HL Deb 02 April 1935 vol 96 cc465-82

Order of the Day for the Second Reading read.

LORD LUKE

My Lords, attached to this Bill you will find a Memorandum which contains a brief statement of the reasons for and the conditions of the Bill. This Bill will enable additional hospitals to provide private accommodation or pay beds in wards of one or more beds and thus enable the neighbourhoods they cater for to have the advantages enjoyed by many other parts of the country. There are already 4,600 pay beds as compared with 73,000 ordinary beds in the voluntary hospitals of the whole country, showing that the principle is well established. These pay beds have not been provided at the expense of a reduction in the ordinary beds; they have, in fact, been accompanied by an increase in ordinary hospital beds. The patients requiring these pay beds are those whom the hospital almoner would not usually accept for the ordinary wards but who cannot afford the cost of private treatment in their homes, and urgently require treatment in a hospital, with all its specialised equipment and staff. These patients sometimes have to be admitted to ordinary wards because the treatment cannot be given outside a large hospital. Thus the provision of pay beds should release ordinary beds occasionally used in this manner.

The patients I refer to are not the very poor but are comparatively poor, when faced with the great cost of serious illness or an operation. They are those who are without the benefits of national insurance, and who have sometimes been called "the black-coated poor," and they are certainly very deserving of our sympathy. King Edward's Hospital Fund records show that the proportion of pay beds to ordinary beds in London hospitals is 1,871 to 13,800. For these 1,871 beds, charges of from £2 2s. to £7 7s. a week are made in the case of 1,680, and higher charges in the case of 191 beds. These pay beds have provided advantages not only for the patients who could not afford to obtain facilities elsewhere, but also for the hospitals. The hospitals have profited financially by the surpluses realised, by the fuller use of their expensive equipment, and by the friends they have made among the new classes whom they have served. This has facilitated the maintenance and extension of their ordinary beds. Because of the advantages to both the hospital and the patients, the provision of pay beds has in recent years become recognised as a customary part of the function of a voluntary hospital.

There seems to be no reason why these advantages should be enjoyed only by hospitals whose trusts were settled after this became recognised, and should be denied to hospitals whose trusts were settled at earlier dates, and therefore denied also to the neighbourhoods served by those hospitals. This Bill is designed to provide a simple method of removing these inequalities. The immediate raison d'être for the Bill is that some hospitals in order to provide pay beds have recently had to obtain Private Acts at considerable expense, and other hospitals which wish to provide pay beds are in the same difficulty. The cost of such a Private Bill is at least £500, and it is a pity that hospitals should have to spend their scanty funds in such a manner. If numerous Acts are obtained privately by hospitals it is sure to lead to a lack of uniformity. This Bill provides a uniform method of removing these anomalies whilst the interests of the sick poor are safeguarded by reserving control to the Charity Commissioners, who are the recognised custodians of such interests. This is not the private Bill of an individual hospital enthusiast; it embodies the considered view of King Edward's Hospital Fund and the British Hospitals Association. Those leaders in the hospital world have approved every clause in the Bill. I should, however, mention that the following Amendments in detail will be submitted in Committee: To leave out the words after "made" in Clause 3, line 22, and in Clause 5, page 2, line 43, after "to," to insert "Scotland or to." As there are several noble Lords who will speak, I have only briefly covered the ground, and now beg to move that this Bill be read a second time.

Moved, That the Bill be now read 2a.—(Lord Luke.)

LORD SANDERSON

My Lords, the noble Lord has done so much good work for the voluntary hospitals for many years that I am sure your Lordships will treat with the greatest respect and consideration any suggestion he has to make with regard to the improvement of the voluntary hospitals. We on these Benches recognise that there is not adequate provision for health treatment for the comparatively poor people and even, I would say, for comparatively well-to-do people. There are many sorts of treatment which it is impossible for them to have in their own homes, and many nursing homes are very bad and most of them very expensive. I suppose also that it is becoming increasingly the case that various kinds of treatment are required which cannot possibly be provided in peoples' houses or even in the best equipped nursing homes, the treatment being too costly to introduce and too elaborate. Therefore it is only in hospitals where people of all classes can have certain necessary treatments for illness.

While we recognise that, we have certain rather serious misgivings about the Bill. While we recognise the necessity for better treatment for the comparatively poor people, we are very anxious that the Bill should not be the means of cutting down services for the people who cannot afford to pay. Nearly all the hospitals at the present time have very long waiting lists. I believe that the Royal Infirmary at Edinburgh, which is a hospital which will be affected by this Bill, has an average waiting list of about 3,000. That means, of course, that there are people waiting to get into hospital and who, when they do get in, may have become so ill that the treatment is not effective. A great deal of suffering is, I believe, caused in that way. Then again there are cases—I am afraid fairly frequent—in which patients have to be sent away from hospital before they have fully recovered or, to put it in another way, who certainly would benefit by a longer stay in hospital, which they cannot have because of the pressure for admission by people on the waiting list. We do not want these waiting lists to become longer. We do not want to run the risk of people's time in hospital being cut short so that they are not able to have full treatment. In fact, we do not want the provision of paying beds to be the means of cutting down services for poor people.

I know that Clause 4 (1) lays down that no order shall be made by the Charity Commissioners unless they are satisfied that accommodation for people who cannot afford to pay will not be diminished or restricted. That is all right but there is a qualification immediately afterwards "having regard to the monies at the disposal of the committee of management and the demand for accommodation" by persons who cannot afford to pay charges. That seems to me to be a loophole. It seems to me possible, as that clause stands, for a hospital to reduce its number of nonpaying beds and increase the number of its paying beds. I do not say that would happen, but it might happen. Supposing the income of a hospital was greatly reduced, then according to this clause it seems to me possible to reduce the number of non-paying people admitted and increase the number of paying beds. Supposing you had a hospital of 100 beds, for example, and the income fell off by 25 per cent., would it not be possible for the management committee to say: "We can only take in seventy-five nonpaying people and we can use the other twenty-five beds and make them into paying beds"? It seems to me that might be possible, but perhaps the noble Lord, Lord Luke, will be able to reassure us on that point when he replies.

My noble friends and I are very much dissatisfied with the hospital system or lack of system. We want to see all the hospitals taken over by the municipalities, to see them publicly controlled and kept open for free treatment for everybody who needs it, and to have them supported by the rates. That, I think, is, if I may say so, a better solution of the problem which this Bill introduced by the noble Lord raises. Of course voluntary hospitals have done good work in the past and are doing good work now, but the methods by which they are financed, or largely financed, are, think, most unsatisfactory; they are chaotic and entirely haphazard. It is not right that a great health service like the hospitals should be so largely supported by costly banquets, balls, bazaars, fêtes, and flag days, and very inadequately supported at that. Again, the present system of supporting the hospitals means they are very largely supported by a comparatively few rich people. Large numbers of people who could well afford to contribute to voluntary hospitals; get off scot-free. If these hospitals were put under public control they would then be supported on the principle of ability to pay, which would be far more satisfactory.

It used to be said, I believe, that voluntary hospitals were necessary in order to provide an outlet for the charitable instincts of the well-to-do and the rich, but I do not know that anyone would hold that view now. If they do I would merely say that if all the hospitals were municipalised there would still be ample opportunity left for charity in the true sense of the word. We shall continue to press for the municipalisation of the hospitals, but in the meantime we realise that adequate provision must be made for people who cannot afford to pay, and we criticise this Bill merely on the ground that it seems to us there is a loophole which might lead to the reduction of nonpaying beds, a reduction of the services to the poor, and the substitution of paying beds. That we should very much regret. We think the Bill requires amending so as to safeguard that position and make the position of non-paying patients, of the poor people, absolutely secure. I hope very much that the noble Lord will be able, if the Bill receives a Second Reading, to accept an Amendment on the Committee stage with that object in view.

THE MARQUESS OF READING

My Lords, I will only detain you for a moment or two upon this Bill, which I desire to support. Nevertheless I think it is necessary that we should pay considerable attention to the point raised by the noble Lord who has just spoken. My anxiety in reading this Bill is not with respect to its main purpose, which is to afford greater facilities for paying patients in the voluntary hospitals. The object of the Bill is to enable this to be done by hospitals which hitherto have not been able to do it because of their trusts. I imagine that your Lordships will have no doubt that the noble Lord in introducing this measure is really anxious, for the benefit of the public, to make it possible for those who are not able to indulge in the expense, of a nursing home and do not wish to go into a hospital in the ordinary way but are prepared to pay a moderate fee for what would be good accommodation and no doubt good nursing and. surgical and medical attendance, to do that. There is, however, a part of the Bill which gives me some anxiety and in regard to which I will address a few words to your Lordships.

We must take great care in the Bill that in giving these powers to the voluntary hospitals the effect will not be to decrease the advantages that are given to the poor people for whom these hospitals exist. Some figures were quoted by the noble Lord who has just spoken, and I agree with all he said on this subject. I think he quoted the case of one hospital where there was a waiting list of some 3,000 patients. There are other hospitals, to which attention could be drawn, in a similar position. I think any of your Lordships who have had an opportunity of looking into hospital affairs will realise that over and over again cases occur in which an outpatient is recommended for treatment at once, surgically, as an in-patient and there is no accommodation for that patient as an in-patient, so that consequently the patient has to wait and suffer. We must take care in this Bill that ample power is given to the Charity Commissioners. Clause 4, to which attention has already been directed, does purport to give the controlling power to the Charity Commissioners. I have no desire to take up your Lordships' time in discussing this matter at this moment. Obviously, it will be considered again in Committee.

As I wish to support the Second Reading, I make now only this one observation with regard to the Bill, that when we are considering it in Committee, and when the noble Lord in charge of the Bill has to deal with it, I hope every attention will be given so as to make the powers in Clause 4 as wide as they can be made. I doubt very much whether the words as they actually appear in the Bill are sufficient. There are some possible dangers, and we do want to make certain, notwithstanding that we in this House are in favour of allowing the voluntary hospitals to have these paying beds for patients, that poor people shall not suffer by decreased or worse attention that is at present given to them. I leave that matter at this stage, simply asking that the noble Lord will consult those who may be advising and acting with him, and take steps as far as possible to strengthen this clause so that it is made clear that, it goes sufficiently far to cleat with the matter have indicated.

With regard to the point raised by the noble Lord at the end of his speech, I do not propose to say anything now, because it does not seem to me that it is germane to this Bill. I do not complain of his having raised it, but it is a matter which has been discussed before, and, for myself, I think that so long as we can we should maintain the voluntary system, for it does afford to persons who really-wish to help poorer people the opportunity of supplying funds to the hospitals and in that way of providing all this accommodation. On the whole, it seems to me preferable to have a voluntary system of hospitals rather than a state or local authority system. I wish to support the Second Reading of the Bill.

LORD GREVILLE

My Lords, as treasurer of one of the voluntary hospitals, I should like to say a few words in favour of this Bill. Any hospital which up to the present date has not had the power to take in paying patients has had to apply for a Private Bill. This is a very expensive and a very lengthy proceeding, and if this Bill goes through it would put all hospitals on an equal footing. Anyone, I think, who has had anything to do with voluntary hospitals during the past twenty years will have noticed that we get a very different class of patient attending, or endeavouring to enter, voluntary hospitals—a patient who, perhaps, is accustomed to a certain amount of privacy and quiet, and who is unable to pay the fees of a nursing home, yet who could probably afford his doctor's fees and some small fee towards maintenance. This is a class of person in respect of whom applications to enter voluntary hospitals are being increasingly made every day. It is a class that probably may be taking beds away from those who cannot afford to pay at all. If this Bill goes through it will remove those people entirely from the general ward of a hospital. These extra paying rooms or beds will be supplementary to the ordinary beds in the hospital and will in no way interfere with those who cannot afford to pay, because the patients who go into these paying beds generally are treated by their own doctors and arrange their own fees and merely pay something towards their maintenance.

There is another class of patient that is continually, I am sorry to say, being brought to, our hospitals, a class of patient which even includes members of your Lordships' House. These are the patients that either are taken with sudden illness or meet with some accident in the street. In the hospital which I have the honour to serve there is no accommodation for any accident case except in the general ward, and we have cases of people in all walks of life brought in there. Many of them are perfectly well able to pay full fees to the doctors and full maintenance, and they are in the class of patients who will use these paying beds. I think that in the future there will be a very much larger demand on all hospitals from people who can pay something, and I should like to emphasise very strongly that these paying beds would be extra to the ordinary beds of a hospital.

As regards waiting lists, those are found in every hospital, but the way to overcome that difficulty, as a rule, is to get the patients out to a convalescent home as quickly as you can and fill your beds with fresh patients. As to the question of State hospitals, I do not propose to deal with that to-day, but as one who has been connected for a very considerable time with voluntary hospitals I should be very sorry to see the voluntary hospitals disappear from this country. I hope your Lordships will give a Second Reading to this Bill, which is long overdue and much needed.

THE EARL OF MALMESBURY

My Lords, as another member of your Lord ships' House who has had the privilege for very many years of being closely associated with hospital life and work, I should like to support my noble friend behind me (Lord Greville) who has commended this Bill to your kind sympathy. I do not think that there need be any real alarm on the part of the noble Marquess, Lord Reading, or on the part of the noble Lord who spoke from the Front Bench opposite (Lord Sanderson) that those who are unable to receive treatment other than through the voluntary system will be excluded by the passing of this Bill. If this Bill is passed, it will merely enable something to be done which has been done already in a great many hospitals, and for which there is, day by day, an increasing demand and need. I was very glad to hear my noble friend behind me refer to the importance of the voluntary system. I am convinced that if the voluntary system ever went, and if a national system was substituted for it, it would be one of the greatest blows which the nation could possibly receive. It is impossible to over-estimate the value of the magnificent work which the voluntary hospitals have done, and are doing, with increased effort at the present time. If it ever came about that an official system was substituted for the voluntary system based on skill, sympathy, care and love, the nation would soon realise the difference.

One thing I would like to say is that, as I think we all know, there is an increasing horror—I say it with all respect—of nursing homes. There are, of course, many good nursing homes, I do not doubt that for a moment, but a large number of people have told me that, if they ever had to receive treatment again, they would prefer to go into the paying ward of a hospital. In a hospital with which I am closely associated, there has recently been a big extension, and that extension was made, not only to provide more free treatment, but to provide paying wards in order to meet the increasing need. Naturally, those who go into, the paying wards of a hospital do not expect all the luxuries to be found in the best nursing homes. I support this proposal, not only because paying wards meet a need, but also because I feel sure that they will be a source of definite income to the hospitals.

There is one danger, however, in modern hospital life, and it is an increasing danger. I will tell your Lordships what that danger is. I have come across it, I am sorry to say, more than once. That danger is that there is a tendency for people to get into a hospital and make every attempt to disguise their means. I heard of a case recently—I will not mention the name of the hospital—in which a very expensive treatment was being given. To that hospital there came a patient whose wife said that his means were very small, and he was taken into the ward. It was subsequently discovered that he was a rich man. In these days when every-body wants everything for nothing—and they do not blush when they ask for it—I venture to say that this is a real danger which we have to meet. I hope that whatever Amendment the noble Lord opposite may think fit to move later, the Bill will be given a Second Reading.

THE EARL OF DUDLEY

My Lords, as chairman of one of the large voluntary hospitals in London I should like to add a few words in support of the Bill. There is, however, one point on which I should like to have an assurance from the noble Lord in charge of it. I should like to be assured that the Bill will not in any way interfere with the power to charge varying fees now possessed by the committees of management of some hospitals. I have heard it said—I hope groundlessly—that under Clauses 2 and 3 it is the intention of the Charity Commissioners to say that the limit of charge shall be seven guineas. That would be a hardship, as I think I can show to your Lordships, on patients who now occupy beds at a lower charge. In the hospital with which I am connected we are able to charge fairly high fees for single bedrooms—as high as ten guineas—because people can get there better treatment than anywhere else. If we have to limit our charges to seven guineas, it would mean that we should have to raise the charges to patients who now pay less, because the fee of ten guineas covers, to a large extent, the cost of the beds below seven guineas. It would tend to increase those charges of four, five and six guineas, which we now make, and that would create a hardship. I hope that the noble Lord will be able to give an assurance that that is not the intention.

I should like to endorse everything that has been said by the two previous speakers about the voluntary system. I think it would be a tragedy for this country if ever it were abolished. The sick would, undoubtedly, not get the same treatment which they receive at the present time. With regard to what the noble Lord opposite said concerning banquets and balls and so on, I think he perhaps did not realise that the revenue derived from these sources is a very small part of a hospital's revenue. Such things are very irksome, but we live in days of publicity, and these things bring publicity to hospitals which increases their revenue. If the noble Lord had been more conversant with the situation, I do not think he would have made the remarks he did make. I hope your Lordships will realise that the higher paid beds cover charges which are of benefit to the poorer patients, and that the noble Lord will be able to assure me that this Bill will do nothing to prevent the charging of a fee which, in the view of the committee of management, the patient in question can pay.

THE SECRETARY OF STATE FOR WAR (VISCOUNT HAILSHAM)

My Lords, the introduction of this Bill has obviously aroused interest in all quarters of the House, and I was glad to hear from every speaker an expression of approval of the principles of the Bill and support of the Second Reading. I cannot claim to speak with the same authority as my noble friend Lord Luke, who brings this Bill forward with the support of King Edward's Hospital Fund, and I cannot claim the same intimate knowledge of the work of hospitals as my noble friends Lord Greville, Lord Malmesbury and Lord Dudley. At the same time, I think it would be useful for your Lordships that something should be said as to the Government point of view upon this measure. I have been at some pains to discuss the Bill with the Ministry of Health, and also with my right honourable friend the Attorney-General, and I have been able to ascertain the attitude which they think ought to be adopted towards the measure now before your Lordships' House.

As my noble friend Lord Luke said, there are a number of cases in which already by Private Bill legislation power has been conferred on individual hospitals to have pay beds, and I think—and I rather gather that your Lordships all agree—that a case is made out from the facts which he states as to the desirability of having some beds available for those who are able and willing to make some payment towards the necessary expense of their receiving adequate medical and surgical treatment, and who at the same time are unable to pay the sort of fees which are necessarily involved in their going to any nursing home. It is not an answer to say that those people might be treated in their own houses because, after all, in many cases very expensive and intricate apparatus is required which would not be available unless they went to some hospital or nursing home.

I think, therefore, that the case for paying beds is a case which is made out, and if that case is made out, then I think it follows that the Bill ought to have a Second Reading. At the same time, the Government have already felt the necessity for considering the point which was made by the noble Lord opposite, Lord Sanderson, and the view which we reached was that it was right to provide pay-bed accommodation but that safeguards should be inserted to ensure two things: first of all, that the property and funds of the hospital settled upon trusts for the benefit of the sick poor were protected; that is to say, were prevented from being diverted to any other purpose; and secondly, that the accommodation which would otherwise be available in the hospital for the sick poor would not be restricted; that is to say, that by the introduction of pay beds there should be no risk of preventing poor people from having that amount of accommodation which would otherwise be available for them.

Your Lordships will probably have noticed that under Clause 2 of the Bill it is possible to provide these pay beds by two different methods: first of all, by the erection of new accommodation on land which already belongs to the hospital or which is acquired by the hospital; and secondly, by the use of existing accommodation for providing for the paying patients. It perhaps tends to clarity if those two matters are dealt with separately. So far as new accommodation for the use of paying patients is concerned, it seems to the Government that there would be no objection to such accommodation being erected upon the land owned by the hospital, provided that such land is not required for the general purposes of the hospital and provided that it is made quite clear that the cost of erection must be borne by funds subscribed for the specific purpose of paying-patient accommodation, and that no part of the funds of the hospital subject to charitable trusts for the sick poor may be diverted to that purpose.

With regard, on the other hand, to the existing accommodation of the hospital, there would appear to be no objection to its user for paying patients in so far, and only in so far, as it cannot be used for the sick poor, either because of the lack of demand by the sick poor for such accommodation, or because of the lack of funds to maintain such accommodation and to keep it open for the sick poor. That is to say, that existing accommodation ought only to be used for paying patients so long as there is in regard to it what would be regarded in legal parlance as a failure of the purposes of the existing charitable trusts. Your Lordships will appreciate that under the existing law the Charity Commissioners or the Court may, in the event of such a failure, establish a scheme cy près, and to some extent the proposals in the present Bill may overlap those powers. The Fill, however, will enable the Commissioners to make orders in cases where under the existing law doubt arises whether failure has in fact taken place, or even to anticipate a failure which appears imminent.

I have pointed out those two matters, but my noble friend Lord Luke will no doubt reply that he has made provision in Clause 4 (1)—which was quoted by the noble Lord, Lord Sanderson—to deal with those two matters. While the wording of that subsection would seem to show that the restrictions therein contained are based on the right lines, yet they seem to the Government to be somewhat indefinite in scope and rather difficult of application. We do not feel confident that they will ensure that protection of the trust funds which is desired, and which we know that my noble friend Lord Luke desires just as much as we do.

Another matter which I think it is necessary to raise, and which was touched upon by my noble friend Lord Dudley, is that of the class of patients to be entitled to use the paying patient accommodation. The Memorandum accompanying the Bill states that the demand for paying-patient accommodation arises from the fact that there are many patients who cannot afford the cost of private treatment but are able and willing to pay for treatment in a hospital at charges proportionate to their means. The Bill as drafted provides in Clause 2 (2) that the charges for accommodation and treatment shall be in accordance with the scales specified in the order of the Charity Commissioners. Your Lordships will, however, appreciate that the fixing of charges does not limit the class-of patient to be treated. It would be equally open to the rich man—to whom I think the noble Earl, Lord Malmesbury, made reference—as well as to the person of more limited means, to pay the charges specified in the order. It is suggested, therefore, that it would be right that power should be given to the Commissioners to insert in any order made by them provisions reserving a certain proportion of the accommodation for patients of limited means. In those circumstances your Lordships will appreciate that, while the Government will support a Second Reading of the Bill, I think it is necessary to state now that we shall feel it our duty to move Amendments imposing specific safeguards with regard to the funds and property of the hospital and dealing with the other matters referred to in what I have just said. Incidentally, I may say that care has been taken to ascertain that the Charity Commissioners concur in the views that I have been expressing.

There is only one other matter to which I desire to refer. I may be asked whether the Government will undertake to give facilities for this Bill in another place. I should like very much to be able to say "Yes" to that question, if it were ever asked, but I am sure that your Lordships will appreciate that it is not possible at this stage to give any definite assurance. It is not possible, in the first place because we do not know in what form the Bill will emerge after the Committee stage, and in the second place because we do' not know what the exigencies of Parliamentary time may permit in the other place. But there is just this to be said. The noble Lord opposite indicated his preference for municipal rather than for voluntary hospitals. I am not going to follow him in that discussion. He will forgive me if I say that I do not agree with him, but I am very anxious not to embark upon a controversial topic of that kind because, although he holds that view, he was good enough to say that he regarded this as a useful measure under the existing condition of things. I think it would be a great pity if any difference of opinion which might prevail on that broader question of municipalisation were to threaten to hamper the quick and easy passage of the Bill, making the provision which we all desire, if it can be achieved, and I hope very much that nothing which is said in this House will give any encouragement to those in another place to raise difficulties about the passage of the Bill.

I hope very much it may be a matter about which it may be possible to obtain such assurances that the Bill would be granted a swift passage, so as to make it possible for the Government to find time to help it. I cannot give an undertaking that that will be so, but I feel sure, when I look around and see the powerful support which is given to the Bill from all quarters here, that there is valuable influence which I hope will be directed to obtaining such a smooth passage for the Bill that it will be possible to find time to discuss it. In these circumstances I can only say that we give it our blessing, for what it is worth, on the Second Reading, and I am sure that Lord Luke will appreciate that we desire only to assist the object that he has in view, when I venture to indicate the direction of the Amendments which we shall feel it necessary to bring forward on a later stage.

LORD MACMILLAN

My Lords, I would like to thank my noble friend the Leader of the House for the very sympathetic reception which he has accorded, on behalf of the Government, to this beneficent and useful measure. The Bill has really, I venture to say, two qualities which ought to commend it to all who are interested in the great work of our hospitals. It has a technical and a legal aspect, which has been alluded to by the Leader of the House, and also a philanthropic aspect. On the philanthropic side there is one point which I would like to bring before the House which is perhaps not fully appreciated. Owing to the very great strides made in medical and surgical science in recent years, the methods of treatment have become much more expensive than they formerly were, and consequently have been placed beyond the reach of many persons who would greatly benefit by receiving such treatment. Suffering knows no class and knows no incomes. It is a visitation which may befall any person, and we, who are responsible for the administration of the hospital system, feel that these means, which the hospitals alone can provide, should be available for all persons, without distinction of class or income. It has come to pass at present that in great hospitals probably better means are now provided for the treatment of sickness and illness than can be had in the best nursing homes, and why should not these means be made available to others who will benefit by them also? That sums up the philanthropic aspect of the Bill—that we desire that nobody should be unable to benefit merely because he is embarrassed with regard to money.

On the legal side what appeals to me is this. The position is really quite chaotic. Some hospitals have full power to provide paying beds. They may go on and carry on their beneficent work without obtaining the consent of the Charity Commissioners. Others are perplexed with doubt. They do not know whether they have power or not. They have to obtain the opinion of Counsel, and indulge in other such expensive luxuries to ascertain their position. Others are quite sure that they have not the power, because of prohibitory words in their charters or constituent documents. This is an anomalous position. We hope that under this Bill it will be possible to bring about a measure of uniformity, and that it will be possible for all hospitals to know where they are in this matter. It has been a feature of our legislation that a General Bill has often been preceded by a number of Private Bills. In this connection several of the hospitals which required these powers came forward and at their own cost got Private Bills. That is an expensive practice, but five or six such measures already stand on the Statute Book. The theory on which this Bill proceeds is that the time has now come for a general measure, and that private hospitals should be relieved of the cost of obtaining Bills for themselves. Those are the two main features.

May I say that I share entirely the anxiety voiced from all quarters of the House that nothing in this measure contained should in any way deflect the hospitals from their great work of ministering to the poor. If that had been even its possibly indirect effect I think this House might take it that the Bill would not have had the support of the two great organisations for which I speak, the King Edward's Hospital Fund and the British Hospitals Association. We have studied the case most carefully. We have endeavoured to secure the most adequate safeguards and I can assure the House that we are in no sense wedded to any particular formula; that those interested in the promotion of the Bill will be in no sense obdurate to any suggestion which may be made. We are most anxious to see that, so far from infringing in any way the primary purpose of the hospitals, these powers will enable the hospitals to do more good.

There are many instances where hospitals have found themselves in the position of having to close down some of their wards owing to shortage of money. In these cases we would be able, with the help of the money derived from paying beds, to reopen wards now closed, and possibly also to expand premises where expansion is needed. The purpose of the Bill is in no sense inimical to the primary purpose of the hospitals, but we believe it will enable them to extend more widely their beneficent services. We shall be most happy on the Committee stage to consider any suggestions which come from this House, which has shown itself so friendly disposed to this measure, because it is manifest that the principle of the Bill is accepted, and all we desire is to make it as workmanlike, as satisfactory and as safe as it can be made. I will only conclude by thanking the House for the reception which it has given to the measure.

THE EARL OF DUDLEY

Before the Second Reading may I press for an answer to my question, whether it is proposed in the Bill to limit the committees of management who at present have rower to charge for paying beds—to limit their powers to less than the scale which they are at present charging?

LORD MACMILLAN

May I say on behalf of Lord Luke that the point is this. The initiative of getting a scheme from the Charity Commissioners is left to the hospitals, and therefore the hospital which already has power will not require to apply for a scheme.

LORD LUKE

My Lords, I beg to thank the House for its kindly reception of this Bill, and I hope we shall be so fortunate as to find time in another place. My experience is that the opening of paying beds has not on the whole reduced the number of beds for the sick poor, but increased them. I would also like to mention with regard to the voluntary hospitals, that many people do not quite realise the magnitude of the finance that would have to be contemplated if we were deprived of them. The actual expenditure in the voluntary hospitals in this country amounts to some £12,000,000 a year.

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