HL Deb 20 December 1927 vol 69 cc1212-26

Order of the Day for the Second Reading read.

VISCOUNT GAGE

My Lords, I beg to move the Second Reading of this Bill. It is a Bill of some importance. It emanates from the Report of the Select Committee set up in the House of Commons in the summer of last year. That Committee heard evidence from a very large number of sources and came to the conclusion that there was a real need for the registration and supervision of nursing homes throughout the country. The Government concurred with that conclusion and this Bill is the result. The special points that emerged in the evidence given to the Committee were, firstly, that the premises of many nursing homes were structurally defective and unsuitable for the purposes to which they were devoted; secondly, that they needed supervision, particularly that class of nursing home that caters for poor and senile patients; and, thirdly, that the accommodation of the nursing staff was often seriously defective.

I might perhaps quote one passage from the Report of the Committee as follows:— The Society of Medical Officers of Health state that they are convinced of the urgent need for registration of maternity homes and still more, for the registration of other nursing homes, that the registration of all nursing homes is a most necessary corollary to the registration of maternity homes and that privately-owned nursing homes form the source of constant complaint to medical officers of health all over the country, but no powers exist, at present, whereby such complaints may be investigated and the matter put right. There was other evidence, of a rather sensational kind, which led the Government to believe that legislation was absolutely essential. I may point out that already there is an Act which deals with the registration of maternity homes, the Midwives and Maternity Homes Act, but the Select Committee came definitely to the conclusion that registration and supervision of maternity homes should be part of one comprehensive scheme covering all nursing homes. The present Bill, accordingly, repeals Part II of the Midwives and Maternity Homes Act, 1926, and brings the supervision of maternity homes within the scheme for nursing homes generally.

The chief objections to this Bill have not centred round the principle that some kind of supervision should be exercised. It has been urged that steps should be taken to prevent the unauthorised nursing home exploiting the public, and that has been more or less admitted. But there have been considerable criticisms of the machinery proposed whereby the inspection may be effected. If your Lordships would turn to Clause 8 it would perhaps be convenient, because this clause defines the local authorities who will administer the Act. Following the principles adopted in the Midwives and Maternity Homes Act and the recommendation of the Select Committee, it is proposed that the county councils and county borough councils should be the local supervising authorities. This is largely to ensure that the medical inspection should be of a high standard, but after considerable negotiation in another place, it was agreed that the smaller authorities shall not necessarily be excluded from the administration.

The case was argued that there were many non-county boroughs of a large size more suitable to deal with these nursing homes within the boundaries of the non-county boroughs than the county councils. The Bill therefore proposes that the county council may delegate its powers to a district council and there shall be an appeal to the Minister of Health if the district council is aggrieved by the refusal of the county council so to delegate powers. This compromise has been reached after prolonged negotiation and my right hon. friend hopes that it will be agreed to in its present form. It will be observed that by entrusting the duties of registration and supervision to local authorities the Bill avoids undue centralisation of machinery.

If your Lordships turn to Clause 1 you will see that it provides that all nursing homes must be registered and lays down the method of application for registration and the qualifications which are necessary for registration to be granted. I do not think the clause needs very much explanation although it is a rather long one. There is a special proviso dealing with existing homes and there is exemption of homes from the necessity of having a qualified nurse in charge provided that the person who superintends the actual nursing has the necessary qualifications. Clause 3 prescribes in detail the notices which the local authority must give if it is proposed to refuse an application for registration, and subsection (3) of that clause provides that any person aggrieved by such a refusal may appeal to a Court of Quarter Sessions. The Select Committee, I think, recommended that such appeals should be submitted to a referee appointed by the Minister of Health, but the Minister prefers that appeals should be heard by a Court of law. Clause 4 empowers local authorities to make necessary by-laws in regard to records and notifications. Clause 5 is an important clause dealing with the inspection of nursing homes. In accordance with the recommendations of the Select Committee the duty of inspection will be carried out by officers of the local authority, but there is a proviso that there shall be no inquiry into the medical record of any individual patient. That is designed to ensure the necessary privacy for patients under treatment. In Clause 6 there is a provision, again following the recommendation of the Select Committee, enabling a local authority to grant temporary exemption to establishments of a charitable character. Appeal against refusal to exempt is in this case also to the Minister of Health.

Perhaps I may call attention to a clause which was inserted following this clause in respect of Christian Science nursing homes. This clause was inserted in the House of Commons in response to considerable demand. It will be noted that there are special restrictions laid down in the case of these homes. The applicants will have to satisfy the Minister that the home is a bona fide Christian Science home and it will have to be described as a "Christian Science house." The intention of the Minister in putting those conditions into the Bill was that the State should not take responsibility in any way for the treatment given in these homes and that the patient should realise before going into the home that it was a Christian Science house. The requirement that the house should be so described was inserted in the Bill so that no mistake should be made. Clause 10 defines nursing homes and excludes from the operation of the Act certain classes of institutions. In Clause 11 provision is made by paragraph (iii) for the repeal of local legislation. The object of that is to secure that in future registration of nursing homes and maternity homes should be governed by one comprehensive Act, as proposed by the Select Committee.

I have dealt with this Bill perhaps rather rapidly, but I hope what I have said is sufficient. The Bill is submitted to your Lordships as affording adequate safeguards against abuses which undoubtedly exist without unduly interfering with well-conducted establishments or impairing the privacy of treatment. It makes use of existing machinery and is in many ways complementary to existing legislation. The Bill aims at ensuring a better standard in nursing homes from the point of view of management, of structure, of accommodation, of equipment and of staffing. I hope that it will commend itself to your Lordships.

Moved, That the Bill be now read 2a.—(Viscount Gage.)

VISCOUNT HALDANE

My Lords, in different circumstances I should have wished that we might have taken time to discuss various incidental topics which arise, such as Christian Science exemption, the delegation to district councils and various other details. But this is what impresses me: the Bill is an extremely valuable one and it would be a public misfortune if it were to be lost. I have been carefully through it and I have consulted experts, and the desire is universal that it should pass into law as quickly as possible. It is founded on a careful Report made by an expert Committee. It is a Bill that is wanted to raise the level of these nursing homes to such a condition as makes them compatible with safety. I am not going to say a word more than is necessary at this hour when your Lordships are pressed for time. I will only say, speaking for myself, that I am very anxious that, late as it is in the Session, this Bill should pass.

LORD HARRIS

My Lords, there is another point of view which you are entitled to take as regards this Bill. This is an instance of the Government—no doubt pressed by worthy people—thinking it necessary to impose registration upon these nursing homes. I dare say it is very possibly necessary. The matter has been carefully considered by a Committee of the House of Commons and the result is this Bill. There is no question, where the Government imposes this class of work on the county council, of the expense that will fall upon the ratepayers. There is no suggestion in the Bill that the Government will contribute anything. As a matter of fact, in other cases of mental homes and so on, the Government contribute sometimes as much as one-half, but I cannot see in this Bill any provisions for pecuniary help from the Government. The whole cost is thrown upon the rates, except such fees as the authority can collect, I suppose for registration. I bow to the judgment of the noble and learned Viscount opposite, and I am not prepared to oppose the Bill, as I have been requested to do by my own County Council in Kent and by another council from which I heard yesterday. They both assure me that the County Councils' Association strongly oppose some of the provisions of this Bill. The noble Viscount who moved the Second Reading referred to negotiations that had taken place. I suppose that the blessed word "compromise" comes in here again, and that this Bill is the result of negotiations, possibly with the County Councils' Association.

What I have to point out to your Lordships is that this Bill is in one particular a retrograde measure. Clause 8, as originally introduced, provided that county councils should be the supervising authorities for the purposes of the Bill within their respective areas, and this was following the previous practice regarding similar homes. But now the Bill allows the county council to delegate their responsibility to a minor authority, and furthermore, if the minor authority wants this delegation, they have the right to appeal to the Minister to override the county council. I assure your Lordships that this is absolutely contrary to previous practice. The noble Viscount has told your Lordships that the Government are anxious that maternity homes and nursing homes should be brought under one Act, and therefore they propose to repeal certain words in Part II of the Midwives and Maternity Homes Act, 1926. I should like to call your Lordships' attention to the fact that the Departmental Committee which reported on the working of the Midwives Act, 1902, reported strongly against any delegation by county councils of their powers in relation to midwifery. The Committee stated that the practice of delegation had been found— to operate detrimentally to the purposes of the Act, and to introduce elements of confusion and uncertainty into administration. Following this Report, Parliament, in 1918, repealed the earlier statutory provision enabling county councils so to delegate their powers. The orders of Parliament only nine years ago are now going to be upset, and we are going back to the possibility of a difference of treatment in different places and to the delegation of powers to subordinate authorities.

I imagine that this Bill has had very little chance of being considered fully by the county councils, but I am given to understand through the medium of the County Councils' Association, that many councils are opposed to it. It comes up at a very late period of the Session, and there are, as the noble and learned Viscount opposite says, various provisions in it which certainly ought to be discussed. Take, for instance, the length of time that may elapse after notice has been given to close a nursing home. The period seems to me to be very short. If the home is a bad one it ought to be closed as early as possible, but what about the people inside? They have to be moved somewhere and some time will have to be given to them and their friends to find other quarters. Again, this is a penalising Bill. It provides for a fine of £50 for offences. Then there is an exemption, of which no explanation was given by my noble friend below me, of Christian Science nursing homes from the provisions of the Bill. Why should they be exempted? Those are my objections to the Bill, which I think would occur to anybody who peruses it, but I do not think that they are of such material importance as to justify my carrying out the wishes of the county councils which have addressed me, and I am not prepared to oppose the Second Reading.

LORD DAWSON OF PENN

My Lords, I agree entirely with the noble Lord who has just spoken that there is by no means a universal approval of this Bill. On the contrary, there is considerable divergence of opinion not only among the laity but among the professional men who will have to carry the Bill out. To my mind, the sole justification for the Bill is that the Committee of the House of Commons did disclose very serious abuses which had occurred in certain nursing homes in various parts of the country. These places were being used for improper purposes and the public were being exploited, and I think that everyone who studied the Report will agree that there was an aggregate of abuses that justified action on the part of the Government. But so far as improvement of nursing homes goes, I look from a professional point of view with considerable scepticism on the idea that you are going to improve them by any system of inspection. The best way to improve nursing homes is to assist the building of proper institutions. In proportion as you do that, inefficient nursing homes will go out of existence. That is actually taking place at the present time. Larger institutions are being built and inefficient homes are being compelled to go out of business.

I think it necessary to draw your Lordships' attention to the very considerable powers which this Bill gives. Under Clause 1 the authority may refuse to register an application if any person employed at the home is not a fit person either by reason of age or otherwise. This is left entirely to the discretion of the inspector. Then it is stated that the application may be refused if for reasons connected with situation, construction, accommodation, staffing or equipment, the home or any premises used in connection therewith are not fit to be used for a nursing home. … and so on. The drafting of the Bill is such that it gives powers of a most extensive character, and unless those powers are used with great discretion they might lead to an intolerable tyranny. I ask myself what sort of inspectors it is hoped to obtain for work of that character. The local authorities will certainly not be able to pay a large enough salary to get efficient inspectors. They will be forced back on what I might call the ordinary wooden type of inspector, a very worthy person with a very limited outlook. It is obvious that the medical officer of health himself cannot undertake work of this character, but must employ other persons for the purpose, and it is quite easy to see that, instead of getting a living inspection that would give inspiration and encouragement and lead to a real improvement, you will get that pettifogging form of inspection which does harm rather than good.

To show that there is some truth in that, if one asks anybody connected with that most important of all services, the maternity service, you will be told that it is the most difficult thing in the world, or rather that the difficulties of obtaining educated women to undertake the work of midwives is increased by the difficulty of finding those who will tolerate the frequent interferences and inspections and annoyances, to which they are put by well-meaning but rather narrow-minded inspectors. One of the obstacles to the improvement of the midwifery service is the fact that already the inspection provided in that service is far from what one would wish from a broad-minded point of view.

Next, I must draw your Lordships' attention to the incidental evils which result from legislation of this kind. Is it not obvious that the more you put the medical profession, and its appurtenances and machinery, under local authorities, the more easy you are going to make it to municipalise medicine in this country? I can quite understand anybody who is in favour of a universal State service in medicine being in favour of this Bill. I should advise them to vote for it, because you are providing machinery by this Bill which enables interference of all kinds to be undertaken which will, I think, control, and I think control unwisely, the practice of medicine in the various districts. If that control were placed in the hands of what I may call a modern and enlightened authority there would be less objection to it, but it is a fact that the machinery of the health services in this country has been outgrown by the number of services. I am the last person in the world to give the smallest impression that I wish to criticise medical officers of health. Far from it. They are able men and conscientious public servants, but if you take the last few years you will see, year by year, new services being set up which are placed on the shoulders of the medical officers of health, who are responsible to the local authorities—even, it may be, to a rather small authority. You are placing therefore in the hands of a perhaps very imperfectly informed local authority, great responsibility and wide discretion, which I think they are ill-fitted to bear.

I venture to suggest that if Bills of this kind are going to be brought in which add to the powers of local authorities, it will be increasingly necessary that the machinery of health in the district should be altered, and that in some way machinery should be set up which would correspond to the education committees in the counties and county boroughs. The bringing in of this Bill brings home to one the large powers which are being conferred by Parliament, and draws attention to the fact that it gives opportunities to those who wish to bring about municipal services, to do so by stealth, for that is taking place year by year. If your Lordships will compare the amount of what I may call official medicine with the amount of official medicine twenty years ago, you will find that more and more of what I may call the practice of medicine is getting under the control of the official world. If this Bill would lead to a consideration on the part of the Government of whether the time has come for bridging over that gulf between the men who practise medicine and who constitute the majority in this country, and the officials, who are increasing—if you were to bring those two sections together and then were to establish a health committee with power of co-option on the same lines very much as the educational committees which now exist, then good might result.

I return to the point with which I began. This Bill, I think, has round it many dangers, but I think the real case for the Bill, and what would lead me not to push my opposition too far, are the agreed evils disclosed by the Committee of the House of Commons—evils so great that I think, whatever may be done in the future, I can quite see there is a good case for passing this Bill, if it is only to prevent the abuses existing in and around about the country.

EARL RUSSELL

My Lords, the noble Lord began and ended his speech by referring to the great and admitted evils which this Bill is intended to cure. In the course of his speech he complained of the drastic and large powers given in the Bill. But he cannot have it both ways. If you want to cure those evils you must obviously have adequate powers for dealing with them, but it is necessary, as he says, that those powers should be well and reasonably administered, as of course it is the intention of the Government, and of the supporters of the Bill, that they should be. That brings me to my first objection to the Bill as it stands, and that is the power of delegation. You have two delegation clauses in this Bill—Clause 11, delegation for London, and Clause 9, delegation for the country. In the country you are going not only to give power to the county council to delegate to district councils, which I think in itself is undesirable, but to allow this authority to compel delegation, if the Minister of Health thinks fit. I think the district council is a very small authority, and that the number of them in the country fit and proper to have such powers delegated to them is very small. The power would be much better left with the county council, particularly because the powers are drastic and because they will have to be exercised in a common sense way, and with the minimum of friction, and also possibly against strong vested interests.

Under Clause 11 you give the London County Council power to delegate to the Metropolitan Boroughs everything in this Act except power to make by-laws. I think you do not under Clause 11 give any compulsory delegation to the Metropolitan Boroughs, but you do allow this delegation. Could anything be more undesirable in London, which after all is more or less of a unit, than that nursing homes should be differently administered in different parts of London, and that a nursing home in Marylebone should be subject to different restrictions and a different kind of inspection from a nursing home in, let us say, Mayfair or Lambeth? I think that is most undesirable. I feel very strongly about that, and unless some good reason is given I should be very much disposed when we come to the Committee stage, if we have any time at all to deal with it—I may be told that it is too late to move any Amendments—to move the omission of those clauses.

May I now refer to the most amazing clause in the Bill, Clause 7? I do not know whether to call Christian Science a religion, or a faith, or a practice that appeals to people, with whom I am bound to say I have no sympathy myself. It is neither Christianity nor science, and in this Bill it is given a clause to itself, and is to be granted exemption from the operation of this Bill in respect of any nursing home. What on earth does that mean? Does it mean that a nursing home which performs the ordinary functions of a nursing home, that is to say, in which there are nurses and doctors, and in which there is medical attendance, is to be exempt from the operation of this Act if it is run by Christian Scientists? Or does it mean that a Christian Science home is to be exempt on the ground that it is non-medical and that no medical treatment is given there?—because I think I am right in saying that one of the articles of their faith is that Christian Science is superior to doctors. If it means non-medical I would very much rather that it exempted homes where no medical treatment was given, instead of advertising this dreadful religion, if it is a religion. And then, not satisfied with that, you say that the home is to adopt and use the name of "Christian Science house"; it is to be officially labelled with that label. Why? No reason has been given by the noble Viscount who moved the Second Reading. I understood him to say that a request was made to the Minister, to which he acceded. But why is this particular curious brand of religion to be given this particular name in this home, and to be exempted? If it is non-medical say it is non-medical, and put it on that ground; but that does seem to me a clause of the most objectionable character.

Then there is quite a small point in which I dare say the Bill is right, and that it the paragraph of Clause 10 which states that a nursing home is not to include "any institution for lunatics within the meaning of the Lunacy Act, 1890." Of course, the House is aware that it is very much desired that incipient lunatics at any rate should be treated at early stages, and in the view of the Royal Commission it is very desirable that they should be treated in the ordinary surroundings of ordinary ailments, when that is possible. I think this would not prevent treatment of that sort, because a person in that condition would not, I think, be a lunatic within the meaning of the Lunacy Act, and if and when, as I hope may some day be the case, legislation is introduced to deal with that, no doubt any amendments that are necessary may be made to this Bill. But I do feel strongly on these points, and unless I am given satisfaction on them I shall certainly raise them again in Committee.

THE MARQUESS OF SALISBURY

My Lords, I do not complain for a moment of the noble Earl's speech, which appears to me not only to be as able as his speeches always are, but very moderate and very fair. There is no reason to complain at all of the debate, but undoubtedly the Bill has been exposed to a good deal of criticism from quarters to which we are bound to pay attention. The noble and learned Viscount the Leader of the Opposition was good enough to say that the Bill was on the whole so good that he would not interfere with its passage at all, although, of course, he might very properly, if he thought fit, take exception to certain of its provisions. The noble Earl has criticised the Bill severely, and so also has the noble Lord, Lord Dawson of Penn, who speaks on questions of this kind with very great authority. The broad defence of the Bill is quite clear. These nursing homes are very often very much to be criticised. Some of them are definitely scandals, others certainly require very careful supervision. If that is so the rest of the main provisions of the Bill follow as a matter of course. You have to have the homes registered, and you have to have inspectors, because without inspectors there is no security that the provisions which you insist upon will be carried out. Therefore the main provisions of the Bill follow as a matter of course in exactly the same way as they did in the case of the Midwives Bill, on which your Lordships were engaged last year or the year before, and which you thought fit to pass into law.

Therefore the main argument for the Bill is quite clear, and it is only when we come to details that there are difficulties. Lord Dawson has made some very severe criticisms on the details, and he did, I thought, very much hesitate as to whether inspection was right, but I think he will see himself that if you are to have any kind of control you must have inspection. Then, if you are to have these things run on a county basis, it must be under a county medical officer, or somebody appointed by the county. That is the provision of the Bill. I am quite aware that a question arises when you come to the delegation clause, about which the noble Earl has just spoken. Undoubtedly there you may criticise not only the fact that the power is delegated from the counties to the districts in certain circumstances, but you may specifically criticise the fact that that carries with it the inspection of a district medical officer, instead of a county medical officer. But all I am trying to show is that the thing is quite consistent; it all works upon an obvious plan. All the points which were urged by the noble Earl in his criticism were points which really are Committee points, and undoubtedly we must postpone them till the Committee stage. He asked me whether there would be any Committee stage. Yes, I hope your Lordships will allow the Committee stage to be taken to-morrow.

EARL RUSSELL

No, I did not ask whether there would be a Committee stage. I said I supposed I should be told that at this period of the Session it would be hopeless to propose Amendments.

THE MARQUESS OF SALISBURY

May I say in the most straightforward manner that, as far as I am concerned, I am going to put no pressure whatever upon your Lordships to abate your rights in these matters. I realise that this Bill has been brought before you at a time which makes the exercise of your functions very difficult, and I shall try to do my utmost to give every opportunity which the time still at our disposal would give us to enable your Lordships to exercise your functions in any way you think fit. I do not say that I shall, on behalf of the Government, agree with all the Amendments which your Lordships may suggest, but I do not want in any way to limit the power of your Lordships to act on this Bill as you would on any other Bill. No, I hope that the noble Earl will raise these points in Committee, and we shall, of course, answer them and deal with them when they are raised.

I should, however, like to say one word upon the criticism which he made of the Christian Science clause. May I say with very great respect to the noble Earl—for he knows I have a great respect for him—I do not think that he is quite entitled to say what he did say as regards Christian Science views of religious matters? I do not share them at all, but at the same time I quite recognise that people are entitled on these difficult subjects to their own opinions, and when you have a very large body of opinion which does not believe in medical science at all, then it appears to be very absurd to subject them to limitations which involve the provision of medically-trained persons in the homes to which this Bill applies, and it would apply to them unless they were exempt. How could it possibly work? You would have practically to forbid a Christian Science nursing home if you placed them on the same footing as others. For those reasons it appeared right to my right hon. friend in another place to make this exemption. If the noble Earl wishes to raise that point in Committee he will do so; but that is the broad answer to his question. I hope your Lordships will give a second reading to this Bill and that the Committee stage will be allowed to-morrow. I am bound to say that I was going to propose to your Lordships that the other stages should also be taken to-morrow. I desire to repeat in the most emphatic manner that if there is any influential body of opinion in your Lordships' House which would wish not to proceed in that hasty way, I will not put any pressure on behalf of the Government on the House. It is only with their consent that I propose to proceed. I recognise the right of noble Lords opposite, I recognise most especially the right of my noble friend Lord Harris to raise these questions of the delegation by the county to the district.

LORD HARRIS

And the costs.

THE MARQUESS OF SALISBURY

And the costs if he likes, although that does not, perhaps, come so much within the purview of your Lordships as the rest of the Bill.

LORD HARRIS

It comes within the Government's purview.

THE MARQUESS OF SALISBURY

It certainly comes within the Government's purview, but my noble friend is aware of the limitation under which we discuss questions of cost. That is the position. I do not desire to detain your Lordships any longer to-night and I ask you to give the Bill a Second Reading.

On Question, Bill read 2a, and committed to a Committee of the Whole House.