HL Deb 04 August 1891 vol 356 cc1233-44

, in rising to call attention to the action of the Board of Supervision in the matter of the appointment of medical officers under the Local Government Act in connection with the Government grant of £15,000 in aid of local expenditure; also to call attention to the refusal of the same Board to sanction the employment of the police as Sanitary Inspectors, said: My Lords, my notice is to call attention to two subjects, but your Lordships will be glad to hear that I do not intend to say anything with regard to the second branch of the matter, which is as to the appointment of Police and Sanitary Inspectors. There is a Committee in my own county considering the matter, and I would rather that another meeting of that Committee should take place before the question is brought publicly forward. But the other matter, to which I shall, with permission, call your Lordships' attention, is one of considerable importance to us in Scotland under our Local Government Act. I think I shall show your Lordships that rules have been laid down by the Board of Supervision which, to a great extent, cripple the free-will of those who have to administer the Local Government Act. Your Lordships may wish to know what that Board of Supervision means. It means bureaucracy for Scotland, and it lives at 127, George Street. It has been called the Board of "Super-vision "—I suppose because its vision is superior to that of the noble Marquess and to the purview of the Act which Parliament has passed. Now, the matter to which I wish to direct your Lordships' attention turns upon the provisions of the Local Government Act with reference to the appointment of medical officers. Nothing can be clearer than the provisions of that Act. It affords to Local Authorities and County Councils two courses which they may take. Indeed, there is a third, but I do not touch upon that now-farther than to say that the third course is that, without appointing any head medical officer, either for the district or for the county, they may appoint all the present officers county officers, and have no heads at all. My noble Friend's Office admitted last year that that construction was possible under the wording of the Act, but said that it would be contrary to its spirit; therefore, I eliminate that third course. But the other two courses are perfectly clear. They are contained in the 52nd proviso of the Act, Part VIII. It is stated there— That the Council of every county shall appoint o; pay a medical officer or medical officers, who shall not hold any other appointment or engage in any private practice or employment without the express written consent of the Council. Those are the two courses. You may either appoint an officer who is to do nothing else, or you may appoint a medical officer who will continue his private practice. Well, counties have acted in different ways upon this construction. They were perfectly free to take the one course or the other. They may either appoint, as I have said, an officer who has done nothing in his profession, and who will, therefore, have no private practice; or they may appoint an officer who is in private practice, and give him a letter to continue his private practice. As far as the Act is concerned, if there had been nothing else, the counties would have so acted, and you would have heard no more of it—the thing would not have engaged public attention at all; some Councils would have taken one course and some another; but it so happened that there was a small grant of £15,000 to be distributed among the different counties of Scotland. There was an Act passed upon this grant being given, which I believe said it was to be distributed—I have not the exact words, but the sense of it was that this grant was to be distributed among the different County Councils in Scotland according to rules to be laid down by my noble Friend the Secretary for Scotland. Then, soon after this, there came out rules and regulations laid down by this Board of Supervision; and they are contained in this Paper which I hold in my hand. The date of it is the 8th January, and it is addressed to the clerks of the different County Councils. It says— I am directed to inform you that the Board have been in correspondence with the Secretary for Scotland as to the conditions under which the grant of £15,000 towards the cost of local inspectors and sanitary inspectors shall be contributed. What the origin of this Paper is I do not know. We only know that they say they have been in communication with the Secretary for Scotland. Whether the Board was moved by the Secretary for Scotland or the Secretary for Scotland by the Board, or whether both were moved by the College of Physicians in Edinburgh, I cannot say, but there the matter stands. Perhaps if the College of Physicians moved in the matter they may have thought, if they could get these rules passed, there would be a good many places for doctors with nothing to do. But whatever the reason may be for this document which we have before us, the conclusions which the Board have come to are these: One knows that County Councils have appointed duly qualified medical practitioners to be medical officers at an adequate salary. Talking of medical officers' salaries, I would remark that one great object on the part of these bodies seems to be to encourage expenditure. Take this very considerable grant which is to be distributed: is it to be distributed in proportion to population, or to the value of rateable property in the country, or in proportion to efficiency? Not a bit; it is to be distributed in proportion to expenditure. What they calculate is, I think, 8s. in the £1. I say that is a wrong principle for the distribution of this or any other grant to a county, that it is to be in proportion to their expenditure in certain branches. Then it lays down this: that the medical officer for the county shall not be permitted to engage in private practice, and that his whole time shall be devoted to the duties of his office. They say they cannot recommend a scheme by which a medical officer of a county, or the chief medical officer of a district, is permitted to engage in private practice. Now this regulation has come out, and it has been variously treated by different counties. Some counties have accepted and acted upon it with the view of getting a portion of this grant. Other counties have declined to act upon it, and have stood upon the Act which these rules practically override. They have said, "We will do without this grant; we will maintain our independence, and we will act as we are entitled to, freely, under the original Local Government Act, which we are sent here to administer." The counties which have so acted, to the best of my belief, are—there may be others—Ross, Berwick, Clackmannan, Forfar, and the large County of Perth. A noble Lord says, No. Well, if Perth has not acted in that way it has changed again; because I hold in my hand the result of a discussion of the question, when, by a majority of 99 to 19, the principle of appointing a medical officer with a letter enabling him to continue his private practice was adopted. There may have been some change since; but, as far as my information goes, those are the counties which have so acted. In my own County Council there are, I think, only four who are in favour of accepting the rules and regulations of the Board of Supervision. Those counties stood on their rights under the Act; and the reasons they did so were twofold: One was that they thought it would be a more economical way of dealing with the question than by appointing a man with a large salary who would have nothing to do but go about to find work—to find something or other to show his raison d'être. At all events, we believe that this is the most efficient way of working the Act, and efficient on this ground. Here it is put in this very debate, to which I refer. It was moved in Perthshire that they should act upon the powers which they have, and that they should give a letter conferring power to the officer to carry on private practice. The gentleman who moved that said, "The question was whether a doctor in practice or a doctor without practice was the better man. A doctor in practice was certainly abreast of the times in medical treatment; while a doctor without practice must in a short time cease to have opportunities of studying complaints." I am perfectly certain of this: that there is not a member of that Board of Supervision, and certainly not, I should say, my noble Friend the Secretary for Scotland himself, who, if he were ill, would call in a doctor who had no practice in preference to one who had a practice; and, therefore, I maintain that, whether you look at the economy of the matter and to the rights under this Act, or to efficiency in its administration, these counties that have stood upon their rights and have declined this "mess of pottage," offered them in the shape of a share of this £15,000 grant, have properly administered the Act, and have done more wisely than those who have not done so, in the interests of their counties and for the purposes of the Act. I have thought it right to call the attention of your Lordships, and especially of my noble Friend, to this matter, on the ground that I think where you have an Act of Parliament passed after great care, and great attention has been paid to the subject, and that Act gives an alternative, those who have to administer it are in their right when they administer it to the best of their ability according to one or other of those alternatives whichever seems best. I say it is not sound in principle, or right or just or any thing else when circumstances arise which are supposed to give to those in authority, whether my noble Friend in the first instance or acting really through the Board of Supervision, the power to decide the meaning of that Act as regards the appointment of medical officers, to say, "If you will not do what we say, you shall not get the grant." I say that is neither right nor sound in policy, principle, or anything else. I have called attention to this matter in the interests of everybody. We do not want bureaucratic Edinburgh government in such a matter as this, and I hope my noble Friend (the Marquess of Lothian) will be prepared to re-consider the matter. In my own county, I may say, it will make very little difference; but I submit to your Lordships that it is not a question of amount, but of principle. I apologise for taking up so much of your Lordships' time on this subject.


My Lords, the noble Lord on the Cross Benches has, with his usual eloquence and energy, brought forward for your Lordships' consideration a grievance which he says is felt in the County of Haddington, and in other counties in Scotland, at the present time. I must take leave to point out to the noble Lord that, whether he agrees or not with the course which has been taken by the Board of Supervision and by myself, we have not, at any rate, been guilty of any act of illegality, but have pursued a course which is perfectly justifiable under the Act he has referred to. Though I am afraid I shall not convince my noble Friend, it is my duty to point out the course we have followed. My noble Friend has referred to the 52nd clause of the Local Government Act. That clause provides that the Councils of every county shall appoint and pay a medical officer or medical officers, who shall not engage in private practice or employ without the express written consent of the Councils. Now, I take quite a different view from the noble Lord of the effect of that clause, because I think if it had not been held that there was some possible disadvantage in employing a medical officer not in private practice those words would not have been put into the clause. I think the fact that it was required that the written consent of the County Council should be granted when a medical officer engaged in private practice, showed that those in office were of opinion that that should rather be the exception than the rule. But that is not the ground on which the action taken by the Board of Supervision has been based. As the noble Lord has pointed out, the action has been taken on the Local Taxation Act of 1890. By the 2nd clause of that Act a sum of £15,000 was to be distributed under such regulations as might be framed by the Secretary for Scotland. In pursuance of the duty which was laid on the Secretary for Scotland under that Act, I issued certain regulations, and those regulations were to this effect: "That in order to entitle a County Council"—


Would the noble Marquess tell us when the regulations were issued, and by whom?


I think it was in October of last year. I have not the exact date— In order to entitle a County Council or any other Local Authority to participate in the distribution the arrangements made with regard to salaries and otherwise shall be approved by the Secretary for Scotland on the recommendation of the Board of Supervision. Naturally, I referred to the Board of Supervision as being the authority most competent to make such a recommendation. They are the authority who ad-minister the Poor Law in Scotland. They have for a long time administered those Acts, and clearly they are the proper body to make such a recommendation. In consequence of those regulations which were issued by the Secretary for Scotland, the Board of Supervision did make certain regulations as they were bound to do. Before issuing the Circular to which my noble Friend has alluded they referred to me as to what were the conditions they proposed to make with regard to the grant of £15,000. I considered that proposal very carefully. There was a great deal of correspondence, and there were objections raised on one side and the other, some people approving generally of the course taken by the Board of Supervision; but the general result was that I did not see my way to withhold my approval from the regulations laid down by the Board of Supervision; and, having granted that approval, I must hold myself responsible to that extent for the conditions which have been laid down by the Board of Supervision. Now, the Circular which my noble Friend objected to was, I think, a very proper Circular—I do not mean as to the wording, though I do not understand that my noble Friend objects to that; but I think it would have been very unfair on the County Councils who are affected by this Circular if they had not been informed at once, at the beginning of January, of the conditions under which the grant would be made. Consequently, the Circular was issued, and, as my noble Friend has observed, some County Councils have taken one view and others have taken an opposite view. With regard to the sanitary part of the question, as my noble Friend has not entered upon it, neither will I; but as to the medical officers being allowed to engage in private practice, I think my noble Friend is wrong in saying that so many County Councils have taken the view he states. There are only two exceptions, and those have been allowed by the Board of Supervision on the ground that the circumstances were exceptional—one was Orkney and Shetland (the Islands), and the other was the County of Bute. With those exceptional cases every county in Scotland—Forfar, Berwick and East Lothian excepted, have accepted the view of the Board of Supervision and of myself. My noble Friend has, of course, stated that the action of the Board of Supervision, approved of by myself, is rather ultra vires as upsetting the arrangements made under the Local Government Act. I do not accept that view. I think at this present moment, as my noble Friend has stated, the County Council of East Lothian and the County Council of Berwick have both acted under that view. Their liberty has not been curtailed by what has happened since. They have simply not accepted the conditions under which the grant was given, and they do not obtain their share in the distribution of the £15,000.


The noble Marquess says their liberty is not curtailed; but they are acting under a pecuniary penalty.


It is so far a pecuniary penalty no doubt, they not accepting the conditions. But if my noble Friend's County Council had accepted the conditions the pecuniary penalty would not have attached. I am not concerned further than to say that whatever view may be taken by my noble Friend or others as to the desirability of allowing medical officers to engage in private practice, I believe there is nothing illegal in the course which has been followed, and that the Board of Supervision have taken a course which it is perfectly competent to them to adopt. I can only express the hope that my noble Friend's County Council will come to take an opposite view, and they will thereupon obtain their share of the £15,000 grant.


My Lords, the noble Earl has done very rightly in bringing this matter before the House. It is a point in Local Government which is considerably larger in its application than many of your Lordships may suppose, and it will apply to England just as much as it will to Scotland. With reference to this particular matter, of course the question which has been raised is a very small one. It is really a question of principle, but it is also a question of how a sum of £15,000 is to be divided. Now, the Act says that that sum is to be divided in such manner and under such regulations as the Secretary for Scotland shall make; and if the noble Marquess will tell us that he himself, as Secretary for Scotland, says he thinks it right that no county should have a share of this grant unless it debars the medical officer of the county from private practice—if he says that is his own deliberate opinion, there is nothing to be said in answer to it. He has the power to enforce it; that is the power given by the Act of Parliament. But the account which he has given us of the transaction, and of the part which he took in the transaction, is quite of another sort. The noble Marquess said that he informed the County Councils that he was going to ask the Board of Supervision to make certain regulations or recommendations; but it by no means followed that those recommendations would be accepted. If the noble Marquess means that whenever he asks a person for advice he considers himself absolutely bound to do what that person proposes, and that everyone who is affected by that advice, and who is informed that certain recommendations are going to be asked for, is thereby bound to anything which that advice may suggest as necessary to be done, I think that is a very extraordinary state of things. But I think the noble Marquess was quite right to ask the Board of Supervision for their advice, and that he was perfectly right to act in whatever manner he saw fit with regard to the advice given him; but the point which I think the County Councils must insist upon is this: that the Board of Supervision have no authority whatever over a County Council, and, moreover, that the Board of Supervision ought not to conduct correspondence with County Councils except upon such matters as they may have some executive authority upon. If it were a matter of the dismissal of a medical officer or of a Sanitary Inspector, there, I admit, the Board of Supervision has a perfect right to write to the County Council, because an officer cannot be dismissed without the consent of the Central Authority; but on such a matter as this the Board of Supervision ought never to have written to the County Councils at all. Any advice ought to have gone direct to the Secretary for Scotland, and the Secretary for Scotland himself ought to have informed the County Council what he proposed to do. He was at liberty either to take advice from the Board of Supervision or from any other advisers he might choose; but his action ought to be his own, and the Board of Supervision ought not to have taken any direct part in the matter. I do not say anything on the nature of the correspondence which was conducted by the Board of Supervision. I do not wish to say anything against them at all; on the contrary, I wish to uphold their authority within their proper sphere. I think it would be unfortunate if the Central Authority in Edinburgh were abolished or done away with; but I must say I think their epistolary style is of a rather unfortunate character. I would suggest to the noble Marquess that he should read these letters; he will find himself referred to in this sort of way: They say, "The general principles of distribution upon "which the Secretary for Scotland and the Board of Supervision will proceed may now be stated." When the Board of Supervision tacks oh its name as of nearly co-equal power with himself, I think it about time the noble Marquess should look into the matter. Now, with regard to the practical course which has been taken, I must differ from the noble Marquess himself, because he says he approves of this proposal of the Board of Supervision. I maintain there is no question that under the Act it was expressly contemplated that any County Council might appoint as local medical officer a person who was engaged in private practice. It is expressly so stated in the Act. That being so, how can it be right by a pecuniary penalty—the matter is trifling, and, therefore, I have the less hesitation in speaking about it—to prevent any County Council from taking any course which the Act says they may take? And moreover, with all due deference to the course taken, it is not, I should say, the most sensible one. I should like to know how many counties there are, cither in England or Scotland, where the whole time of a medical officer is required? I must admit that there is some support for the remark which was made by the noble Earl just now that the object of the Board of Supervision appeared to be to encourage expenditure. They said, "You must employ the medical officer; it does not matter whether you want the whole time of the medical officer or not, you must pay his salary; "and of course it stands to reason that if you are to have a medical officer worthy of the name, his whole time cannot be obtained without paying him a considerable salary. In Forfarshire, as far as I can understand the matter, to pay for the whole time of a medical officer would be perfectly unnecessary. The Committee appointed for the purpose carefully inquired into the matter, and they came to the conclusion—a very sensible one it seems to me—that the principal part of the administration of this Act would fall upon the Sanitary Inspector, and not upon the medical officer, and, therefore, while they were perfectly prepared to pay a large salary to the Sanitary Inspector, they did not see any necessity for employing the whole time of a medical officer. I think that course is not only in harmony with the Act, but is consonant with common sense. I suppose it is too late to make any suggestion to the noble Marquess now; but what I should say would be the right course would be to throw the whole burden and responsibility upon the shoulders of the County Councils to inquire into the manner in which the officers perform the medical duties which are incumbent upon them under the Act, and if those medical duties are not performed in a satisfactory manner, then fine them or punish them in any way you choose; but to begin by saying that the Central Office in Edinburgh does understand what the county wants, and that the County Council does not understand, appears to me to be centralising the administration to the very last extreme and to be taking a course of action which certainly was not contemplated by the Local Government Act.