HC Deb 29 July 1947 vol 441 cc408-24

11.45 p.m.

Mr. Snadden (Perth and Kinross, Western)

I beg to move, That the National Health Service (Scotland) (Determination of Areas of Regional Hospital Boards) Order, 1947 (S.R. & O. 1947, No. 1311), dated 25th June, 1947. a copy of which was presented on 27th June, be annulled. This Order determines the areas for which Regional Hospital Boards shall be constituted under Section 11 of the National Health Service (Scotland) Act. I and other hon. Members have put down this Prayer, because objection is taken to certain of the areas defined in the Order as being unsaticfactory. In particular, we object to area No. 3, Eastern Region, and area No. 5, Western Region, in so far as they relate to the western part of the County of Perth. It may be that other hon. Members take exception to other areas. If that is so, then no doubt they will say so, but I particularly wish to deal with this area which forms the major part of the constituency which I represent in this House. It is suggested that the western district of Perthshire should be transferred from the Eastern Hospital Region to the Western Hospital Region. Having lived for the greater part of my life in the western district of Perthshire, and having served for many years in a junior capacity as director of the Stirling Royal Infirmary, I must say I was very much surprised when I saw this Order and realised that the Secretary of State had decided to include the whole of the County of Perthshire in the region detailed as the Eastern Hospital Region, in direct opposition to the advice which I understand he received from the British Medical Association and from the British Hospitals Association. If that is not so, then the right hon. Gentleman can inform us.

The preamble to this Order says: after consultation with such bodies as appear to be concerned but what the Order does not say is that in respect of the boundaries to, which exception is taken the Minister may make an order in direct opposition to the advice received from those organisations. The Secretary of State is thus ignoring not only the natural geographical affiliations of West Perthshire, with the county and market town of Stirling, but also the advice given him by his medical experts. I am troubled to know why the right hon. Gentleman rejected the advice that was given. I wonder if the reason was that because of his inability, possibly under pressure, to give way in respect of the county of Fife he found that he could not give way in respect of the Western part of Perthshire in spite of the fact that all the evidence and all the arguments are in favour of including West Perthshire in the Western Region.

The Secretary of State himself is familiar with the Stirling and Falkirk burghs. He must know as I know, if he remembers that part of the country just to the north, that the whole of the rural population of West Perthshire, right up to Crianlarich and Callander, has a natural geographical affiliation with the county town of Stirling. Stirling is the main road and rail communication of that neighbourhood. It is the West Perthshire market and shopping centre, and it is to Stirling Royal Infirmary that the patients of West Perthshire have always looked for treatment. For years, I find, looking up the statistics, that the natural flow of patients from West Perthshire has been to Stirling. If we look at the latest figures for 1946 we find that 512 hospital patients were admitted to Stirling Royal Infirmary from West Perthshire in the year but only four were admitted to the Royal Infirmary for the county and city of Perth. I and other hon. Members feel that this fact has been ignored in this Order. Unless it is recognised, it seems to me that serious obstacles will be placed in the way of efficient hospital administration, not to speak of the discontent among the people in that particular area.

I submit that to include West Perthshire in the Eastern Region in the face of these figures I have quoted, is entirely wrong, and that there is an overwhelming case for including the western district of Perthshire in the Western Hospital zone. The Secretary of State may say that the boundaries laid down in this Order are administratively more convenient to him and that they will in no way prevent patients from going from one hospital region in which they are domiciled, to another for treatment. Of course, what that means is that having drawn a line, he now proceeds to rub it out. If that is his answer, I would like to ask him the question: How can a regional hospital board be efficient and give an efficient service to its region in such circumstances? Surely a board must base its plan on the population of its area. If a small number of patients from one area is admitted to another area outside the domicile of its patients, then that might be quite possible. But in this case, where a large number of patients will be asking for admission within an area in which they are not domiciled, I submit that such a state of affairs would completely upset the hospital accommodation arrangements.

One can see that the regional board, such as that of the Western Region, which would include the Stirling Royal Infirmary within its region, would very soon say: "We have a waiting list in our hospital; we cannot take any people from a neighbouring region." And these people would be excluded. I can also see that there would be serious financial complications. There would be one hospital region lodging a claim against another hospital region in respect of finance. The regional board, having budgeted for so many patients, would in practice have to deal with quite a different number. Therefore, I cannot see how the Secretary of State could carry out an efficient administration on these lines.

I am informed—though I am bound to confess that I have no expert knowledge on this point—that the Minister of Health in regard to the hospital regions of England and Wales has admitted the principle of the convenience of the patient, and in a very large number of cases he has accepted that principle to such an extent as to get right down to the parishes, and has seen that they are not excluded from the local authority area. For these reasons, I submit that this Order should be taken back and reconsidered, and I would like to tell the right hon. Gentleman that in my own particular area this proposal is viewed with some concern, not only by the responsible medical authorities—the Scottish branches of the British Hospital Association and British Medical Association—but by the people themselves living in the area. I should like an assurance from him on why such a decision has been taken.

11.56 p.m.

Colonel Gomme-Duncan (Perth and Kinross, Perth)

I beg to second the Motion.

My hon. Friend has put the case very clearly, and whereas he hopes that West Perthshire will still be allowed to go to Stirling Royal Infirmary, I am faced with the situation that they will be ordered to go to the Perth Royal Infirmary instead. But I understand it is still to be open to them to go to their previous hospital centre but, as my hon. Friend pointed out, there are many difficulties that might result from that if that hospital area is not prepared to receive them. He has mentioned one or two reasons when they might say: "We have had you up to now but cannot do it any longer now for this reason or that reason." Is It right to have a hard and fast rule in a matter of this kind? It shows the danger of these very carefully delineated areas.

In the case of Perthshire we want to go back to where we were before and the right hon. Gentleman, from his knowledge of life will say it is undoubtedly still possible, but the right hon. Gentleman the Member for Moray and Nairn (Mr. J. Stuart) will say that exactly the opposite has happened—that Nairn has to go to one region and Moray to another. That is quite illogical. I want to ask for an explanation of why these cases were determined in such a way when it is perfectly obvious that a happier solution would be to allow the thing to continue as it is at present. I hope, without being unduly carping, we shall be given a reasonable explanation bearing in mind the difficulties, and, however well intentioned the right hon. Gentleman may be.

11.59 p.m.

Sir John Graham Kerr (Scottish Universities)

The few words that I would like to say in this connection are based on the fact that the success of any system of public health however perfectly planned, depends in the end on the training of the men who carry it out. I happen to have been a teacher in one of the two largest medical schools in the country and also to have been a medical student in the other of the two medical schools. Therefore, I have a certain qualification to speak, and also I have every enthusiasm to help the colleges. Under the new health arrangements it is made necessary that every medical student, after he has graduated, but before qualifying as a medical practitioner, should put in one year on a resident appointment in a hospital. Each of the medical schools, to carry out its duties efficiently, must have a district which will include a sufficient number of hospitals to afford opportunities to its graduates to put in this year of residence.

Then there is the other point, in regard to teaching itself. Practically, the most important part of all medical training is its clinical work. Therefore, the medical schools must also have at their command sufficient clinical material. It follows that if we have in Edinburgh and Glasgow two of the greatest medical schools in the world, with an approximately similar number of medical. students, in order to be fair, and to enable them to do their work properly, there should be a roughly equivalent amount of clinical material and a similar number of hospitals for their resident appointments. In the scheme before us the scope, in regard to population and the number of hospitals, is totally unequal between these two approximately equal medical schools. The one, I am assured, is allocated a population of pretty nearly three millions, the other a population of a little over one million. Surely that is not only grossly unfair, but if it were carried into effect would be a tremendous blow to the medical school of the University of Edinburgh, which is acknowledged all over the world as one of the greatest in existence. For those reasons I add my wish to those already expressed that the right hon. Gentleman should take back this Order and see whether he cannot re-arrange the districts, particularly No. 4 and No. 5, so as to include roughly similar populations.

12.1 a.m.

Mr. Malcolm MacMillan (Western Isles)

I apologise for rising so late, and I will try to be brief in what I have to say. I have had correspondence with the right hon. Gentleman on a question which has been raised with me at different times by the doctors in the Western Isles and many of the people there, over the inclusion of the Outer Hebrides in the Western Region based on Glasgow rather than the Northern Region. I am grateful to the right hon. Gentleman for the attention he has given to this point, and I would press him, if he can, to consider it once again before it comes into administrative operation. The right hon. Gentleman does say in a letter to me I can assure you that if in practice it is found that a boundary is unsuitable, I will alter it. It is a great relief to us that the Secretary of State has not made any sort of rigid decision, and I think the charge of rigidity is to that extent weakened, but I hope he will have in mind the views of the doctors and people in my area.

Very briefly, the reason they give to support their view is that the Island of Lewis is part of Ross and Cromarty and comes under the county council, and the other islands, coming under Inverness shire, will be in a minority in representation under the two different counties. The Secretary of State says he does not wish to split the councils, but in fact we already have that split as between the two counties and the two counties are always in a minority. I fear that schemes framed to suit the majority will naturally be framed to suit the mainland. I submit that for geographical reasons and many others, very special reconsideration should be given to the position of doctors and patients in the Outer Hebrides. Often they cannot have representation because of bad weather and delay in regular transport. When they do have representation, they are in a perpetual minority and, of course, liable to be overlooked.

The natural flow from the Islands is to Glasgow. Travel by air is to Glasgow rather than across the high mountains which may have a bad effect on patients. This consideration should be kept in view in framing these areas. The people from the Islands have always emigrated to Glasgow, and people who are sick and in need of treatment can get accommodation there with relatives and friends. Anyone going to the Highlands will see it is almost impossible to find accommodation. Sick people and people who are going to be ill are less likely to get accommodation than healthy people. Invalids are largely in the hands of hotel keepers and landladies and they are less welcome on short notice in places like Inverness than in Glasgow, where so many have relatives. The natural way people would go is to Glasgow. Doctors prefer to send them to Glasgow for institutional reasons rather than to Inverness. Indeed, if they send them to Inverness, they have to bring specialists up from Glasgow to Inverness to examine their patients. This is in no way disrespectful to the institutions in Inverness. Far from it. The people are grateful and have no complaint in that respect. But Glasgow has better institutional accommodation and equipment. I ask the Secretary of State to have this in view before he finally and rigidly fixes the boundaries. I know he has been sympathetic about it and I am going to remind him at all times to consider this when boundaries are being changed. I hope it is still possible to turn towards Glasgow and not Inverness.

12.7 a.m.

Mr. Niall Macpherson (Dumfries)

I am sorry to detain the House but I have an entirely fresh point to put forward. We have heard the subject treated from three points of view and it is interesting to see that from two hon. Members, the representations made to the Secretary of State have been for adjusting, as it were, county boundaries for the purpose of hospital services on the grounds of custom and communications and I for my part will fully endorse what the hon. Member for the Western Isles (Mr. M. MacMillan) said on that subject. [An HON. MEMBER: "What have you against Inverness?"] I agree with the hon. Gentleman opposite that there is no desire to attack Inverness. The argument is on the ground of custom and communications. I would like to take a case from an entirely different view. One would naturally consider that the south-west of Scotland would look to Glasgow. When I looked at the map I thought so, too. I was surprised, therefore, to get representations from the B.M.A. branch in the south-west to the effect that they desired the south-west to be linked to Edinburgh. And they desire it on two main grounds: first, the ground that the hon. Member for the Scottish Universities (Sir J. Graham Kerr) has already put forward, namely, that there should be a more even division between the east and the west. On that point I would draw attention to the fact that Amendments to this Order have already been put forward to add to the Western area.

What I am suggesting is that we should take away from the west and add to the east. I thought this was a strange thing, so I took the precaution to see the county authorities about it and they said they would rather be attached to the east. The hon. Member for the Scottish Universities has made a case that there must be an outlet for the two universities which have to have post-graduate billets in hospitals on a more or less even basis, and, therefore, it is better to have a more even division. The natural flow from the south-west is to Glasgow, and by train—although the train service is not as good now as it used to be—but by road there is nothing in it. In actual fact, one will find that the majority of medical opinion hails from Edinburgh and there are strong reasons and there is custom for linking the south-west to Edinburgh already. So I would urge the Secretary of State—and he will say he must get this Order now—to say at the least that he will be able without much difficulty, to make alterations from time to time in this Order, and to say that he will examine the representations made tonight.

12.9 a.m.

The Secretary of State for Scotland (Mr. Westwood)

I can give at once the assurance that if, as a result of experience we find we can improve administration by a change, there will be no hesitation in making an Order. The main consideration has been that the convenience of patients is the first thing to be considered. That must be the first consideration if we are to have effective results from the new legislation. I might say that I have been in touch with many organisations before any action was taken. These bodies were the Scottish Universities, the three Scottish medical corporations, the British Medical Association (Scottish Section), the Association of Mental Hospitals in Scotland, the Nuffield Provincial Hospital Trust (Scottish Committee), the local health authorities in Scotland, the Convention of Royal Burghs, the Association of County Councils, the Association of Counties of Cities, the Scottish T.U.C., the British Employers' Federation, and the Federation of British Industries (Scottish Section). I think hon. Members will agree that it would have been impossible for me to have consulted more organisations in Scotland and it was only after the fullest consultation that I made the Order. Each of the organisations was clearly advised that the boundaries of the hospital regions did not in themselves imply any restriction on the admission of a patient from one region to the hospital in another. That is what appears to be in the minds of hon. Members who have spoken. They appear to think that the flow of patients in a particular direction might be impeded by the regional organisations I have set up. But I have made it clear that there must be no restriction on admission of patients from one region to another.

The boundaries are not to be regarded as barriers across which no patient or medical practitioner can cross. Also it was made clear that the boundaries would not restrict the provision of undergraduate or post-graduate medical teaching of students from one university being made in a hospital associated with another university. The Act requires that so far as practicable each area is such that hospital and specialist services can be provided in convenient association with a university which has a school of medicine. This requirement has been complied with so far as my scheme is concerned in determining the five regions in Scotland, with the exception of Inverness. It is intended that the Northern Region, which has no university within its boundaries, shall be associated principally with Aberdeen University, and with the Edinburgh and Glasgow Universities as well in view of local associations. In examining the recommendations and representations made by the various bodies consulted, I would point out that my duty as Secretary of State for Scotland was to view Scotland as a whole for the administration of hospital and specialist services under the new Act and, in considering where boundaries were to be drawn to have regard to all relevant factors. I was not merely to have regard to teaching nor merely to hospital accommodation as such. I had to consider all relevant factors—traditional associations, the customary flow of patients, the co-ordination of the various parts of the National Health Service, association with medical schools, the natural geographical boundaries, communications and, generally, the convenience of the administration of hospitals by the regional boards.

Since the Order was laid, the allocation of the following areas has been the subject of representations—the Outer Isles, Moray and Nairn, Western Perthshire, Dumfries, Stirling, and Clackmannan. So far as the regional hospital board is concerned, it has to deal with the provision and management of hospitals. There is no hospital in western Perthshire, and I do not think it is likely that there will be in the near future—perhaps not for a year or two—under the National Health Service. The outer division of the B.M.A. represented that the Outer Hebrides should be included in the Western Hospital Region. Their argument was based on the fact that patients and medical practitioners, especially in the Southern group of the outer isles, had always looked to Glasgow for hospital and specialist services. This position was fully recognised when the boundaries were fixed. It was, however, decided to allocate the Outer Isles to the Northern Region to avoid splitting the areas of the two local health authorities, namely, the counties of Inverness and Ross and Cromarty. Looking to the future, we felt that the development of the hospital and specialist services in the Northern Region, together with the development of improved air communications between the islands and Inverness, would tend to influence the direction of the flow of patients; but the convenience of patients is the prime factor and there will therefore be no interference with the freedom of choice of hospitals, patients or medical profession alike. People in the Outer Isles will be free to seek admission to the Glasgow hospitals as well as to the Inverness hospitals. There is no attempt to make a hard and fast rule so far as these boundaries are concerned. The patients, the welfare and the health progress of the patients, are, and must be, the first considerations in connection with the Administration. I could go on dealing with individual points, but I think there is no desire by the House that at this early hour of the morning I should go more fully into this matter. I can assure hon. Members on both sides of the House that the fullest consideration was given and after the fullest consultation with all interests, keeping in mind that what is desirable and to give what is best to those who require it. If, as a result of experience, it is found that there should be adjustments, no on is more ready than I to make them. I hope, therefore, that the Prayer will be withdrawn.

Mr. James Stuart (Moray and Nairn)

Can the right hon. Gentleman say why he departed from his own circular of 7th May with regard to the County of Nairn and its removal to the Inverness area? His circular said it should be in the same area as the County of Moray as the two counties were together. The joint county councils had approved that, but his circular was departed from and Nairn was put into the Northern area.

Mr. Westwood

That is a perfectly fair point. The provisional proposal was to put Nairn in the North-East Hospital Region but it was strongly opposed by the British Hospitals Association (Scottish Section), and transferred to Inverness County. The joint counties did agree to the inclusion of Nairn in that region on the understanding that the patients could go to Inverness for examination. This ruling does not impede patients going to other hospitals. On examination the figures showed that so far as Moray and Nairn were concerned ten times more went from Nairn to Inverness than to Aberdeen. It was decided to allocate Nairn to the other region. This was the only realistic course—that if patients are to go to the Inverness hospital for consultative services they should be associated with Inverness.

12.22 a.m.

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

I had hoped that the right hon. Gentleman would have taken the opportunity tonight to add something to the letter which he has sent to various Members and with the contents of which we were all tolerably familiar, but as he has not done so I venture [...] put some points which still seem to be very obscure and which require some elucidation. I shall do so with a series of questions to save time.

The first question is this: On what basis are the regional hospital boards to budget for their requirements for hospital space? The right hon. Gentleman said that patients are free to choose to go where they like. Obviously, that may be so and statistics may work out all right but that will not be so if the regional hospital boards limit themselves to making a scheme to cover the population in their area, neither more nor less. If they do they will get it right only if as many patients flow out as flow in, or they will find they are too congested or that they have a surplus of accommodation which they need not have. Take the case of the regional hospital board budgeting for the Stirling Royal Infirmary. Is it to estimate that the whole of West Perthshire will for all practical purposes be part of their area? Is that to be an assumption they are to make? If they are, then the purpose of the Prayer may be to a large extent met. But why should they assume that? Is the right hon. Gentleman going to give them directions as he has power to do so, or has he expected the people will appoint will take that view? I should not have thought that was a satisfactory basis on which to build a national system. I should have thought that he must say: I am going to direct the regional hospital boards when making their schemes to consider the population of West Perthshire as one of their responsibilities.

I had thought, of course, that the right hon. Gentleman rather took credit for the view that he was not going to direct the regional boards, that they were going to be practically autonomous. But that cannot be in present circumstances. He has to direct them; or, at least, to see them if they do not speedily take the point he has taken. He does direct them. He will have to do it either at once, or after a short interval if they do not speedily indicate to him that they are going to take his point of view. I think that he ought to clear up what he is going to do. Is he going to make it quite clear in the western area to the Regional Hospital Board that West Perth is one of their responsibilities? Is that going to be done similarly with regard to other areas? Is it to be made clear, on the other hand to the Eastern Regional Board that a number of patients from the South-West will want to go to their area, so that a proportion of the requirements of the South-West is the responsibility of the Eastern Hospital Board?

When we get to the regional proportion of responsibility, who is to say to these two boards whether it is fifty-fifty between Edinburgh and Glasgow or 75–25, or whatever it is? How is it to be done? I think we ought to know. It is obvious that the right hon. Gentleman must have thought this out. I cannot believe he has not, because if he has not, how he is going to get this scheme to work next April passes my comprehension. If he has not thought it out, then it is as well we have this discussion, because it must be made clear in a short time. I go on to ask him just how this freedom of choice is to work? I cannot see it. How does a man in future get into the hospital? What happens? I think we must know these things before we can dispose of this Prayer. Does the man or his doctor simply ring up any hospital which the doctor chooses and say, "John Smith wants to get into your hospital tomorrow"? Is that what happens? The right hon. Gentleman has told us the patients have the choice. If we are to take his statement at its face value, that must be what it means. But I really cannot believe that happens. How does a patient go to a hospital outside his region? Does he ring up Stirling Royal Infirmary or Edinburgh Royal Infirmary and say, "I want to come"? Does he get in? With the best will in the world, however energetically the Government tackle this job, it is not possible to avoid waiting lists within the next few years.

It is the intermediate years that are of primary importance today. What is the position with regard to a person outside the region who wants to get on to a waiting list? Has he an equal right with anybody else? Can a person from Galloway, from Dumfries, or Orkney or Shetland claim an equal right to take his place in the Glasgow or the Edinburgh Royal Infirmary with anybody who lives in Edinburgh or the Lothians? I think we must know. Otherwise, it is of vital importance to get the boundaries of the regions right.

If the right hon. Gentleman tells us that the position is "first come, first served, no matter where you live," I agree; the boundaries of the regions are purely of administrative importance, not that I deprecate administrative importance, but it does make the matter clear. What is the position? Then suppose—is it for the doctor to go hunting around—the doctor at Edinburgh found that the Edinburgh Royal Infirmary waiting list had been cluttered up by a large number of people from other regions who exercise the freedom of choice that the right hon. Gentleman says they have, what happens to the Edinburgh patients? Are they to go hunting around for a hospital? This is supposed to be a co-ordinated service, but how is it going to work? I have tried to follow the development of these ideas through the passage of the Bill and I am bound to say I am still in a fog about this matter. I notice the right hon. Gentleman always brings in admirable expressions about freedom of choice but how they are going to work I do not understand.

Before we can agree with the drawing of the regional boundaries as a pure matter of administration, and not affecting the patient in the least—because that is what the right hon. Gentleman says—we must have a detailed statement as to the practical question. Take for instance the question of specialists. The right hon. Gentleman says there is nothing to prevent a specialist from going out of his area where people have to be visited in their homes. True, but what is there to compel him to go out of his area? Can a doctor in some part of West Perthshire simply ring up the Stirling Centre and say, "I have a man here who requires a heart specialist and cannot travel to Stirling. Will you please arrange to send a heart specialist to him? Is Stirling bound to comply or not? That is a vital thing we ought to know. Otherwise, one would have to send to Perth or Dundee. What is the position? Can a doctor outside the area, demand as of right that a specialist be sent from one region into another? If he can, I agree again that boundaries do not matter very much except for administration.

Let me sum up. On what basis have regional boards to budget? Is it on the population in their area, or is it on the population which they think likely to come to their hospital or is it on the population which the right hon. Gentleman tells them they have to take into account? If the first is the case, it will not work. If it is the second, how do we know without co-ordination that there will not be overlapping between two regions? If the third case is the right one, it does not seem that there is any autonomy left to the regional boards at all. The whole thing is done by the right hon. Gentleman. That might be inevitable. Is he prepared to do that? If not, how in the world are we going to make the scheme work? My other point is as regards the choice of hospital. Has the patient or the doctor got the right to choose a hospital in any region he likes? If he cannot get in, does somebody in the region say "Yes, I will accept him" or does he have to go hunting around hospital committees trying to get in and ultimately have to be put on to the waiting list? And with regard to specialists, has the specialist to go out of the area when he is called. If the right hon. Gentleman can answer these three questions in line with the general statement he made a few moments ago then I would advise hon. Members to think that their purpose in raising this matter was served. If he cannot, then I would say that the outlook for Scotland is really serious.

12.35 a.m.

Mr. Westwood

Again, with the permission of the House, I will try briefly to deal with the points raised: First of all, the basis of budgeting for the requirements of hospitals. The regional boards have not yet been set up. My regional chairmen are appointed or are being appointed. I have not got the full replies yet. So soon as they are appointed there will be meetings in which we will attempt, at least, to give guidance in connection with coordination so far as the services are concerned. To begin with, the powers must be guided, and they will be guided, I am sure, by the previous experience of the individual hospital. They will know the districts from which the patients have come. They will take into their calculations exactly where the patients have been coming from with a view to making the requisite provision. This is a matter in which the regional boards will call on the guidance of the boards of management, of those who, today, control the hospitals. That is how I will go about the organisation and I hope it will be successful. We will consult those who have been managing hospitals up to the present time to find what will be best in the interests of the patients. At the present time, the Central Hospitals in Glasgow and Edinburgh take patients without regard to areas. There is no intention of interfering with the past arrangement but they are able to initiate provisions which should be made.

As soon as the hospital boards are set up they will get down to these particular problems and they will be able to get all the facts from the existing hospitals and they will know just where the floor basis has been coming from. I do not seek to interfere with the established form. In the densely populated areas such as Glasgow, where there are hospitals in a relatively small area, it is intended to set up an admission bureau to deal with applications according to the urgency of need for in-patient treatment. The individual patient will look to his general practitioner. I can speak from my own experience. I did not trouble about the hospital to which I was to be sent. I had faith in the general practitioner who attended me. He selected the hospital and the specialist. I was only anxious to get into the hands of the specialist as soon as possible. The same thing will operate under the new Health Service. There will be the general practitioner who will know where the best service is to hand. Through him, I presume, the arrangements will be made for the patients' entrance into the hospital. Exactly the same will apply in connection with this special service. I have tried to be as brief as I can and I trust I have dealt with the two points that were raised. So far as the provision of consultant service is concerned, there will be collaboration between the regional boards. The intention is to have the fullest co-operation between these boards so that we can make the service a really useful one as far as Scotland is concerned.

12.39 a.m.

Mr. Snadden

I cannot say that I feel quite happy about the explanation of the Secretary of State. I do not think he has answered my right hon. Friend effectively but we do not wish to carry this Motion to a Division, and I think he said at the beginning of his remarks that if the regional allocation is found to be impracticable he will reconsider the whole setup and adjust it in such a way as to make for efficient hospital administration. With the assurance given us by the Minister that that will be done, I beg to ask leave to withdraw the Motion.

Motion, by leave, withdrawn.

    c424
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