HL Deb 06 August 1913 vol 14 cc1633-42

THE CHAIRMAN OF COMMITTEES informed the House that the Promoters do not intend to proceed further with the Bill: Ordered, That the Bill be not further proceeded with.


Read 3a, with the Amendments: Further Amendments made: Bill passed, and returned to the Commons.


Read 3a, with the Amendments.

*LORD LEIGH moved to leave out Clause 15, which ran as follows—

Agreements as to ambulance services.

15. The Council on the one hand and the Managers of the Metropolitan Asylums District the Port of London Authority the Metropolitan Borough Councils and Boards of Guardians of Poor Law Unions within or adjoining the Administrative County of London or any of such authorities on the other hand may enter into and carry into effect agreements for the working and use by the Council or any of such authorities for the purposes of the ambulance service authorised by the Metropolitan Ambulances Act 1909 of ambulances lands premises and appliances used by the Council or any of such authorities in connection with ambulance services provided by them for purposes other than those of the said Act and for utilising for the purposes of the ambulance service authorised by the said Act the services of any persons employed by the Council or any of such authorities.

The noble Lord said: My Lords, venture to express the hope that Clause 15 of this Bill will not be sanctioned by your Lordships. The clause refers to ambulances for London. The whole question was thoroughly debated in your Lordships' House in the year 1909; but that is four years ago, and I would like to be allowed to recapitulate very briefly a few of the salient facts. At present in cases of accident cabs or hand litters have chiefly to be relied upon for removal to a hospital or to a home in place of proper horse-drawn, motor, or electric ambulances. This entails in many cases, like that of a broken leg, added torture to the torture inevitable in the case of such an accident. A service of rapid ambulances is established in many of the chief cities of Great Britain and Ireland and also in many of the principal cities abroad, such as Paris and Vienna, cities of far less size than London. The model ambulances which, perhaps, show the way to the whole world are those to be seen in all the principal cities of the United States of America; and of late years a most efficient electric ambulance service has been established in the City of London. Yet in the county of London these mediaeval methods still obtain.

In 1909 it was decided in your Lordships' House that the London County Council should be authorised to establish and maintain a rapid ambulance service for cases of accident or illness other than infectious disease within the county of London, exclusive of the City. No other local authority is authorised to expend money or to levy a rate for such a purpose. The London County Council have, however, neglected to provide such a service, which is notoriously required. The County Council have recently begun to exercise their statutory powers by maintaining at a cost of £300 a year a motor ambulance generously presented to the Hampstead and North-West London Hospital by the Grand Duke Michael of Russia. Last November a recommendation was made to the London County Council to seek for further legislation which should tend to enable the Council to pay in aid and use the various conveyances possessed by the sixty different local authorities—namely, the Metropolitan Asylums Board, the Port of London authority, the twenty-eight borough councils, and the thirty boards of guardians—and to claim these as constituting the ambulance service which Parliament had authorised the Council to provide.

The clause which I am moving to delete is very obscure. It is not an amendment of the Act of 1909, which was a Public Act, while this is a Private Bill. It does not, presumably, authorise any expenditure out of the rates by the authorities named for the purposes of the Act of 1909. It would enable the County Council to use the smallpox and fever ambulances of the Metropolitan Asylums Board, thereby destroying all confidence in the ambulances used in the case of street accidents; and it would permit old horse cabs provided by boards of guardians for the conveyance of paupers to be used to cope with work similar to that with which motor ambulances are dealing so efficiently in the City of London. It appears from a report made to the County Council in November last that of the thirty boards of guardians twenty stated that their conveyances were not available for public use, and of the twenty-eight borough councils only three possessed any conveyances at all, while the Port of London authority stated that they had no more conveyances than were adequate for their own purpose. Now that it seems probable that St. George's Hospital will be removed from its present site it is more essential still that there should be rapid ambulances to remove urgent cases to hospital. The County Council admitted that they had not consulted the various authorities in seeking these powers. I trust that I have said enough to show how totally inadequate the proposed scheme, if such it can be called, would prove if ever put into practice. It is most essential that there should be not more than one authority in this matter, and that authority should be the London County Council. In this case centralisation is essential. I trust that your Lordships will not allow Clause 15 to pass.

Amendment moved— Leave out Clause l5.—(Lord Leigh.)


My Lords, I desire to support the noble Lord's Amendment to delete this clause. It comes as a shock to hear that if one is run over in the streets of London by a motor-'bus, one is not only likely to be smashed up, but may possibly be conveyed to hospital in an ambulance that had been used for a fever patient, so that during one's period of getting over the accident one might develop some dangerous fever. As the City of London possesses a service of motor ambulances, and they are a great success, I do not see that there is any reason why motor ambulances should not be provided throughout the whole of the county of London. It is much more desirable that there should be one authority providing a proper ambulance service than that the County Council should have to go to the numerous local authorities and arrange with them in regard to a matter which affects so seriously the millions of people in London. I hope that your Lordships will delete this clause, and that eventually the question may be settled for the county of London in the same way as it has been settled in the City of London, where things in this direction are running in a satisfactory manner.


My Lords, I am glad that the noble Lord opposite has moved the omission of this clause. One thing which has been established to the satisfaction of all persons acquainted with the administration of London is the absolute necessity of a good ambulance service, and I think that all parties are agreed that whoever is the authority to manage the ambulance service for London, it should be one authority. A committee was appointed by the Home Office some years ago to report on the subject, and they recommended that the Metropolitan Asylums Board should be the body entrusted with the management of the ambulance service. I am anxious to see one authority undertake this work, and I agree with the noble Lord opposite that the London County Council is the best body for the purpose. I am not maintaining that the London County Council alone has a claim to manage this service. I should be content if a good central body such as the Metropolitan Asylums Board, if the House thought proper, were made the authority to carry it out. There can be no question as to the urgent need of an improved ambulance service, for in two years the number of accidents in London has risen from 16,800 to something like 19,000. Those figures bring home the necessity of having an efficient ambulance service for the Metropolis, and all the information which has been put before the public on the subject shows and enforces that necessity. I see no reason whatever why one body should not be constituted for the purpose. But the suggestion contained in the clause which the noble Lord opposite has moved to delete appears to me to be absolutely unworkable and unmanageable. A scheme whereby the London County Council should agree with something like sixty bodies for the use of these ambulances seems to me a ridiculous scheme to put forward. Those of us who have served on the London County Council or on other municipal bodies know the extreme difficulty there is in getting local authorities to agree on any matter of administration of this kind, and it is on that ground, above all, that I trust your Lordships will agree with the Amendment and delete this clause in order that further consideration may be given to the subject. I am convinced that if this clause passes, instead of its ending in providing a decent ambulance service, it will only prove a further procrastination of this very important matter.


The noble Lord who has moved the deletion of this clause contends, I understand, that the London County Council should set up a separate and complete ambulance service of their own provided by the ratepayers of London. I am not at all sure that the ratepayers of London will be as grateful to the noble Lord as he appears to imagine. I would point out that there is nothing in this clause which will in any way remove any obligations which have been imposed on the London County Council under the Metropolitan Ambulances Act, 1909. The history of the matter is this. In 1906 the London County Council sought powers in their General Powers Bill to set up and maintain an experimental ambulance service for London. It was to consist of only two stations. The cost of those two stations was calculated to be in the first year £5,200, and in subsequent years it would involve an annual charge of £3,000, and each of those stations it was admitted would only serve an area within a radius of a mile or of between one mile and two miles, so that I think the House can judge what a very heavy expenditure would be entailed if the London County Council were to set up all the stations which would be required to meet the needs of London under the scheme advocated by Lord Leigh. The powers which were sought by the London County Council on that occasion were strongly objected to by the Home Office, who advocated at the time the extension of the existing service provided by the Police, and the proposal was subsequently thrown out by a Select Committee of your Lordships' House.

This question has not been, as Lord Welby rather suggested, hurried through. It has been fully considered for a long time by the London County Council, and this clause is the result of very careful thought and consideration. The proposal is supported by the Metropolitan Borough Councils of Bermondsey, Bethnal Green, Finsbury, Hammersmith, Hampstead, Lambeth, Paddington, Wandsworth, Woolwich, and by many other boroughs as well as by the local authority of the City of Westminster. Lord Mayo seemed to fear that persons meeting with accidents in the streets of London stood the risk of being conveyed to hospital in an ambulance in which there had previously been a smallpox or fever patient. He referred, I presume, to the ambulances of the Metropolitan Asylums Board. A great many of the ambulances belonging to the Asylums Board are reserved at the present moment for non-infectious cases. And as regards Lord Leigh's suggestion as to mediæval ambulance methods, I would remind him that the ambulances of the Metropolitan Asylums Board are all motor vehicles.

In 1912 there were 11,500 non-infectious cases dealt with by the Metropolitan Asylums Board. I think that disposes of the argument that there would be any danger to the public in the co-ordination of the different existing ambulance methods. This clause, as I said just now, does not remove any of the obligations which were imposed on the London County Council by the Act of 1909. All that it does is to enable the County Council to attempt to utilise, as far as may prove to be practicable, the existing ambulance services of London; and if experience shows that this co-ordinated service is inadequate to meet the needs of London, it will be open to the London County Council either to further supplement these services or to set up and maintain a separate and distinct ambulance service of their own as suggested by the noble Lord. They can do that under the Act of 1909. In fact this clause does not give increased power to the London County Council so much as it does to the other local authorities. The London County Council could enter into agreements without this Bill. Until this co-ordinated service has been proved to be insufficient for the needs of London I protest against a great waste of public money in setting up what would amount to a very costly scheme which would in all probability prove to be in no way required.


My Lords, I only intervene to state the view taken by the Local Government Board upon this question, and I think I can best do so by quoting from the Report of the Local Government Board made in the usual way to the House of Commons Committee when that Committee were considering this Bill. The Local Government Board then stated that the County Council had communicated with them on the question of utilising the ambulances of the Metropolitan Asylums Board, the Port of London Authority, and the other local authorities in London for the purpose of maintaining an ambulance service for London, and the Board had informed the Council that they approved of the principle of a united ambulance service for London but advised that legislation would be necessary for the purpose which the London County Council had in view. What the London County Council desire to do at the present moment is to see whether they cannot co-ordinate the services of the local authorities, including that of the Metropolitan Asylums Board, which authority has been able to deal in three years with 5,000 non-infectious cases in ambulances used only for non-infectious cases, showing that there is no risk, as Lord Mayo seemed to think, of a person who was knocked down by a motor-'bus being conveyed to hospital in an ambulance which had previously carried fever patients. It is clear that this is not at all the idea of the London County Council. The Local Government Board gather that the Council's desire is to save the rates, and I think the majority of your Lordships will agree that it is desirable, if the County Council can get an efficient service for £4,000 or £5,000 a year extra, not to go to the expense of £20,000 or £30,000 a year in order to have a separate ambulance service.

It seems to me rather late in the day to raise this objection to Clause 15. The Bill went through the House of Commons absolutely unopposed as regards Clause 15. As your Lordships know, there are many active members of the London County Council sitting on both sides in the House of Commons, and if there had been any serious objection to this clause surely objection would have been taken there. Again, this Bill has passed its Third Reading to-day in your Lordships' House without any objection being taken up to this moment. Therefore I think it would be rather unfortunate at this stage to omit this clause, which represents the views of the various local authorities concerned, and refuse the opportunity of seeing whether the clause will work. The clause would not prejudge any further action on the part of the London County Council if this scheme should prove unwise, but it will give an opportunity to the County Council to try this scheme, and if it is found to be unworkable there will be an opportunity during the next session of Parliament to deal with the question on a larger scale if desirable.


My Lords, I desire to add very little to what the noble Lord behind me (Lord Strachie) has said, because the circumstances are such that he and I look at this question from a similar point of view. The Parliamentary history of this clause is as the noble Lord has described it. This clause was unopposed in the House of Commons and it was unopposed in your Lordships' House, although the Bill did not lack opposition on other points. Going a little further back than the Parliamentary history of the matter, the noble Lord opposite (Lord Leigh) can congratulate himself that he has been consistent on this question for a number of years. I have this afternoon read the debate which took place in 1906, and I find that the noble Lord then advocated what he advocates to-day. Of course, he realises, as I realise, that the Act of 1909 largely arose out of the discussion in 1906. The Act of 1909 is so drafted that the London County Council could set up an ambulance service for the whole of London irrespective of any other authorities. I only refer to 1906 to remind your Lordships that the proposal of that year was thrown out by a Committee over which I think the noble Earl, Lord Camperdown, presided. I do not know why that Committee threw out that proposal, but I have been reminded of some of the estimates that were then formed. The proposal in 1906 was to set up two ambulance stations only, and they would have involved an initial expenditure of £5,000 and an annual expenditure of £3,000. Your Lordships will therefore realise that the setting up of a large chain of ambulance stations throughout London is a very large question financially, and I am sure we cannot blame the London County Council for proceeding with great caution in the matter. Surely it is important to notice that although Parliament did in 1909 give power to the London County Council to set up ambulances, the Act of 1909 will not be affected by this clause in any shape or form. On the other hand, the Act of 1909 is really largely amplified, if not improved, by this clause. Because what does the Act of 1909 say? It enacts that— It shall be lawful for the London County Council to establish and maintain— that is the scheme, I understand, which the noble Lord who has moved this Amendment desires to see carried out— or to contribute towards the cost of or otherwise to aid in establishing or maintaining. From that I read that everything that the London County Council desire to do under this clause they could do already under the Act of 1909. But the obstacle in their way is that the other authorities have no power to agree with them. It may at some time be necessary for the London County Council to organise a big ambulance scheme for the whole of London, but they have come to the conclusion that there is a certain amount of wasted effort now in London which they could make use of, which Parliament has given them the power to make use of in the Act of 1909, but which the other authorities are not at liberty to place at their disposal. Surely it is not unreasonable, knowing as we do that this is an expensive matter, to progress step by step, and to allow the London County Council to make use of any available effort, if they can find any such, in the hands of other authorities before they embark upon the provision of an ambulance station for every district all over Greater London. That is the position as it strikes me. It seems to me not an unreasonable power that the London County Council are asking for. Lord Welby referred to the difficulty of local authorities coming to an agreement upon such a matter, but surely it is not necessary to come to an agreement with every local authority. If the London County Council can agree with one authority, they can, so to speak, earmark the small area which that authority can serve and so provide the public with this accommodation. It is not, therefore, an unreasonable proposition that these local authorities, none of whom has opposed this clause either in the House of Commons or in your Lordships' House, should be given this power, and for that reason I should be sorry to see this enabling clause struck out of the Bill.


My Lords, there is no doubt something extremely attractive in the idea of an extensive ambulance service maintained by the London County Council and covering the whole of the vast area with which that authority is concerned. But in these matters we must, I think, pay some heed to the question of expense, and in spite of the high authority of my noble friend Lord Welby I venture to think that in this case the argument of expense is deserving of consideration. We have been told this evening that to carry out the kind of scheme which my noble friend behind me has in his mind would cost £25,000 a year. It would be a very strong order to impose that expenditure upon the ratepayers of London except in case of proved necessity. Now is there proved necessity in this case? This clause, as the Lord Chairman has told the House, is an enabling clause. It enables, on the one hand, the London County Council to do what is proposed in the terms of the clause and in the Act of 1909; while on the other hand the County Council have power, if they find it necessary, to set up an ambulance system of their own. What we are asked to do is to allow the London County Council to see what can be done in co-operation with these other bodies, but without in any way impairing the discretion of the County Council eventually to resort to a system of their own. In these cases your Lordships should hesitate before you strike out a clause in a Private Bill which has passed the ordeal of both Houses, and in this particular instance I do not think that sufficient case has been made out for taking so strong a step.


In the circumstances I beg to withdraw my Amendment.

Amendment, by leave, withdrawn.

Bill passed, and returned to the Commons.