CLAUSE 5.—(Accommodation for private patients.) (Hansard, 21 April 1947)

§ Mr. Westwood
I beg to move, in page 4, line 8, at the end, to insert: Provided that no accommodation shall be so set aside unless there will remain available, as part of the hospital and specialist services, for other patients at least as much accommodation as was immediately before the appointed day available free of charge or at hospitals vested in local authorities, being accommodation which became part of the hospital and specialist services on that day. During the Committee stage of the Bill, I was strongly pressed to delete the provisions enabling charges to be made in respect of certain blocks for hospital accommodation. The main criticism was directed against Clause 5, which permits the Secretary of State to set aside accommodation for the use of patients prepared to pay the whole cost of the accommodation and services provided for them. Now this provision relates specially to private patients of doctors working on the spot in hospitals within the service. Its object is in the interests of patients receiving hospital treatment free of cost within the service to encourage front rank specialists to come into the service. This the Clause seeks to do by enabling the specialists to treat patients of their own who wish to continue as private patients in accommodation as physically convenient as possible to the specialist's work for ordinary patients within the service. The number of specialists is thought to be considerably short of the numbers required to provide a fully efficient service for the whole population. No specialists are to be compelled to come into the new service, and it is important, therefore, that as Secretary of State I should do everything possible to encourage them to spend the maximum time within the Service.
I appreciated the motive which led to certain objections to the retention of the Clause, and in the light of discussions I have had with the Scottish specialists since the Committee stage, it is clear to me that the success of the new service would be prejudiced if this facility were not extended to the specialists. In these circumstances it seemed to me that, on balance, the right thing to do was to retain the Clause, but I made it clear to the Committee when we were discussing this matter, that there was no question of so operating this Clause as to reduce the number of beds available free of charge below the number so available 657 immediately before the new service came into being. Scottish specialists, indeed, appreciate—because I have discussed it with them since the Committee stage—that this is out of the question, and they have never suggested that it should be done. Therefore, I am glad to propose the insertion in the Bill of the proviso incorporated in the Amendment, which will provide an absolute statutory safeguard against any trespass of this kind.
5.45 P.m.
The reason why the Amendment refers, as regards accommodation available before the appointed day, not only to accommodation available free of charge, but also to accommodation in local authority hospitals, is that accommodation in local authority general hospitals provided in accordance with schemes made under Section 27 of the Local Government (Scotland) Act, 1929, is not technically free of charge, for Section 28 of that Act in effect required a local authority to recover a charge in respect of persons maintained by them in institutions other than infectious diseases hospitals. I am prepared to admit that there is nothing in the Amendment to limit the proposal to such accommodation set aside for private patients. Because it is impossible to draft a sufficiently flexible provision, apart from Subsection (1), this Amendment is proposed. I fully recognise that for a long time to come it will not be possible to set aside more than a very small proportion of any new hospital accommodation, or equivalent accommodation in existing hospitals. In trying to meet the position which was put before me in Committee, I have tried to get a reasonable compromise, safeguarding the position of the specialists and likewise, as far as possible, the available free accommodation in our hospitals.

§ Lieut.-Colonel Elliot
There are two quite separate things here; the proposal made by the Secretary of State and our Amendment, at the end, to add: and provided that accommodation previously used for paying patients shall be so set aside unless the result of so doing shall be to diminish the accommodation hitherto available free to patients. I do not know if you are calling our Amendment, Major Milner?

§ Mr. Deputy-Speaker
Yes.

§ Lieut.-Colonel Elliot
The Amendment makes it possible for the proviso to apply both ways. The Secretary of State said 658 that it is not right that the transfer should diminish the number of free beds now available. That is quite right, we accept that position, but it should also hold that the transfer should not diminish the number of paying beds available. This matter was argued at great length in Committee. I think it was the general feeling, at least it was not confined to one side of the Committee, that paying beds and free beds ought to be mixed, and not segregated into purely nursing homes on one side, and hospitals on the other. That would lead to a slur being placed on the free hospital beds, which is not desired by anyone. The case was brought out that many hon. Members and many town councillors had had experience of paying beds. In particular the name of a former hon. Member very dear to us, Mr. Maxton, was mentioned. He was occupying a paying bed in Glasgow Infirmary, and was obtaining services—

§ Mr. Westwood
That is dealt with under Clause 4.

§ Lieut.-Colonel Elliot
This is a general point. The point is that free beds and paying beds would be available. It is quite true that this is a special kind of free bed. We did not make any point about the matter on Clause 4, but Clauses 4 and 5 were discussed together, and a good deal of the discussion overlapped. It is a good thing for the prestige and working of the free beds that the widest possible scope should be given to paying beds as well. That holds in the case of the specialist beds, for which the Secretary of State is arguing, and of the general beds. Our contention is that there should be an undertaking that the provision of free beds should not impinge on the provision of paying beds. Otherwise, there would be a danger that the paying beds might be crowded out, and they would move over to specialist places like nursing homes, and the places where it would be possible for all to be treated would thereby diminish. I do not know whether the Secretary of State would indicate whether he will accept our Amendment—

§ Lieut.-Colonel Elliot
I think the right hon. Gentleman is a little unreasonable in 659 that, and I think he might address himself to our argument. I am not quite sure of my position, and whether I can speak again on my Amendment. I am merely speaking at present to the Secretary of State's Amendment, subsequent to which I wish to move my own Amendment. I think it would be a little unjust if I were deprived of permission to speak to my own Amendment. I am speaking to his Amendment, under which there would be a proviso that the free beds should not be diminished by the provision of paying beds. That I accept, and propose subsequently to move my Amendment—[HON. MEMBERS: "No."] The procedure of moving an Amendment is well known, and I gave warning that I intended to move my Amendment. I think I am entitled to obtain an expression of opinion from the Secretary of State on this. I am at present offering my support and the support of my hon. Friends to the proposal he has put forward, and as a Scotsman I am asking for a "giff gaff"—I am asking a reasonable thing, that if I support him on his proposal, he will support ours. He does not refuse, he merely indicates dissent. The Secretary of State brings forward a proposition to which we on this side will attach our heartiest support. We have a further proposal to put forward at a later stage, and hope that it will meet with the approval of the Secretary of State, and if not, with the approval of the House.

§ Mr. Deputy-Speaker
I rather thought the right hon. and gallant Gentleman would move his Amendment, but he has not done so, and, therefore, it will be necessary for someone else to do so.

§ Lieut.-Colonel Elliot
I am rather in your hands, Mr. Deputy-Speaker; no one rose to continue the Debate on either side and therefore—

§ Mr. Deputy-Speaker
On any side.

§ Lieut.-Colonel Elliot
On any side, and I was supporting the proposition on the Paper. At a later stage I hoped to have the opportunity of moving my Amendment to that Amendment. Surely the Government Amendment would be put first, and then the Amendment in my name would be put?

§ Mr. Deputy-Speaker
I think the right hon. and gallant Gentleman has now exhausted his right to speak, and someone else must move his Amendment.

§ Lieut.-Colonel Elliot
In that case, one of my hon. Friend's will be in a position to speak to the Amendment to the proposed Amendment which is in my name.

Mr. Gallaeher
I want to draw attention to a mistake which has been made by the right hon. and gallant Member for the Scottish Universities (Lieut.-Colonel Elliot). He kept making it in Committee, and I think he was making it deliberately. He keeps saying that if we do not have private beds as well as open ward beds, a situation will arise in which the nursing home stands out in certain respects as superior to the ordinary hospital. The confusion he is making is in mixing the idea of private rooms with what he wants, paid private rooms. No one in the House does not understand the need for private rooms in the big hospitals. Wards should be as small as possible, and there is also a need and a desire for private rooms. The right hon. and gallant Gentleman referred to the late Jimmy Maxton. There is no one who would not have been prepared to see that everything possible was done for Jimmy Maxton. We would all have done all we could to help him in his trial and tribulation, and to ensure that the very best and most highly skilled attention was given to him. But, I want to ask the right hon. and gallant Gentleman if Jimmy Smith—the ordinary labourer—is not entitled to the same care and attention, or should we get special attention? Is not the ordinary labourer, Jimmy Smith, entitled to a private room if it is felt necessary and to the same skilled attention as the late Jimmy Maxton?

§ Lieut.-Colonel Elliot
I think the hon. Member for West Fife (Mr. Gallacher) is himself confusing two things, and he continues to confuse them, sometimes I think intentionally. He does not allow for the fact that certain people, of whom the late Mr. James Maxton was one, were using facilities which were of the nature of hotel facilities over and above the skilled attention the hon. Member was mentioning. That is to say, Mr. Maxton was reading papers, receiving constituents, and attending to correspondence. When I was in hospital there was the same thing, an element of hotel accommodation, as well as hospital accommodation. I was anxious to have that, and was willing to pay, as was the late James Maxton, who was willing to pay. It was right and 661 proper that we should pay for those things, but not right that the community should have to pay.

§ Mr. Gallacher
The right hon. and gallant Gentleman introduces something very special in regard to Jimmy Maxton and himself. But Jimmy Maxton was not in a position to receive constituents or deal with correspondence. Do not tell me that; I saw him in his last stages, and I know that he could not do so. But that is not the proposal for which the right hon. and gallant Gentleman or his associates are asking one or two special advantages, but a proposal that certain rooms should be reserved for people who have money, and can afford to pay. That is the proposition. I say that if there are two cases, one a labourer and the other a lord, they should be treated on their merits, not from the point of view that one happens to have money, and the other has not. There should be no payment of any kind for private rooms. If anyone is in a private room and wants something which is entirely outside hospital treatment, it may be that an arrangement can be made. But that has nothing to do with what we are discussing now. The average patient in a private room in a hospital is not going there to use it as an hotel. We want private rooms for those who require them, and there should be no payment for the private room any more than for the ward.
6.0 p.m.
I have said before that there were all kinds of cases where it was desirable for their own sake or for the sake of other patients that they should be in private rooms while it was desirable that others should be in a ward accommodating a number of patients. I do not think that we should have wards of 20 or 30 beds, for it is more comfortable and more congenial if the wards have six or eight beds at the most. We should try to sort the patients in such a manner as to enable them to be helpful to one another in the wards. There are some who would prefer private wards and there are others who would be better off in public wards, but there should be no question of any rooms in any hospital being set aside as a priority for those who have money as against those who have none. All of us here will unhesitatingly agree that it is highly desirable and essential in the development of hospital accommodation that 662 there should be private rooms as well as public wards, but these rooms must remain free for everyone.
I would advise the Secretary of State that when the Bill is in another place he should go a little further than this Amendment and completely ban payment for private wards. I am certain that if there are private wards in all our hospitals and a complete bar on payment, we will be able to provide conditions that will steadily eliminate any idea of separate nursing homes, because the hospitals themselves will be able to build up such a reputation and gradually to expand in such a manner that there will be widespread demand for hospital accommodation, both of a public and of a private nature, according to the needs of the particular case.

§ Lieut.-Colonel Elliot
Do I understand that the hon. Gentleman would leave the nursing home position untouched and that everybody would be accommodated in the hospitals? Is that his contention?

§ Mr. Gallacher
My contention is that as far as the hospitals are concerned there should be no charge of any kind for a private room. I say that there should be no consideration for the proposition that any room in a hospital should be set aside as a priority for someone who has got money against someone who has not got any money.

Mr. Ross
On a point of Order. Is any of this discussion relevant to this Amendment by the Secretary of State? As far as I understand it, we have already ruled out for the moment the question of the Amendment later to be moved by the Opposition, and we are only discussing now the merits of this Amendment by the Secretary of State. I do not think that anything said so far by either of the two hon. Members who have spoken, with all due respect to them, is really relevant to the Amendment.

§ Mr. Gallacher
Further to that point of Order. May I point out that in this Amendment the Secretary of State provides that under certain conditions there will be private rooms for hire, and I want him to reconsider that in another place.

§ Mr. Deputy-Speaker
I am sorry but the Amendment of the Secretary of State deals with nothing of the sort. The original Bill provides that such accommodation is to be available and the Secretary of State has 663 moved that the accommodation shall only be set aside upon conditions. That is the question which at the moment we are discussing.

§ Sir T. Moore
I am glad, Major Milner, that you gave that Ruling, for our guidance, because I want to make it quite clear that I am attacking the Amendment of the right hon. Gentleman and that I am not speaking to the Amendment to the Amendment to be proposed by my right hon. Friend. I think that the Secretary of State has been a great disappointment to hon. Members on this side of the House. We thought we had encouraged hint to be strong and courageous in fighting our battles, in fighting the opposition in the Cabinet and in fighting his own opposition. When we thought we had got him up to the state of Joe Baksi, he got two strong punches, one from the hon. Member for Motherwell (Mr. A. Anderson) and one from the hon. Member for West Renfrew (Mr. Scollan) and he capitulated so that we have the Amendment which we are now considering. Candidly, I cannot see why it was necessary to introduce this at all. I do not think that it has made the position very much different because Clause 5 and its corollary Clause 4 are very much of the same kind and the Debate ranged over the two of them.
The Clause left the Committee sound, foresighted and based on good economy. Now the Secretary of State has yielded to the clamour from his more determined and aggressive supporters, and has rendered the Clause as it stood far less valuable for the purpose for which he had intended it. My argument on this is that it was sound economy to have the Clause as it stood, because it practically ensured that all accommodation would be taken up and possibly it would even make a profit, thereby saving the taxpayer from having an unnecessary impost pressed upon him at a later date. My right hon. Friend mentioned the case of a very dear friend of, all of us, but let us take the normal person who is in hospital. Let us take, for instance, a Cabinet Minister—

Mr. Ross
On a point of Order.

§ Mr. Deputy-Speaker
If the hon. Gentleman did not continually raise these points of Order I am sure we should proceed a little more quickly. The hon. and gallant Member for Ayr Burghs (Sir T. 664 Moore) is going beyond the Amendment.

§ Sir T. Moore
Thank you very much, Mr. Deputy-Speaker, for your guidance for the hon. Member opposite. He is new to the House and he will soon learn. In the meantime, if I may respectfully say so, we are discussing the question whether there should be accommodation left in hospitals for those willing to pay provided the number of free beds is not disturbed. There are conditions under which paying beds are almost a necessity in the best interests of the State. For instance, take the case of a Cabinet Minister who has gone into hospital suffering from some illness or some disease. He is recovering, but he is not well enough to leave the hospital. He wants his secretaries to go there in order that he may carry on the duties of his high office of state. If he has not got a separate room, for which he is able and willing to pay, the State must inevitably suffer. The same applies to trade union officials, to high business executives and in many other directions in our national life. So I say that it is essential to have the qualification that there should be a definite number of paying rooms.
To descend to a lower scale, there may be the case of a man whose wife has to go to hospital. He has a little reserve of money, and with it he wants to get her some of the amenities and privacy that only can be procured by taking a private room. All of those arguments are quite sufficient to convince anyone, even so unpredictable and inconvertible a Member as the hon. Member for West Fife (Mr. Gallacher), that it is desirable to have these paying rooms.
There is only one other point that I wish to stress further and that is, what is wrong with the Clause as it stands, and what is the necessity for this Amendment? As I read the Clause, anyone who is unable or unwilling to pay is not denied accommodation, and the only security we want is to ensure that those who are able to pay and for whom it is necessary to have reserved accommodation in the interests of the patient or of the State as a whole shall have access to that private accommodation with the attention, if necessary, of the tried and trusted family physician who has attended the family for years. That is 665 a perfectly legitimate request, and it should be encouraged by the right hon. Gentleman and not prevented. I am deeply disappointed and grieved that he has not maintained that strength of character that he showed in Committee and that he has yielded to this clamour which means so little to the State as a whole and to the best interests of the country.

§ Mr. Willis
I welcome this Amendment. It seems to me that it ensures that the accommodation which is at present free of charge will remain free, and to that extent the Amendment is a good one. However, I want to ask my right hon. Friend whether, in setting down in the Bill the amount of accommodation that will be free, is he not thereby limiting the amount of accommodation that will be free when we come to extend our hospitals? Is there any danger—and I think that this is an important point—that this might become the maximum amount of accommodation available free of charge? If my contention is correct I think my right hon. Friend should look at it again.

§ Mr. Buchanan
I should like to make one or two remarks on this question. First let me make it clear that we are not discussing the question of free places. The right hon. and gallant Member for the Scottish Universities (Lieut.-Colonel Elliot) put the question fairly and properly. The principle of free places is accepted. That is the Bill. What the Secretary of State for Scotland is now doing is simply saying that the number of free places which will be available will at least be the present number. The argument as to whether the principle of free places is a good thing or a bad is not for this Amendment at all. It is for the general Clause itself. The only issue here, is, is it advisable to lay down in the Statute that a number of free places should not be encroached upon?
The hon. and gallant Member for Ayr Burghs (Sir T. Moore) expressed regret that my right hon. Friend the Secretary of State has slipped from what he thought was the path of virtue. I understand the hon. and gallant Gentleman fully. He thinks that everyone who does not follow him as a leader has slipped from the path of virtue, he being more virtuous than all the rest of us. Not being a virtuous person myself, I do not want to follow him. 666 I prefer a person with a few faults than a person with none at all. The Secretary of State in Committee gave way to many people and very properly, too. He is quite entitled to consider those of us on his own side of the Committee who make representations. He hears those representations and he thinks if they are a reasonable way of meeting apprehensions he should accept them. As to the last point made by the hon. Member for North Edinburgh (Mr. Willis) we do not think that this proposal conveys what he thinks. We do not think it is the maximum but rather that it is the minimum and that whatever is done in the future must be an extension of that number.

§ Mr. Willis
Is it not likely, in actual practice, to develop into becoming a maximum?

§ Mr. Buchanan
We do not think so. We rather take the opposite view. However, in all these things, whether a maximum or a minimum, it depends greatly on the vigilance of the House of Commons. We take the opposite view, and the only safeguard we have on this question of maximum and minimum is the vigilance of the House. I agree with the hon. and gallant Gentleman the Member for the Scottish Universities, that this safeguards the present number of free places, and we say that that will be the minimum number of free places for Scottish people in the various hospitals.

§ Mr. Scollan
May I ask the hon. Gentleman one question? At the present moment there are in Scotland a considerable number of hospitals that have set aside a certain section of their accommodation for fee-paying patients. Does this mean that the number of beds so set aside will remain the same?

§ Mr. Buchanan
That point will arise in connection with a later Amendment. What we are doing here is simply this. Suppose, for the sake of argument, that there are 5,000 free beds in Scotland at the present time—I am using this number merely for the sake of illustration, and in fact there may be 10,000—and that there are 500 paying beds. When this Measure is passed at least 5,000 free beds must continue to be provided. The fee-paying beds may be eaten into, but the 5,000 free beds may not be decreased.

§ Commander Galbraith
I beg to move, as an Amendment to the proposed Amendment, at the end, to add: and provided that accommodation previously used for paying patients shall be so set aside unless the result of so doing shall be to diminish the accommodation hitherto available free to patients. I think I am speaking for all the Members of my own party when I say that we are absolutely in agreement with the Amendment which has been moved by the Secretary' of State. We desire to see preserved the number of free beds now in existence. We also desire, however, that there should be preserved at the same time the number of fee-paying beds in existence when the appointed day arrives. That is the whole purpose of our Amendment. We believe that there is a very great need at the present moment for these fee-paying beds, and the case has been argued in Committee and again this afternoon. We are firmly of the opinion that persons have the right to additional accommodation if they require it and are willing and able to pay for it.
In introducing his Amendment the right hon. Gentleman said that it was necessary to have free beds for the purpose of attracting the specialist to the service. I think that is abundantly obvious, but how he expects to attract the specialist if the number of fee-paying beds is to be reduced I cannot well imagine. I should have thought it logical that the Amendment which the right hon. Gentleman has moved and that which I am now moving were part and parcel of the same thing. We cannot reduce the free beds; at the same time, we cannot reduce the fee-paying beds. Let me just remind the House that there have been wings set apart in hospitals with money provided specially for that purpose for the class of persons who cannot afford to go to nursing homes yet can afford to pay for fee-paying accommodation in our big hospitals. I think there is every reason why they should be kept as fee-paying beds under these circumstances, and it is for these reasons that I move my Amendment.

§ Sir W. Darling
I beg to second the Amendment to the proposed Amendment.
I do so for the very important reason that I want to preserve in this matter a certain amount of choice for the sick. If the Government Amendment goes through unsupported by the subsequent Amend- 668 ment moved by my hon. and gallant Friend, I do not see that that choice will be adequately preserved. The proportion given by the Joint Under-Secretary of State for Scotland was 5,000 free beds and 500 paying beds. I accept those figures merely as a basis for discussion and not as accurate figures, but they are, after all, a reflection of the circumstances in Scotland as regards sickness, and if there are 500 persons who elect to put themselves to some financial inconvenience to purchase what they think a reasonable advantage I contend that their right should be preserved. It may be a whim on their part, but none the less if they choose to pay for privacy I think they are entitled to have that advantage. Others may prefer to spend their money on other things, but it would seem to be a denial of the right of the individual to say, "You may spend your money on this or that improper or proper thing, but on this one thing you shall not spend it."
If a man's wife is ill and he wants to buy for her some privacy which ordinarily she will not receive, it seems to me a denial of elementary liberty that a poor man is not allowed to exercise his desire to benefit his wife in that way. While I am adamant that there shall be 5,000 free beds and that that number shall not be encroached upon, I think that if there is to be a National Health Service Bill for Scotland meeting all the needs of the Scottish health services, this important matter of privacy cannot justifiably be overlooked. I hope that the Secretary of State, who has gone so far and, I think, acted so wisely in putting down the new Clause, will accept this Amendment to his proposed Amendment. We hope that through the years there will be rising standards of approach to sickness, and that there will be increasing sensitiveness and delicacy in these matters. I am sure that it is not the desire that sick people should be treated en masse. If the free bed system is abolished there will be a tendency to treat the sick en masse and I think it desirable that persons who resist or who are disinclined to accept this wartime kind of treatment and are prepared to do so—without any additional expense to the taxpayer—should be allowed to purchase the advantage they desire. This would give the Bill that completeness and fullness which the Secretary of State desires. For this reason, I hope the right hon. Gentleman will accept the Amendment.
669 He has already accepted the principle in Clause 22 in connection with the Amendment we have taken this afternoon. He allows that whereas something in the nature of a drug, a medicine or an appliance of a normal type—that is to say, the apparatus of healing—will be supplied free it shall nevertheless, be permissible in the case of an article of abnormal type for the local authority to supply that article at the charge of the recipient. If one admits the wisdom, validity and commonsense of supplying an appliance of a slightly superior or different type at the charge of the patient, what is the difference between that and supplying the privacy which the private room might confer upon a suffering person? I hope the Secretary of State will follow the logic of his own new Clause and accept the Amendment which has now been moved by my hon. and gallant Friend.

§ Mr. Westwood
I think it might be for the convenience of the House if I intervened at this stage to explain my attitude to the Amendment to the proposed Amendment which has been moved. When I moved my own Amendment I made it perfectly clear that it was my intention under the Clause to set aside a limited amount of accommodation for private patients, following on the discussions I had with specialists who were in the position of serving patients who were provided for under this particular Clause. Some hon. Members appear to have become confused with Clause 4; the Amendments which are now before the House deal with Clause 5, which concerns the patient who is to pay the full cost—the private patient.
I have already pointed out that it is my intention to set aside under this Clause a limited amount of accommodation for private patients but the best use of some of that accommodation would probably not be served in many instances if the Amendment to the proposed Amendment were carried. For instance, it might become advisable to put the beds in the main pool available without charge or available for patients who wish to pay a little extra under Clause 4, to which no Amendment of any kind has been moved today on the Report stage. If I were to accept the Amendment now before the House it would limit my choice of the accommodation to be set aside whereas I suggest, as the one charged with the 670 responsibility of the administration of this Bill and this Clause in Scotland, that the Secretary of State's discretion in the choice of accommodation to be set aside should be free. It will be my intention to choose for this purpose the accommodation which will most effectively serve to bring the specialist into the closest association with the hospitals generally while maintaining in use the accommodation specially needed for the treatment of ordinary patients.
I have discussed my Amendment with the profession itself, and I asked them if they would consider it any breach of faith with them if I safeguard the position so far as free bed accommodation was concerned. That is the basis of my Amendment which is accepted on both sides the House, and it seemed to me completely to satisfy the specialist with whom I conferred following the discussions in Committee. I cannot accept the Amendment moved by the hon. and gallant Gentleman, and in this connection there is one final point which I had not yet mentioned since I wished first to deal with the arguments that had been put forward. I certainly could not administer Clause 5 in the best possible manner if that Amendment were accepted by the House. I am also very doubtful about its wording and am of the opinion that it is defective. For example, it does not define the meaning of "paying patients" in relation to the period before the appointed day. People may begin to ask, "Does it include patients who pay for accommodation in the hospitals set up under Section 8 of the Act of 1929 on purpose to preserve the position so far as concerns free accommodation?" The House will know that in the Amendment which I moved provision was made for counting these places as free places because they were already in hospitals which were controlled by the local authorities. Thus, for the reasons I have given, I cannot accept the Amendment to the proposed Amendment, and in fact, I think the Amendment itself is not properly drafted.

§ Lord William Scott
The points we have been discussing on these two Amendments are points which have been discussed by boards of managements of the larger hospitals during the last 30 years. I myself joined the Board of one of the big London hospitals nearly 20 years ago and was particularly interested in the financial side. 671 There the question was asked as to the extent to which we should provide wards for paying patients and private bedrooms. It was a big London hospital and one of the points we had to consider was that practically the only class of the community which did not come in as patients comprised those responsible for providing something like three-quarters of the funds which kept that hospital going.
The Bill we have before us is called a "National Health Service Bill" and one of the questions we have to consider is whether under it the hospitals of Scotland will cater for all classes or just for those who happen to be of a particular interest for the time being.
A national health service should cater for all classes. If there are patients who wish to pay for their hospital service, I see no reason why we should not cater for them. Whether it is right or wrong that they should pay, or whether it is right or wrong that they should have privacy, is another matter which does not really concern us. If this is to be a national health service, it is just as right that the State hospitals should cater for this class as it was for the voluntary hospitals, who in the past found it worth their while to provide these paying wards. In those earlier days when we provided private rooms and wards, they gave just as much satisfaction to our specialists as the free wards.

§ Mr. McAllister (Rutherglen)
May I point out that the noble Lord is talking about Clause 4 and not Clause 5?

§ Lord William Scott
I am addressing myself to the second Amendment under discussion, which suggests that we should be allowed to retain as many paying beds as existed before the Bill became an Act. I see no reason why, in this so-called National Health Service Bill, these people should not, in future, have the same opportunities in the hospitals of Scotland as they have at present. I do not see any special reason why we should deny them what they have enjoyed in the past.

§ Mr. N. Macpherson
The Secretary of State for Scotland referred to his intention of setting aside what he described as a "limited" amount of accommodation for fee patients. The purpose of the Amendment to the proposed Amendment 672 is to retain the present ratio of free and paying beds. The reason why the Amendment is put down is because it is felt that, in view of the present acute shortage of hospital accommodation, we shall be driving paying patients out to nursing homes if we reduce the proportion of paying beds. If this is to be a national service, then it should cater for all classes of the community. The first point is the question of how much of the accommodation is to be set aside for paying patients. There is a second point, and that is that it is possible for this Clause to become a dead letter, if we reach the point where there are sufficient beds for all demands. The question will then be whether it is desirable that this practice should continue, and whether it is desirable that there should be the possibility of obtaining a little extra benefit by way of payments. No one denies that if there are medical grounds for a separate room, the patient should have one whether he pays for it or not. Without an Amendment such. as this, it is possible for the Secretary of State for Scotland to eliminate fee-paying patients altogether to the detriment—

§ Mr. Willis
All this discussion is on the question of whether or not patients should pay certain amounts, whereas this Clause deals only with private patients of doctors.

§ Mr. Speaker
The hon. Member is quite correct. The Amendment deals with accommodation, and not with payments.

§ Mr. Macpherson
It seems a nice distinction. The House must address itself to the general demand for accommodation, and if private patients cannot be accepted in private hospitals, then they must go elsewhere. I submit, therefore, that this is germane to the discussion. I would also point out that the Amendment contains the words "for paying patients." I wish to ask the Secretary of State his views when there are sufficient beds to meet all demands. Will he then stop paying patients? If he did that, there would be a loss of revenue to the State. These paying patients can help in meeting the overheads of hospitals, and for that reason alone it is desirable to include some such Amendment as this. The Secretary of State for Scotland has criticised the Amendment in detail. He has said that the question of paying patients relates both to Clauses 4 and 5.

§ Mr. Westwood
I did not say anything of the kind. I said that the Amendment would require some explanatory Clause as to what was meant by "paying patient." I was not dealing with beds but with paying patients, and I tried to point out that as far as paying patients are concerned, I have safeguarded the position, because all patients are paying patients so far as the local authorities are concerned.

§ Mr. Macpherson
That may be so, but we should like an explanation of the attitude of the right hon. Gentleman. Will he accept the spirit of our Amendment, and if not, why not? On the question of the type of accommodation, if I understood him aright, he said that this Amendment would tie his hands and limit his power to set aside certain types of accommodation for these people.

§ Mr. Westwood
It would definitely tie my hands to the extent of setting aside accommodation for fee-paying patients. That might not be to the advantage of the fee-paying patients, because it ties my hand to the existing accommodation previously used, without taking into consideration the new health service to be provided.

§ Mr. Macpherson
Even that would not be to the disadvantage of the fee-paying patients, because the gist of our Amendment is that accommodation should be set aside.