HC Deb 05 May 1959 vol 605 cc235-45
Dr. Summerskill

I beg to move, in page 1, line 20, at the end insert: and shall continue to carry out such duties, in respect of the regular visiting of hospitals and the issuing of reports of such visits, as the Minister may direct ". Under no circumstances do I wish to repeat what has already been said in Committee, as I do not wish to waste the time of the House. We feel very strongly about the matter mentioned in the Amendment; indeed, the Minister will recall that we had a long debate on a similar Amendment in Committee.

Why do we feel strongly? The House will agree with us that we must ensure that these patients are safeguarded. If we feel that an opportunity has been missed whereby a safeguard might have been injected into the Bill, we must reconsider the position. In Committee, we all paid tribute to the Board of Control. I have had some knowledge of the Board of Control over many years and I have never met anyone connected with it who has not fulfilled his obligations, who has not been dedicated to his work, and who has not been of the highest integrity.

Under the Bill, the Board of Control is to disappear, but the Minister will employ the officers. What we are asking is that those officers shall continue to carry out such duties, in respect of the regular visiting of hospitals and the issuing of reports of such visits, as the Minister may direct. I do not want to repeat all the arguments which we had in Committee, but I think that I am fair in asking the Minister to recall that my hon. Friend the Member for Oldham, West (Mr. Hale) who, everybody will agree, is a rather astute lawyer, had to admit that the Minister's answer was so involved that he had no idea what the right hon, and learned Gentleman was talking about. My hon. and learned Friend the Member for Brigg (Mr. E. L. Mallalieu) came to his aid and said that he knew what the Minister was talk- ing about, but we were left with a rather blurred idea of what was in the Minister's mind.

I looked up the Minister's reply. He agreed with me in principle, but he said that he did not wish to make the duty statutory and he said that he would regard the visiting of these hospitals by officers who were originally in the Board of Control as part of Ministerial responsibility. He also said: …they are all patients, whatever their origin [OFFICIAL REPORT, Standing Committee E. 10th February, 1959; c. 11] I want to address my remarks to that. I cannot agree that these patients can be put in the same category as patients suffering from some physical disorder. These patients are often friendless and it is commonplace for relatives not to visit them. If they manage to write lucid letters, people wonder whether the letter is the result of a disturbed mind, or whether the complaint which a patient may be making has any foundation.

I suggest that patients with mental disorder should have greater care, that we should exercise greater vigilance to ensure that they are properly protected, and that the conditions surrounding them are adequate, than would be the case with patients suffering from physical disorder.

I remind the right hon. and learned Gentleman of when visiting mental hospitals officers of the Board of Control were concerned not only with the condition of patients, but with the standard of cleanliness in the hospital. They chatted with medical officers and they examined all the domestic arrangements, and so on. I am asking that as a result of the disappearance of the Board of Control we should not lose the special care which those officers exercised. I ask the Minister not to think of these patients as he might of patients suffering from some medical or surgical disorder, but as patients demanding special care, special vigilance and special sympathy.

4.15 p.m.

Mr. Walker-Smith

I respect the motive which underlies the Amendment and I do not dissent from its general intention, although, as I shall explain in a moment, I cannot advise the House to add it to the Bill, for reasons which I shall give.

In Committee, I gave a necessarily somewhat technical disquisition on the present law. The right hon. Lady has recalled that and I wish only to disclaim any intention of seeking to arbitrate between the hon. and learned Member for Brigg (Mr. E. L. Mallalieu) and the hon. Member for Oldham, West (Mr. Hale). I am sure that the House will be at one in welcoming my statement that I see no necessity to repeat that disquisition and again inflict it on the House.

What I was concerned to do was to show the limitation of the present statutory position in this regard. I then went on to define my general objective. I said that what was wanted was a system of visiting by experts from the centre to see that all is well in these hospitals, to convey new ideas as they go round and to act themselves as a clearing house and channel for the dissemination of the ideas which they themselves are picking up and are able to transmit throughout the Service."—[OFFICIAL REPORT, Standing Committee E, 10th February, 1959; c. 10.] I think that that is the common desire of hon. Members opposite, as it is of hon. Members on this side of the House.

The House has to decide whether this Amendment is necessary or appropriate as an instrument to that end. I regret that I have to give my view that it is not, for three main reasons. First, it is technically defective; secondly, and perhaps more important, it is constitutionally inappropriate; thirdly, it is unnecessary for the objective which we have in mind.

It is technically defective because as drafted it would apply only to the individual members who are transferred; in other words, it would not extend beyond their term of service; nor would it extend to other officers within the Department to whom such duties might be assigned.

On the second ground, the House must remember that with the dissolution of the Board of Control these gentlemen will become officers of the Ministry of Health. The right hon. Lady, who has much experience of these matters, knows that it is impossible in an Act of Parliament to spell out specific duties for members of the staff of a Minister when he has an overall responsibility. The Minister can give directions to his staff within the ambit of his broad Ministerial responsibility without the intervention of any words in a Statute such as this.

The third reason, as I said in Committee, is that sufficient powers already exist. The Minister of Health already has a power and responsibility in respect of visits, inspections, and so on, by virtue of the combined operation of Section 1 of the National Health Service Act, 1946, and Section 2 of the Ministry of Health Act, 1919. All the powers are there, and no further powers are required. They would, in fact, be otiose.

So far as the exercise of those powers is concerned, which is what we are really concerned with in the long run, it is my intention that there should be visits by experts from the Department to hospitals and that the visits should continue and that we should have an appropriate system of visiting to ensure both the cross-fertilisation of ideas to which I referred in Committee, and the raising of standards in the hospital service, with special regard to the psychiatric cases that we are concerned with here.

As I envisage it, the Ministry itself will act as a clearing-house for ideas and we shall use the annual report of the Ministry to make a proper contribution both to the collation of ideas and the sorting of them and to their dissemination in a proper form to all interested persons.

I think that the visits should be neither routine nor inquisitorial, and should neither be superficial nor yet suspicious. The sort of visits we want should be purposeful, thorough, constructive, and designed to help those responsible for the hospitals to raise their standards. The right hon. Lady the Member for Warrington (Dr. Summerskill) referred to the range and scope of these visits. With respect, I entirely agree with that, and that will be reflected in the categories of people who will carry out the visits.

There will be visits by varied categories of experts, by medical and nursing staffs, and by various specialised experts like dieticians. In addition, and by no means least important, there will be visits by the general administrators who will be concerned with the general administrative complexion of the whole thing.

I now come to the question of reports. Reports made by the Ministry staff following their visits and inspections are corn-piled in the first place for the Minister so that he can discharge his duty of raising the standards of administration in the hospitals and acting as a clearing-house for all constructive ideas and improvements so that they can be disseminated as widely as possible. The further use and distribution of reports necessarily depends on the individual case. In many cases, and, I should think, in most, the reports will be circulated to the hospital management committee and/or the hospital board specifically concerned with the visit in question.

Sometimes, however, it may be more appropriate for the points raised to be pursued either by correspondence or further oral personal exchanges with the authorities in question. Whatever methods are used, the object will be the same, and the object will dictate the method, the object being to help the committees or boards to the full with the aim of improving the particular hospital, and the hospital service in general.

I do not think that a general commitment or obligation to publish reports in the wide sense would be either appropriate or helpful, because experience shows that one gets a greater degree of frankness and freedom of criticism if the reports are communicated privately to the authorities concerned without being disseminated to the world. I think that that is implicit in the right hon. Lady's Amendment, which contains the words: …as the Minister may direct. Before parting with the matter, perhaps I might say to the right hon. Lady that I think that there is some little misunderstanding between us about my meaning in the passage of my speech in Committee to which I was referred. I said: …they all become, from my point of view, and that of the National Health Service, patients; and wherever they may have come from…"—[OFFICIAL REPORT, Standing Cornmittee E, 10th February, 1959; c. 11.] I was speaking in the context of mental or psychiatric patients and, as my preceding words make clear, what I was then addressing myself to was whether they came in under Part IV or whether they came in under Part V, by transfer directions, or by hospital orders from the courts. From that point of view, whatever the origin, they are all patients so far as the National Health Service is concerned.

I was speaking in the context of mental and psychiatric cases. I was not then dealing generally with what one might call physical or surgical cases. I was stressing that point, and I think that it is one with which the House will agree. I realise that there must be certain differences of approach between physical and mental cases.

I conclude by saying that I must reluctantly advise the House against accepting the Amendment. In doing so, it is not because I quarrel with its underlying purpose, but because in my view, for the reasons I have given, it is neither necessary nor effective for translating that purpose into action.

Dr. Johnson

Those of us who are sympathetic with the Amendment, as I am sure we are, appreciate my right hon. and learned Friend's argument, but I am wondering whether he can give us a little more comfort on one particular point than he has done. When we discussed this matter in Committee, my right hon. and learned Friend—and he will correct me if I am wrong—tended to equate the inspection of mental hospitals and mental patients with general hospitals and patients suffering from physical illness.

There is one distinct difference between these two categories from a practical point of view. We repeatedly get complaints of ill-treatment from patients who are being detained as mental patients, but during my experience over four years in the House I have not had a single complaint of ill-treatment from anybody suffering from physical illness in a hospital. The worrying part of these complaints is that we do not believe they are true, but we do not know whether they are or not. The satisfaction we obtain depends on our confidence in the particular inspecting body that we approach.

We have to remember one important change. Hitherto, not only we, but members of the public, had direct access to the Board of Control, the legal advisers to the Board of Control, or other members of it. Apparently we shall be denied access to the proposed inspecting body. It has been a considerable measure of comfort on occasions to feel that one could go direct to the Board of Control. They were the people responsible and we knew them, and I am wondering whether the Minister would consider an arrangement of that nature. I do not want to press him at all, but perhaps he would give consideration to these complaints of ill-treatment should they keep on occurring.

Mr. Hale

The right hon. and learned Gentleman, during the Committee stage, was always courteous, always helpful, and often very clear. I expressed the view then that what was perhaps his first explanation in the course of a long Committee was not particularly clear to me. The arguments he has put forward today are somewhat different and, frankly, were a little more impressive to me, and a little more clear. Perhaps his explanations may be regarded as conveying sufficient promise to me. At any rate, it was worth while putting down the Amendment in a slightly different form.

4.30 p.m.

The difficulty is that when the right hon. and learned Gentleman displays the hat to his audience he is apt to forget on which occasion it is supposed to contain the rabbit and on which occasion it is not. We always get a reference to the power to make regulations. We are told that any defects or lacunae in the Bill will be put right or filled by the making of an elaborate statutory regulation to cover the point.

The right hon. and learned Gentleman seems to forget that here we are discussing—and my right hon. Friend put down her Amendment to deal with—a temporary arid immediate situation relating to the function of the Board of Control whose major powers and officers are b being transferred direct to the Ministry of Health. Therefore, the point of the right hon. and learned Gentleman that this is not a temporary effect is not very strong. The Amendment would have the effect of dealing with an immediate situation until regulations have been approved by Parliament, and it will mean that the duties are carried on.

On the main question of what are these duties, in a later stage of the Standing Committee debate I expressed the view that reports from the Board of Control to the House had never been very full or adequate. The reports which many of us read with pleasure from the Prison Commissioners are, in many ways, models of their kind. They are one of the few documents in which the appendices are often more interesting than the report, because they give individual and humane examples of cases. The reports from the Board of Control are examples of what is usually said to be the supreme quality of wit—they concentrate on brevity.

The explanation of the Minister, I am quoting from the OFFICIAL REPORT, was: When we come to the question of what these duties and rights are, we find that they are not a particularly clear or comprehensive pattern. Under the present naw, the statutory duty of inspection, which would be transferred to the Minister if we made this Amendment to the Clause, relates in the first place to mental deficiency institutions, whether inside or outside the National Health Service, and, secondly, to registered hospitals and licensed houses, but only where they are outside the National Health Service. This is, in fact, provided for in Section 194 of the Lunacy Act. 1890, which refers to visits to hospitals, but hospitals in that context are defined in Section 341 of the Act, in effect, as being hospitals outside the National Health Service. The right hon. and learned Gentleman went on to qualify that by saying that the statutory duty of reporting does not, in fact, exist, but that …the Commissioners do have a duty to report to the Board on visits to hospitals which are hospitals designated under Section 20 of the Lunacy Act, 1890. That again is a comparatively narrow range, confined, broadly speaking "— how we can have a narrow range broadly speaking I do not know— to the observation wards. Their other statutory duty of reporting is in Section 162 of the Act of 1890 …"—[OFFICIAL REPORT, Standing Committee E, 10th February, 1959; c. 8–9.] It was this classical statement of the position which my hon. and learned Friend the Member for Brigg (Mr. E. L. Mallalieu) found crystal clear. I was reminded of the lad who was asked to explain an abstruse point arising from ecclesiastical history in Chapter 1 of Genesis. He said that he did know, but had forgotten. His teacher said, "Here is someone who has understood the subject, and the eternal pity is that the world has lost that understanding which might have been so much valued in our discussions today." That was my unhappy situation.

We never did find out what are the full duties. But we all know what is the real importance of this matter. There must be public responsibility for these institutions; there must be accountability by these institutions. It is vital to us to know, in the answers that are given, that the Minister is at least to reserve, in accordance with the terms of this Clause, the present system of inspecting, the present system of reporting.

Whether it is carried on by the same individuals or by other officers is a less important matter, so long as they are qualified officers responsible to the Minister, and so long as the Minister is responsible to this House, and so long as this House can obtain, by means of these reports and inspections and by means of Questions, full information about the management of these institutions and the fullest inquiry into alleged complaints about management, and ascertain how they are being conducted in detail.

Mr. Peter Rawlinson (Epsom)

I was not a member of the Standing Committee which considered the Bill, but I gather from what has been said that there has been some discussion about this matter previously. I have, I think, more mental hospitals in my constituency than there are in any other constituency. I receive a great many letters from patients, and I have some knowledge of the staff of mental hospitals. I have the greatest respect for the staff of these hospitals, who discharge their great task, with dedication, to use the phrase of the right hon. Lady the Member for Warrington (Dr. Summerskill). They carry out their duties to the great admiration of practically everyone.

While I cannot support the Amendment in its present form, I feel that there is great force behind what the hon. Lady has suggested to my right hon. and learned Friend. Though there are many matters in which the absence of the Board of Control is not something about which there will be great grieving, I feel uneasy that this power should be taken away from the members, commissioners or inspectors of the Board. It seems a very different thing when they become officers of the Ministry and these visits become visits of inspection. They may not be routine visits, but they are mere visits or inspections by officers of the Ministry. Therefore, they assume a different proportion and have a different importance.

Psychologically, it is very important that visits of inspection be made by some outside body. I appreciate the force of the arguments advanced by my right hon. and learned Friend and I was interested to hear them, but I am concerned about this and I should be obliged if a way could be found of returning to a system of inspection by an outside body. I feel that that is a most important safeguard.

Mr. Blenkinsop

The Minister has come a long way to meet the point which we have raised. He said that the reports would frequently be made available to the hospitals. I hope he meant that in the normal course of events the reports would be available to the hospitals, because that is perhaps the most important matter of all.

Mr. Walker-Smith

If I may, by leave of the House, reply to that point—

Mr. Ede (South Shields)

As the right hon. and learned Gentleman is in charge of the Bill, he has no need to ask the leave of the House if he wishes to speak more than once.

Mr. Walker-Smith

I am obliged to the right hon. Member for South Shields (Mr. Ede) for his expert guidance. I shall certainly seek not to abuse the privilege to which he has so kindly drawn attention.

In reply to the point made by the hon. Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop), I think that in the ordinary course the reports would be available. But there may be cases where the individual points in a report can be taken up in a more informal manner either by correspondence or by visiting. Hon. Members may be reassured, if they require reassurance, that the form of visit which I have in mind will be an effective one.

My hon. and learned Friend the Member for Epsom (Mr. Rawlinson) said that he did not have the advantage of serving on the Standing Committee which considered the Bill. I ask him to be good enough to read the speech of the hon. Lady the Member for Liverpool, Exchange (Mrs. Braddock), who was a member of the Royal Commission, and the paragraphs in the Report of the Royal Commission which deal with the point. He will see that the disadvantage of having an outside body in this new concept of things to make these visits is that it would suggest a distinction when we are anxious to emphasise the uniformity between these types of hospital.

I was not anxious to come back to the technical disquisitions on the present law which I had to give in Standing Committee, but the hon. Member for Oldham, West (Mr. Hale) has done it. I do not know whether there is a word to cover the vicarious infliction of pain upon another, which he has done by recalling my rather complicated observations. He says they Were not altogether clear to him. I reply, as Dr. Johnson did on a celebrated occasion, "I can give you the argument, but not the understanding". I console myself with the knowledge that I was understood by the hon. and learned Member for Brigg (Mr. E. L. Mallalieu).

I gave that description to show—and this is the point—the relative narrowness of the present statutory position, and thereon to found an argument that it was not necessarily a particularly good thing to project the present law into our future relations. What we are doing now will set up an efficient system of visiting and reporting. having regard to the dual considerations, first, that we want a thorough system of visiting and reporting in a constructive and helpful way, and, secondly, that we want a system which will not emphasise the distinction between the hospital which takes psychiatric cases and the hospital which does not. I think that we have the highest common denominator in the methods which I propose, so I very much hope that the Amendment need not be pressed.

Dr. Summerskill

I must say that we have all understood the Minister this time. One point is always in my mind. I always like 10 reject any discrimination in visiting and reporting hospitals. We shall ail watch closely what is done in these establishments. In view of the Minister's assurance, I beg to ask leave to withdraw the Amendment.

Amendment, by leave, withdrawn.