INFECTIOUS HOSPITALS BILL [H.L.] (Hansard, 21 June 1892)

§ *LORD THRING

My Lords, a very few minutes will suffice for explaining the Bill to which I trust your Lordships will give a Second Reading, in order that the subject may be discussed, and considered during the Recess. The Bill is brought in at the instance and recommendation of the County Councils Association; it is to provide for isolation hospitals, or rather to facilitate the promotion of isolation hospitals—or, in other words, hospitals for the reception of people suffering from dangerous infectious diseases. With regard to the necessity of such isolation I think I need say hardly a word. We all know that if there is one thing which is rendered more certain than another by the progress of medical science, it is that the most dangerous diseases that affect the human race, such as cholera, scarlet fever, or smallpox, may be to a great extent prevented by isolation. A vessel comes into port on which there is a case of cholera; the vessel is sent into quarantine, which is the most effectual isolation hospital, and the danger practically ceases. But we all know the dangers that occur from small-pox coming into a parish—it creates a centre of infection, and desolates the parish; whereas, if at the first moment the patient is isolated the disease is reduced to a condition in which there is little risk, and the patient alone suffers. At the present moment the authorities who have power to make infectious hospitals are the Rural Sanitary Authorities, and the Urban Sanitary Authorities. My Lords, I have no fault to find with these authorities; in the larger towns, notably in London, there are complete establishments for the purpose of isolation. But when you come to the Rural Sanitary Authorities, to the administrative counties, for which I am pleading, you find that in a great many cases indeed infectious hospitals are not established. The reason for this 1654 is not far to seek. The Rural Sanitary Districts are extremely inconvenient areas, they very often comprise parishes which are not connected together by any link; and, on the other hand, Urban Sanitary Authorities in counties are very often too small for establishing infectious hospitals. These then are the difficulties which this Bill endeavours to palliate; and it does so through the medium of the County Councils. The Bill says that when a local application is made to the County Council, the Council may then provide for the establishment of an infectious hospital. The procedure is as follows: A local application must be made by the Rural or Urban Sanitary Authority, or by a contributory place—that is by one of the constituent parishes, or villages, that form part of the Rural Sanitary district. There is also one provision which is in some degree a coercive power. The County Council may proceed on the authority of their Medical Officer as if it were a local application if he reports that any part of the county is so desolated by disease or so open to infectious disease, that it absolutely requires an infectious hospital. When this application is made the County Council are to direct a local inquiry whether an infectious hospital is wanted or not. Supposing the answer to be in the affirmative, they either adopt the area suggested in the Report, or they have power to subtract or add to the area. But here again the local feeling is consulted; for any Local Authority, or bodies of Local Authorities may appeal to the Local Government Board if they think that area is improperly constructed. Supposing the area to be approved of, then the next thing the County Council have to do is to establish a Hospital Committee. This they do, either out of the Local Authorities themselves, or partly out of the Local Authorities, and partly out of their own members. And here again we have safeguarded the Local Authorities, because any of them may appeal to the Local Government Board, if they think they are inadequately, or imperfectly represented. I come now to the powers necessary for establishing an infectious hospital. With regard to the power of purchasing land we 1655 give them compulsory powers only through a Provisional Order; so that there can be no complaint on that point. The expense is to be thrown, as it is now, upon the Local Authority, to be paid out of the sanitary rate. These expenses are divided into structural expenses, establishment expenses, and patients' expenses. The structural expenses are those of building; the establishment expenses are those of maintenance of the building; and the patients' expenses are the costs for the patient while lying on his sick bed—medicine and food. With respect to structural expenses, supposing the district consists of more than one contributory place, the constituent places are to contribute in proportion to the rateable value; we think the villages in the district ought to put up the buildings. On the other hand, the management expenses are to be paid in proportion to the population, as we think they ought to be paid according to the use of the hospital. These are details to be considered. With respect to patients' expenses we have adopted altogether the principle which prevails in the metropolitan infectious hospitals. We are told, and I believe rightly, that isolation is a public benefit, not a private good; it is for the public benefit that you take a man suffering from a dangerous infectious disease and put him into a hospital; we therefore adopt the principle of the present metropolitan legislation, and declare that the expenses of the patient, rich or poor, are to be paid out of the sanitary rate. There is one exception. We think, and I submit rightly, that there may be a class of patients who we hope will come to the hospital—a higher class altogether—well-to-do and rich persons, who we think may be very well asked to pay; we do not compel them, but give them inducements to do so. We say that if they like to pay their own expenses, and any additional sum which the hospital may have to incur, they can have separate rooms and attendance. That my Lords, is the scheme of the Bill. You will perceive that it interferes in no respect with the Local Authorities; it endeavours to aid them. I will not trouble your Lordships with any further 1656 description of the Bill; all I say is that it is an honest attempt on the part of the County Councils Association to improve the law. We create no fresh liabilities; we only aid the Local Authorities; and I trust your Lordships will consent to read the Bill a second time.