	Manningham-Buller, R. E	Strauss, H. G. (English Universities)
Galbraith, Cmdr. T. D.	Marlowe, A. A. H.	Stuart, Rt. Hon. J. (Moray)
Gammans, L. D.	Marples, A. E.	Sutcliffe, H.
George, Maj. Rt. Hon. G. Lloyd (P'ke)	Marshall, D. (Bodmin)	Taylor, Vice-Adm. E. A. (P'dd't'n, S.)
Glossop, C. W. H.	Marshall, S. H. (Sutton)	Teeling, William
Thomas, J. P. L. (Hereford)	Wakefield, Sir W. W.	Winterton, Rt. Hon. Earl
Thorneycroft, G. E. P. (Monmouth)	Watt, Sir G. S. Harvie	Young, Sir A. S. L. (Partick)
Thornton-Kemsiey, C. N.	Wheatley, Colonel M. J.
Touche, G. C.	White, J. B. (Canterbury)	TELLERS FOR THE NOES.
Turton, R. H.	Williams, Gerald (Tonbridge)	Mr. Drewe and Major Ramsay.
Vane, W. M. F	Willoughby de Eresby, Lord

Question put, and agreed to.

Division No. 294.]	AYES.	[8.40 p.m.
Adams, Richard (Balham)	Evans, E. (Lowestoft)	McKay, J. (Wallsend)
Allen, A. C. (Bosworth)	Evans, John (Ogmore)	Mackay, R. W. G. (Hull, N.W.)
Allighan, Garry	Evans, S. N. (Wednesbury)	Maclean, N. (Govan)
Anderson, A. (Motherwell)	Ewart, R.	McLeavy, F.
Attewell, H. C.	Fairhurst, F	MacMillan, M. K. (Western Isles)
Austin, H. L.	Farthing, W. J.	McNeil, Rt. Hon. H.
Awbery, S. S.	Fletcher, E. G. M. (Islington, E.)	Macpherson, T. (Romford)
Ayles, W. H.	Follick, M.	Mainwaring, W. H.
Ayrton Gould, Mrs. B.	Forman, J. C.	Mallalieu, J. P. W.
Bacon, Miss A.	Freeman, Maj. J. (Watford)	Mann, Mrs. J.
Baird, J.	Gaitskell, H. T. N.	Manning, Mrs. L. (Epping)
Balfour, A.	Gallacher, W.	Marquand, H. A.
Barnes, Rt. Hon A. J.	Ganley, Mrs. C. S.	Marshall, F. (Brightside)
Barstow, P. G.	Gibbins, J.	Mayhew, C. P.
Barton, C.	Gibson, C. W.	Medland, H. M
Battley, J. R	Gilzean, A.	Messer, F.
Bechervaise, A. E	Glanville, J. E. (Consett)	Middleton, Mrs. L.
Belcher, J. W.	Goodrich, H. E.	Mikardo, Ian
Bellenger, Rt. Hon. F J	Gordon-Walker, P. C	Mitchison, Maj. G. R.
Benson, G.	Greenwood, Rt. Hon. A. (Wakefield)	Monslow, W.
Berry, H.	Greenwood, A. W. J (Heywood)	Montague, F.
Bevan, Rt. Hon A. (Ebbw Vale)	Grey, C. F.	Morgan, Dr. H. B.
Bing, G. H. C.	Grierson, E.	Morley, R.
Binns, J.	Griffiths, D. (Rother Valley)	Morris, Lt.-Col. H. (Sheffield, C.)
Blackburn, A. R	Griffiths, Rt. Hon. J. (Llanelly)	Morris, P. (Swansea, W.)
Blenkinsop, A.	Guest, Dr. L. Haden	Moyle, A.
Blyton, W. R.	Gunter, Capt. R. J	Murray, J D.
Boardman, H.	Guy, W. H.	Nally, W.
Bowden, Flg.-Offr. H. W.	Haire, Flt.-Lieut. J. (Wycombe)	Naylor, T. E.
Bowles, F. G. (Nuneaton)	Hale, Leslie	Neal, H. (Claycross)
Braddock, Mrs. E. M. (L'pl, Exch'ge)	Hall, W. G. (Colne Valley)	Nichol, Mrs. M. E. (Bradford, N.)
Braddock, T. (Mitcham)	Hamilton, Lieut.-Col. R.	Nicholls, H. R. (Stratford)
Bramall, Major E. A.	Hannan, W. (Maryhill)	Noel-Buxton, Lady.
Brook, D. (Halifax)	Hardman, D. R.	O'Brien, T.
Brooks, T. J. (Rothwell)	Hardy, E. A.	Oldfield, W. H.
Brown, George (Belper)	Harrison, J.	Oliver, G. H.
Brown, T. J. (Ince)	Hastings, Dr. Somerville	Orbach, M.
Bruce, Maj. D. W. T.	Henderson, A. (Kingswinford)	Paget, R. T.
Burke, W. A.	Herbison, Miss M.	Palmer, A. M. F.
Butler, H W. (Hackney, S.)	Hewitson, Capt. M.	Pargiter, G. A.
Callaghan, James	Hicks, G.	Parker, J.
Castle, Mrs. B. A.	Hobson, C. R.	Parkin, B. T.
Chamberlain, R. A	Holman, P.	Paton, Mrs. F. (Rushcliffe)
Champion, A. J.	Holmes, H. E. (Hemsworth)	Paton, J. (Norwich)
Chater, D.	Horabin, T. L.	Pearson, A.
Chetwynd, Capt. G. R.	House, G.	Pearl, Capt. T. F.
Clitherow, Dr. R.	Hoy, J.	Perrins, W
Cluse, W. S.	Hughes, Hector (Aberdeen, N.)	Platts-Mills, J. F. F.
Cobb, F. A.	Hughes, H. D. (Wolverhampton, W.)	Poole, Major Cecil (Lichfield)
Cocks, F. S.	Hutchinson, H. L. (Rusholme)	Porter, E. (Warrington)
Coldrick, W.	Hynd, H. (Hackney, C.)	Porter, G (Leeds)
Collick, P.	Hynd, J. D. (Attercliffe)	Pritt, D. N.
Collins, V. J.	Irving, W. J.	Proctor, W. T
Colman, Miss G. M	Janner, B.	Pursey, Cmdr. H
Comyns, Dr. L.	Jeger, G. (Winchester)	Randall, H. E.
Cook, T. F.	Jeger, Dr. S. W. (St. Pancras, S.E.)	Ranger, J.
Cooper, Wing-Comdr G.	Jones, Rt. Hon. A. C. (Shipley)	Rankin, J.
Corbel, Mrs. F. K. (Camb'well, N.W.)	Jones, D. T. (Hartlepools)	Rees-Williams, D. R.
Corlett, Dr. J.	Jones, Elwyn (Plaistow)	Reeves, J.
Corvedale, Viscount	Jones, J. H. (Bolton)	Reid, T. (Swindon)
Daggar, G.	Jones, P. Asterley (Hitchin)	Rhodes, H.
Daines, P.	Keenan, W.	Ridealgh, Mrs. M.
Davies, Edward (Burslem)	Kenyon, C.	Robens, A.
Davies, Ernest (Enfield)	Key, C. W.	Roberts, Goronwy (Caernarvonshire)
Davies, Hadyn (St. Pancras, S.W.)	Kinghorn, Sqn.-Ldr. E	Rogers, G. H. R
Davies, Harold (Leek)	Kinley, J.	Sargood, R.
Davies, S. O. (Merthyr)	Kirby, B. V	Scollan, T.
Deer, G.	Lang, G.	Scott-Elliot, W.
de Freitas, Geoffrey	Lavers, S.	Segal, Dr. S.
Diamond, J.	Lee, F. (Hulme)	Shackleton, Wing-Cdr. E. A. A.
Dobbie, W.	Lee, Miss J. (Cannock)	Sharp, Lt.-Col. G. M.
Dodds, N. N.	Leslie, J. R.	Shawcross, C. N. (Widnes)
Donovan, T.	Levy, B. W.	Shurmer, P.
Driberg, T. E. N.	Lewis, A. W. J. (Upton)	Silverman, J. (Erdington)
Dugdale, J. (W. Bromwich)	Lewis, T. (Southampton)	Silverman, S. S. (Nelson)
Dumpleton, C. W.	Lindgren, G. S.	Simmons, C. J
Durbin, E. F. M.	Lipton, Lt.-Col. M.	Skeffington-Lodge, T. C
Dye, S.	Longden, F.	Skinnard, F. W.
Ede, Rt. Hon. J. C.	Lyne, A. W.	Smith, C. (Colchester)
Edwards, A. (Middlesbrough, E.)	McAllister, G.	Smith, Ellis (Stoke)
Edwards, Rt. Hon. Sir C. (Bedwellty)	McEntee, V. La T.	Smith, H. N. (Nottingham, S.)
Edwards, John (Blackburn)	McGhee, H. G.	Smith, S. H. (Hull, S.W.)
Edwards, N. (Caerphilly)	Mack, J. D.	Snow, Capt. J. W.
Solley, L. J.	Tiffany, S.	Wilcock, Group-Capt. C. A. B
Sorensen, R. W.	Titterington, M. F.	Wilkins, W. A.
Soskice, Maj. Sir F	Tolley, L.	Willey, O. G. (Cleveland)
Sparks, J. A.	Tomlinson, Rt. Hon. G	Williams, D. J. (Neath)
Stamford, W.	Turner-Samuels, M.	Williams, J. L. (Kelvingrove)
Steele, T.	Ungoed-Thomas, L.	Williams, W. R. (Heston)
Stewart, Capt. Michael (Fulham, E.)	Vernon, Maj. W. F.	Williamson, T.
Stross, Dr. B.	Viant, S. P.	Willis, E.
Stubbs, A. E.	Walkden, E.	Wills, Mrs. E. A.
Summerskill, Dr. Edith	Wallace, G. D. (Chislehurst)	Wilmot, Rt. Hon. J
Swingler S	Wallace, H. W. (Walthamstow, E.)	Wise, Major F. J.
Symonds, A. L.	Warbey, W. N.	Woods, G. S.
Taylor, H. B. (Mansfield)	Watkins, T. E.	Wyatt, W.
Taylor, R. J. (Morpeth)	Weitzman, D.	Yates, V. F.
Thomas, I. O. (Wrekin)	Wells, W. T. (Walsall)	Zilliacus, K.
Thomas, John R. (Dover)	West, D. G.
Thomas, George (Cardiff)	White, H. (Derbyshire, N.E.)	TELLERS FOR THE AYES
Thorneycroft, Harry (Clayton)	Whiteley, Rt. Hon. W.	Mr. Joseph Henderson and Mr. Popplewell
Thurtle, E.	Wigg, Col. G. E.
NOES.
Agnew, Cmdr. P. G	Hare, Hon. J. H. (Woodbridge)	Pickthorn, K.
Aitken, Hon. Max.	Harvey, Air-Comdre, A. V.	Pitman, I. J.
Amory, D. Heathcoat	Henderson, John (Cathcart)	Ponsonby, Col. C. E.
Astor, Hon. M.	Hinchingbrooke, Viscount	Poole, O. B. S. (Oswestry)
Barlow, Sir J	Hogg, Hon. Q.	Prescott, Stanley
Beechman, N. A	Howard, Hon. A.	Price-White, Lt.-Col. D.
Bennett, Sir P.	Hudson, Rt. Hon. R. S. (Southport)	Raikes, H. V.
Birch, Nigel	Hurd, A.	Rayner, Brig. R.
Boles, Lt.-Col. D. C. (Wells)	Hutchison, Lt.-Cm. Clark (E'b'rgh, W.)	Reed, Sir S. (Aylesbury)
Bower, N.	Joynson-Hicks, Lt.-Cdr. Hon. L. W.	Reid, Rt. Hon J. S. C. (Hillhead)
Boyd-Carpenter, J. A.	Lancaster, Col. C. G.	Renton, D.
Braithwaite, Lt.-Comdr. J. G.	Law, Rt. Hon. R. K.	Roberts, Emrys (Merioneth)
Bromley-Davenport, Lt.-Col. W.	Legge-Bourke, Maj. E. A. H	Roberts, H. (Handsworth)
Buchan-Hepburn, P. G. T.	Lennox-Boyd, A. T.	Ross, Sir R.
Butler, Rt. Hon. R. A. (S'ffr'n W'Id'n)	Lindsay, M. (Solihull)	Sanderson, Sir F.
Byers, Frank	Low, Brig. A. R. W	Shepherd, W. S. (Bucklow)
Carson, E.	Lucas, Major Sir J.	Smiles, Lt.-Col. Sir W.
Challen, C.	Lucas-Tooth, Sir H.	Smith, E. P. (Ashford)
Clifton-Brown, Lt.-Col. G.	MacAndrew, Col. Sir C.	Snadden, W. M.
Conant, Maj. R. J. E.	Macdonald, Sir P. (Isle of Wight)	Stanley, Rt. Hon. O.
Corbett, Lieut.-Col. U. (Ludlow)	Mackeson, Brig. H. R.	Strauss, H. G. (English Universities)
Crookshank, Capt. Rt. Hon. H. F. C.	Maclay, Hon. J. S.	Stuart, Rt. Hon. J. (Moray)
Crowder, Capt. John E.	Macmillan, Rt. Hon. Harold (Bromley)	Sutcliffe, H.
Cuthbert, W. N.	Manningham-Buller, R. E.	Taylor, Vice-Adm. E. A. (P'dd't'n, S.).
Davies, Clement (Montgomery)	Marlowe, A. A. H.	Teeling, William
Digby, S. W.	Marples, A. E.	Thomas, J. P. L. (Hereford)
Dodds-Parker A. D	Marsden, Capt. A.	Thorneycroft, G. E. P. (Monmouth)
Drayson, G. B.	Marshall, D. (Bodmin)	Thornton-Kemsley, C. N.
Drewe, C.	Marshall, S. H. (Sutton)	Touche, G. C.
Eccles, D. M.	Maude, J. C.	Turton, R. H.
Eden, Rt. Hon. A.	Medlicott, F.	Vane, W. M. F.
Fletcher, W. (Bury)	Mellor, Sir J.	Wadsworth, G.
Fraser, Sir I: (Lonsdale)	Molson, A. H. E.	Watt, Sir G. S. Harvie
Gage, C.	Moore, Lt.-Col. Sir T.	Wheatley, Colonel M. J.
Galbraith, Cmdr. T. D.	Morris, Hopkin (Carmarthen)	White, J. B. (Canterbury)
Gammans, L. D.	Morris-Jones, Sir H.	Williams, Gerald (Tonbridge)
Gates, Maj. E. E.	Morrison, Maj. J. G. (Salisbury)	Wittink, Rt. Hon. H. U.
George, Maj. Rt. Hon. G. Lloyd (P'ke)	Morrison, Rt. Hon. W. S. (Cirencester)	Willoughby de Eresby, Lord
Glossop, C. W. H.	Mott-Radclyffe, Maj. C. E.	Winterton, Rt. Hon. Earl
Glyn, Sir R.	Nicholson, G.	York, C.
Gomme-Duncan, Col. A. G.	Noble, Comdr. A. H. P.
Gridley, Sir A.	O'Neill, Rt. Hon. Sir H	TELLERS FOR THE NOES
Grimston, R. V.	Orr-Ewing, I. L.	Sir Arthur Young and Major Ramsay.
Harmon, Sir P. (Moseley)	Peto, Brig. C. H. M.

Question put, and agreed to

CLAUSE 34.—(Distribution of medical practitioners providing services.)

Lords Amendment: In page 27, line 34, leave out "hearing," and insert "determination."

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

This Amendment deals with the question of the time when a successful applicant should take up his position when an objection has been raised by an unsuccessful applicant. As the Bill stands, it is held up until the appeal has been heard, and what we wish to put in here is that it shall be held up until the appeal is determined.

Lords Amendment: In page 28, line 13, at end, insert: (9) The Medical Practices Committee shall, in a case where persons have to be selected from a number of applicants and the Minister shall, on an appeal in any such case, have regard to any desire expressed by any applicant to practise with other medical practitioners already providing general medical services in the area or part of an area concerned, and of any desire expressed by such other medical practitioners to take any applicant into practice with them, and shall have special regard to the matters aforesaid in cases where an applicant is related to any such other medical practitioner.

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

This is concerned with the appointment of applicants to the new medical practices; it is desired that consideration shall be given to applications to serve either with relatives or in partnerships that are already in existence.

CLAUSE 35.—(Prohibition of sale of medical practices.)

Lords Amendment: In page 29, line 23, leave out from "death" to the end of line 26, and insert: not being a payment in respect of that partner's share in past earnings of the partnership or in any partnership assets or any other payment required to be made to him as the result of the final settlement of accounts, as between him and the other partners, in respect of past transactions of the partnership.

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

In this case, on consideration, it was felt that there were certain cases where a partnership agreement already in existence might make some sort of provision for payments to be made at death or retirement that were quite legitimate and, as a matter of fact, would be normal processes in the winding up of a partnership. It was considered that there was no reason for regarding these as being part of the sale of the goodwill; they could be settled up without that being the case.

Mr. J. S. C. Reid

This of course is a most admirable Amendment, and if anybody on either side had thought of it at an earlier stage it would undoubtedly have been adopted. The fact that it was not thought of until the very last moment by anybody, although we had all been busy going through this Bill with a tooth comb, shows how unduly elaborate this very harsh Clause 35 is, and I fear very much that there may be other equally im portant points which have still escaped our notice. I hope that the fact that an important point like this was not discovered until the last moment may weigh with the Government when they come to consider other Clauses of this character in other Bills; and that they will see fit not to try to cover the ground as elaborately as here, because this sort of thing shows that they are doing more harm than good. I hope it will be a lesson causing the Government to revert to a more simple mode of life.

CLAUSE 4I.—(Supplementary ophthalmic services.)

Lords Amendment: In page 36, line 2, leave out "and opticians."

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

This and a subsequent group of Amendments are all related to the same purpose, namely making plain on the face of the Bill the distinction between the ophthalmic optician who both tests sight and supplies spectacles and the dispensing optician who only supplies spectacles. It has been felt, after consultation, that this distinction will add to the better administration of the Bill. The definitions are included in pages 60 and 6I, and this series of Amendments to page 36 relate to the same point.

CLAUSE 42.—(Disqualification of practitioners.)

Lords Amendment: In page 38, leave out lines 19 to 22, and insert: (i) of appearing, either in person or by counsel or solicitor or such other representative as may be prescribed, before the Tribunal and, in the case of an appeal, before a person appointed by the Minister; and (ii) of being heard by the Tribunal or the person so appointed and of calling witnesses and producing other evidence on his behalf; and that the hearing, whether by the Tribunal or the person appointed as aforesaid, shall be in public if the person who is the subject of the inquiry so requests.

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

This Amendment relates to hearings before the tribunal, and will enable the practitioners concerned to be represented by counsel and to call witnesses. It also secures that there may be a public hearing. These matters would have been covered by the regulations which would have been made under the Bill, but it was thought that they should be made plain in the Bill, and we have no objections.

Mr. David Renton (Huntingdon)

I should like to congratulate the Government upon having made clear this principle, namely, that doctors concerned may have either a counsel or a solicitor appearing for them. If the hon. Member for Oldham (Mr. Hale) had been present, I am sure that he would have been anxious to express his gratitude that solicitors as well as counsel have been included in this Amendment.

CLAUSE 43.—(Powers of Minister where services are inadequate.)

Lords Amendment: In page 39, line 37, leave out "for the purpose of such other arrangements he."

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

This and a subsequent Amendment deal with the extent of the Minister's powers to dispense with regulations. These words really restrict, and the restrictive words in the second Amendment make the Minister's exercise of power dependent on exceptional circumstances, and then only to the extent necessary to enable special arrangements to be made.

CLAUSE 48.—(Provision of courses for medical and dental practitioners.)

Lords Amendment: In page 40, line 43, leave out "practitioners", and insert "persons."

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

In the Bill, we talk sometimes of "medical practitioners," sometimes of "dental practitioners" and sometimes merely say "practitioners." In order that there may be no confusion, we propose to omit "practitioners" and insert "persons."

CLAUSE 60.—(Power of trustees to make payments to Regional Hospital Boards and Boards of Governors.)

Lords Amendment: In page 5o, line 6, after "hospital," insert "or to a Hospital Management Committee."

9.0 p.m.

Mr. Key

I beg to move: "That this House doth agree with the Lords in the said Amendment."

This Amendment introduces a reference to hospital management committees being the recipients of endowments, and is consequential on the New Clause A.

Subsequent Lords Amendments to line 25 agreed to.

Mr. Key

On a point of Order. Are we not taking, Sir, the Lords Amendment in line 25, at the end to insert new Clause A (Preservation of associations of denominational hospitals)? Where the character and associations of any voluntary hospital transferred to the Minister by virtue of this Act are such as to link it with a particular religious denomination, regard shall be had in the general administration of the hospital and in the making of appointments to the Hospital Management Committee to the preservation of the character and associations of the hospital.

Mr. Deputy-Speaker (Major Milner)

I am sorry, but I thought the hon. Gentleman had included that new Clause in his remarks about the Lords Amendment to which we have just agreed. We cannot go back now.

CLAUSE 65.—(Qualifications, remuneration and conditions of service of officers.)

Lords Amendment: In page 51, line 25, after "authority," insert "in their capacity as such authority."

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

The effect of this Amendment is to make clear what we have always intended, that any regulations which govern the qualifications and remuneration of officers of local health authorities should apply only to those officers of the local health authority who are acting in a capacity in the health services, and not to other members of the staff of the local authority who have other functions besides that of maintaining the health services.

CLAUSE 66.—(Superannuation of officers.)

Lords Amendment: In page 53, line 26, leave out "so employed who leaves his employment," and insert: who leaves employment in Scotland of Northern Ireland entitling him to participate in superannuation benefits (whether provided under the said Act or otherwise).

Mr Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

As the Bill stands without this Amendment it would mean that when the Scottish National Health Service Bill has been passed the regulations will provide for the preservation of the potential superannuation rights of people who are employed in that national health service. When any of them were transferred to the health service in this country their superannuation rights would be preserved. What is wanted here is to make this extend not merely to those who would have served in the national health service in Scotland, but in other local government services as well.

Question put, and agreed to.[Special Entry.]

THIRD SCHEDULE.—(Regional Hospital Boards, Hospital Management Committees and Board of Governors of Teaching Hospitals.)

Lords Amendment: In page 65, line 44, at end, insert: Before making appointments to fill vacancies the Minister shall also consult the Board.

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

This Amendment deals with appointments to be made by the regional hospital boards and by hospital management committees, and ensures that the Minister shall consult with both these bodies before appointments are made.

SEVENTH SCHEDULE.—(Constitution of Tribunal.)

Lords Amendment: In page 70, line 43, after "solicitor," insert "of not less than ten years' standing."

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

This is a common form of requirement and one which, in the Regulations, would have been observed. It is felt, however, that it should be put into the Bill.

Mr. E. Fletcher

In view of the discussions which have recently taken place, would the Minister confirm that the words being added apply equally to barristers, as well as to solicitors? I think it would be unfortunate if there were any distinction.

Mr. Bevan

indicated assent.

NINTH SCHEDULE.—(Amendment and repeal of Enactment relating to persons of unsound mind and mental defectives.)

Lords Amendment: In page 75, line 35, at end, insert: in subsection (3) the word 'private' where it last occurs shall he omitted; and for subsection (6) there shall be substituted the following subsection:— '(6) Where any patient detained in a registered hospital in pursuance of a contract with a Regional Hospital Board is permitted under this section to be absent upon trial two members of the managing committee of the hospital may make an allowance to the patient during the period of his absence not exceeding the amount payable under the contract for his maintenance in the hospital and the allowance shall either be paid to him or for his benefit as the members of the managing committee may direct.'

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

This is one of a series of Amendments which arise from the same point. It deals with the question of registered hospitals. Under the Lunacy Act, 1890, a registered hospital is defined: As any hospital not being a public mental hospital wherein patients are received and supported wholly or partly by voluntary contributions or by any charitable bequest or gift or by applying the excess of payments of some patients for, or towards the support of, provision or benefit of other patients. When this Bill was being prepared, it was thought that any registered hospital likely to be regarded as necessary for the services to be provided under this Bill would automatically be taken over into the hospital service under Clause 6, and any other registered hospital not so acquired would be disclaimed, and, therefore, would, in future, receive only such patients as were being treated outside the National Health Service. After discussion with the Registered Hospital Association, it has been agreed that there may be a further alternative: That the registered hospital may provide for national health service patients by contract with the Regional Board; and, therefore, to make this third alternative possible it has been necessary to reinstate in the Bill some of the provisions of the Lunacy Act, 1890, which, as the Bill was drafted, had been modified or repealed. The series of Amendments deals with various points of that kind. For instance, the Amendment, which we are now considering enables, first of all, that the superintendent of the registered hospital shall be given power to allow a patient so received under contract to be sent out on trial, and also, in the second part of the Amendment, it will enable the governors of the registered hospital to make a payment to such a patient who is sent out on trial. These are necessary conditions if we are to be able to accept the third alternative.

Question put, and agreed to.[Special Entry.]

Lords Amendment: In page 75, line 44, at end, insert: For section sixty-one there shall be substituted the following Section:— '61. Where a patient is detained in a registered hospital in pursuance of a contract with a Regional Hospital Board, the Board may make an order for the removal of the patient and may direct the mode of removal and on production to the manager of the hospital of a copy of the order he shall forthwith remove the patient or permit him to be removed in accordance with the order'.

Mr. Key

I beg to move. "That this House doth agree with the Lords in the said Amendment."

This Amendment is necessary to give the hospital regional board the power to remove or maintain patient under contract from the regional hospital to any other care.

TENTH SCHEDULE.—(Consequential Amendments and Repeals.)

Lords Amendment: In page 85, line 5, at end, insert: "The Children and Young Persons Act 1933 23 & 24 Geo. 5. C. 12. In section ninety-two, for the words 'Board of Control' there shall be substituted the words 'Minister of Health'.

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

This Amendment is really consequential upon the transfer of certain powers of the Board of Control to the Minister of Health under this Bill. Section 92 of the Children and Young Persons Act, 1933, excludes from the term "voluntary home", for the purposes of Part V of that Act, any institution, house or home certified or approved by the Board of Control under the Mental Deficiency Acts, 1913–1927. The functions of the Board of Control relating to such certification and approval are transferred, by this Bill, to the Minister of Health, and it is for the purpose of their operation that it is necessary to make this Amendment.

Lords Amendment: In page 88, leave out lines 29 to 34.

Mr. Key

I beg to move, "That this House doth agree with the Lords in the said Amendment."

This provision in the Schedule brings officers of Executive Councils who leave their service to undertake war service within the scope of the Local Government Staffs (War Service) Act, 1939, which enables the war service of such officers of local authorities to be taken into account for superannuation purposes; but there are other bodies established under the Bill, such as the Regional Hospital Boards, for whom it should be necessary to make a similar provision, and the appropriate provision cannot be made by a simple simplification, by the Bill, of the 1939 Act. Therefore, power to modify Acts of Parliament for superannuation purposes is conferred in the Bill already under Clause 66, and it is proposed to leave out the provision referred to in the Amendment, and to operate under Clause 66. I would point out, however, that any of the regulations made under that Clause will be subject to an Affirmative Resolution of both Houses, and therefore, the position is adequately safeguarded.

Remaining Lords Amendments agreed to. (Several with Special Entries.)

Committee appointed to draw up Reasons to be assigned to the Lords for disagreeing to certain of their Amend- ments to the Bill: Mr. Aneurin Bevan. Mr. Eric Fletcher, Mr. J. H. Hare, Mr. Somerville Hastings, and Mr. J. S. C. Reid: Three to be the quorum.—[Mr. A. Bevan.]

To withdraw immediately.

Reasons for disagreeing to certain of the Lords Amendments reported, and agreed to: To be communicated to the Lords.