HC Deb 01 April 1968 vol 762 cc59-79

No patients may be refused admission or denied treatment at a teaching hospital or a university hospital because they refuse to be used for teaching purposes.—[Mrs. Joyce Butler.]

Brought up, and read the First time.

Mrs. Joyce Butler (Wood Green)

I beg to move, That the Clause be read a Second time.

Under the Bill as at present drafted, the scope of teaching hospitals will be greatly extended to other hospitals, and this will take place at a time when the scope of surgery also is extended considerably. At one and the same time, there will be more teaching hospitals, with wider techniques beginning to be practised in them.

The majority of patients going to a teaching hospital know that they wilt be expected to co-operate with consultants. They know that students will attend them when they go to the out-patients' clinic or when they are in-patients in those hospitals. They accept the situation and co-operate willingly.

With more new hospitals becoming teaching hospitals, many patients are uncertain about the position. There is a widespread idea that they must accept teaching when they go into hospital and that they have no opportunity to refuse.

It is the practice in a number of teaching hospitals of which I have some notes that, where a patient refuses to be used for teaching purposes, in some cases he is asked to wait until the end, when the consultant will see him privately. That seems to me quite reasonable. In other cases, a patient may be transferred to a junior doctor. In most cases that may be satisfactory, but it may not be if the case is a particularly difficult one which the consultant should see himself. Other cases are transferred to a non-teaching hospital, and that may seem reasonable if there is a non-teaching hospital within a reasonable distance.

In practice, these hospitals issue a leaflet to incoming patients, but I am informed that the leaflets do not always get to the patients and, in any case, they do not state any right that a patient may have to object to teaching. The leaflet says that because it is a teaching hospital, the patient will be expected to accept teaching, and it does not give any alternative. There is no doubt that a number of intending patients do not go to teaching hospitals if they receive the leaflet and do not wish to have students present during consultations.

I have notes of one or two cases which perhaps I might mention. The first is that of a former nurse who refused to have students present at a consultation, whereupon the consultant walked away and left her without treatment. Another case, details of which have been sent to my right hon. Friend, concerned a hospital for nervous diseases. The woman in question had a back injury and was wheeled into the consultation begging all the time not to be seen by students. Nevertheless, the consultant proceeded with the consultation in front of students, with the result that the woman became completely incoherent in answering questions put to her. Then there was a recent case of a woman who felt very embarrassed, which is fairly common, and did not want to discuss her condition in front of students. But the consultant insisted that she could not refuse because this hospital had been designated as a teaching hospital. After a very unpleasant scene and, for her, a most humiliating experience, she was finally passed to another doctor.

Finally, a man who regularly attended the out-patient clinic at a teaching hospital had the feeling that the doctor was more concerned with the students than with the patient. He therefore asked to be seen privately so that he could discuss his case with the doctor. He was refused the opportunity for private consultation. Because he was about to have an operation he was afraid to complain, so he did not make any protest.

These cases are typical of a number. Although the Minister, when he spoke to the Teaching Hospitals Association in February, 1965, said that he would deprecate any effort to make co-operation in teaching a condition of treatment and although he assured the hon. Lady the Member for Petersfield (Miss Quennell) in Committee that he had given guidance to hospital authorities and teaching hospitals that co-operation in teaching should not be made a condition of treatment and that that would apply to university hospitals as well, the position is by no means clear. I ask my right hon. Friend when he gave this guidance, what form it took, and whether it was to each teaching hospital authority. Patients ate not aware of their rights in this respect and many have to go through humiliating experiences if they want to assert their rights. It comes down to whether teaching hospitals have the right to refuse treatment. I would be glad if my right hon. Friend could give a categorical reply to that.

I do stress one point which I think is sometimes overlooked. Where doctors, consultants and students are absorbed in the work that they are doing, they do not always appreciate that for an average person going into hospital is a considerable ordeal. While most of them may not go all the way with Alf Garnett in recent assertion, that if he went into hospital he was afraid that the surgeon might look at his kidneys and say, "That's a nice healthy pair of kidneys. I'll just whip them out and use them myself", there are many apprehensions in the minds of patients when they go into hospital and very often they have to use all their reserves of courage to face the ordeals before them. Therefore, it is necessary, when people are in this frame of mind, that they should know their rights. They should know how far the teaching hospital can go in compelling them to have students present at the consultation or the operation. This should be made abundantly clear and should be written into the legislation. That is why I ask my right hon. Friend to write it into the Bill. I am not very happy about the wording of the Clause—it was somewhat hurriedly drafted—but the intention is clear. If the Minister will not accept it as it is, I hope that he will find an opportunity at a later stage of the Bill to put in something on those lines.

As a London Member, I am particularly concerned about the position in the London area. There is a great extension of teaching hospitals in the London area and it is becoming increasingly difficult, and will be even more so in future, for patients to go to a hospital which is not a teaching hospital. Therefore, this practice of transferring patients to non-teaching hospitals, if they do not want to be subjected to teaching, may become almost impossible in the London area. Because of this, and because this is now such a rapidly developing situation, the rights of patients should be clearly written into the Bill, and I ask my right hon. Friend to accept the spirit of the Clause when he makes his reply.

4.45 p.m.

Miss J. M. Quennell (Petersfield)

I congratulate the hon. Lady the Member for Wood Green (Mrs. Joyce Butler) on her speech in moving this Clause. She has put on the Order Paper in printed form succinctly and clearly a great many of the worries that beset members of the Committee when, in its third sitting, it considered this problem.

As the hon. Lady the Member for Wood Green said, it is quite obvious that soon patients will find their choice of hospitals more and more limited. Whether they like it or not, they will find themselves admitted to the big new hospitals which are the result of the rationalisation of the hospital service and which are in their nature teaching hospitals.

The hon. Lady has described some of the incidents that have come to her knowledge concerning patients who have disliked the idea of finding their persons exposed, as shall we say, guinea pigs. Let us consider the most important person in the hospital service. With great respect, it is not the doctors, nor the nursing staff. Unquestionably it is the patient, and the patient is the one person who appears all too seldom in this very complex Bill.

In the type of constituency which I represent, people who have to be admitted to hospital generally come from rural villages, and they have a long journey to make before they get to the hospital. They are admitted into a rather strange, bewildering and slightly frightening institution and are then faced with the request that they should be prepared to allow themselves to be used for teaching purposes. It is intolerable that anybody should be pressurised in any way, shape or form into allowing himself to be so used. To my mind it is an offence against human dignity.

The Minister said: I have certainly given guidance to hospital authorities and teaching hospitals that cooperation in teaching should not be made a condition of treatment. Whatever I have said on the subject in the past I stand by, and it will go for the university hospitals as well."—[OFFICIAL REPORT, Standing Committee D; 30th January, 1968, c. 137.] Though welcome, it is nevertheless imprecise.

I welcome the Clause, because it gives expression to a defence of the patient about which he can know and be reassured. I accept that the Minister may not feel that the wording is quite as happy as his expert draftsmen would produce, but, if he is prepared to accept the Clause, or a version of it which could be introduced at a later stage, I think he would go a very long way to meeting the real worries of many people about these constant reports of over-pressurisation on patients newly admitted into hospital in circumstances which are, to say the least, rather frightening when they are somewhat upset and certainly not feeling very well. He would also go a long way towards ensuring his niche in the annals of hospital history and record as being one of the patient's best friends.

Dr. Shirley Summerskill (Halifax)

In general I support the Clause, but I should like to make some comments so that the result of this discussion will not present an exaggerated picture of what a patient is submitted to when he or she is admitted to hospital. I think that some rather extravagant phrases have been used, such as "guinea pig", and patients being pressurised into being examined by medical students.

Like any other doctor in the House, I was trained at various medical schools, such as hospitals for skin diseases, hospitals for nervous diseases, hospitals for children, as well as my own medical school, and never in all those years did I see a patient being pressurised into being examined, or even talked about, by medical students if he did not wish that to be done. In fact, the last thing that a consultant, or a registrar, or a medical student would do, would be to force himself on an unwilling patient.

The cases mentioned by my hon. Friend the Member for Wood Green (Mrs. Joyce Butler) are extremely rare, and far from typical. When people are admitted as emergencies to the casualty department, or to wards, there is never time for a group of students to be assembled to discuss, and examine. Usually those who are taught upon—I object to the word "used" in the Clause—and taught about are those who have been admitted from the waiting list, and not as casualties. Before they are admitted they are warned by means of a booklet, that they are entering a teaching hospital, and that one of the things that happens there is that medical students have to learn their profession.

The attitude of patients to medical students is not the general attitude described by the hon. Lady the Member for Petersfield (Miss Quennell). Many of them are extremely flattered by the attention which they receive from medical students. They feel that instead of getting only one doctor to talk to them, and having only one doctor interested in them, and asking about them, they are being attended by a whole group of doctors.

I suggest that the wording of the Clause should be altered. Perhaps my right hon. Friend can find a more appropriate way of expressing my hon. Friend's intentions. I am sure that no one will deny that unless we have patients who are willing to co-operate with medical students, we will never be able to train our future doctors, because they cannot go into general practice without seeing cases the like of which they may never see for many years, and of which they must be aware if they are to recognise them when they do see them.

It is not for nothing that the status of the teaching hospital is often regarded by patients as higher than that of a general hospital. I am merely putting the case for many patients who prefer to go to teaching hospitals rather than to others. They learn more about their own cases. Very often patients complain that they are not told anything about their treatment, or the diagnosis of their illnesses by the doctors in charge. At teaching hospitals, if anything, they know too much about themselves, because day in and day out they are surrounded by medical students who discuss among themselves the ins and outs of the case. Very often patients are suffering from complicated diseases, and more than one mind is put to work on making a diagnosis. The majority of medical students are sympathetic and understanding, and, if anything, reticent. They do not push themselves on to a patient without his understanding the purpose of them being there. I do not say that students are mare qualified than their seniors, but it may be that many of them are more sympathetic in dealing with patients.

Dr. M. P. Winstanley (Cheadle)

I do not dissent from much, if anything, of what was said by the hon. Lady the Member for Wood Green (Mrs. Joyce Butler), but my views approximate much more closely to those of the hon. Lady the Member for Halifax (Dr. Summer-skill), which is perhaps hardly surprising, since we share a common background.

The hon. Lady the Member for Wood Green described cases which she said ware typical of many, but I think she w ill agree that complete satisfaction with the way they are treated in teaching hospitals is typical of many more patients. There may be occasions such as those described by the hon. Lady, but if there are, there should not be, and if something can be done to obviate them so much the better, but I hope the idea will not be spread that teaching hospitals and university hospitals are teaching factories in which the patients come second to medical students. This is certainly not the view of the students. They always feel that they are a long way behind everybody. It is not the general feeling that our teaching hospitals are less humane than other hospitals, and I hope the idea will not be spread that they consider patients to be of less importance than they are considered to be in other hospitals.

As is to be expected, the attitudes of patients towards medical teaching vary considerably. I accept that from time to time there are patients who find it embarrassing to be examined in front of a group of students. Different patients have different temperaments, and naturally their reactions vary, and on occasions some of them are embarrassed. I am not surprised that one does not receive constant complaints from patients about being used for teaching purposes simply because some patients do not want to raise objections. I think that the small number of complaints does not necessarily prove that there are not people who have some misgivings about this practice, but I agree with what has been said about this being a matter of communication. If things are properly explained to patients, and they fully understand what is required and expected of them, many of the difficulties can be ironed out.

Hospitals are often criticised for a lack of communication. We know that this is due not to any lack of desire to explain things to patients, but to a shortage of staff, and a shortage of resources, which make it impossible for doctors to go into the detail that one would like. I hope that the Minister will improve the present situation. The story is told of a 'phone call being made to a teaching hospital and a voice saying, "How is Mr. Smith in Ward C?", the operator answering, "He is very well, and is going home tomorrow. Are you a relative of his?", whereupon the voice answers, "No, this is Mr. Smith speaking. They tell you nothing here." I think we all agree that medicine is a co-operative business between those who practise it, and those on whom it is practised, and that we would all welcome anything that can be done to improve communications.

I hope that the Minister will say that he agrees with the spirit of the Clause, but that he will not recommend its acceptance by the House, because it would give rise to difficulties. First, what is a teaching hospital, or a university hospital? We know what it is. But teaching is going on in almost every hospital nowadays. It would therefore be a mistake to pick out certain hospitals.

5.0 p.m.

Secondly, it is very difficult to say what teaching is in terms of the wording of a Clause of this kind. If an operation is being performed in an operating theatre and doctors are present who are not there to assist but to watch, is it something that one ought to object to? Teaching is difficult to define. In many cases consultants, although being assisted by their registrars, are necessarily teaching at the same time.

I do not want to put forward all kinds of technical objections, but if this Clause were interpreted in a certain way it would bring many hospitals almost to a halt. It should be made clear that no patient is refused admission or denied treatment on the ground of his objection to being used for teaching. I hope that the Minister will confirm that this is the case. It is my view, and that of colleagues of mine with whom I have discussed the matter. We feel that this is not the way in which hospitals are conducted. It would be wrong to agree to the Clause in this form because it would imply that a procedure which had hitherto been in general operation was now to be stopped.

I have worked in hospitals and have taken part on both sides of the teaching processes. I do not object to the hon. Lady's putting forward her case. I agree that we must be mindful of the efficiency of the Health Service and the wellbeing of patients, and that it is necessary to have the fullest consultation and consideration when embarking on any procedure—not only that of teaching.

Whatever is taking place should be explained to the patient. It should be made clear that any patient is entitled to object to any procedure, whether or not it be teaching.

Mr. Herbert Butler (Hackney, Central)

The hon. Member is a member of the medical profession. If he were lying in bed with four or five students round him and he had a pain in his stomach and did not know what it was, how could he object to the presence of the four or five students?

Dr. Winstanley

I referred to that point earlier, and said that it was difficult for such a patient to object. But I went on to point out that it was not only in respect of teaching that patients had the right to object; there were other things to which they could object. I say that the fact that a patient objects to being subjected to teaching processes should not result in his being denied treatment at a hospital of his doctor's choice. I agree with much of what the hon. Lady has said, but for various reasons which have been made clear by hon. Members on both sides of the House I take the view that it would be a pity if the Clause were accepted in its present form. I hope that the Minister will be able to say something to help us to achieve the end that we all have in mind.

Mr. Laurence Pavitt (Willesden, West)

In spite of the eloquent protestations of the two doctors who have spoken on this matter, I hope that my right hon. Friend will accept the Clause, or a Clause in a similar form. It makes explicit a trend which has been going on for some time. Many years ago the prime responsibility of teaching hospitals was to teach. It used to be almost their exclusive function. Recently, however, under the leadership of my right hon. Friend, there has been an extension of the domain of teaching hospitals. They now take in geriatrics and mental health. A trend has been established for teaching hospitals to take on more responsibilities.

The hon. Member for Cheadle (Dr. Winstanley) talked about the definition of a teaching hospital. When a consultant does his ward rounds with his registrar or house man teaching takes place. We are merely trying to preserve the right of a general practitioner to refer his patient—whether he be an outpatient or an in-patient—to the consultant of his choice. If too dominant a feeling should arise that teaching comes first a general practitioner may refer a patient to a teaching hospital because he feels that the facilities at that hospital are those which will most benefit his patient. If the patient has an objection to being used as teaching material the general practitioner's wish cannot be fulfilled unless it is specifically provided that, in spite of the fact that that patient does not wish to be used or exhibited for teaching purposes, he can obtain treatment at that hospital.

Most teaching hospitals have a higher staffing ratio, and there are more nurses per patient. Such hospitals seem to have more of everything. In acute hospitals in my area it costs £46 a week for a patient in hospital, whereas in London it is nearer £67. A general practitioner may wish his patient to receive the benefit of the facilities available at a teaching hospital because of his diagnosis of the treatment that his patient desires.

There can be—there has been in the past—a depersonalisation of the patient. Two or three years ago a constituent of mine who went to Westminster Hospital was told to strip off in the waiting room. She was then taken by a nurse through a door and found herself stark naked in front of 40 students, after which the consultant gave a demonstration. She received a shock, which may have had a bad effect on her. She was not warned beforehand what might happen. I hope that that is a thing of the past.

Mr. Dempsey

Can my hon. Friend develop this point? At what stage and in what circumstances, what sort of procedure is used to acquaint any patient with the fact that he or she can opt out of such an examination?

Mr. Pavitt

As my hon. Friend the Member for Wood Green (Mrs. Joyce Butler) said, on admission the patient is often given a booklet or some kind of material which sets out the rules and regulations concerning what may happen. I agree with my hon. Friend the Member for Halifax (Dr. Summerskill) and the hon. Member for Cheadle that in the main the kind of thing to which I have just referred does not happen; there is a I attempt to make sure that the patient is fully aware of what is going on. Nevertheless, for some time, the Patients Association and the Socialist Medical Association have been waging a campaign to protect the rights of patients—including their rights in situations of the kind to which I have just referred.

The only place that I know of where one is talked at and talked over is in a hospital bed with a group of students sanding round. A person feels like an inanimate object and there is a continual conversation going across him concerning what is the matter with him—usually in technical terms. It has been said that this adds interest for the patient, especially if he is a little morbid. But many people cannot understand what is being said.

Dr. M. S. Miller (Glasgow, Kelvingrove)

Would not the best way to overcome this problem be to encourage communication between doctors and patients? There should be discussion not merely as to what is wrong with a patient but also as to what kind of treatment the doctor proposes to give.

Mr. Pavitt

My hon. Friend is right. That is part of the thing that we are trying to move towards. The medical profession may be doing its best, but the process still needs the kind of pressures that my hon. Friend has mounted. It should be made clear that a person who does not want to be talked at, looked at, or used in this way should nevertheless have a right to be treated in a teaching hospital if his or her general practitioner recommends treatment for that patient at that hospital.

In London this is a more acute probblem than ever, because about 50 per cent. of the total number of beds are in teaching hospitals. In the last few weeks Paddington General Hospital has gone over to St. Mary's. Another district hospital has become a teaching hospital. That is the trend. There are about 8,000 beds in the pipeline for designation at the moment. This might be right, because there is an urgent need for more doctors. But there is also a need to protect the rights of an individual.

A person may go into a teaching hospital with his eyes open. He may say, "I am prepared to go to this hospital. I am grateful to the hospital and glad to be of some service in respect of teaching." But other people who may want treatment in a teaching hospital for their sickness or disability should have the right to object if they wish to. Personal feelings enter into the matter. They should have the right to say that they want to go to Guys, or Barts or the London Hospital, although they are not prepared to be used for teaching purposes by consultants.

Dr. Winstauley

Does the hon. Gentleman agree that the tendency to which he has referred, for teaching to take place in more and more hospitals, has the effect of reducing the student to bed ratio and is, therefore, doing something to reduce the difficulties about which the hon. Lady the Member for Wood Green (Mrs. Joyce Butler) complains?

Mr. Pavitt

I accept that. That is another argument. I would prefer that they should not be designated in that way.

Mr. Deputy Speaker (Sir Eric Fletcher)

I do not think that the argument arises on the new Clause.

Mr. Pavitt

It is possible to have more students per bed without necessarily designating the hospitals, because there can be the type of arrangement which the Central Middlesex Hospital has with the Middlesex. Even if my right hon. Friend cannot accept the precise wording of the Clause, I hope that he will write such a provision explicitly into the Bill. This is part of a general trend in which he has played his part.

Mr. Tim Fortescue (Liverpool, Garston)

All hon. Members have assumed that the patient who is to be taught on, so to speak, is an adult capable of speaking for himself and of deciding whether he wants to be taught on. Children have not been mentioned. I have had direct experience of this, because one of my children unfortunately broke her arm in a complicated way. Her arm was skilfully and effectively set in a hospital. This was, apparently, something of a medical miracle and my child was used extensively, together with the X-rays of her broken arm, to demonstrate to students what had been done and how much use she had of her arm after the setting.

My wife and I were a little taken aback by this, because this was done without our permission. The child was asked whether she would mind. She said that she would not, although she had not the faintest idea of what was involved. When she had to appear before a large body of students, she was rather frightened, but the kindly treatment of the doctors and nurses coaxed her round and in the end she was happy about it. When children are involved, I believe that there is room for abuse of any safeguard which at present exists. I therefore urge the Minister to consider this proposal very carefully.

5.15 p.m.

Mr. Herbert Butler

I hope that the Clause will be accepted. I have been a member of a regional hospital board since the appointed day. I have been the chairman of a management committee covering five hospitals. I say this only to indicate that I have had experience of what happens in hospitals. I am amazed that my medical friends take the view that hospitals are there merely for the purpose of teaching medical students. Hospitals are there to ease the pain of those who are in pain and who cannot be treated at home. They are also there to cure diseases. People in pain and with diseases are the objects upon which doctors can gain experience. However, hospitals do not exist specifically for the purpose of teaching doctors. The hon. Member for Cheadle (Dr. Winstanley), who gives television lectures, must live in cloud-cuckoo-land if he believes that patients are told that they may be the subject of lectures to students.

When I was a very important Member of the House—Parliamentary Private Secretary, running about with pieces of paper for the Financial Secretary to the Admiralty and my hon. Friend the Civil Lord—my Minister was in the London Hospital. I went to see him. The First Lord wanted to go to see him as well. I happened to be a member of the regional board, and I went to see him. As I was talking to him in the ward about one or two things which Parliamentary Private Secretaries discuss with their Ministers—I am not sure what happens today, but I know what happened then—a bunch of people were running up and down the ward. I heard all the conversation that went on around the bed opposite that occupied by the Civil Lord. I thought how dreadful it was.

I want to discuss, not what happens on designation, but what happens in regional hospitals with association, where numbers of beds are allocated to teaching hospitals. In my case down in Hackney we have had to make it clear that patients must be made fully aware that they cannot be used as specimens unless they agree. By the time the person is aware of the true position, he is already a victim in the hospital. How much resistance does a patient have once he is in hospital? How effective is any notice that a person who is going into hospital may in certain circumstances be used for the purpose of teaching?

I believe that payments are made to those who agree to become specimens for people to examine, investigate, comment on, and prognosticate on. In view of the new developments in the hospital service, I ask my right hon. Friend to say, in the words of the Clause, that No patients may be refused admission". Even this is not the substance of the matter. We want it established that a patient should not be forced to act as a specimen unless he agrees to do so voluntarily. I hope that my right hon. Friend will accept the spirit of the Clause and act upon it.

Mr. K. Robinson

My hon. Friend the Member for Wood Green, (Mrs. Joyce Butler) must be very gratified at the almost universal assent of the House to the general idea embodied in the Clause, which she moved so moderately. The House will know that I agree entirely with the principles set out in the Clause. I have made it clear on countless occasions that, although I hope that as many patients as possible will co-operate in the teaching of medical students, a willingness to co-operate should not be made a condition of treatment by teaching hospitals.

This view of mine is very well known indeed to every teaching hospital in England and Wales. Apart from having answered a number of Questions on the matter in the House, I addressed the Teaching Hospitals Association on this subject in 1965. Copies of my statement were sent to all teaching hospitals following that meeting. My Department has on several occasions stressed my views at meetings of teaching hospital administrators and doctors. Only recently—in Committee on this Measure—I said that the same principle would apply to the new university hospitals which are being set up under the Bill. I am not aware of any teaching hospital which does not accept this principle.

My hon. Friend referred to leaflets and I am inclined to agree that the leaflets on this subject in some hospitals could be improved. Most of the leaflets do not make it clear enough that the patient has a right to refuse. Interestingly enough, however, Hammersmith Hospital does this and apparently it has made no difference whatever to the proportion of patients who agree to be treated. I am considering whether leaflets should make this right clearer, but I should like to await the Report of the Royal Commission on Medical Education which is expected shortly and which is considering the whole of this subject of teaching on patients, among other topics. I should like to consider further guidance in the light of whatever the Royal Commission may have to say on the subject.

However, although I agree with the idea behind the Clause, I do not think that it is an appropriate subject for legislation. The Clause seeks to legislate for the treatment of a particular type of patient at a particular type of hospital in a particular situation against a background of legislation for hospital treatment which is deliberately and necessarily couched in very broad and general terms. It rather prompts the question: why should we not, if we are to pass this Clause, legislate for other particular types of patient of whom there is an infinite variety.

Occasionally—very occasionally indeed in relation to the number of patients who are treated in teaching hospitals—I receive complaints by patients about teaching. My hon. Friend mentioned one or two instances but I think she would agree that it is not appropriate to discuss particular cases on the Floor of the House. I assure her that I carefully investigate any such complaints that are made to me or my Department. When I have looked into them I have sometimes found that there has been a misunderstanding, sometimes that a doctor has not been as thoughtful as he might have been and sometimes that a doctor has made a mistake. I do not see that if we were to accept the Clause it could have any effect on the number of occasional misunderstandings and mistakes. It would be a law directed against people because a refusal of treatment, if it were ever to happen, would be a refusal by an individual person. What sanctions would operate if the occasional individual did not abide by the law?

Even if the situation were to arise in which a teaching hospital did not carry out my policy, I would still think that the Clause was not necessary. I say that because I already have ample powers under present legislation to direct hospital authorities to act in accordance with my policies. Fortunately, the need for a direction on the sort of matter covered by the Clause has not arisen, but I assure the House that I would not hesitate to use my powers if I thought that it were necessary to do so.

Mr. A. P. Costain (Folkestone and Hythe)

What would be the position if a G.P. recommended that a patient should be excused being the subject for teaching?

Mr. Robinson

I am certain that if a G.P. were to tell a consultant that a patient whom he was referring to the consultant did not wish to take part in teaching procedures, that would be helpful all round, since the consultant would then decide whether he would treat the patient himself, despite that proviso, or suggest that another consultant might better take on the treatment. I would certainly hope that that would be the case.

I assure my hon. Friend the Member for Hackney, Central (Mr. Herbert Butler) that there is no question of any payment being made to people who are patients in hospital. I understand that some medical schools make payments to people who come back specially to be taught on, but that is a rather different matter.

Perhaps I can sum up by saying once again that I entirely agree with the principle expressed in the Clause. I am sure, however, that there is no need to legislate on these lines because teaching hospitals accept this principle and because, if they did not, I could direct them to do so under existing legislation. I also believe that it would be wrong to particularise about the treatment of a defined group of people in legislation which is otherwise in very broad general terms. Additionally, the Clause would not carry penalties against individuals who did not observe it. Thus, it would be bad law, and, accordingly, I ask the House to reject it.

Mr. Dempsey

My right hon. Friend says that he has ample powers under present legislation to take action or give a direction. How would he get to know that an individual who had refused had, in fact, declined to be examined in this way?

Mr. Robinson

I was saying, in somewhat general terms, that if a teaching hospital did not accept the policy which I have outlined and which I have commended to hospitals, then I could direct them to abide by it—as I say, in general terms—but obviously if a particular situation were to arise I would not be likely to hear of it until after it had arisen.

Mr. J. T. Price (Westhoughton)

I intervene because I have been deeply impressed by the speeches which have been made in support of the Clause. I also intervene because my right hon. Friend has wide general knowledge of the medical profession and might be able to answer a question about medical practitioners in view of his past association with the profession, particularly in view of the medical experience of previous generations of his family.

Where does the Hippocratic oath come into all this? I have always understood that a qualified practitioner, whatever the level of his skill or expertise, undertook to give his services to any member of suffering humanity, regardless of conditions. I would have thought, therefore, that the intervention of a condition imposed by any hospital authority—by a medical member of a hospital or by a member of the administrative staff—would, by implication, be a breach of the Hippocratic oath. This question raises a genuine issue of conscience and hon. Members who do not frequently indulge in the luxury of carrying their consciences on their sleeves will agree that we are right in pointing out forceably to the Government that matters such as these are not trivial.

When a "quack"—I use the word affectionately—is registered, he is able to do certain things. If he is experienced he can perform operations, but he would not perform one merely for the heck of doing it or for the joy or interest that performing it would give him. However attractive an operation may seem, he cannot perform it if it offends against the ethical principles of his profession.

It is against this background that I regard my right hon. Friend's answer on this occasion as a bit of flannel. He said that in certain circumstances he would be prepared to use his powers of direction. As my hon. Friend the Member for Coatbridge and Airdrie (Mr. Dempsey) pointed out, he would be unlikely to use them because he would have no means of knowing of people who had been turned away from hospitals in the circumstances that have been described. For this reason the Clause is worthy of further consideration. If I were not such a loyal member of the Labour Party I would probably feel inclined to abstain on this issue if a Division is called.

5.30 p.m.

Mr. Will Griffiths (Manchester, Exchange)

I apologise to my hon. Friend the Member for Wood Green (Mrs. Joyce Butler) for not hearing her open this debate, but I have heard sufficient of the speeches, and particularly the slightly astonishing reply of my right hon. Friend, to persuade me to add my support to the Clause.

The Minister has not contradicted what any of my hon. Friends have said. He admits that though complaints are few they do exist. He says that if the Clause were passed there would be no sanction against any misbehaviour, if that is the right word; against doctors using patients for teaching purposes without the patients' consent. If the Clause were written into the Bill, an obligation would be placed by Statute on the medical profession to make it absolutely explicitly clear to patients that their consent must be sought.

As I say, my right hon. Friend does not deny that these cases occur. He says that there are few of them, and I do not think that anyone would contradict that statement. He has not refuted the stories I have heard recited to the House, but says that in any case he has reserve powers. He is therefore saying that there is mistreatment, or that the correct procedure is not always applied in all teaching hospitals, but that he proposes to do nothing about it. On the other hand, if he were to accept the Clause, a statutory obligation would be placed on the Minister to take direct action through the regional boards to make sure that those in teaching hospitals observed the law. I see nothing improper in that being done.

I am quite sure that a large number of the doctors in our teaching hospitals are impeccable in their behaviour in this respect, but we all know from experience, either personally or within our families, that in the medical profession, as in other professions, there are those who behave with the utmost arrogance. An example is their attitude towards patients. It is well known that constituents go to the out-patient department of a teaching hospital—and not necessarily a teaching hospital—and very often have not the slightest idea who the doctor is who may be carrying out the most intimate examination. They may be attending Mr. Smith's clinic, but they are not at all certain, as they ought to be, that it is Mr. Smith who carries out an examination of considerable intimacy. Often it is not Mr. Smith at all. This amounts to thoughtlessness on the part of the doctors in the clinics.

I have often suggested to individual members of the profession that I see no reason why on their white jackets they should riot have labels bearing their names. That practice is observed by matrons, sometimes by theatre sisters, sometimes by sisters in the out-patient department, and sometimes, perhaps, by many doctors. At the same time, many doctors still like to cloak themselves in an aura of anonymity which I believe to be undesirable. Whether they are fearful of the patient knowing who they are I do not know—

Mr. Deputy Speaker

Order. The hon. Gentleman's argument does not appear to have any relevance to the new Clause.

Mr. Griffiths

With respect, Mr. Deputy Speaker, I should have thought that the relevance is that I am illustrating the attitude in general of some members of the medical profession towards some patients.

Mr. Deputy Speaker

No. The new Clause merely deals with the question whether patients should be refused admission to a teaching hospital.

Mr. Griffiths

I bow to your Ruling, of course, Mr. Deputy Speaker. I was merely trying to illustrate in connection with the new Clause that there are certain sanctions which may be exercised in certain circumstances against the patient. However, I leave the point at once.

Sufficient has been said by hon. Members—and the Minister has done much to reinforce their arguments—to persuade me that even now my right hon. Friend should look again at the Clause. It is not enough for him to adopt the attitude he has adopted so far.

Mrs. Joyce Butler

In view of what my right hon. Friend has said about the difficulty of writing this provision into the Statute, it would not be right to press the Clause. However, I would ask him to see whether some form of words could not be written in later; and, in any case, whether he would accept, as I think has been made abundantly clear on both sides of the House—and in many cases outside the House—that there is need for better guidance, if that is the right word, to the teaching hospitals. If my right hon. Friend cannot insert this provision into the Bill later, perhaps he will consider achieving its purpose by a letter or by instructions to teaching hospitals.

Mr. K. Robinson

I will certainly accede to my hon. Friend's request to consider what further guidance should be given. It is my intentiton in due course to give further guidance after we have had the advice of the Royal Commission on Medical Education. I will consider what has been said in the debate, but I ought not to leave my hon. Friend to think that it would be possible to find a satisfactory way of achieving in statutory form a situation which all of us want. This is not a matter for statutory provision. But, I repeat, we all agree—and hospitals have been told that this is my policy—that it should not be made a condition of treatment in a teaching hospital that patients co-operate in the teaching process. That being so, I hope that my hon. Friend will withdraw the new Clause.

Mrs. Joyce Butler

In view of what has been said by my right hon. Friend, I beg to ask leave to withdraw the new Clause.

Motion and Clause, by leave, withdrawn.