§ Order of the Day for the House to be put into Committee read.
THE PARLIAMENTARY SECRETARY OF THE MINISTRY OF HEALTH (THE EARL OF ONSLOW)
My Lords, in moving that the House do now resolve itself into Committee, I should like to say one word on the subject of the White Paper to which attention was drawn by the noble Lord, Lord Strachie. I promised him I would look into it, and I would like to inform the House that the Paper was placed on the Table on April 4, so that it was in the possession of the House, though not actually on the Table, when the debate on the Second Reading of the Bill took place.
§ Moved, That the House do now resolve itself into Committee.—(The Earl of Onslow.)
§ On Question, Motion agreed to.251
§ House in Committee accordingly.
§ [THE EARL OF DONOUGHMORE in the Chair.]
§ Clause 1:
§ Further provision with respect to arrangements for treatment.
§ 1.—(1) Where the council of any county or county borough has, before the passing of this Act, made arrangements for the treatment of persons suffering from tuberculosis (including persons insured under the National Health Insurance Acts, 1911 to 1920) at or in dispensaries, sanatoria, and other institutions in accordance with the scheme approved by the Local Government Board or the Minister of Health, or, in the case of Wales, under an agreement made with the King Edward the Seventh Welsh National Memorial Association and approved by the Welsh Insurance Commissioners or the Minister of Health, that council shall, for the purposes of this Act, be deemed to have made adequate arrangements for the treatment of tuberculosis so long as such scheme or agreement, with such modifications, if any, as the Minister may On the application of the council from time to time approve, continues in operation. For the purpose of the foregoing provisions an application made by the King Edward the Seventh Welsh National Memorial Association with the approval of a council shall be deemed to be an application of the council.
THE EARL OF ONSLOW
The first two Amendments standing in my name are purely drafting. The object of all my Amendments to this Clause is to set out more clearly the position in Wales.
§ Amendments moved—
§ Clause 1, page 1, line 13, leave out from (" Health ") to (" that ") in line 17
§ Clause 1, page 1, lines 19 and 20, leave out (" or agreement ").—(The Earl of Onslow.)
§ On Question, Amendments agreed to.
§ LORD O'HAGAN moved, in subsection (1), after "modifications" to insert "and extensions." The noble Lord said: At this late hour I shall best consult the convenience of the House if I state briefly the reason for my Amendment and ask for an assurance upon a point already mentioned to my noble friend. As to the Amendment it is unfortunately probable that in many instances the alterations required in existing schemes and arrangements for providing institutional and dispensary treatment will be in the nature of extensions. It is feared that the word "modification" does not cover "extension" and that therefore alterations required on this latter ground are not provided for. Perhaps my noble friend can give me an assurance on this point. The other matter is this. In this clause there does not appear to be any safeguard that in the consideration 252 of these schemes, or in the modification of existing schemes, the National Health Insurance Committees will have the right to make representations. The functions which are now being handed over to county councils and borough councils regarding institutional treatment have been discharged hitherto by the sanatorium benefit sub-committees of the county health insurance committees, and, as I have had the honour of serving on one of the county insurance committees for some years, I have been asked to raise this point. These committees have been in existence for nearly ten years and, as a result, they naturally are more fully cognisant of the requirements of the counties in regard to institutional treatment and dispensary treatment than the county councils or borough councils, or any other body, and it does not seem unreasonable to ask that when these arrangements are made, and when the schemes are about to be modified, that they should have the right to make representations. Take for instance the County of Essex. At the present time formal agreements have been entered into between the national health insurance committee and the county council and the borough council of East Ham providing for 82 beds. On March 31 of this year, I understand, there were no fewer than 180 patients receiving treatment, and of those about 86 were ex-Service men. Additional provision has been made, by an arrangement with the county council and the East Ham Borough Council, for 57 beds. The insurance committee provide the balance of 41. This clause, it would appear, does not ensure that the additional accommodation which is required at the present moment shall be continued in the future. I think this is an illustration showing why the bodies I have described should be given the right to make representations when these schemes are being approved by the Ministry of Health, or are being modified, and why my Amendment is necessary.
Page 1, line 20, after (" modifications") insert ("awl extensions").—(Lord O' Hagan.)
THE EARL OF ONSLOW
Perhaps I had better take first the last point raised by my noble friend. He said that when any modifications of schemes are being considered at the Ministry (being proposals from the local authorities) the insurance committees should have the right to make representations. I do not think it is necessary to make that a statutory right.
253 If insurance committees have anything to say on these matters their opinion would, of course, be most welcome to the Ministry. I can assure the noble Lord that any representations received from the insurance committees would have the most careful consideration, but I do not think it is necessary to make that statutory by including it in the Bill. Obviously representations from such bodies would be most opportune.
As for the Amendment of the noble Lord, I venture to suggest that it is unnecessary. The clause provides that arrangements for treatment shall be deemed adequate if they reach a certain minimum standard. It is clear that any extension of the arrangement must raise the standard above the minimum, and such extended arrangements would, therefore, be not merely adequate, but more than that, according to the standard laid down by Clause 1. Moreover there is nothing to prevent a council extending its scheme, of course with the approval of the Ministry of Health, if it chooses to do so. It is only where it desires to modify a scheme—that is to say, make some alteration in the character of the arrangements— that the approval of the Minister is necessary in order to secure that the modification made is not such as to reduce the standard below the minimum. In these circumstances I hope the noble Lord will consider that his point is met.
I am much obliged to my noble friend. I am sure the committees concerned will be glad of the definite public assurance given by the noble Earl that they have the right, and that it is desirable that they should exercise it, to make representations on the occasions to which I have referred.
§ Amendment, by leave, withdrawn.
§ Amendments moved—
§ Page 1, lines 22 to 23, leave out (" For the purpose of the foregoing provisions") and insert (" In the application of this subsection to Wales an agreement made with the King Edward the Seventh Welsh National Memorial Association, and approved by the Welsh Insurance Commissioners or the Minister of Health shall be treated as equivalent to a scheme approved by the Minister of Health, and")
§ Page 1, line 24, leave out from (" by") to (" Association ") in line 25, and insert (" that "). —(The Earl of Onslow.)
§ On Question, Amendments agreed to.
§ Clause 1, as amended, agreed to.
§ Clauses 2, 3 and 4 agreed to.254
§ Clause 5:
§ Joint committees.
§ 5.—(l) For the purpose of facilitating co-operation between county councils and county borough councils, in the exercise of the powers conferred upon them by any enactment to make arrangements for the treatment of tuberculosis, the Minister may, by order, with the consent of the councils concerned, make such provision as appears to him necessary or expedient, by the constitution of joint committees or otherwise, for the joint exercise by such councils of their powers in relation thereto, and any such order may provide how, in what proportions, and (nit of what funds or rates, the expenses incurred by such councils are to be defrayed, and may contain such consequential, incidental, and supplemental provisions as may appear necessary fur the purposes of the order.
§ THE EARL OF ONSLOW moved, in subsection (1), after "of "["such councils of their powers in relation thereto "] to insert" all or any of." The noble Earl said: This Amendment has been suggested by the Association of Municipal Corporations, and I understand that it will be acceptable also to the Association of County Councils. The object is to enable the Minister, with the consent of the councils concerned, to constitute a joint committee of county councils and borough councils for the general exercise of any of the powers of the councils in relation to the treatment of tuberculosis. It was pointed out that it may be desirable for councils to combine in the exercise of certain of their powers in relation to tuberculosis, although they might not wish to have a joint committee for the exercise of the whole of their powers. Consequently, it is thought desirable that the clause should be as elastic as possible. The Ministry has no hesitation in agreeing that this Amendment is desirable.
Page 3, line 16, after (" of ") insert (" all or any of ").—(The Earl of Onslow.)
§ On Question, Amendment agreed to.
§ Clause 5, as amended, agreed to.
§ Clause 6 agreed to.
§ THE EARL OF ONSLOW had an Amendment on the Paper to insert a new clause after Clause (6). The noble Earl said: It is proposed to insert this clause in accordance with an undertaking which was given by my right hon. friend in another place. I should perhaps preface what I have to say- by stating that there are one or two alterations to the clause as it appears on 255 the Paper. These alterations are thought desirable by those who have promoted the clause. One of the alterations is purely drafting. I will, with your Lordships' permission, read the clause as I propose to move it. It will read—
§ Further provision with respect of treatment of seamen.
§ 7.—(1) The minister may by order constitute an advisory committee for the purpose of assisting the council of any county or county borough in making arrangements for the treatment of any persons suffering from tuberculosis who are masters, seamen, or apprentices to the sea service or the sea-fishing service.
§ (2) An order under this section may provide
- (a) For the representation on the said committee of any society approved under the National Health Insurance Acts. 1911 to 1920, more than three-fourths of whose members are such masters, seamen and apprentices as aforesaid, and of the council of any county or county borough having a substantial number of such masters, seamen and apprentices resident within their area, and may contain such other provisions as may appear necessary to the minister for giving affect to the order; and
- (b) if the governing body constituted under subsection (6) of section forty-eight of the National Insurance Act, 1911, as amended by section twenty-seven of the National Health Insurance Act, 1918, agree to contribute, out of the special fund referred to in the said subsection (6), towards the expenses of the said committee, for the appointment by the governing body aforesaid from among their own members of representatives on the said committee of all such societies as aforesaid.
§ (3) An order made under this section may be revoked or varied by another order so made.
§ The terms of the amended new clause have been agreed to by members of the House of Commons who are more particularly interested in the requirements of the seamen. The object is to constitute a Committee which will pay special attention to their case and secure adequate treatment for those suffering front tuberculosis. The councils will be expected to provide for such treatment, and there is no reason to anticipate that they will not do so; but the proposed Advisory Committee may perform a useful function in seeing that tubercular seamen are properly dealt with. Subsection (2) provides for the constitution of the Committee, and subsection (2) paragraph (b), contemplates the possibility that the body formed to administer what is known as the Lascar 256 Fund may possibly desire to appoint members.
After clause 6 insert the said new clause.—(The Earl of Onslow.)
§ On Question, Amendment agreed to.
§ Remaining clauses agreed to.
§ Schedule agreed to.