PUBLIC HEALTH (SCOTLAND) AMENDMENT BILL. (Hansard, 19 November 1925)

LORD BALFOUR OF BURLEIGH
My Lords, this Bill seeks to empower local authorities in Scotland to provide treatment for persons suffering from diabetes. This power is already possessed by local authorities in England under the Public Health Act of 1873, which gives local authorities general powers of the kind; but in Scotland the powers of the local authorities are limited to epidemic, endemic, or infectious diseases, a definition which does not include diabetes. As your Lordships are aware, insulin has proved most efficacious in the treatment of this disease. Insulin undoubtedly has kept alive many persons who would otherwise have died, and has restored to working capacity many people who otherwise, without it, would have been permanently incapacitated.
I understand that in the majority of cases the treatment of diabetes is by means of dieting. It is only in more serious cases that the necessity for insulin treatment arises. But where cases require insulin treatment it is generally for a long period and possibly for the whole life of the patient, and in these circumstances the cost of the drug becomes a serious factor. The cost of insulin is much less than it was when the drug was first introduced, but still in an average case I understand the cost may be as much as 5s. a week, which is sufficient to place the treatment beyond the reach of considerable classes of the community. There are, of course, a large 815 number of people who are able to obtain insulin under existing legislation. Persons insured under the National Health Insurance Acts are able to obtain it as part of medical benefit, persons on the Poor Roll are entitled to treatment by insulin by way of medical relief, and, finally, expectant and nursing mothers and young children under five years of age may also receive it through the medium of maternity and child welfare schemes. The persons who will benefit by this Bill will mainly be such persons as the small man working on his own account and also the wives and children of insured persons who are not entitled to medical benefit under the Insurance Acts.
I have only to add that the Bill is an enabling Bill; it is not made obligatory on local authorities to provide insulin free except in cases where the recipients can not afford to pay anything. The local authorities will make such charge as the recipient can reasonably pay and the Bill will be worked under a scheme approved by the Scottish Board of Health. As your Lordships have on many occasions expressed a dislike of retrospective legislation, it is right to point out that this Bill is to a small extent retrospective, dating back to March 1, 1924. The reason for this is that certain local authorities have, in fact, been providing the drug to a small extent and this Bill is intended to regularise the position.

§ VISCOUNT HALDANE
My Lords, I am entirely in favour of this Bill. The small cost which it imposes ought to be much more than compensated by the saving in health and life which the system should bring about. But I want to ask the noble Lord a question: Who is to provide and administer these drugs, and particularly insulin? It is a dangerous drug for people to handle by themselves and one would like to know that under the vague terms, arrangements to be made with the Scottish Board of Health, the administration of the drug, the quantities and the conditions, are to be under the supervision of somebody less abstract than the Scottish Board of Health. Is it meant that the patient is not to have it by merely asking for it, that the panel doctor or somebody of the sort is to superintend the administration? Perhaps the noble Lord can tell us that.

LORD BALFOUR OF BURLEIGH
The answer to the question is, I think, that this drug will be provided in capsules. It is quite true that it is a dangerous drug, but the quantities in the capsules will be quite definite. When this question was raised in another place the Secretary for Scotland was able to give an assurance that the drug would be manufactured directly under the supervision of the Medical Advisory Council and that, so far as the handling and manufacture of it are concerned, they will be done by properly qualified people. The suggestion was made in another place that provision should be made for the drug to be issued only by qualified people—which I think is the point that the noble and learned Viscount has in mind—and this objection was met by the fact that it is provided in capsules and the danger of any mishaps such as the noble and learned Viscount has in mind is not likely to arise.

§ VISCOUNT HALDANE
I can only speak again by the leave of the House, but it seems to me that to put capsules into the hands of somebody in the country who does not know anything about them would be rather dangerous. He might use half a dozen capsules and as he has to inject the drug subcutaneously he might, so far as I know, inject a great deal too much. However, we have raised the point and no doubt the Scottish Board of Health will see to it.