§ Order for Second Reading read.
§ 6.26 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Edith Pitt)
I beg to move, That the Bill be now read a Second time.
The sole purpose of the Bill is to make new provision, in particular by enabling a statutory board to be set up, for the administration of the bacteriological service which the Minister of Health provides for England and Wales under Section 17 of the National Health Service Act, 1946, and which is known as the Public Health Laboratory Service.
For reasons related to its origin, the Service is at present administered for the Ministry of Health by the Medical Research Council, assisted by a board of the Council's own appointing and with no legal status. This agency arrangement was never intended to be permanent and in the last few years, for a variety of reasons, it has become increasingly inconvenient.
Immediately before and during the last war, the Medical Research Council, at the request of the Committee of Imperial Defence, developed and operated an Emergency Public Health Laboratory Service for England and Wales. This Emergency Service was envisaged as providing a defence against possible enemy use of bacteriological warfare and against any major outbreaks of epidemic diseases arising from war-time conditions, including large movements of population and disruption of normal sanitary services.
In the event, the Service was not called upon to deal with any major emergency due to the war. On the other hand, it came to be used by medical officers of health as a very valuable aid to their ordinary work such as had not previously been available, except in the areas of some of the larger local authorities. The main reason for creating such an emergency service had, indeed, been the inadequacy of the pre-war arrangements for the bacteriological work required for public health purposes, particularly in the vulnerable southern part of England.
In the light of this experience, it was decided to maintain the Service after the 1394 war as part of the regular machinery for the diagnosis and control of infectious diseases. Power to provide such a bacteriological service was given by the National Health Service Act, 1946, as I have already mentioned. In view of its earlier association with the project, the Medical Research Council agreed to continue to administer the Service during an initial period of five years. In so doing, it acted as agent for the Minister of Health outside its ordinary functions, for which it is responsible to the Committee of the Privy Council for Medical Research.
The primary function of the Service is to undertake bacteriological and viro-logical examinations for the assistance of local public health authorities in the control of infectious diseases. The work consists in part of the examination of specimens from human subjects suffering from infectious diseases, or suspected of having been exposed to infection. For the rest, it consists of examination of so-called sanitary specimens, namely, samples of water, milk, foodstuffs and other materials which may be the sources of infection.
A major feature of the work of the laboratories has been the availability of the bacteriologists to go into the field to assist medical officers of health in the investigation of outbreaks. Although the laboratory methods used are largely the same as those of hospital bacteriological laboratories, the aim of the work is quite different. It is concerned with the control of infection in the population at large and not with the treatment of the individual patient, so that its field is in the community and not in the wards of hospitals.
Unlike the hospital laboratory services, the Public Health Laboratory Service is organised on a national, and not on a regional or hospital basis, for the whole of England and Wales. Infectious diseases observe no administrative boundaries, and an outbreak often has to be traced from one area or region to another. There is also facility in reinforcing one laboratory with staff from another in times of local stress. Furthermore, when epidemics occur it is important to have a national intelligence network. In this connection there is a frequent and continuing liaison with the appropriate medical division of the Ministry of Health.
1395 The Service thus comes under a single director with an office in London and it includes a Central Public Health Laboratory at Colindale with specialised departments to which reference can be made in matters of special difficulty by the regional and area laboratories throughout the country and which are also able to undertake intensive research on particular problems.
Although organised on a national basis, the constituent units of the Public Health Laboratory Service work in close touch with the hospital laboratories in their areas. The policy is to site public health laboratories in or near hospitals, and, where appropriate and convenient, to provide joint laboratories in which the public health bacteriologist and the hospital bacteriologist work side by side and share various facilities. Where there is no hospital bacteriologist, the public health laboratory may undertake the relevant hospital work. This arises particularly in the smaller hospitals where the sole pathologist may be a specialist in morbid anatomy or chemical pathology. This tendency seems likely to develop, but at least from the public health point of view the advantages of a national rather than a regional bacteriological service still remain. The Public Health Laboratory Service at present consists of the Central Public Health Laboratory, eight regional laboratories and fifty-one area laboratories. There are also several special reference laboratories, some included in the Central Public Health Laboratory, but some placed in other institutions. The Service is considered now to be fully developed and no increase in the number of public health laboratories is envisaged. The staff of the Public Health Laboratory Service numbers about 1,068 of whom 126 are medically qualified. Scales of pay are equated to those of the hospital service.
The cost of the Service is £1,212,000, and this is provided in the Civil Estimates for 1959–60 to cover the salaries and running expenses of the Service, including the cost of the purchase, testing and issue on behalf of the Minister of Health of certain immunological preparations distributed through the laboratories. An additional £50,000 is provided for capital expenditure on buildings.
1396 On the expiry of the initial post-war period of five years, the Medical Research Council agreed to continue its agency administration of the Public Health Laboratory Service for a further term. At the same time, owing to the growing pressure of its ordinary work, the Council found it necessary to delegate this agency function almost entirely to a Public Health Laboratory Service Board which it appointed for the purpose, including officers of the Ministry of Health. The executive work remained in the hands of the Council's headquarters staff.
This agency arrangement was still regarded as temporary, and more recently the Council has been anxious to divest itself of the responsibility entirely, for the following reasons. The work of the Public Health Laboratory Service is peripheral to the Council's interests; although scientific it is largely routine and includes research only as a secondary function. There is inconvenience in the anomaly that the Council is in this matter responsible to the Minister of Health, whereas in respect of its normal functions it is responsible to the Committee of Privy Council for Medical Research. It is embarrassing for the Council to be the employer of two staffs paid by different standards and subject to different conditions. The ordinary work of the Council and of its headquarters staff has continued to grow, so that it has become expedient for the Public Health Laboratory Service to be given its own administrative machinery as soon as practicable.
The object of the Bill is therefore to enable the Minister of Health to administer the Service through a new Public Health Laboratory Service Board which he will appoint. This Board will exist as a separate entity, with legal status, not possessed, or attainable, by the present Board assisting the Council, enabling it to employ staff and hold property in its own name. This body, in a general way, will be analogous to a regional hospital board, that is to say, it will administer the Service as the agent of the Minister of Health, it will be appointed by him, and its staff will not be civil servants. It will be subject to the directions of the Minister of Health, whose control of the Public Health Laboratory Service will thus remain 1397 much as at present. No significant additional expenditure is involved, as the cost of administration by a separate staff should be largely offset by saving the payment at present made to the Medical Research Council for the performance of this function by its own staff.
Very briefly the main provisions of the Bill are as follows. Clause 1 constitutes a Public Health Laboratory Service Board, to administer the Service as the Minister of Health may determine and under his direction. The Board is empowered to appoint staff, and to pay expenses to its own members. The Minister will provide premises for their needs under Section 17 of the 1946 Act.
Clause 2 transfers the staff of the Public Health Laboratory Service, other than certain headquarters staff, from the employment of the Medical Research Council to that of the new Board. Contingent provision is made for the payment of compensation for loss of employment or emolument, but it is in fact thought unlikely that this will be required.
Clause 3 transfers from the Medical Research Council to the Minister of Health property held for the purpose of the Public Health Laboratory Service. The Board itself, however, is empowered in paragraph 2 to the Schedule of the Bill to accept and hold on trust property for the purpose of these functions.
Clause 4 provides for the cost of the Public Health Laboratory Service to continue to be met by the Exchequer. Provision is made in respect of accounts and audit in the usual form and continuing the practice followed under the existing arrangements.
The Schedule provides for the Board to be a body corporate and to be able to accept and hold property on trust for the purposes of the Public Health Laboratory Service or otherwise connected with bacteriological research.
The members of the Board, all appointed by the Minister of Health, are to be a chairman and such other members as the Minister thinks fit, including two members appointed after consultation with the Medical Research Council, two bacteriologists, two medical officers of health, a person representing the hospital service, and a general practitioner.
1398 I might perhaps explain that the representation on the Board was changed from that in the original draft of the Bill following representations made in another place by Lord Taylor who felt that it was not essential that the chairman should be of the medical profession, as was at first envisaged, and that the hospital service, which would be calling on this new Board, should be represented. Amendments to that effect were accepted in another place.
The position now is that we are asking the House to provide permanent machinery for a Public Health Laboratory Service. I hope that the House will accept the Bill.
§ 6.39 p.m.
§ Mr. Kenneth Robinson (St. Pancras, North)
We on this side of the House welcome the Bill, the purposes of which the hon. Lady has described with commendable clarity and brevity, which I will try to emulate.
It is a small but by no means unimportant Bill. It is non-controversial in the party sense. It comes to us from another place, where the Second Reading debate was notable for a speech which I can only describe as fascinating from my noble Friend Lord Taylor, in which he surveyed the achievements of the Public Health Laboratory Service and the very wide range of its activities. Those of us who are in any way associated with the National Health Service know what excellent work the Laboratory Service has done since it came into being, almost accidentally, at the beginning of the war. It has done its work very unobtrusively, and research has discovered that in the whole twenty years of its existence it has only once been the subject of a Parliamentary Question—and that was a Question for Written Answer. There is probably a moral somewhere in that, but I hesitate to draw it.
I echo the tribute paid by my noble Friend in another place to Sir Wilson Jameson, who was the Chief Medical Officer of the Ministry at the time of the inception of this Service, and who did more than anyone to bring it into being, and to Dr. Wilson, who has been the director of the Service since its inception.
Hon. Members on this side of the House agree that the time has come to bring to an end the temporary and somewhat fortuitous arrangements for this 1399 Service, and to give it a new structure. Had the Minister wished to do so he could have integrated the Service into the regional board system. It would have fitted into it in the same way as the blood transfusion service has now become part of the regional board system. On second thoughts, however, I believe that, on balance, this method of changing the structure is the right one. It is better for the Service to be under its own statutory board. As the hon. Lady said, the composition of the Board has been changed since the Bill was first drafted—and in my view it has been very much improved—as a result of the suggestions made by my noble Friend.
The hon. Lady said that the pay and conditions of the staff has been equated with those of the hospital service. I hope that I am right in assuming that that position will continue, because it is highly desirable that it should.
The hon. Lady did what her noble Friend, Lord Hailsham, did when he introduced the Bill in another place— wearing his Minister for Science hat at the time, I assume; she said that research was very much a secondary function of this Service. I thought that she and her noble Friend both tended to minimise this function. In terms of the expenditure of time it takes up about 25 per cent. of the Service's work. About 75 per cent. of its work is routine. Research is probably the most important part of its work, because it is doing things which no other body in Britain is doing, and in some cases work which probably no other body in the world is doing.
We feel that this research must be encouraged. If it is encouraged, and finance is generously provided by the Minister, the work of the Service should grow, and the organisation should grow with it, despite what the Minister said about its having now reached its maximum size. There is a great deal of work still to be done in this field. The Public Health Laboratory Service has shown itself to be admirably fitted to do this work in the past, and we hope that it will go on and extend its activities. From this side we wish it well in its new guise.
§ 6.43 p.m.
§ Dr. Barnett Stross (Stoke-on-Trent, Central)
If I am brief in my remarks I hope that you will understand my 1400 reasons, Mr. Deputy-Speaker, and not hold it against me. Like other hon. Members I could speak at some length on this subject, but it is not necessary to do so. All I would say is that this Service, with very little money, has given us a unique position in the world in bacteriological research. It is a network, with a national centre, spread throughout the country and ready at any moment to assist local authorities, general practitioners or hospitals. It is available at all times, and for very little expense.
It costs £1¼ million per annum for this Service, which is roughly the cost of firing one rocket into outer space. It is interesting to think that at very reasonable cost we can protect ourselves against a very serious enemy which constantly attacks us, and against whom we always have to be on guard. We can use the Service to prevent disease rather than wait too long and then have to attempt to cure it, when it is often rather late.
My principal reason for rising is to say that Stoke-on-Trent owes a debt of gratitude to the Service for the fragment of research it did when, in 1957, there was a catastrophe in the North Staffordshire Royal Infirmary. A number of patients in operating theatres became infected with tetanus as a result of being operated on, and there were one or two fatal cases. This Service was brought in to discover why this dreadful thing had happened. It carried out a countrywide sample investigation of dressings used in operating theatres, to see whether any of them were contaminated with the spores of the normal organism of tetanus, and it was able to demonstrate beyond doubt that unbleached cotton wool, as it is or made up in bandages, sometimes contains the tetanus organism. From this fact it deduced that under no circumstances must any unsterilised dressings be allowed to enter an operating theatre. Stoke-on-Trent is very grateful to it for the work it then did, and I believe that the country as a whole is also grateful.
I also read the fascinating contribution made by Lord Taylor in the Second Reading debate in another place. We who knew him as the hon. Member for Barnet are not surprised that he found this Service of great interest. He objected very strongly to the Long Title of the Bill, which refers to "the bacteriological 1401 service". He preferred it to be called a "microbiological" service, and I sympathise with him, for the Laboratory Service carries out research on infestation by worms, and it is interested in fungi as well as in viruses, and the word "bacteriological" is, therefore, perhaps too narrow. However, I doubt whether any of the abominable "No-men" that Lord Taylor spoke of, who sit on committees and say "No" to anything outside their terms of reference, will ever exist on the kind of board that we envisage the Minister appointing under the Bill.
Our proceedings here are not as leisurely as they are in another place that we wot of, and I shall not say much more. Before I sit down, however, I would say that I am delighted to see that the Minister is to appoint not only representatives of the general hospital service but a representative of the general practitioner service, for that service exists to help him, and it is right that it should have a representative on the Board who can state the requirements of men in general practice.
§ Question put and agreed to.
§ Bill accordingly read a Second time.
§ Bill committed to a Standing Committee pursuant to Standing Order No. 38 (Committal of Bills).