§ Mr. Buchanan
I beg to move, in page 57, line 26, after the second "to," to insert "such."
This arises out of an Amendment proposed in Committee when the right hon. and learned Member for Hill head (Mr. J. S. C. Reid) suggested that the treatment as described in the Bill might cover something out with the procedure under the Lunacy Act. This Amendment is to make it quite clear that we only wish to cover procedure under the Lunacy Act.
§ Amendment agreed to.
§ 9.37 P.m.
§ The Secretary of State for Scotland (Mr. Westwood)
I beg to move, "That the Bill be now read the Third time."
This House has now finished its task of considering in detail the provisions of the Bill. The time has come for us to look at the provisions in the form they now take, and to decide whether the Bill is worthy of being passed to another place as a Measure with which this House is satisfied. A considerable number of improvements have been made and I am grateful to hon. Members on both sides of the House for the suggestions and helpful criticisms [...]ey have put forward.
What now does the Bill achieve? The main essential point is that the Bill places squarely on public authorities the duty to provide all necessary facilities needed for the health care of all our people. These public authorities fit into our democratic framework of Government in one of two ways; either as regional hospital boards and hoards of management they are acting on behalf of the Secretary of State who is responsible to Parliament, or, like the local health authorities, they are responsible directly to local electors. Over all, the Secretary of State has a duty, in the words of the opening Clause of the Bill, 726to promote the establishment in Scotland of a comprehensive health service designed to secure improvement in the physical and mental health of the people of Scotland and the prevention, diagnosis and treatment of illness,In this difficult and responsible job the Secretary of State will be guided by the Scottish Health Services Council and its standing advisory committees now provided for in the Bill. Its members will be chosen for their ability to give the Secretary of State necessary expert advice on all aspects of the problems that will arise. The hospital and specialist services stand in need, as many commissions and committees have told us, of having their various component parts fitted together into a unified service based on fairly wide areas and giving all people in all parts of the country access to any particular kind of specialist treatment they require. I suggest that this Bill certainly achieves that major reform. Inevitably this has meant the displacement of both the existing voluntary hospital system and the existing local authority hospital system. In the hospital organisation of the future I believe we have kept the proper place both for voluntary services and for local interest. Regional boards and hoards of management will be chosen from people with local interest in and knowledge of the hospitals they are to administer and will be chosen from people who come forward to give voluntary services on those bodies.
On the financial side, too, the Bill makes it possible in my opinion for the very best features of the voluntary hospital system to be maintained. The generous benefactors of the past, who have put gifts of endowments at the disposal of our hospitals, have planned their benefactions to fit the hospital system of the country as they knew it, and we have kept faith with them I suggest by establishing an independent authoritative commission, which will settle the future use of these endowments, assisted in such manner as seems to the commission most in keeping with the hospital organisations of the future as envisaged in this Bill, having regard always, as enjoined by the Bill now before the House, to the spirit of the intention of the donors. These endowments and funds are not taken over by the State. They will not be used to relieve the State of any part of the expenditure which as the authority responsible for the hospital service in future it must meet out of current public resources. 727 The endowments are left in the hands of the public boards of management and regional hospitals boards to be expended by these boards at their discretion in connection with their work. Future donations can be made to those bodies for the same kind of purposes.
The hospital organisation set up under the Bill contains one other very important feature. We in Scotland are proud of our standing as a centre of medical education. If the standard of medical teaching given in Scotland is to be maintained there must be access for teacher and student to an ever wider range of practical experience and demonstration in the hospitals where clinical teaching is carried on, and so in that way are kept in touch with developments in medical science and encouraged to maintain the highest standards of treatment and care. The Bill now before the House places a specific duty upon the Secretary of State to provide facilities in the hospital service for the teaching of medicine. The organisation which the Bill provides makes it easy for the biggest number of hospitals to come within the teaching field and to share in the advantages which participation in that work will confer. This Bill I submit without trespassing by the State upon the responsibility of the teaching and the licencing authorities brings them fully into the administration of the hospital service far as it affects their responsibilities.
As to the local authorities we have restated and enlarged their responsibilities for those local clinical and other services they are best fitted to administer. Building on the foundation that their duty is to watch over the incidence of disease, especially infectious disease, in their districts, the local authorities are now given the necessary power for important developments in the prevention of disease and the treatment of health in the community life. The Bill now before the House provides a system of grants which will I hope enable the local authorities to make the maximum use of the new powers conferred upon them.
The third division into which the new Service will be organised deals with general practice. In some ways developments in this field will be those which will touch most closely the largest number of our people in Scotland. In future there will be available for everyone, and not 728 only for people who pay insurance contributions, the care and attention of the family doctor of the patient's own choice without any need to stop and count the cost before turning to the doctor for his help. I believe that the proposals in the Bill will enable us to do this and they do not confer any power—as was pointed out earlier this evening by my hon. Friend the Joint Under-Secretary—to direct individual doctors to work in particular localities or at particular jobs.
We must remember that the passing of the Bill will not produce more doctors overnight. I believe that the organised service the Bill provides, with the new system of remuneration we have in view and the abolition of the sale and purchase of practices, will improve the attraction of general medical practice as a career, and that when taken in conjunction with the other measures which the Government are introducing to bring further education within the reach of all, the result at no distant date will be an adequate number of doctors for the tasks that lie ahead. In the mental health field we have taken steps in the Bill which will link the provision of mental health care more closely with that of physical health care. Other important proposals, including a substantial Amendment of the lunacy laws of Scotland, were recommended recently by the Russell Committee. These are now being considered and I hope that I shall be able before long—
§ Mr. Westwood
I accept your correction, Mr. Speaker, and will leave the subject immediately. These, briefly, are some of the points which I now invite the House to consider. The preparatory work connected with the Bill is already under way, and if the Bill is passed in substantially in its present form, we hope to fix 1st April, 1948, as the appointed day.
§ 9.47 p.m.
§ Lieut.-Colonel Elliot (Scottish Universities)
I beg to move, to leave out from "That" to the end of the Question, and to add instead thereof:this House, while it would welcome an adequate and comprehensive health service foe Scotland, declines to give a Third Reading to a Bill which centralises control of institutions in the hands of the Secretary of State and deprives local authorities and voluntary bodies of the powers of administration which they 729 have hitherto exercised to the great advantage of the people of Scotland, which takes and retains for the Secretary of State the power of diverting trust funds and benefactions in despite of the declared wishes of donors and subscribers, and which gravely threatens the future of the practice of medicine in the widest sense and the research upon which its progress depends.As the Secretary of State has just said, it is true that we are coming to the end of a long process, and it is right at such a time to congratulate those who have been in charge of the Measure on the assiduity and skill with which they have piloted the Measure through the House. If I may say so, this is particularly so in the case of the hon. Gentleman the Joint Under-Secretary of State, to whom the Committee upstairs has been indebted for his knowledge of the Bill and the care he has taken to acquaint himself with the views of hon. Members on the subject. In fact, he is suffering—as not infrequently occurs in such cases from a certain degree of the very illnesses of which he is attempting to cure the rest of Scotland, and indeed we might perhaps say to him this evening, "Physician, heal thyself." At the same time we are glad to see him back amongst us restored to health and, as I say, we thank him for the care he has taken of the interests of the whole Committee and of the House in the piloting of the Bill tonight.
For all that, however, we cannot say that we find ourselves in agreement with hon. and right hon. Gentlemen opposite. They have taken steps which we think will not be fulfilled in the hopes which they have of them. After all, the steps which hon. and right hon. Gentlemen are taking could be justified only if the medical system of Scotland had been a signal failure instead of being, as it admittedly is, one of the great scientific and practising successes of the world. The whole of Great Britain, the whole of the Empire, is indebted to the medical system of Scotland. It is a system which, both in the past and in the present, has been the Mecca of students from all over the world. It has standing to its credit some of the most resounding medical discoveries from the working out of a system of antiseptics and the discoveries made in the science of anaesthetics, down to Sir Alexander Fleming's discovery of penicillin. We can show a roll of names of fame in medicine second to none in the world Whatever one may say of the new system proposed, 730 either on training, or on doctor-patient relations, it will have a hard task to equal, let alone surpass, what has been successfully put through under the system now being swept away—it is not too much to say that that is what is being done this evening.
It is our intention to divide against the Third Reading, and to divide on this reasoned Amendment. It is unfortunate that owing to the telescoping of so many stages of the Bill, beginning with the Committee stage and passing on through the whole of the Report stage to the Third Reading, it has not been possible, within the Rules of Order, to place our Amendment on the Order Paper.
Beginning briefly with the argument that the Bill is inadequate, the Secretary of State has stated that he is faced with a shortage of doctors, and still more with a shortage of nurses. This is, far and away, the main limiting factor in the practice of medicine just now. It is not that the people of Scotland cannot get sufficient medical advice, but that they have the greatest difficulty in carrying out the medical advice given in half a hundred ways. There is the field of hospitalisation. The people of Scotland are only too willing to accept medical advice, to seek treatment, to hospitalise themselves, to take rest, to take good food, to take better housing and to take half a dozen recipes any of us could write down. It is not the advice, but the power to fulfil the advice, and we say that this is an inadequate Bill in that it does not take a sensible step towards carrying out the object we all have at heart.
§ Dr. Morgan (Rochdale)
Why did not the right hon. and gallant Member take such steps when he was in office?
§ Lieut.-Colonel Elliot
The hon. Member for one of the English divisions will, no doubt, have an opportunity to speak later.
§ Dr. Morgan
May I interrupt the right hon. and gallant Gentleman and tell him that I am one of his constituents?
§ Lieut.-Colonel Elliot
I am well aware that the hon. Member is one of my constituents, but it is not simply on that ground that I would ask him to hold his peace and allow me to develop my argument. The Bill centralises the control of institutions, both local authority and voluntary, in the hands of the Secretary 731 of State. Nobody can deny that. The right hon. Gentleman spoke of the new set-up of local authorities which was being produced, and claimed that in some respects he was giving additional power to them. That is true, but he is also withdrawing from them, as part of the great process which is going on now, a great field of activity, which has been a traditional field of activity of local initiative and effort. The danger is immediate and pressing. During the Committee stage, the hon. Member for West Renfrew (Mr. Scollan) actually advocated nominated members as being greatly superior to elected members. That is the sharp edge of a very thick wedge indeed. The hon. Member said:Is any hon. Member going to tell me that because they"—that is, the representatives—are not elected once a year they are not as capable of administering the service locally as would be persons who were elected every three years? … What we want is to have people given a job locally, who are capable and who have the necessary experience, and who are not subject to the whims and fancies of somebody electing them once in every three years.' —[OFFICIAL REPORT, Standing Committee on Scottish Bills, 28th January, 1947, c. 48.]That is a dangerous doctrine.
§ Mr. Willis (Edinburgh, North)
On a point of Order. Is it in Order, Sir, for the right hon. and gallant Gentleman to discuss something which is not in the Bill, something which is merely the expression of opinion of an hon. Member?
§ Mr. Speaker
I wondered where the right hon. and gallant Gentleman was leading to but I thought it was part of the general argument and therefore in Order.
§ Lieut.-Colonel Elliot
It is not only in the Bill; it is one of its cardinal features. The Bill says, in so many words, that the elected representatives are to be taken away, and replaced by nominees of the Secretary of State I do not think that there could be anything more germane to, or more directly concerned with, the Bill than these provisions. My comment on the provisions is merely a comment on something which has been written into the Bill. If I was concerned with the comment of a Private Member I would have no objection at all, but from tonight, these provisions become the law of the land so far as we in this House are con- 732 cerned. The comments of the hon. Member were in favour of such provisions.
§ Mr. Scollan (Renfrew, Western)
As the right hon and gallant Member is quoting from something I said in Standing Committee, would he not agree that when the Minister appoints someone to do a particular job it is necessary that he should appoint someone with experience, knowledge, and ability to do that job, and not leave it to the hazards of election?
§ Lieut.-Colonel Elliot
There we have it. You will see, Mr. Speaker, that every word I said has been completely justified by the statement which the hon. Member opposite has just made. The statement that somebody nominated by the Minister is adequate to, or indeed superior to, the representative elected by popular election is the thin end of a very thick wedge. The other end of that wedge is Fascism.
§ Dr. Morgan
The right hon. and gallant Gentleman is using a very peculiar argument. Is he arguing that the elective system should run through the whole hospital system? If so, why have not the voluntary hospitals adopted it through all these years?
§ Lieut.-Colonel Elliot
I am addressing myself to the argument by the Secretary of State that he had increased the power of the local authorities, and I was pointing out to the Secretary of State in my defence of the local authorities that he had removed powers from the local authorities and had substituted for them nominated persons—and that was brought forward from the other side of the House as a positive advantage, which we have just heard repeated. We say that that has deprived local authorities and voluntary bodies of the powers of administration which they have hitherto exercised to the great advantage of the people of Scotland. None would deny that. That these powers have been exercised to the great advantage of the people of Scotland is certainly true, and it is also true that the people of Scotland are being deprived of them by this Bill in this field, and by other Bills in other fields. The inroads being made on the local popularly elected administrations have been the subject of adverse comment, not only from this side hut from the other side of the House during the passage of many Bills now before the House. We go on to say that the 733 Hill takes and retains for the Secretary of State the power of diverting trust funds and benefactions and that these powers are not merely exercised for the time being by the Hospital Endowment Commission but that the Secretary of State takes power to extend the life of the Endowment Commission so far as he wishes, and when the Commission passes away the powers vest themselves in the Secretary of State himself.
In spite of all this, the Secretary of State says that he hopes that it will he possible for people to continue to give large sums as they have done in the past for the special advantage of particular institutions. I hope that it may be so. I have not in any way attempted to sabotage this effort. I have appealed for support, and I have appealed widely' for support for the great Royal Infirmary of Glasgow in spite of the effects of this Bill. None of us would deny that support of the hospitals will be a very much more difficult task in the future with a Commission.
Our next point is that it may threaten the future of the practice of medicine. We have had statements on this Bill and on the English Bill which made it perfectly clear what was afoot. The Under-Secretary of State for Health for England speaking in the House said:This is not some private arrangement between a private practitioner and a private individual. … If a dustman cannot find a job with a particular local authority because no vacancy exists, he does not start to howl about being subject to bureaucratic direction because he has to go and seek work elsewhere." —[OFFICIAL REPORT, 30th April, 1646; Vol. 422, C. 213.]That is the attitude of mind that will creep in and which will be followed by grave inroads into the relationship between doctor and patient as we have known it. We have testimony of this from many quarters. We have had it from the hon. Member for Rochdale (Dr. Morgan), who, discussing this Measure, said:I shudder when I think of the Colonial medical services of which I know; I tremble when I think of the prison medical services and pension services.''—[OFFICIAL REPORT, 30th April, 1946; Vol. 422, c. 134–5.]He was not aware of any Government medical service which had been a success. These are the directions in which the Government tonight ask the House to allow it to authorise it to encourage it to 734 move. We say that along these lines we fear not an advantage but a disadvantage to the people of Scotland, and to medical teaching in Scotland will arise. Lastly, we say, without any hesitation, that the principles upon which we are asked to act will gravely threaten not only the practice of medicine but the research upon which this practice depends.
We have as much evidence as we should wish. The Secretary of State himself will be well acquainted with the hospital which wrote to him asking for permission to go ahead; it had gathered money, it had long waiting lists, it was anxious to extend and develop, but it was told to wait—the Regional Board was coming into existence, let nothing be done now. Where was this hospital? It was in Greenock, in the town which hon. and right hon. Gentlemen opposite use as the pivot, indeed as the only justification, of their contention that some areas in Scotland are under-doctored as compared with others. When the citizens of Greenock gather their own money and seek to go ahead developing their own medical service, without anything more than the permission of the Secretary of State, the answer they get is "Wait, wait, the Bill is not yet law, the Bill has to become law, the Regional Medical Board has to be set up, and a new plan has to be made." While the grass grows, the steed starves; and while these plans are waiting to be carried through, the practice of medicine to help the people of Scotland is being held up.
Lastly, as to scientific progress itself, let us take one aspect of scientific research with which we are intensely concerned just now—the feeding of the people. Investigations were done in that direction by great authorities such as Sir John Orr, with whom I had the honour of working myself, and in many cases results were brought out inconvenient to the Government of the day, yet those results showed —here are the books which show it—that even before the war sufficient food was coming into the country for 2,900 calories a day for every single soul in it. Now we are told that the people of this country are better fed than ever before because the figures still 2,900 calories. When we try to ascertain how it is made up and how it is distributed, we find that it becomes a political question. We find that the whole resources of the Government are turned on to defend their position and to explain how the people are better fed 735 than they were before. It is with the utmost difficulty that we extract from the Government the fact that the average intake per head is not 2,900 calories, which is the gross figure; last December it was 2,390, which has fallen this December to 2,300, although the International Food Board [An HON. MEMBER: "Which part of the Bill does this come under?"] It comes under the subject of research, which is one of the main claims which the Secretary of State has made in putting forward this Measure. We have carried a new Clause dealing with it this evening, and undoubtedly it is one of the most important subjects to the people as a whole. I say that the stereotyping of research into a Government system, where pro and anti claims are brought forward, where the subject becomes political as it inevitably does when these things come up to the Cabinet and concern the fate of Ministers, is a strong argument against the whole system which the Secretary of State brings before us. It is an argument which I fear will find itself extended into other fields than that of food, which I have taken as an example.
It is not my desire to detain the House. [HON. MEMBERS: "Oh."] Does anybody suggest that I have dilated too long upon a subject of the greatest importance to the people? Does anybody suggest that we have taken too long tonight, that we have not co-operated to the utmost with the Minister in bringing forward his Measure? I say that these things, which received far greater and longer consideration in the case of England than they have received in the case of Scotland have received by no means too long consideration here tonight. We could easily have continued the Debate for many, many hours, and indeed for days, in discussing what we have passed over in a few hours, this evening. The hopes of the Secretary of State are admirable hopes which all of us share. The action he has taken is action in which, although it has many points with which we disagree, we shall cooperate as far as we possibly can so far as it can advance the health of the people of Scotland; but we feel deeply and sincerely that the right hon. Gentleman has embarked upon a line not only bad in itself, but one that will lead to very much worse things to come. We say that he and Scotland will regret many of the steps that are enshrined in this Bill to which 736 he is asking the House to give sanction tonight.
§ 10.11 p.m.
§ Mr. Henderson Stewart (Fife, East)
I wish to associate myself and my hon. Friends with the Amendment that has been moved. I say without any hesitation or condition that, in our view, a great expansion of the health services of Scotland is desirable as soon as possible, and as far as this Bill aims at an expansion of those services, it is a good Bill. The objective is not one about which there is any question, and as the right hon. and gallant Gentleman the Member for the Scottish Universities (Lieut.-Colonel Elliot) said, we shall all do everything we can to help; but it is the machinery adopted in the Bill for arriving at that objective which seems to us to be, to put it mildly, doubtful.
The Secretary of State is an extraordinary man. He makes speeches in Scotland and in the House in which he gives us the impression that he does not really understand what he is doing. He talks in Scotland as though the various nationalisation Measures that have been passed have given Scotland a measure of control over its destiny. Everybody knows that is not true. Tonight the Secretary of State has given us the impression that the spirit of the voluntary hospitals and the local authority hospitals continues to illuminate the whole of the new services he is bringing into being at this time. That is the very opposite of the truth. The truth, as we see it, is that the right hon. Gentleman is killing the very spirit that has made great the medical and hospital services of Scotland in the past, and we are convinced that by taking, as he does, ultimate control of the action of these new bodies, he is destroying once and for all part of the greatness of our race and something that has, perhaps more than anything else, made famous the medical services of our country.
Why does the Secretary of State do this? Under the Scottish Education Act he assists, he advises, he urges, he exercises a measure of guidance upon Scottish education, which, however, is run in its details by the local authorities. Why does he break away from that long-established Scottish precedent and, in this case, take control and exercise actual dictatorship over this great Measure of 737 health services in Scotland? This is an entirely new thing. It is against all the principles and traditions of our country. By all means, let the Secretary of State guide. I recognise that the State, as the State, has great functions to perform, but one of the functions is not the intimate day-to-day control of detailed services of this kind. I believe this goes to the very roots of our Scottish system and destroys those roots. I stand for local authority control to the fullest possible extent. I believe that voluntary effort has helped to make our country great. I believe that when you kill that voluntary effort, you do something disastrous to Scotland. For those reasons, if for no other, I and my Liberal friends oppose the Third Reading.
§ 10. 15 p.m.
§ Mr. Rankin (Glasgow, Tradeston)
While I do not propose to follow closely the right hon. and gallant Gentleman the Member for the Scottish Universities (Lieut.-Colonel Elliot), I wish to say that he is not alone in paying tribute to the success of the medical system. Equal tribute is paid to it on this side of the House. I am saying that because I am assuming that when he spoke of the medical system, he referred to the system under which our medical students were trained. So far as that aspect of it is concerned, we do not yield one inch to him in our appreciation of that service. This Bill will not in any way interfere with the training of students and in the preparation of the doctors of the future. It will not interfere with them in the least in that preparation, but it will do something which the system the right hon. and gallant Gentleman tonight supported, does not do at the moment.
What happens today to the young doctor when he comes out? He faces a system of complete anarchy. There is no organisation; neither his university, his medical school, the British Medical Association nor any other organisation, which takes the slightest interest in placing that young lad in any medical post. That is a fact, and any medical man will admit that. He is left to fight his way into a practice, or to become an assistant to a doctor, and to accept for his services a salary from a doctor who may himself resist the very idea of the application of a salary to his own profession.
§ Commander Galbraith (Glasgow, Pollok)
Is the hon. Member aware that he is flatly contradicting a statement which was made earlier this evening by the hon. Member for Rochdale (Dr. Morgan)?
§ Mr. Rankin
No, I am not in the least aware that I am contradicting any such statement. I am stating a fact which is known to any young doctor who seeks to start in medicine today. If he refuses to accept such a situation, then he is faced with a capital outlay, which it is impossible for him to meet at the present moment without help in seeking to start in practice on his own account. I hope that under the Bill that system of anarchy will be stopped, and that we will be able to absorb at once, into active useful work in the hospitals of the future, every young doctor who leaves the universities. The right hon. and gallant Gentleman also made another statement with which I disagree. He stated that there was a shortage of doctors today. The fact, so far as I understand it, is that at the moment there is such a plentitude of doctors that they simply cannot be placed in private practice.
§ Mr. Rankin
One swallow does not make a summer.
I rise to put before my right hon. Friend a particular point, on which I hope he may be able to give the House some assurance tonight. I, with other Members in the House, will wish the Bill well when it goes to another place, in its passage to the Statute Book, but there is one point which I would like to put before my right hon. Friend. It concerns the local authority services.
At present we know that these are unified services. In the Bill they will be segmented and the patient may come under two, or even three, authorities. In the case of the T.B., the midwifery or the infectious diseases service, he, or she, will come under the hospital service, the general practitioner service and the local authority service. Those are the three authorities who will have control at one stage or another. It is important that there should be a link connecting the three. I suggest that my right hon. Friend should use his powers under the Fourth Schedule to appoint persons such as he may think fit. I hope that he 739 will utilise the position of the medical officers of health in our large burghs and in the counties as the link through the regional hospital board and the boards of management to connect the three different units, and thereby bring about a co-operation in that service which he will find in practice is necessary in order to achieve the success which every one desires. I hope that we may have some assurance on that point tonight, and that the Bill will have a safe and speedy passage on its way to the Statute Book.
§ 10.23 p.m.
Lady Grant (Aberdeen, South)
In considering this Bill, I join with my hon. Friends on this side of the House in stressing our support for a national health service for Scotland. Unfortunately, we shall be forced to divide tonight, not on the broad principles, which we have always supported, but because there are, in our opinion, certain glaring defects in this Bill which destroy much that is good of the past, limit the possibilities for the future, and give us instead, a rigidity of administration which is quite unsuited to the living human art of caring for the sick. Our present health services, of course, have certain defects, but it is true to say that they have shown a natural growth over a period of years, and also have demonstrated our genius for adaptation to new circumstances.
Surely our aim in politics, when we are trying to weed out what is bad of the past, is to safeguard against too much' destruction, in case we forget to conserve what is good of the past in our search for the new. That is why many hon. Members on this side of the House very much regret the transfer of all hospitals to the Secretary of State. In my own city of Aberdeen I know that the local authority hospitals and the voluntary hospitals have worked together in the closest harmony with great success. The voluntary hospital has provided an outlet for voluntary effort and private generosity. That is something of value which should be preserved. Regularly once a year we have campaigns to try to extract funds from the Aberdonian, which is an enjoyable, magnificent and successful achievement. This has resulted in our local people taking a very personal interest in our own institutions. It is true that today we find that the private benefactors are withholding their bequests. That is of great detri- 740 ment not only to local interests but also to the administration of the whole health service, and incidentally it will come back in the end on the taxpayer. I only trust that in the search to co-ordinate the hospital services the teaching hospitals will really be given a measure of independence. Therefore, I would like to say how much we welcome the Clauses in the Bill which have openly acknowledged the value of voluntary effort. I refer particularly to those Clauses dealing with the home nursing and health visiting services. It is true that our country has been admired the world over for our extraordinary capacity to date to join together voluntary and State effort, and now we have openly acknowledged the value of the district nursing services, which to my mind will be of very lasting benefit to the medical services of Scotland.
There is, however, one question which perhaps more than any other in consideration of this Bill has very gravely concerned not only the professional people but the ordinary men and women in Scotland today. That is, above all, the provisions regarding the personal relationship between the doctor and the patient. I will not agree with the Secretary of State when he says that freedom of choice of doctor will not in any case be vitiated, because I feel that with the abolition of the sale of the goodwill of practices and the element of the basic salary we are laying the way open to the full State salaried service which is the acknowledged aim of hon. Members opposite. I personally cannot see how hon. Members on the benches opposite can on the one hand dedicate themselves to a full State salaried service and on the other accept the principle of the freedom of choice in doctors, because to my mind, the two things will not add up in the future. Therefore, one regrets that the Secretary of State has seen fit by insidious means to lay the way open to enter into the sanctity of a professional man's relationship with his patient, because there is not doubt that he will in future be confronted with divided allegiance to the State who appoints him, and his Committee, on the one hand, and on the other, his personal responsiblity to his own patients.
This Bill is perhaps unique among those passed by this Government in that it rests for its success almost entirely on the human element, and on the patient in the 741 case of sickness and pain where perhaps the will to recover can be as much stimulated by a medical adviser known to him through years of experience as by all the resources of medical research. I suggest that the recovery and cure of the patient is not only due to the superbly organised hospital or to every device of skill and knowledge surrounding disease; it is surely also due to the fact that a doctor over a period of years has built up a very intimate understanding of his patient's background, his character, his family life and difficulties, and also his place of work. We are coming to a state of affairs where we have made the provisions in this Bill so wide that we shall find doctors unable to remain out with the scheme, patients unable to pay private fees as well as insurance contributions, and when patients call at the health centre they may find that the particular doctor they went to see is working on another shift.
While we support this Bill in principle, we arc forced to vote against it because we feel that in its passage through Committee, although it has obtained much of good, it has also contracted much of evil. Nevertheless we wish the Secretary of State all good fortune in the very great administrative powers that he has given himself, and which we, on these benches, consider to be inordinately large. Furthermore, we on this side, do trust that the Secretary of State will use his discretion in trying to make the minimum use of these powers so that he may give us as flexible and as human a service as he possibly can. On that, the future of medical science undoubtedly depends.
§ 10.31 p.m.
§ Dr. Morgan (Rochdale)
The hon. Lady the Member for South Aberdeen (Lady Grant) has treated us to a dissertation on medical services which has been subtle and interesting, but it was certainly not objective and did not deal with the kernel of the problem. She has spoken as one with a superficial knowledge of medical practice as it affects the bulk of the people in this country today. The fact is that the people of Scotland have not, for years, been getting a good medical service, and despite all that has been said on the other side in the course of the Debate on this Bill, and despite the grace with which the hon. Lady has dealt with the subject, in repeating the slogans 742 of the Conservative Party, she has not touched the real problem. However, I pass from the gracious speech of the hon. Lady and return to the remarks of a speaker who, at any rate, should have some knowledge of the deeper problems of medical science; I refer to the right hon. and gallant Gentleman the Member for the Scottish Universities (Lieut.-Colonel Elliot). When I think of the right hon. Gentleman in past years—vitriolic in his vituperations of the Tory Party—and when I see him in his present pathetic condition, I can only say that he has deteriorated in his present environment. I agree that I have condemned certain medical services, but I have done so because the medical profession wants democratising from the top to the bottom, starting with medical education.
§ Dr. Morgan
The hon. Gentleman's corporeal rotundity is not matched by his mental profundity.
I want to say that I like this Bill. It is a better Bill than the English Bill. The right hon. and gallant Gentleman said I had disapproved of certain medical services. Why should I not? I want this Bill because under it the Secretary of State, for the first time, has a duty to provide an excellent medical service, and he is doing that duty by taking responsibility through Parliament and by saying "I am going to provide a medical service as democratic as I can through the different bodies—through the executive councils, and through the local authorities." I say that you cannot have a better service. Now, for the first time, the health services of this country are being unified, both the hospital system and the general practitioner system and research. It is astonishing that the right hon. and gallant Gentleman who had a great university education and who represents a university, should make statements which can be riddled. The right hon. and gallant Gentleman talked, for example, of research and mentioned food. Long before Sir John Boyd Orr started research into food there was a certain medical officer of health of Stockton, who showed that good housing was not sufficient, unless people had good food as well.
§ Lieut.-Colonel Elliot
Does the hon. Gentleman suggest that Dr. McGonigle began to work on nutrition before Sir John Boyd Orr?
§ Dr. Morgan
No, but he made his researches and came to his conclusions long before Sir John Boyd Orr made his and they have been proved right. Up to the present they have not been challenged. Far be it from me, who served my apprenticeship under the very excellent tutelage of a Scottish university to which I am always grateful for the great opening it gave me in my own general and medical education—far be it from me for one moment to deny the pre-eminence of the Scottish schools that are known all over the world. But does the right hon. and gallant Gentleman say that, because Scottish schools have been pre-eminent in the past they must always remain so under the old system? Things are changing. They were talking of research while the Scottish population was dying in slumdom and poverty and the death rate was higher than in England. Really, I am surprised at the right hon. and gallant Gentleman. Does he not want changes in medicine? Does he not want the general practitioner to' be better educated? Is he satisfied that the general practitioner, having once passed his examinations, should not necessarily open his book again in 20 or 30 years? Does he not wish for a system under which the young general practitioner could keep up to date and should be asked to give the people the best of modern medicine? Can that be achieved unless the hospitals are organised in one system—both local authority and voluntary? Is he satisfied that it can be done unless the research system is democratised? I am really surprised that a Member for the university for which he speaks—my own university could come here and speak as he has spoken.
With regard to the lunacy law, the great question in Scotland is that of safe custody. Protective custody is a matter of rivalry between the big city corporation and the official side, on legal and other important matters. That matter cannot be settled until we have a really decent system. I am glad the Secretary of State is taking into his hands the question of medical research. I hope he will put some democratic people, even non-medical people, on the medical research body because if he does he will find that the democrats will be useful from the point of view of representing the working classes more than the medical men who are trained as research workers. I am glad, too, to think that the 744 health centres will also be kept under the purview of the Secretary of State. All the arguments used against the Third Reading of this Bill are trivial, naive, annoying, taunting, and meant to be delaying. Hon. Members talk about the shortage of doctors and nurses but that shortage originated from the tactics of the party opposite. The whole relationship of doctor and patient will improve under the proposed system. The whole medical system of this country will be improved by a Bill such as this. I can only say this in passing: There is some objection on the opposite side to trust funds being used in a way different from the donor's intention. But have not trust funds been misapplied before? Have members opposite forgotten that Henry VIII seized the monasteries? There is nothing new about it. Surely if a trust fund, because of present circumstances, can no longer be used beneficiallly, in the way for which it was donated, then it should be used for another purpose. My final word is this. This is a most important Measure. First England has had such a Bill; now Scotland is to have one. I hope that the vote tonight will not betray any deterioration of the Tory Party; that many of them will abstain from voting against a very good Measure which will do a great deal of benefit to the health services of Scotland and will redound to our credit.
§ 10.42 p.m.
§ Lord William Scott (Roxburgh and Selkirk)
I had not intended speaking on the Third Reading of this Bill but the remarks of the hon. Member for Rochdale (Dr. Morgan) require some answer. When, many years ago, I first joined the board of a London hospital I was rather surprised to discover that on the board of management there were no doctors. We had of course a medical board which worked under the board of management. I inquired why there were no doctors on the management board, and I was told that the patients did not like it and that the medical officers did not like it either. When I listened to the speech of the hon. Member for Rochdale tonight I thought of that situation. I was also told that in the ordinary course of events, those doctors who worked at medicine were not necessarily good at administration and that if they were good at administration, very likely they knew very little about medicine. I hope that the hon. Member for Rochdale is a high-class physician.
745 In connection with this Bill which we are going to pass tonight whether we like it or not, and in regard to which some of us are going to support an Amendment, I do believe that this House has lost a very great opportunity. We have lost the opportunity of giving to Scotland something which she wants, and something which she deserves, something which she is not going to get under this Bill. In the past, the hospital services of Scotland have been managed either by a collection of private individuals or by local authorities, and it does look as if, under this Measure, from now onwards there will be an ever-decreasing opportunity for those bodies who, in the past, have done reasonably well, and increasingly well, over a period of years. There will be less and less opportunity for them in the future. It looks to me as if those who are to be nominally in charge of the hospital system of Scotland in years to come will have immense responsibility, and very little power. There is nothing more awful for any body of citizens than to be confronted with responsibility and no power. Under this Measure, which is apparently going on to the Statute Book, we are giving to those in charge of the hospital services the responsibility, and to the Secretary of State we are giving the power. In Clause after Clause we give the power, the direction, into the hands of the Secretary of State. When I first glanced through the Bill I wondered why the Secretary of State demanded all this power. Was it that he did not trust those who were to be given the responsibility? Was it that he desired ever-increasing patronage—because, of course, this Bill will give him unbelievable possibilities of patronage? Or was it merely a part of the system to which we have become so accustomed during the last two years? I am not quite certain in my own mind which it was. It is probably a combination of all three. But one thing of which I am certain is that this Measure is not going to give to Scotland what she hoped she was going to get, and what I think we all consider she deserves, and what many of us hoped it would be in our power to give her.
§ 10.47 p.m.
§ Mr. McAllister (Rutherglen)
The Debate, so far, has shown that hon. and right hon. Members opposite are singularly unaware of the deep feelings and innermost thoughts of the great majority 746 of the Scottish people. I think it is perhaps natural that it should be so. The noble Lord who has just spoken is even proud that he is not "of" the Scottish people.
§ Lord William Scott
I do not understand the hon. Member. Does he suggest that I am not of the Scottish people? Does he suggest that I am a Welshman perhaps, or a foreigner?
§ Mr. McAllister
No. I think the noble Lord need not get so angry or truculent. I was merely making reference to a little incident which happened in the Scottish Committee when, by a mere accident, and purely by a slip of the tongue, one hon. Member referred to the noble Lord not with due formality and decorum as "the noble Lord," but as "the hon. Member." The noble Lord was indignant, and not only corrected the hon. Member, but in high dudgeon walked out of the Committee and left us to our deliberations.
§ Lord William Scott
Mr. Deputy Speaker, I state quite positively that there is not one word of truth in what the hon. Member for Rutherglen (Mr. McAllister) has just said. On that particular occasion I complained to the Minister in charge—
§ Lord William Scott
With respect, Mr. Deputy-Speaker, a definite charge has been made, and I feel that I am entitled to answer it. I feel that I must inform the hon. Member for Rutherglen that on that occasion I did, in answering the Minister in charge, tell him that certain of us were not able to meet the extra hours which he was requesting us to sit. I among others had other work to do elsewhere, and a quarter of an hour after I had finished speaking, when due to go elsewhere, I left to keep my other appointment.
§ Mr. Deputy-Speaker
No, this kind of irrelevancy spoils a Debate, and I think we should now leave it and get on with the Third Reading.
§ Mr. McAllister
I was making a simple point. I leave the noble Lord out of the question which he has raised and put it in this manner. There is in Scotland a landed gentry and a landed proprietorship. There are industrialists and people of great wealth. But there is also the vast bulk of the Scottish people, who are not landed gentry, are not Scottish nobility and have not any great wealth.
§ Lieut.-Colonel Dower (Penrith and Cockermouth)
Where did the hon. Gentleman get his information from?
§ Mr. McAllister
The right hon. and gallant Gentleman the Member for the Scottish Universities (Lieut.-Colonel Elliot) raised a fundamental issue. He said that this Bill was in some senses unnecessary, because what Scotland needed and what the Scottish people needed was not more doctors or more doctoring, but good food and good housing. They did not want more medical attention and more prescriptions; what they wanted was more hospitals and more hospitalisation. With all that I would entirely and emphatically agree, but I was a little surprised that the right hon. and gallant Gentleman dared to raise such a profound issue on the Third Reading of this Bill. Of course, the people of Scotland need good food; of course, the people of Scotland need better housing; but in the course of the long years before the war when the right hon. and gallant Gentleman was in power in this House his contribution to the improvement of those conditions were not such as to cause the people of Scotland to raise a monument in his honour. He raised the question of the wider aspect of medicine. I am not satisfied with the Bill as it now stands when it comes to the wider aspect of medicine, but the point that he and other speakers on the other side of the House have missed completely is that the basic factor of this Bill removes one great fear from the minds of the Scottish people. The Scottish people always had the fear of unemployment. They have always had the fear of great poverty, but beyond that and other hazards of life, the Scottish people have had the special fear of what is going to happen when somebody falls ill. This Bill if it does nothing else, deals with that aspect, because the people of Scotland will now know that they will be entitled to a decent medical service, without 748 respect to the amount of the money they earn or whether they are in employment or not. That seems to me a great advance, a great democratisation, not of health but of medicine.
The hon. Member for South Aberdeen (Lady Grant) used a charming phrase—and it was a pity that such a charming phrase and such charming eloquence were -devoted to a condemnation of this great Measure which is for the advancement of the medical care of the Scottish people—when she referred to "the living, human art of caring for the sick. "That is what this Bill is primarily concerned with" the living human art of caring for the sick." I cannot speak as the right hon. and gallant Gentleman the Member for the Scottish Universities spoke or as my hon. Friend the Member for Rochdale (Dr. Morgan) spoke, as a medical man. I can only speak of medicine from the receiving end—as a patient. I was a patient for five long months in one of our great voluntary hospitals. I have the greatest admiration for the men and women who have administered and conducted the medical side of these great institutions. But when the right hon. and gallant Gentleman and the hon. Lady refer to the charitable drives in Glasgow and Aberdeen to help these hospitals to maintain themselves, as if these drives were things of which we ought to be basically proud, I cannot help feeling a little astonished. As a student I took part myself in these charity day drives in Glasgow; indeed, I was one of the chief organisers of one of the first of them. But what a dreadful way it was to raise money for our hospital services for thr care of our sick, for this "living human art" of which the hon. Lady spoke. What a shocking way to maintain our services. Surely there can be no argument to gainsay that, properly financed and properly organised, our hospitals will he able to care for the sick better than they were ever able to in the past.
I think that this is, in the main, a very great and a very good Bill. I would agree with the right hon. and gallant Gentleman the Member for the Scottish Universities in one respect: we do want to widen medical research but, as my hon. Friend the Member for Rochdale said, we want to widen it beyond the bounds at present envisaged by the General Medical Council or the British Medical Association. I have refrained throughout the various stages 749 of this Bill from saying one word on a subject to which I attach great importance—nature cure and nature cure practitioners. 1 refrained from mentioning this matter because I did not want unduly to waste the time of the Committee or the House. But I hope the Secretary of State for Scotland—although he has been unable to make any provision for the inclusion of these services in the Bill as it stands—will enter into consultation with the accredited representatives of these people, and see what can be done towards giving proper professional status to the best of these practitioners. It is true that they arc in an embryo stage as a profession, but every profession has had to go through that stage and I hope that the Secretary of State will—as I am sure he will—receive deputations of these people and try to evolve some scheme whereby the nature cure practitioner, the masseur, the physiotherapist, the homeopath and others—can be brought into the working of our national health scheme. In that spirit I commend the Bill to the House for its Third Reading and hope that the House will decisively reject the appalling Amendment which the Tories have put down.
§ 10.58 p.m.
§ Sir William Darling (Edinburgh, South)
The hon. Member for Rutherglen (Mr. McAllister) described this as a great and good Bill. I hope I am not striking an unusual note of the negative if I disagree with him. I see no greatness and little good in it. It is a collection of bureaucratic pieces of machinery. Let me draw your attention, Mr. Deputy Speaker, to what this "great and good" Bill is. It is the setting together of eight committees for the purpose of looking after the health services of Scotland. The eight committees are the Scottish Health Services Council and Advisory Committees; the Hospital Endowments Commission; the regional hospital boards, medical education committees and boards of management; the Scottish Medical Practices Committee; and the tribunal which is to be set to look after the doctor-criminal class which is being created by this Bill. This is not a great and good Bill; it is a piece of bureaucratic patchwork rather badly collected together in a volume of some 80 pages. It is not a great and good Bill because it changes nothing. It modifies administrative form—it may make it better or it may make it worse—but there 750 is nothing great or good about it. We have had health services in Scotland for many centuries. This is merely codifying, co-ordinating if you like, but I am not aware that recodification and coordinating necessarily make for better health services.
A Socialist generally thinks that unless a thing is neatly adorned, grooved and tongued together, it is not a good thing. They are appalled at the prolific wastefulness of the world, but unfortunately that is how the world is made, with the Creator expending 10,000 spawns in order that one herring may eventuate. The good Lord is wasteful, extravagant and clumsy, according to Socialist planning. I would make it clear that there is a good health service in Scotland; otherwise the population would not be as vital as they are.By their works ye shall know them.But it is not a tidy arrangement. The unregulated and unco-ordinated system was a living move, and it was an improving system, with each hospital stimulated by the criticisms of local people who knew its best and its worst. That lively system seems to me to be more fruitful than the kind of thing proposed by the Scottish Health Services Council. If that is true of the voluntary hospitals, it is even more true of the local authority hospitals, which have had a far shorter time in which to develop and expand themselves. I agree that the local authorities are troublesome to the Secretary of State, and to Lord Provosts and others, but because a body is troublesome, that is no reason why it should be swept away. The only orderly place in the world is a well-managed cemetery. Everyone lies quiet there, and there is no disturbance. The Secretary of States rules unchallenged; but I do not want him to rule unchallenged over our hospitals and other institutions.
Doctors are of infinite variety; some good, some indifferent, and some, doubtless are bad, although I have never met them. This rich human variety, this manifestation of the profound quality of differences in human nature cannot be made better by being bound together under the Secretary of State. I want this disparity to continue. I know that under it, great and fruitful progress can be made. If it is true of the doctors, it is also true of the nursing association and the ambulance services. This multifarious and unco- 751 ordinated service, active and vital, interwoven together produces a plan for a health service for Scotland. The hon. Member for Tradeston (Mr. Rankin) looks on this as a tradition of anarchy, but he has his nose too close to the ground. If only he would raise it above ground level, he would see some purpose and order, otherwise there would be no Scotland at all. This Measure is a proposal to convert the lively, vigorous institutions of the health services of Scotland, into a series of eight committees, one of which has the unusual powers to fine a doctor £500, or send him to gaol for three months.
Let us look at the most important part of the Bill. In the very beginning, we read that it shall be the duty of the Secretary of State, not to "provide", but to "promote" a comprehensive health service in Scotland. Whose duty is it today to promote a comprehensive health service in Scotland? It is the duty of every single citizen in Scotland, and the citizens of Scotland are transferring their moral, personal and financial responsibility to the Secretary of State. Formerly it was the duty of the people to provide a health service for Scotland, but now it is the duty of the Secretary of State. In this unification, in this complete centralisation and co-ordination, Scotland may be happy and healthy, but I do not think it will be as progressive as it has been in the past.
§ 11.5 p.m.
§ Mr. Gallacher (Fife, West)
I am glad to be able to participate in the discussion on the final stage of this Bill, and to join in the tributes which have been paid to the Secretary of State and the Under-Secretary. The Standing Commitee did a good job in helping to shape this Measure, and, during our discussions there, the right hon. Gentleman and his colleague listened with the greatest possible attention, and gave to every Member all possible help as we went through the various Clauses. My hope now is that we shall get the results that we desire from the operations of this Bill in Scotland. Always, in these matters, we find ourselves up against the old Tory tricks. The hon. Member for East Fife (Mr. Stewart), who is a crypto-Tory, and the hon. Lady the Member for South Aberdeen (Lady Grant) both started off with one of the most ancient Tory tricks which Members opposite put up whenever we are discussing reforms. Their line was, 752 "We recognise the need for a comprehensive health service in Scotland, but not in this form." We can go back generation after generation and find that sort of thing coming from the Tory benches.
The right hon. and gallant Member for the Scottish Universities (Lieut.-Colonel Elliot) said that the world owed a debt to Scotland for her medical services, and the hon. Member for East Fife declared that never had there been medical services like those we had in Scotland. Yet we have, in Scotland, the poorest health of any people in any country in Western Europe. [HON. MEMBERS "Oh."] Yes. Take the most recent statistics for maternal and infant mortality, and it will be found that we have the worst record of any country in Western Europe, with the exception of Spain and Portugal. What about tuberculosis, and other infectious diseases? Have hon. Members opposite, who talk so much about Scotland's wonderful medical service, had any association with working class streets and working class homes? Where was all this fancy medical service when our children in the slums were dying? I remember that when I was a lad we used to talk about some of our companions being in a decline—which was what we used to call tuberculosis in those days. They used to die slowly before our very eyes. Where was all this wonderful medical science? Where is it today? What about the relationship between the doctor and patient? If a doctor has 1,000 patients he has to run from one house to another a few minutes here, a few minutes there, in order to get his work done. The workers in any working class district do not choose a doctor because of his higher qualities or higher skill, but choose the nearest doctor, it is proximity that decides who will he the doctor.
This Amendment is an attempt at procrastination. Hon. Members opposite want to hold things back as long as they can. They want to hold back reform. That has always been the line of the Tories. They use any and every method to hold up any advance. They cannot make a frontal attack, so they try to attack from the flank. I only hope that the doctors, dentists, opticians, nurses, domestic staff, and the administrative bodies and the Secretary of State, all engaged in great service to humanity, will harmonise the work so that the people of Scotland will get the very best and 753 highest results from this great Measure. One thing is essential. There is so much power in the hands of the Secretary of State that it requires an intelligent and imaginative Secretary of State who is in close touch with the people. That means that the Tories are barred. We cannot have a Tory Secretary of State. I hope that ensuring that co-ordination will be regarded as one of the biggest jobs. I discussed this with the medical officer in my own constituency, and some of the members interested in health, and the difficulty of co-ordination is something that concerns them very much. I hope it will be brought about. Scotland is a beautiful country. We often hear that said. We are inviting tourists to come to Scotland. But the most beautiful thing we could have would be a strong, robust, and healthy people. While I have been sitting here, I have remembered the lines of Sir Walter Scott:Breathes there the man, with soul so dead, Who never to himself hath said,This is my own, my native land!That is not enough. I would add:But raise our people strong and wise, With joyful health the common prize, For this, 'Wee Joe,' will stand.
§ 11.13 p.m.
§ Major McCallum (Argyll)
The hon. Member for West Fife (Mr. Gallacher) would presumably like to have a Communist Secretary of State to administer health.
§ Major McCallum
I must confess I find it very odd that a certain number of hon. Members opposite, including the hon. Member for Rutherglen (Mr. McAllister), who claim to themselves great understanding of the Scottish people, pretend that hon. Members on this side have no cognisance whatever of the wants and difficulties of the Scottish people. May I tell the hon. Member that hon. Members on this side representing Scottish constituencies for the great part come from and live in those constituencies, and have almost daily contacts with their people? They probably know a great deal more about the feelings and opinions of the Scottish people than an hon. Member who lives in London and occasionally goes up to visit his constituency. I ask the hon. Member to give us the credit for knowing just as much as he does about the 754 feelings and opinions of the Scottish people.
§ Mr. McAllister
I cannot understand why the hon. and gallant Member has chosen to be so offensive. I spent the first thirty years of my life in a Scottish industrial town, and the people of Rutherglen knew when they elected me as their Member that I was not at that time, as I am not now, living in the constituency. I am probably in my constituency as often as any hon. Member on the other side of the House.
§ Major McCallum
I cannot entirely agree with that, because I am certain that the hon. Gentleman is not in his constituency as often as many right hon. and hon. Members on this side. But that is not a matter which is in the Bill. In this Bill, we see the last of a service which, for years past, has been a very good service in the Highlands and Islands of Scotland. It is a service which the Secretary of State has told us will be swallowed up, and become part of the complete Bill.
§ Mr. Westwood
I must correct that statement. I have never said such a thing during these Debates. Since the hon. and gallant Gentleman has made that remark, I hope that he will quote anything I have said. He usually tries to be very fair, and I do not think he would wish to have it believed that I had said something which, in fact, I have never mentioned.
§ Major McCallum
I had a recollection that, on the Second Reading of this Bill, the Secretary of State said that the Highlands and Islands scheme would be included in the complete national service scheme.
§ Mr. Westwood
I would ask the hon. and gallant Gentleman to withdraw that remark because there is no foundation in fact for what he has said. I made an exactly opposite statement. I said that this unique service had been so successful, that it was the basis of our scheme for the rest of Scotland.
§ Major McCallum
If I am wrong, Mr. Deputy-Speaker, I will withdraw unreservedly. I will certainly look up the OFFICIAL REPORT to-morrow, and if I find I am wrong, I will withdraw what I have said. I, and my constituents, are 755 under the impression that the scheme does disappear into the Bill.
The Secretary of State has taken to himself, as many right hon. and hon. Members have already pointed out, considerable powers, and he has also allocated to local authorities considerable powers. Yet I find that local authorities are much mystified over one or two parts of the Bill. There is the question of district nursing, which has been mentioned. I take it that, under this Bill, the local authority is to take over the Queen's Nursing Association, but my own local authority is unable to find out who is to take over the financial burden. Is it to remain with the voluntary organisation, because in the Bill it is stated that the local authority has the power to utilise the voluntary organisation to carry on the service if it is efficient.
§ Major McCallum
I have read the Bill just as closely as the hon. Member for Rochdale (Dr. Morgan), who is always interfering and interjecting his remarks.
§ Major McCallum
No, I cannot give way. The question of the nursing services and the ambulances was raised with me by my constituents this weekend. I have written to the Secretary of State about the ambulances, and I hope that, in his reply on this Third Reading Debate, he will say something on this subject. It would reassure the local authorities if they knew exactly what is being taken over. There is much uncertainty. In the Committee stage, Clause 25 was passed without discussion. It is only natural that the people of Scotland are not satisfied; they do not realise what is the position of the nurses. Again, we are not entirely satisfied as to the position regarding the ambulances. I, therefore, agree with the right hon. and gallant Gentleman the Member for the Scottish Universities (Lieut.-Colonel Elliot.) While we shall have to make the best of this Bill, there are several points upon which I, for one, like my hon. Friends, do not agree with it.
§ 1I.21 p.m.
§ Miss Herbison (Lanark, North)
I had no intention of intervening in this Debate until what is termed a "reasoned Amend- 756 ment" was moved by the Opposition. It seems to me absolute hypocrisy for Members on the Opposition benches to assure us, and possibly, the people who will read it in the newspapers tomorrow, that they are all ready for a really fine and good medical service in Scotland, and at the same time, in this House tonight, to move such an Amendment.
§ Mr. E. P. Smith (Ashford)
On a point of Order. Is it in Order for the hon. Lady to accuse Members on this side of hypocrisy?
§ Miss Herbison
By this Bill Scottish people will get a much better medical service than they have ever had, because we have a majority on this side of the House, and in spite of the reasoned Amendment we will be able to carry it through this House tonight. I was also surprised at the arguments put forward by some hon. Members. The hon. Member for East Fife (Mr. Henderson Stewart) and the hon. Lady the Member for South Aberdeen (Lady Grant) made great play with the work of our voluntary hospitals. I am willing to add my tribute of gratitude also to the voluntary hospitals for the marvellous work which they have done. But greater play was made with the effect of the charity drives in Aberdeen and other parts of Scotland. The hon. Lady said that these charity drives gave the people a chance to show their generosity. Surely, if the people are really generous, and really want a good medical service, they will still want to show that generosity. Surely, on the other hand we, as a Government, are responsible for giving our people the best health service we can possibly give them. We cannot take any risks of leaving the voluntary hospitals as they are today, just for the sake of giving those people the chance of showing their generosity. I have much greater faith in the people of Scotland than in the majority of the Members on the other side.
There is another point I would like to stress. I believe it is very wrong for hon. Members opposite to try to get the people of Scotland to believe that there is going to be any direction in regard to the choice of doctor. The hon. Lady said there was great concern among the ordinary people of Scotland on this point. I 757 really wonder whether hon. Members opposite know the system in Scotland. There is not a bit of concern in the whole of my constituency which is a very big and a very mixed one, ranging from mining on the one side to a very good residential district on the other side. I have never come up against this problem, this fear, this concern that we are always being told is being felt by the ordinary people. It was suggested that if a patient went to one of the health centres and found that he could not have his own doctor, there would be great concern. But surely that is what is happening today? Our own doctor at home has Saturday afternoon off every week. If one of his patients is ill, he has to take one of the other three doctors in our village. If our doctor wants a holiday—and every doctor needs a holiday—we either have to depend on one of the other doctors or a locum whom he brings in. It seems to me that if we examine this health service which we are proposing to introduce we shall find there will be just as much right in the choice of doctor as we have today. And, as I think I said on the Second Reading, for the majority of people there is no great choice of doctor today. You have the doctor and if he decides under the present system to clear out of his district—and the majority of Scottish people are panel patients—you must accept the doctor who comes in his place. There is not much choice in that and I am quite certain that if we go to our people, as we do, on this side, and explain this to our people, we have nothing to fear from this reasoned Amendment which has been moved by the Opposition tonight. I was surprised to hear the hon. and gallant Member for Argyll (Major McCallum) exposing doubts about the continuance of the Highlands and Islands medical service. Opposition Members seemed to think that this a very splendid service indeed. Yet there are many things about that—almost a State salaried service.
§ Major McCallum
I do not want the hon. Lady to misunderstand me. I said that it was being merged into this Bill.
§ Miss Herbison
If hon. Members opposite think that that is a good and splendid service, then why move an Amendment against a service which is following on the same lines as that service? The hon. Lady the Member for South Aberdeen spoke of doing away with the sanctity of the re- 758 lationship betwen doctor and patient—again hypocrisy. Can any hon. Member suggest one single line in this Bill as it has reached its Third Reading which will interfere in any way with the ordinary relationships between the doctor and the patient? If we take a specialist, the patient goes to a specialist whom he has never seen before. He goes to a voluntary hospital; he is treated by the specialist there whom he has never seen before, and yet the majority of patients who go to voluntary hospitals have the greatest faith in those specialists. I am quite certain that there is not a single thing in this Bill which is going to mar the service in our hospitals, or the service from our specialists or the splendid nursing staffs which we undoubtedly have in our Scottish hospitals. There is not a single thing in this Bill which is going to do anything to harm the relationship between patients and those people.
The hon. Member for South Edinburgh (Sir W. Darling), I see, is not in his place. He gave us many very fine, glowing adjectives. He talked about the bureaucratic patchwork of our medical services, the multifarious, unco-ordinated medical service which we have today, but which he considered a fine and good service. He also saw no greatness, and very little good, in what we propose in this Bill. My people know that when the provisions in this Bill are really implemented for the Scottish people, they are going to have the sort of medical service they have dreamed of for a long time, but which they saw no chance whatever of having when hon. Members now in Opposition were in control in this House. The ordinary wife of the ordinary worker who is not covered by his contributions today very often has to do without a doctor in Scotland when she ought to have one. Under this scheme she will be able to have a doctor as soon as she is ill. That is only one of the many advantages which are coming to the Scottish people. I welcome this Bill, and hope that the greatest speed will be shown in carrying out all its provisions for the Scottish people.
§ 11.31 p.m.
§ Mr. Niall Macpherson (Dumfries)
I admire the faith of the hon. Lady in the machinery of this Bill, but I do not admire to the same extent her assumption that she knows what are the motives of hon. Members on this side of the House. I 759 cannot agree with her attitude when she describes the views of Member after Member on this side as "hypocritical." How can she know? Why should she deal in this way with hon. Members on this side who are doing their duty as legislators, and judging of the machinery which is set up in the Bill?. Of course, everybody in Scotland wants a Bill. The hon. Member for West Fife (Mr. Gallacher) said there was room for the Bill. Of course there is room for the Bill. There is a necessity for a Health Bill. I go further and say that if the National Government had been here at present, we should not have waited 20 months for the Third Reading of the Bill. [AN HON. MEMBER: "Sixty years."] That there should be a Bill is the natural result of the National Insurance Bill, and to that the Coalition Government was pledged. There should be a Health Bill, but what we say is that it should not necessarily have this particular machinery.
§ Mr. Macpherson
The hon. Member says it is the old, old story. It is the old, old story of every Opposition which questions, not the purpose of a Bill, but the machinery set out in a Bill. That is exactly what we are doing. Our points of criticism are well known. In the first place we do not agree that because a financial contribution is made, therefore there should be full control. We do not agree with complete centralisation. We think that vital error in this Bill is this tendency to centralisation. That tendency is not confined to this Bill. If it were, the administration of the Bill might in the future be better. But Bill after Bill comes before this House now, throwing additional burdens on to the Secretary of State. How is he to fulfil all the various duties? How is Parliament to control his fulfilment of them? There is growing up too much bureaucracy, and the Secretary of State will not be able to know what is going on under these various Measures. This House of Commons should be giving a health service to the people of Scotland. But this will not be a health service; it will be a vast bureaucracy of red tape. [Laughter.] Hon. Members opposite laugh but they themselves in Committee criticised the tendency towards centralisation.
760 We have heard from the other side of the House complaints about the taking away of responsibilities from the local authorities. It is true that the local authorities are to get representation on the boards of management and on regional hospital boards, but they cease to have any control of the health services in their own areas or any control of the hospitals in those areas. Even the health services are to be controlled by the Secretary of State direct. I hope sincerely that it will not be long before the Secretary of State sees his way to pass the control of the health centres to the local authorities, for I believe that that is 'the sort of service that can and should be controlled as closely as possible to the people, which can best be achieved by their municipally elected representatives.
I am well aware that criticism has been made in the past by doctors of local authorities running hospitals. I wonder whether the doctors will fare any better at the hands of the Secretary of State. I do not think they will. It is true that doctors have opposed control of the health centres by the local authorities. Again, I believe that they will find in the course of time, that local control is better than remote control, and being professional men they naturally prefer that the executive councils should be dominated by profesional men. Here again I believe that the executive committees should have a dominating influence on local authorities.
Another of the faults we find with this Bill is that the Secretary of State has repeatedly stated that he cannot be responsible for the health of the people of Scotland unless the ultimate authority is reposed in him. It is for that reason that he intends to take over not only the endowments along with the hospitals— which incidentally he reserves the right to dispose of exactly as he pleases—but of the doctors, nurses and dentists themselves. Therefore, he is setting up three separate organisations controlled by him without local co-ordination. He may make neat paper schemes, but he cannot so readily provide the personnel. There is a nation-wide and Empire-wide shortage of doctors. The hon. Member for Tradeston (Mr. Rankin) says that there are doctors unemployed a present. Of course, there are, for they are waiting to see what sort of a Bill this is going to be before deciding what action to take. None the less, there is a shortage of 761 doctors. The right hon. Gentleman is going to find that the creation of the right to free medical attention—with which I do not disagree—will increase the demand for doctors' services. He is also going to find that devoted as doctors are to their profession they are but human, and now that their livelihood will no longer depend on the number of patients they attend, the number of hours they work will fall. I am not saying that that the hours of work of a doctor should not fall, because it is most desirable in my view, but the question is: Is this the right moment to introduce this, when there is such a shortage of doctors?
§ Mr. Macpherson
The hon. Member says that it is always the wrong moment with us, but at the moment we are turning out more doctors in Scotland than ever we turned out before, and sooner or later the number will overtake the need that is now so apparent. In the same way, eventually, the number of hospital beds will overtake the need, too, but that is a matter of finance. Again, I say it is not necessary to take over and control the whole hospital service because the Government are going to make a contribution to the hospitals. As for the dental service I am afraid that the failure of the Secretary of State to meet the dentists is going to mean that for a long time we are going to be fearfully short of dental services.
To sum up, the objects of the Bill are entirely praiseworthy but the reasons why I oppose it are, first, because it takes away local initiative except in matters of home nursing, midwifery, the care of expectant mothers and children and infectious diseases; second, because it sets up three separate medical systems all responsible to the Secretary of State without proper co-ordination; and, third, because it seeks to bring a grandiose scheme into operation without sufficient reserves in personnel, doctors, dentists and nurses. I greatly fear that owing to the Government's desire to show quick political results they will bring chaos into the health services of Scotland.
§ 11.36 p.m.
§ Mr. Malcolm MacMillan (Western Isles)
The hon. Member for Dumfries (Mr. Macpherson) pointed to the necessity for 762 this Bill when he indicated the legacy left to the Government from the past, in the shortage of hospitals and hospital beds, the shortage of nurses and nursing services and even the shortage of doctors. There was little incentive in the system in the past and little was done to try to improve the service and encourage people to come into the service. We still find legitimate objections by girls against coming into the nursing service. The conditions in the past did not attract girls except those who entered the service from the highest motives, and girls cannot afford to live on highest motives alone. We on this side of the House pay tribute with equal if not greater sincerity than hon. Members opposite, to the great work of the medical services and the voluntary services at the present time. Hon. Members opposite cannot outdo us in sincerity and enthusiasm and in genuine gratitude to the people who have manned the medical and nursing services and to a certain extent the administrative services. But that does not mean that we are going to sit down and not do anything in the way of moving forward. We have a mandate from the people for a national health service along the lines of this Bill.
It was the hon. and gallant Member fur Argyll (Major McCallum) who provoked me to speak and the responsibility is on his own head. He referred to the Highland and Islands medical service. He feared, for some reason that I cannot understand—because I think we got an assurance on the matter which he now says is in dispute—that this service would be swallowed up. There would be no complaint I imagine if the service were embodied in the new set-up, if as good or a better service were given us in its place. I do not think that the hon. and gallant Member can be strongly against the embodying of that service if we are to get a better service in return. I cannot honestly believe he was strongly against it I would like to ask him a question. I should like to know whether he has had any representations from the Highland and the Islands people or from doctors or nurses against a national health service. I have had none where I come from, and ours is a most characteristic area.
§ Major McCallum
I took the precaution last week to investigate the matter, and I have a most definite mandate from the 763 people of my constituency to oppose any such service.
§ Mr. MacMillan
As far as the Outer Hebrides are concerned, I have not received any representations against the service. The doctors there more than two years ago, expressed themselves in favour of centralisation, having had a measure of centralisation from Edinburgh for some time. They have expressed themselves in favour of a national health service and they want to go into such a service. Further, they have signed a document to that effect. The nurses are in the same position, and undoubtedly the people are entirely for it. The people want an expansion of that service to the highest level we can give, on a national basis. I can only say that there was no serious opposition among the doctors and nurses administering that service, as among the people who have had the benefit of it for years. I want to pay tribute to them. If we can bring the general level up to that service, and if we can surpass it, we shall be going a long way towards providing the people with what they want.
We cannot dissociate the objections urged by hon. Members opposite, from the kind of objections they have to rationing. They have been accustomed to privilege and to treatment which one can buy. But those days have passed in the medical service, as in other things, and those objections are the least feasible of all objections which will be over-ruled tonight. So far as the area for which I happen to be one of the Members is concerned, I do not think there was any widespread feeling against this Measure. I am sure that the vast majority understood at the Election that a national health service would be introduced. I know they understood that, because I told them at the time. I am sure that the vast majority welcome it, and I congratulate the Secretary of State on having brought in this Bill. I congratulate him and his colleagues on the way they dealt with the Bill in Committee and I know that we are all behind them in asking for the Third Reading of the Bill.
§ 11.48 p.m.
§ Commander Galbraith (Glasgow, Pollok)
We have now practically reached the end of our consideration and discussion of a matter which has been before the public for many years and on this occa- 764 sion we should remember those who are in the forefront of the movement to bring about a comprehensive health service. I am referring to the work done by the medical profession over a long period of years. I think it is more than 20 years ago since they started to consider how the medical services could be enlarged. We were told by the right hon. and learned Member for North Croydon (Mr. Willink), during the Debate on the Third Reading of the English Measure, that it is now more than eight years ago since instructions were given by the then Minister of Health to start conversations and take proceedings which would eventually result in a Measure of this nature being introduced. I have no doubt that the Department of Health in Scotland were similarly employed over an equal period of time. One thing is absolutely certain, and that is that every party in this House has been completely committed to the introduction of a comprehensive medical service. We had the Government White Paper on the health services during the time of the Coalition Government, and in the last Parliament. The battle has been going on for a long time, and it has been somewhat hotly contested. It is not surprising, when one realises the very great and real differences of opinion which exists on how the best possible service should be provided. There are even wider differences than the organisation of the administration of a comprehensive service. I am certain that Members in all parts of the House wish to ensure that medical science shall continue to advance even more rapidly towards even greater efficiency and without in any way lessening that human touch, that understanding which is the pride of a very great profession.
The provisions of this Bill very gravely affect these things. During the past 100 years, the advance in medical science has been stupendous, but, still, the human touch has been maintained. I do not think that any other country which has developed medical science and surgery has reached a higher level than our own country. The complaint is not that the service has not been good; it is that the service has not been large enough to take care of all the people requiring its attention. These outstanding results have been achieved through free and independent institutions, and through a free and independent profession. I should have imagined that those responsible for framing the Bill, and setting up this new ser- 765 vice, would have endeavoured to maintain to the greatest possible extent, and fostered by every means in their power, that freedom and independence. But the Bill proceeds in the opposite direction. The control of our great free hospitals, all local authority hospitals, institutions for reception, the treatment of illness, and for convalescence, now pass into the hands of one man—the Secretary of State for Scotland. The ownership of the physical essentials to the service—the lands, buildings, and equipment—are to be vested in him. Minor authority will be delegated to the regional hospital boards, and also to the boards of management, but nothing in connection with these lands, buildings, and equipment will be able to be altered without it having first received the approval of the official channels. At the end of every one of those channels will be the Secretary of State. In consequence of this great over-centralisation, I think we shall find that in a few years we shall hear, in this House, complaints about the inadequacy of hospitals, the out-of-date buildings, and stupid standardisation, such as we heard of in connection with naval establishments when we debated the Navy Estimates. Over-centralisation is the blemish on the whole administrative machine which is set up under this Bill.
The most important body which the Bill creates is the Scottish Health Services Council. It is composed of 35 persons, who can be chosen from seven different categories. Each of those categories has an association of its own, which should know their ability, competence, and suitability for appointment to this great new Council. Yet every one of these appointments is retained in the hands of the Secretary of State—and in this matter I am not only referring to the present Secretary of State, but also to his successors— who will appoint only those whom he knows to be in sympathy with his policies and his views. No others, no matter how competent they may be, will have any opportunity of serving on this important body. I wonder whether, if these associations had been affiliated to the Trades Union Congress, the right hon. Gentleman would have dared to act in what I consider to be a most undemocratic way? I wonder whether the hon. Member for Rochdale (Dr. Morgan) believes that what I have described, and what is actually in the Bill, can be called "nomination" or even "democratic"? The regional 766 hospital boards are also to be appointed by the Secretary of State. He is going, to appoint these gentlemen from five different categories of persons. Four of then, have associations of their own capable of pointing out who the best men are Not even the local health authorities are to have the right to appoint from their own body. The Secretary of State reserves the entire right of appointment, again, to himself. The boards of management are to be appointed by the Regional Hospital Boards which, as I have already said, are the creatures of the Minister; but the right hon. Gentleman still retains to himself the power to alter and to vary the schemes which the Regional Boards send forward and under which these appointments to the hospital boards are made. So far as the administration of our hospitals and specialists services is concerned, all authority rests in the hands of the Secretary of State under this Bill.
§ Commander Galbraith
I am describing the system which is set up under this Bill. What a change this Bill is going to introduce. Here the hon. Gentleman will get his answer. It is going to bring about a revolution in the present system. Instead of free institutions combining with each other to produce the most efficient possible service for the benefit of the public, at liberty to pursue any course they think most likely to achieve that end, in a position to compare results with one another, to adopt rapidly any better system which has been proved by the experience of some kindred institution, we are going to have a completely centralised control which will inevitably bring in its train uniformity and standardisation, which will deaden, if it does not kill, both initiative and progress. I repeat to the right hon. Gentleman words which the right hon. and learned Member for North Croydon (Mr. Willink) spoke to the Minister of Health, substituting the name of the Secretary of State for that of the Minister. He said that the Secretary of State should be terrified of the powers which he is taking unto himself, and which are nothing short of directing the whole administration and management of every place where the citizens of Scotland can obtain hospital care.
The Secretary of State has today alluded to the very high regard in which 767 Scottish medical men are held in every country in the world. That is undoubtedly due to the excellence of the training which they receive at our Scottish universities and also at our Scottish training hospitals, and it is also due to the traditions which were instilled into them from the very first day on which they started to prepare themselves to enter the medical profession. Hitherto these matters have been left in the hands of the universities and of the teaching hospitals, and none of us can pay too high a tribute to these institutions for the remarkable way in which they have performed their task. But the Secretary of State is not prepared to leave well enough alone. It seems he has got to have his finger in every pie, and he is taking unto himself the duty of providing facilities for clinical teaching and deciding what is necessary to meet these reasonable needs. The Secretary of State seems to think that that is being helpful. I have very grave doubts as to that. He is only going to be assisted by the advice which is given by the medical education committees to the Regional Boards, or so much of that advice as these Boards pass on to him, and then, again, that advice will have to pass through the filter of his own officials. It is obvious the advice he will receive will be only the advice of his own Department of Health. In any case, it is pertinent to inquire into what these educational committees consist of. To the extent of one-third they are appointed by the universities, and therefore, we can take it they are independent. To the extent of the remaining two-thirds they are appointed either directly or indirectly by the Secretary of State himself. I have the impression that the whole of this set-up is something of a pretence—something of a farce, and it would have been much more seemly if the Bill had stated that the medical education would proceed on lines laid down by the officials of the Department of Health, after consultation with such representatives of the universities as they chose to select for that purpose. The effects of these provisions on the prestige of our medical schools, and on the prestige of our doctors, time alone will show. All I would say to-night is that many of those to whom I have spoken, and who are people well qualified to judge, have received these proposals with grave misapprehension and even with dismay.
768 Much has been said of the manner in which this Bill interferes with the independence of the individual doctor. I have stated before, and I repeat tonight, that one cannot expect the best from any medical man unless he is entirely free and independent. But this Bill saps the independence of the doctor at its very roots through the prohibition which it places on the doctor owning his own practice, and also from the salary element. The patient is going to suffer because the doctor will no longer owe one loyalty to the patient alone. The doctor will have two loyalties—perhaps opposing loyalties—to the patient and the authorities. The doctor is not going to have the benefits of greater skill and harder work, which are qualities entitling those who possess them to higher rewards, and the doctor is going to suffer in character to large extent. Prohibition on doctors practising where they will, and in partnership with those with whom they desire to take on that relationship, is wrong. No matter how it is cloaked in this Bill, all this is a measure of direction, and no matter how the Secretary of State may try to argue otherwise, it is a Measure highly repugnant to the people of Scotland. By forbidding the sale of goodwill, and by forbidding doctors to enter into partnership, and by introducing the salary element, it seems to me that the Government are preparing the way—and I would challenge the Secretary of State to deny it—for the achievement of their declared view—that is the establishment of a full time, salaried, State medical service. The country should know the facts, and I hope that the hon. Gentleman, in his reply, will give a fair answer. As Lord Moran said in another place, after having made a full investigation into the medical services of the fighting forces, it would be highly detrimental to the people of this country.
My right hon. and gallant Friend the Member for the Scottish Universities (Lieut.-Colonel Elliot) and other hon. Members have spoken on this question of endowments. I would add this. These provisions are going to have a most depressing effect on all voluntary effort, and will bring no encouragement to benefactors. Not only in this field of medicine, but in all other fields as well, the Bill is full of discouraging influences to those who desire to give service on voluntary bodies or to serve local authorities. It is our belief that the benefits of a compre- 769 hensive service are more than counter balanced by the harm that is being done to the public interest through the centralisation of control, through the unnecessary interference with the freedom and independence of the medical profession and of medical institutions, and through the incursion of officialdom into the field of medical education. Because we believe that the Bill will do more harm than good, we are going into the Lobby tonight in support of the Amendment, and against the Third Reading of this Bill.
§ 12.6 a.m.
§ The Joint Under-Secretary of State for Scotland (Mr. Buchanan)
We have come to the end of a Debate on the Third Reading of this Bill, which is an important one from the point of view of Scotland. I must confess that I did not think that the Third Reading would have engendered quite as much heat as it looked like doing at one period of the Debate. Far be it from me to deprecate the introduction of heat into Debates, or to object to one saying hard things to the other, though I do not like to see men who have always taught me benevolence, falling from the great grace they have always tried to teach me. I was somewhat disappointed with the hon. and gallant Member for Argyll (Major McCallum) in that respect. He wanted to know one or two things. First, let me say to him that I cannot understand his point in regard to the Highlands and Islands service. You have a State medical service now in the Highland and Islands, a State medical service, which, for devotion, self-sacrifice and capacity, is far ahead of anything connected with the private practice, or panel patients right throughout the length of Scotland. Let me say this to him: I propose to repudiate his somewhat brusque and unfair treatment of our people—
§ Major McCallum
I hope the hon. Gentleman will remember that I gave way to several Members opposite. What I wanted to say was that you cannot deny that doctors in the Highlands and Islands medical scheme are private doctors who are semi-subsidised by the State—not totally subsidised.
§ Mr. Buchanan
I say that private practice could not last a minute—not a minute. The basis on which the scheme is built and maintained is a State subsidy, and without that, there would not be a private doctor in the Highlands today; and it is no use hon. Members riding away on that. Let me say one word about this argument which has emanated from somebody who opposed the scheme.
§ Mr. Buchanan
Let us be frank. Not a single servant in this scheme has made one representation of any kind against this Bill, either through the British Medical Association, which he could have done with complete freedom, or in any way to the Secretary of State or to the chief medical officer and, indeed, all the representations that we have received go to consolidate support of the step we are taking. Now let me turn from that to the ambulance scheme. Why should hon. Members ask me the same thing again and again. I dealt with that before. The ambulances will be a State service. I have explained that already. The district nurses will be the service of the local authority. Let me say a word or two on the other point. I wish that I could continue this Debate longer than is possible. [HON. MEMBERS; "Go on."]
Let us compare the present system with what we are proposing to do. People opposing this Bill talk as if the present system was a health system. The present system is only partially a health system. Let me for a moment or two examine this. I was very pleased with the hon. Lady the Member for South Aberdeen (Lady Grant) for her kindly indulgence tonight. It was much kinder than we could expect. We are city-bred and city born; and this is a democratic Assembly, 'his House of Commons, and when city bred men are elected Members of this House they are entitled to be here. Take the system you have got now. You have the panel system, the local system, that deals with the poor law and that which deals with infectious diseases. You have the voluntary system, and then you have the large category of other things about which nothing is done at all. Take the question of dental treatment. Who would deny that a dental system is as important as any other system in medical teaching? 771 Yet we have no connection with dental treatment. What we have got is a higgledy piggledy system, that no one who knew anything at all about it would defend for five minutes. You have the system for free dental treatment. A person may be in a certain selected approved society which, with good fortune, can provide him with free dental treatment, or he may be in a very poor society, with recourse only to the poor law. The great mass of the people covered by National Health Insurance are denied any health treatment in regard to the dental side. Take the question of treatment by the doctor. The man is covered—the most important member of the family possibly. But no free medical treatment for the wife. No free medical treatment for the children. All out. And we come along tonight and we propose a Bill which creates a system, which says that a modern health service for the people shall be available without any test as regards calling or income, but available in its broadest and widest sense for the community as a whole. That is what we are doing tonight.
What are the objections to it? The hon. Lady said that she is in favour of a national health service. She wants a national service but not this one. What kind does she want? I do not know. She surely does not want the present system. It is not a national service. And we have the spectacle of the pleading voluntary hospitals, giving people the chance of running about with a collecting box, asking for pennies. [An HON. MEMBER: "Cheap."] It is not cheap. It was said. Let me say this one thing; that the most disagreeable thing I know is to see these people running round with boxes. Mind you, it is not done for dealing with infectious diseases. There are no penny collections for those hospitals, no running about with tin boxes. There axe no voluntary associations for the infectious diseases: everything for them is done either by the State or municipality. Voluntary associations have nothing to do with tuberculosis. This, again, is dealt with by the State or the local authority.
§ Mr. Buchanan
When it is a matter of notifiable diseases the State deals with them; and the State does all. We see people on Saturday afternoons in Glasgow cadging pennies from other people for doing what should be a most elementary duty of the community—caring for the sick. Can it be suggested that that is a good way of running a system of society? We should never dream of looking after those injured in war in that way, and I think it is wrong in this connection.
Let me say a word or two about certain points which have been raised. One hon. Member raised the question of research. Far be it from us to lessen research. We are now going to increase the opportunities for research. We are going to make it possible for the local authority, if it cares to do so, to provide funds for research. We propose, through the State, to provide funds for research, and to allow the regional board to provide funds for this purpose. Indeed, we take it that under this Bill larger sums than ever before will be available for research. Another hon. Member said that within months there would be grumbles because there were not enough hospital beds or provision made. Of course there will be grumbles. I do not claim that within six months, or in a year, or in two or three years, this Bill will have solved the very acute shortage of hospital beds throughout Scotland. No one makes that claim. All I say is that if the voluntary hospitals were left to do it by voluntary effort, it would take much longer to deal with the matter, because the voluntary hospital in Scotland could not carry on unless up to 80 per cent. of its income were to come from local authority or State sources. It is a misnomer to call them voluntary hospitals. That name has long since been completely out of date.
Now, regarding the question of the free choice of doctor, a great deal of this free choice of doctor does not work out in practice. Free choice exists as a great deal of by-play, but not in reality. I happened to be ill last month. Until then I cannot remember having been ill before. I had never had a doctor, but I needed one. What did I do? I went to the doctor nearest to my home. That is my free choice of doctor. Most people who go to a doctor do not go to him in the 773 sense that they have a doctor with a label on him, as if he were a piece of merchandise. The fact is that in any great working-class district, a doctor is chosen for two reasons. The first is his availability at the particular moment at which his service is needed. A great deal of this family doctor business is nonsense. I should like to see a person residing in my Division walking up to Woodside Crescent, which is the Harley Street of Glasgow, and getting one of the doctors there to come and attend whoever is sick in that man's home. The thing would just be nonsense. In my district the choice of doctor is limited to the doctor who happens to practise in that particular area, seven, eight or nine of them altogether. In the State scheme the choice of doctor will be at least as wide, and in my view wider than is the case at the present time.
There has been talk about doctors working a shift system. Plenty of the noblest doctors in the country at present work a shift system. The doctor in a hospital works a shift system. After all, the doctor in the hospital must have his time off and his freedom. One of the things that I have always wanted and planned for is to see the ordinary medical men get something like reasonable hours off work. If I may quote from a speech which I made in the old political days, I would say that one can get a policeman at any time to look after one's property but to find a doctor to look after one's health is a most difficult thing, particularly at times when epidemics break out. Then the doctors are overworked and it would be in the interests of both patient and doctor if the doctor could occasionally lie off from work and take a rest. As far as the shift system is concerned, it has been represented to almost every working-class representative from Glasgow, and even to the hon. and gallant Member for Pollak (Commander Galbraith), that on a Tuesday afternoon it is almost impossible to get a doctor, while on Sundays it is 'well nigh impossible. One of the things that always offended me in my public life is that the very poor person, who is chargeable to the poor law, can walk along and demand to get a poor law doctor and get him to attend to whatever his wants are. Similarly, a panel patient can go along to his panel doctor and get attention. When we come to the wife who is not too poor or who has no 774 panel, things are different. All the right she has, is to beg the doctor to come and it is optional with him whether he comes or not. We think that that system should end, we think it can be ended through the far-sighted provisions which we are making in the Bill. Mention has been made of the medical service in the Highlands and the Islands. We propose to unify the health service in the Highlands and the Islands and extend it under this scheme, making it more useful than it is.
On the general question, we think that this Bill can be made workmanlike and that it will be a good proposition. It is said that the Secretary of State will have too much power. I do not want to go over all that hon. Members have mentioned but I could not help recalling that in one night hon. Members opposite when they were in power—and I was here in this House at the time—rushed through a Bill by means of the guillotine which swept away the whole system of local administration and suppressed the local authorities. They took the poor people and put them into an institution not under a Scottish Board but under an Assistance Board run from London without any democratic representation at all. Then hon. Members opposite talk about the people who are to be appointed to these boards. The first people they appointed were discarded Cabinet Ministers. I am not saying anything against them because one of the discarded Cabinet Ministers was an excellent choice.
Let us take this thing seriously. The arrangement which we have been discussing tonight in regard to hospital treatment under a regional board is, in our view, very easy and flexible. I admit that a great deal will turn on the humanity of the Secretary of State and his officials. Much of the success of this scheme will depend on the vigilance of the House of Commons and of the Secretary of State for Scotland. Whatever influence I have, whether it be for a long or short period, will be wielded on the side of the regional boards to make that system into a really sound authority even when mistakes are made. In this Bill we have set out on what I believe will be a great and noble task. The Secretary of State has undertaken a first-class job. I would only like to make two points in reply to questions raised by my hon. Friends on this side of the House 775 One is in regard to the link-up with the local authorities. In that connection, we took the first step today in an Amendment which was adopted. In the course of time these things will work out in the proper way. The planning scheme was not made in a month or a week. It evolved in time and so will this scheme. Then there was the matter of the nature cure doctors. I have no particular objection to the nature treatment practitioners. I say that the nature doctors will have to find clients, and if they get clients who say that they want a nature doctor I will have no objection to the nature doctor treating them.
This is the Bill which this Party has set itself the task of getting through
§ Parliament. I have been asked what is the future of the State medical service. All I say now is that tonight we pin our faith to this Bill. What will be decided in five years' or ten years' time will be decided first by the electorate and then by those who occupy the offices of State at that time. What I claim now for this Bill is that, for the vast majority of the Scottish people, there is now the chance of a health service better than ever was the case before and for that reason, we think, that it will make for a better Scotland, too.
§ Question put "That the words proposed to be left out stand part of the Question."
§ The House divided: Ayes, 143: Noes, 54.777
|Division No. 130.]||AYES.||[12.28 a.m.|
|Adams, W. T. (Hammersmith, South)||Greenwood, A. W. J (Heywood)||Parker, J.|
|Alexander, Rt. Hon. A. V.||Grierson, E.||Pearson, A.|
|Attewell, H. C||Griffiths, D. (Rother Valley)||Pritt, D. N|
|Awbery, S. S||Guest, Dr. L. Haden||Randall, H. E.|
|Barton, C.||Gunter, R. J.||Ranger, J|
|Battley, J. R.||Hale, Leslie||Rankin, J.|
|Bechervaise, A. E.||Hamilton, Lieut.-Col. R||Robens, A.|
|Berry, H.||Hardy, E. A.||Roberts, Goronwy, (Caernarvonshire)|
|Bing, G. H. C||Hastings, Dr. Somerville||Ross, William (Kilmarnock)|
|Binns, J.||Henderson, Joseph (Ardwick)||Sargood, R.|
|Blackburn, A. R.||Herbison, Miss M.||Scollan, T.|
|Blenkinsop, A.||Hewitson, Capt. M||Sharp, Granville|
|Braddock, Mrs. E. M. (L'pl, Exch'ge)||Holman, P||Shawcross, C. N (Widnes)|
|Bramall, Major E. A||House, G||Shurmer, P.|
|Brook, D. (Halifax)||Hoy, J.||Silverman, J. (Erdington)|
|Brown, T. J. (Ince)||Hubbard, T||Skeffington, A. M.|
|Buchanan, G||Hudson, J H. (Ealing, W.)||Smith, C. (Colchester)|
|Burke, W. A.||Hughes, Hector (Aberdeen, N.)||Smith, S. H. (Hull, S.W.)|
|Butler, H. W. (Hackney, S.)||Hynd, H. (Hackney, C.)||Snow, Capt. J. W|
|Champion, A. J||Jager, G. (Winchester)||Steele, T|
|Cocks, F. S.||Jeger, Dr. S W. (St. Pancras, S.E.)||Stewart, Capt. Michael (Fulham, E.)|
|Collindridge, F.||Jones, D. T. (Hartlepools)||Swingler, S.|
|Collins, V. J.||Jones, Elwyn (Plaistow)||Taylor, R. J. (Morpeth)|
|Colman, Miss C. M||Jones, J. H. (Bolton)||Taylor, Dr. S. (Barnet)|
|Comyns, Dr. L.||Keenan, W.||Thomas, D. E. (Aberdare)|
|Cook, T. F.||Kenyon, C.||Thomson, Rt. Hn. G. R. (Ed'b'gh, E.)|
|Cooper, Wing-Comdr. G.||King, E. M||Thorneycroft, Harry (Clayton)|
|Corbet, Mrs. F. K. (Camb'well, N.W.)||Kinley, J||Tiffany, S.|
|Corlett, Dr. J||Lee, F. (Hulme)||Ungoed-Thomas, L.|
|Crawley, A.||Lewis, A. W. J (Upton)||Wallace, G. D. (Chislehurst)|
|Grossman, R. H S.||Longden, F.||Wallace, H. W. (Walthamstow, E.)|
|Dagger, G.||McAllister, G.||Weitzman, D.|
|Davies, Edward (Burslem)||Mack, J. D.||Wells, P. L. (Faversham)|
|Davies, Harold (Leek)||McKay, J. (Wallsend)||Westwood, Rt. Hon. J.|
|Deer, G.||Mackay, R. W G (Hull, N.W.)||White, C. F. (Derbyshire, W.)|
|Diamond, J.||McLeavy, F||White, H. (Derbyshire, N.E.)|
|Dobbie, W.||MacMillan, M. K. (Western Isles)||Whiteley, Rt. Hon. W.|
|Driberg, T. E. N.||Mallalieu, J. P. W.||Wilkes, L.|
|Ede, Rt. Hon. J C.||Manning, Mrs. L. (Epping)||Wilkins, W. A|
|Ewart, R.||Middleton, Mrs, L.||Williams, J. L. (Kelvingrove)|
|Fairhurst, F.||Mikardo, Ian||Williams, W. R. (Heston)|
|Farthing, W. J.||Mitchison, Major G. R.||Williamson, T.|
|Field, Captain W. J.||Morgan, Dr. H. B.||Willis, E,|
|Fletcher, E. G. M. (Islington, E.)||Morris, P (Swansea, W.)||Wills, Mrs. E A|
|Foot, M. M.||Moyle, A.||Yates, V. F.|
|Gallecher, W.||Nally, W.|
|Ganley, Mrs. C. S.||Neal, H. (Claycross)|
|Gibson, C. W.||Nicholls, H. R. (Stratford)||TELLERS FOR THE AYES|
|Greenwood, Rt. Hon. A. (Wakefield)||Palmer. A M. F||Mr. Simmons and Mr. Hannan.|
|Agnew, Cmdr. P. G.||Hollis, M. C.||Shepherd, W. S.(Bucklow)|
|Beamish, Maj. T. V. H.||Hutchison, Lt.-Cm. Clark (E'b'rgh, W.)||Smith, E. P. (Ashford)|
|Buchan-Hepburn, P. G. T.||Kerr, Sir J. Graham||Snadden, W. M.|
|Carson, E.||Lucas-Tooth, Sir H.||Spearman, A. C. M.|
|Clarke, Col. R. S.||McCallum, Maj. D.||Spence, H. R.|
|Conant, Maj. R. J. E.||Macdonald, Sir P. (Isle of Wight)||Stuart, Rt. Hon. J. (Moray)|
|Corbett, Lieut.-Col. U. (Ludlow)||McKie. J. H. (Galloway)|
|Crosthwaite-Eyre, Col. O. E.||Maclay, Hon. J. S||Studholme, H. G|
|Cuthbert, W. N.||Macpherson, Maj. N. (Dumfries)||Teeling, William|
|Darling, Sir W. Y.||Manningham-Buller, R. E.||Thornton-Kemsley, C. N|
|Drayson, G. B||Marlowe, A. A. H.||Vane, W. M. F.|
|Drewe, C.||Marshall, D. (Bodmin)||Ward, Hon. C. R.|
|Duthie, W. S.||Mellor, Sir J.||Wheatley, Colonel M. J.|
|Elliot, Lieut.-Colonel W||Moore, Lt.-Col. Sir T.||Williams, Geraid (Tonbridge)|
|Foster, J. G. (Northwich)||Morrison, Maj. J. G. (Salisbury)||Willoughby de Eresby, Lord|
|Fox, Sir G.||Neven-Spence, Sir B.|
|Galbraith, Cmdr. T. D.||Peto, Brig. C. H. M.||TELLERS FOR THE NOES|
|Comme-Duncan, Col. A. G||Price-White, Lt.-Col. D.|
|Grant, Lady||Robinson, Wing-Comdr, Roland||Major Ramsay and Lieut.-Col|
|Headlam, Lieut.-Col. Rt. Hon. Sir C.||Scott, Lord W.||Thorp.|
Bill read the Third time, and passed.