PUBLIC HEALTH (SCOTLAND) AMENDMENT BILL. (Hansard, 30 July 1924)

§ LORD MUIR MACKENZIE
My Lords, this Bill is to extend the powers of local authorities in Scotland so as to enable them to provide for the use of the lately discovered drug, insulin, in cases of diabetes where the person is a poor person and unable to go to the expense of providing himself with this valuable remedy. That is the main purpose of the Bill; it deals with cases for which insulin has been found to be valuable. I believe it is a direct mitigation even if it is not always a remedy. In addition to that, there is a provision dealing with such other diseases as the Board may by order prescribe, and in regard to which, in the opinion of the local authority, persons require assistance. That, of course, is extending the Bill beyond its main purpose, but it is thought that this would be very useful and make it unnecessary to come to Parliament in the event of some new remedy being found. There are some further supplementary provisions, one of which is important, as providing a safeguard that the orders shall not be too hurriedly and immediately passed in such a case, but I think I have said sufficient to justify me in asking your Lordships to read the Bill a second time.

§ VISCOUNT YOUNGER OF LECKIE
My Lords, if this Bill had stopped as Lord Muir Mackenzie has said at the question, of providing for the treatment of diabetes there would have been no- objection, I am sure, from this side of the House. Your Lordships will agree that where the Board of Health in Scotland has asked for this power to supply a particular medicine to those who are not able to afford it this power should be granted. But I think this creates a, precedent in regard to other non-infectious diseases of that kind, and in this respect it places the whole burden upon the local authority 87 and does not bring in the central authority, as in the case of tuberculosis and diseases of that sort. But when the noble Lord proposes that we should pass a Bill that would extend those privileges and place those burdens upon the local authorities in regard to a number of unnamed diseases, then I join issue with him at once, and I hope that the House will not agree to that particular part of the Bill. I propose to move in Committee that the words which bring in the other diseases should be omitted, together with a consequential clause which follows with regard to the necessity of Resolutions being passed by the House of Commons.
This is a very serious matter, and I do not know why it should be regarded so lightly by the noble Lord opposite as it appears to be. In this Bill, not only do you import every kind of infectious disease into the system and place, in my opinion, a burden upon the local authorities, but the local authorities also have power, if they choose, to build hospitals, and so on, for the purpose of treating those diseases. They may make such arrangements as they think proper for the purpose, and a wholly impossible burden will be placed upon the local authorities. It seems to be the fashion now to place all kinds of burdens upon local authorities. Those of us who have to pay the rates know very well what that means. There is no margin left, especially where demands are made upon the land. T think, therefore, that we require to look-very narrowly at all these proposals.
Above all things, the precedent is one which ought not to be extended beyond the particular point concerning which everyone is agreed. It is no use saying that subsection (2) of Clause 1 is any protection. It may be a protection against the. folly of placing some non-infectious disease on this list which there is no necessity to include, but it is no protection whatever against the local authority being involved in this possible expense if the proposal is approved by the House of Commons. To that extent I think this is an unfair burden to place upon the local authorities, and I hope that this House will object. I am glad, indeed, that the Second Reading of this Bill should pass. Its history is well known. It was asked for in connection with diabetes by the Public Health authorities in Scotland, and it was originally an ad hoc Bill. Now it 88 is nothing of the kind. No doubt it is still to a certain extent permissive, but it is not an ad hoc Bill since it has been widened beyond its original purpose. It is to this extension that I very strongly object.

§ THE LORD CHANCELLOR (VISCOUNT HALDANE)
My Lords, I think the noble-Viscount has put the case too high. This is not a Bill which puts any obligation upon the local authority. It only enables the local authority, with the approval of the Scottish Board of Health, to make such provision for diabetes as may be urgently necessary. I have known cases in my own experience where an unfortunate man, doomed by the local doctor for want of special treatment, recovered his health within six weeks as soon as he was properly treated in a way that was not locally possible without assistance. There are other diseases of the same kind. Take, for example, diphtheria, where the treatment may be very urgent. It is not an expensive matter to provide the proper toxin. There are one or two diseases where the treatment has to take place at once, and the toxin or anti-toxin required must be immediately available. When you consider that this is nothing more than a power given to local authorities to provide in cases of very grave urgency, and does not impose any obligation, I think the noble Viscount will agree that he is unduly alarmed at the prospect of the burden which may be placed upon the ratepayers. After all, the local authorities are the people who know the circumstances best and are specially fitted to look after their own ratepayers.

THE DUKE OF BUCCLEUCH
My Lords, my noble friend Viscount Younger has raised no objection to the Second Reading of this Bill, nor has he raised any objection regarding treatment for diabetes. He confines his objection to these other diseases. The noble and learned Viscount on the Woolsack says that it is entirely left to local authorities. I think that is somewhat doubtful, because the Bill reads— or such other diseases as the Board may by order prescribe. "Prescribe " is a very strong word. In an earlier part of subsection (1) of Clause 1 the Bill says that local authorities shall have power— 89 to make such arrangements as they may think fit and as may be sanctioned by the Scottish Board of Health. So far as I can see, under this Bill the local authority might be able to build hospitals, or to take any other steps of that kind. The noble Lord, in moving the Second Reading, stated that the main purpose of the Bill was the treatment of diabetes, and I hope that when we reach the Committee stage the Government will accept the Amendment which will be moved by my noble friend Viscount Younger, to confine the Bill to that purpose. I cannot speak with authority, but I think I am more or less correct in saying that, if the Bill is passed in that form, it will be much more satisfactory to the local authorities than it is at present. I understand that a very large number of them have requested that it should be in that form, and I am also under the impression that it would probably meet the requirements of the Scottish Board of Health.
This is, at any rate, a very wide question, and it raises the very important point upon which I think that every local authority will agree, that no assistance is to be given by the central authority. I am informed that it is calculated that the treatment of diabetes will not cost a very large sum per annum, and I do not think, therefore, that the local authorities will object to that part of the Bill. But it is a very wide extension to bring in these other diseases, and, if they remain in the Bill, they may lead to the expenditure of hundreds of thousands of pounds without any assistance from the Exchequer. I do not think that such a provision should be put into a Bill of this kind, and I hope that my noble friend will be successful when he moves his Amendments.
As regards the safeguards provided in the Bill, I should like to point out to your Lordships that, although the House of Commons has power to object to the orders that may be prescribed by the Board of Health, your Lordships under this Bill have no power whatever. I certainly think that, if the Bill remains as it is, both Houses should be put on an equal footing. We have no wish to impede the Second Reading of this Bill, but there is a very strong feeling on this side of the House and, also I believe, in the country, that it should be restricted to that which my noble friend described 90 as the main purpose of the Bill—namely, the treatment of diabetes.

§ LORD MUIR MACKENZIE
My Lords, the remarks that have been made have really anticipated to a great extent that which I thought was likely to take place in the Committee stage of the Bill, but I dare say that, before that stage arrives, I shall have been furnished with such persuasive arguments from the Scottish Board of Health that I shall be able to maintain the Bill as it stands.