SECOND READING. (Hansard, 10 March 1893)

§ LORD THRING

said, he brought this Bill forward at the instance of the County Councils Association, a Body representing 51 out of the 61 counties of England, a population of 16,000,000, and a rateable value of £88,000,000. It must necessarily interest the House as the best means, he believed, for preventing some of the most virulent and destructive diseases afflicting mankind. Though doctors differed in many things, they were agreed that isolation was the only effective protection against infectious diseases. Even in their Lordships' own houses isolation was no easy thing—one or two cases they might be able to isolate, but in poor men's dwellings—even of two or three rooms in the case of the better class of artisans in the larger towns—that was impossible, and it was a miracle if the disease did not spread through the house. Nay, the very charity of the poor increased the dauger by their going to assist neighbours, and carrying back with them the seeds of disease, so that a disorder which might have been easily checked at first would spread and destroy a whole town. Isolation hospitals were essential, for by no other means could isolation be produced. At whose expense were they to be built? Modern legislation had replied, in the case of London, in no doubtful voice, that isolation was a public and not a private benefit. If a man broke his leg, he was carried to the hospital for his own benefit; but if he had scarlet fever, or, still worse, small-pox, his removal to the hospital was not so much for his own benefit as for that of the community, and his isolation was, therefore, to the public advantage. The expense ought, therefore, to 1550 be borne by the community, for the necessity of isolation hospitals was as great as that of the supply of water, gas, or any other requisite. By the present law sanitary or urban sanitary districts might establish isolation hospitals, but only 400 out of 1,500 such authorities had made adequate provision for them. To some extent, that might be due to the apathy of the Local Authorities, who were slow to move and very much afraid of increasing the rates. But the fact was, that the division of the country into sanitary and urban sanitary districts, though apparently a systematic arrangement, was perhaps the most perplexing that had ever puzzled an inquirer. Urban Sanitary Authorities contained towns from the size of Manchester to places of 500, and sometimes fewer, inhabitants. Sanitary Authorities, again, were the residue of Unions after taking out of them the Urban Sanitary Authorities. They even consisted of scattered parishes having little communication with each other, and being little able to combine. That being the case, the first object of this Bill was to further the protective system of combination; to enable County Councils to combine parishes or Rural Sanitary Authorities, or indeed any rating authorities, and to remove the difficulty of their unequal aptitude for combination. Another difficulty lay in the selection of sites. Learned persons had stated that some 40 ft. of space was sufficient to prevent the spread of contagion in all diseases except small-pox; but however that might be, people had a terror of having isolation hospitals near them. The two great factors in the question were the combination of appropriate districts and the selection of sites, and they had been found almost insuperable. Dr. Seton, the medical officer of Surrey, had informed him that one bed to 1,000 people was the requisite number, and that the ideal hospital would contain some 30 beds to a population of 30,000. Such an arrangement was unfitted for sparsely-populated places, and medical men were of opinion that village hospitals might be sometimes substituted, the arrangements being made in every case in reference to the local peculiarities of the place. That this Bill would effect, through the medium of the County Councils, giving the necessary flexibility for the combination of the small areas, either 1551 sanitary districts or parishes. The safeguard against unjust combination would be an appeal to the Local Government Board, which might take out of the combination any place possessing a proper hospital or giving a just reason for objecting. A Governing Body would be formed for the hospital district; and there, again, the Local Government Board might be appealed to if any of the constituent areas thought they had been unjustly treated. County Councils might exercise this power of forming a hospital district on the application of 25 ratepayers, and they might even, if they thought fit, direct their medical officers to make inquiries as to the necessity for a public hospital in a particular locality, and might thereupon form a hospital district -subject always to an appeal to the Local Government Board, so as to entirely prevent any injustice. When the hospital district was formed and the Governing Body constituted, either from members of the Local Authorities or by the County Council and the Local Authorities with it, the system would begin to work. They would then have every power, including that of buying land. But that, again, was fettered, for they bad only the same power of buying land as they had under the Public Health Acts—they might buy it by agreement; but if they wanted to purchase it compulsorily, they must have a Provisional Order. Then they must be provided with ambulances, and put in communication with the system of telegraphs. This, also, was on the recommendation of the medical men, who said that patients could be easily removed five or six miles by ambulance, and in many cases even a much greater distance. Being a public benefit, the expense of the hospitals was to be borne, as in the case of London, entirely by the public. As a patient was removed for the benefit of the community and not for his own, be he rich or poor, he was entitled to relief gratuitously in the infectious hospitals; but of course it was expected, as in all hospitals now, that rich patients would contribute to the funds, and the hospitals might, if they chose, provide separate rooms for those who could afford to pay for them. In small areas in the hospital district the hospitals would be built at the public expense according to the rateable value of the constituent areas, but the establishment expenses 1552 would be paid according to the population of the various areas. The patients' expenses would be paid out of the sanitary district. A subsidiary power was given to provide nurses. Trained nurses were essential, and, as their Lordships were aware, many hospitals not only trained nurses themselves, but obtained funds by sending them out to private persons, and power was given for that purpose. This was not an ambitious Bill; and while it did not pretend to make any great change, it would be productive of great good. The counties had been zealous in carrying into effect the medical education provisions, and would, he believed, if power were given them, show equal alacrity in undertaking this difficult and important subject of the establishment of isolation hospitals. There could not be a graver object for the counties to undertake than to prevent, if possible, an invasion of infectious diseases; and even if they were unsuccessful in attaining that result, at all events they would palliate those evils.

LORD MONKSWELL

said that the provisions of the Bill had received from the Local Government Board the attention due to the importance of the subject dealt with, to the high authority of the noble and learned Lord who had introduced it, and to the vast body of representative opinion at the back of it. The Local Government Board was thoroughly in accord with the object sought to be attained by this Bill—namely, the provision of increased accommodation for the isolation of infectious disease. There could be no doubt that there were many sanitary districts, both urban and rural, which were without the hospitals with which they ought to be provided, and at times it happened that persons, not paupers, who were suffering from infectious diseases, were taken to the workhouse infirmaries as being the only places in which they could be treated. That was an illegal and thoroughly objectionable arrangement. The view, therefore, of the Local Government Board was that the present law, under which it was optional for Sanitary Authorities to provide hospital accommodation for infections cases, was defective, and that further provision should be made for 1553 such accommodation, and the Board was of opinion that some powers with this object should he conferred on County Councils. Consequently, the Board welcomed this Bill as an endeavour to deal with a pressing evil on sound principles, and invited the House to give it a Second Reading. The Local Government Board was not, however, satisfied that the provisions of the Bill were in all respects the best that could be adopted to secure the end in view. So far as the Bill proposed that petitions should be made to the County Councils by Sanitary Authorities for the establishment of hospitals for their districts, no provision would seem to be needed, for there would appear to be no reason why a Sanitary Authority which had already, under the Public Health Act, 1875, full power to provide hospital accommodation for its district, should apply to the County Councils to provide it for that district, and at the same time—for that was the proposal in the Bill — to set up a separate Body to have control of the hospital and to charge the expenses to the Sanitary Authority. In such cases the Sanitary Authorities, if they wished to move in the matter at all, would probably prefer to act under the powers they now possessed rather than to place themselves under the control of the County Councils. With regard to the proposals in the Bill for the formation of hospital districts, as the law now stood, united districts could be formed by Provisional Order for hospital purposes; but, practically, such districts could only be formed when the Sanitary Authorities of all the districts concerned were willing to contribute. Several united districts had, however, been formed. The powers given to County Councils by this Bill would no doubt facilitate the formation of hospital districts. As to those cases where the Sanitary Authorities, being desirous of having a hospital district carved out, would be obliged to approach the County Council instead of proceeding under the powers they now possessed, the Local Government Board entertained some doubt whether it would be well to let Sanitary Authorities throw upon the County Council the task—often a difficult one—of providing a hospital merely by asking that a hospital district might be formed. The Board suggested that it might be better to follow the lines of 1554 other legislation on subjects in which both County Councils and Sanitary Authorities were concerned, and to empower the County Council to provide a hospital where the Sanitary Authority made default in doing its duty in this matter. It might be provided that where the County Council dealt with a complaint that a Sanitary Authority had made such default, the Council might take into account the circumstances of the neighbouring districts as regarded hospital accommodation, and, if necessary, form a district to contain two or more sanitary districts or contributory places. He hoped the Bill, with such amendments as might be considered desirable, would pass into law, and he was sure the country and the House were much indebted to his noble and learned Friend for introducing and drafting it.

Motion agreed to; Bill read 2a accordingly, and committed to a Committee of the Whole House.