§ LORD MERTHYR had given Notice that he would ask His Majesty's Government how many county councils in England and Wales have failed to formulate arrangements for securing that medical officers of health shall not engage in private practice as medical practitioners, in accordance with the provisions of Section 58 of the Local Government Act, 1929, and of Section 111 of the Local Government Act, 1933; and what steps are proposed to be taken for ensuring the observance of the law by such councils; and move for Papers.
§ The noble Lord said: My Lords, in asking the Question which stands in my name this afternoon I am pleading for a reform, but, unlike most persons asking for a reform, I neither seek nor require any new legislation. The legislation required already exists, and I am only asking that this existing legislation shall be put into force. The point which I raise, I venture to say, is a not unimportant one, and I also hope I am not wrong in saying that it is one which will perhaps command the sympathy of noble Lords opposite, as well as of members of the Party which really passed the Local Government Act. There being no legislation required, I think I can deal with the merits of the question comparatively briefly. The gist of the point is that no local practitioner in a county district shall engage in private practice while at the same time serving his district.
§ I think that we all have due and proper respect for medical officers and for their profession, but they would be the first to admit that they are not supermen, and that they cannot really serve at one and the same time two masters or interests, very frequently conflicting. If I may give an example of that I find it very difficult to believe that a conscientious medical officer can, let us say, enter a small cottage in a rural district one day and treat his patient, and expect in due course to be paid by his patient, when perhaps in the following week it may be his duty to go into that same cottage on behalf of his local authority, and to say that it is unfit for human habitation and that the family must consequently leave. I confess that I see a considerable difficulty there for a conscientious medical officer. It seems to me that if, as must 688 frequently happen, the interests of his patients therefore conflict with the interests of his local authority, it is only natural that the interests of his patients will be placed first and those of his authority last.
§ One more reason that I would like to give for the merits of this point is that specialists are required in local government, as nowadays in other walks of life. It seems to me that it should be quite unnecessary for a medical officer to know more than the merest details about surgery, while on the other hand he should be steeped in the law of public health, and I wonder how many of our present part-time medical officers in small rural districts are really conversant with all the branches of public health law.
§ Passing to the existing legislation, in 1929 there was passed, as we all know, the Local Government Act of that year, and Section 58 of that Act said in the plainest terms that county councils should formulate a scheme under which medical officers subsequently appointed should not engage in private practice. Then followed in 1933, four years later, a further Local Government Act, Section 111 of which said, if I may translate it into colloquial terms: ''If you have not done what we told you to do four years ago, do so now." Another four years have passed, and it has come to my knowledge that in one or two counties at the least this mandate of this 1929 Act has not been obeyed—in how many counties I do not know, and I am very anxious to know. The local authorities are not alone to blame. I venture with great respect to say that it is surprising that the Ministry of Health have not at an earlier date put into force the powers which are given to them under both these Acts of Parliament, for each of them says in the relevant section that if six months after a demand made by the Ministry of Health to the county council has not been complied with, then the Minister may carry out the work himself, after consultation with the county authority.
§ I would like to ask the noble Viscount who will reply if he can tell us why it is that these powers have not universally been put into force, if indeed they have not; and, if they have not, when it will be that they are set upon their way. I 689 would like to know, if it is possible for me to be told, in how many cases this formal demand has been actually made, if it has not been made in every case; and further, if possible, in how many cases it has not yet been complied with. I have tried to think what objection there can be on behalf of local authorities to complying with this Act. I can think of only one at this moment, and that is a financial objection. I admit that it is one which should have serious consideration, but I think there is a tendency on the part of county councils to ignore the benefits which may accrue from putting legislation into force. They think only of the extra burden on the rates. They are inclined, I think, to forget the advantage which the county districts will derive from the increased efficiency and improvement of the public health and, in particular, the housing of their districts. After all, this is a question of the health of the people, and it seems to me not the best of subjects in which to cut down expenditure, or to refrain from increasing expenditure if there be a need for it. I said "cut down expenditure" and I did not use the word "economy" because I do not think it is an economy to cut down the expenditure on such a subject as the health of the people of this country.
§ Finally, may I just mention the legal aspect? I think we all have a due and proper respect for the law. Anybody who has that must feel a little uneasy, I think, when he comes across such a situation as this, where a great Act of Parliament introduced by the Government, which passed through your Lordships' House and which came into force no less than seven years ago, has not yet been put into operation in all parts of the country. There is a saying—and indeed there is some truth in it—that to get an Act of Parliament passed is only half the battle, and I am afraid that this rather bears out that statement. If there is some good reason for not putting this Act into operation, then the question should arise whether it ought not to be repealed in some measure or in respect of some part of the country. I say, "if there is a reason"; I know of none. But I think that "Enforce or repeal" is a motto that might be applied to this and to similar situations. If I could have some enlightenment on these points I should 690 be very much obliged. I think it is a matter of some substance, and if nothing-can be done we should be plainly told whether this section of the Act is to remain unrepealed on the Statute Book. I beg to move.
VISCOUNT GAGEMy Lords, the first question asked by the noble Lord is the number of county councils in England and Wales which have failed to formulate arrangements for securing the employment of whole-time medical officers in accordance with Acts that he has quoted. The answer to that question is that out of sixty-one county councils in England and Wales, twenty-seven have so far failed to complete the formulation of such schemes. The noble Lord may perhaps feel the situation is even worse than he fears, but I think he would be making a mistake if he deduced from those figures that there has been a serious breakdown in the administrative machinery. The principal cause of the delay is the fact that the review of county areas which was initiated in 1929 has proved to be a very big operation, and there are still certain counties that have not entirely completed their review in every particular. I think your Lordships will appreciate that it is not easy to devise a scheme for furnishing medical services to particular areas until it is certain what those areas are going to be.
Moreover, the relations between the Ministry and the local authorities have to be maintained with discretion. Speaking as a member of local authorities myself, I sometimes feel that there are many of us who are very glad to welcome the use by the Minister of his default powers in matters of which we approve, and very often would resent strongly the use of those powers in matters with which we are not in agreement. Nevertheless, while it will be generally agreed that local authorities ought to be given as free a hand as possible, there must obviously be a limit. The noble Lord was perfectly justified in the general argument he put forward, and I can assure him that my right honourable friend fully appreciates the importance of compliance with the requirements of this section at as early a date as possible. It has been his practice, as soon as these county reviews have been completed, to draw the attention of the county councils to the statutory obligation resting on 691 them in this respect. In spite of appearances to the contrary, he is satisfied that the majority of these twenty-seven councils who have not formulated schemes are taking steps to do so. In the case of only three counties does it appear to him that a position has arisen which amounts to failure to comply with the requirements of the section. He has addressed a letter to one of them requiring the council to formulate arrangements, and if after six months they have failed to do so the Minister will himself form a scheme in pursuance of his "in default" powers. In the event of continued failure to carry out their obligations in the matter the Minister will not hesitate to exercise his power to formulate the arrangements in place of the county councils.
I have answered the two precise questions which the noble Lord has addressed to me, but I may also draw attention usefully to one or two points that arise out of the discussion. In the first place, the county council remains responsible for making this arrangement after consultation with the councils of the county districts in the county. It is preferable that agreement should be secured if possible, but my right honourable friend takes the view that the county council should formulate such arrangements as seem to them most suitable for securing the objects of the section. After that has been done no more part-time medical officers can be appointed except with the special consent of the Minister. That, as the noble Lord is aware, is in the Act. The second point is that the section does not require that all vacancies shall be filled in the manner of the formulated arrangements. There may be cases, by reason possibly of circumstances which have arisen since the formulation of the arrangements, where the services of a medical officer restricted from private practice can better be secured by other means.
Thirdly—and this is a point perhaps overlooked by my noble friend—it has been argued in certain cases that the appointment of a whole-time medical officer to cover a district at present served by several part-time officers must be delayed until all the part-time officers have finished their contractual periods 692 of engagement. It has been further argued that, as these part-time officers are all unlikely to finish their periods of engagement at the same time, this delay is likely to be still further prolonged. In order to overcome this difficulty as far as possible, provision was included in the Regulations issued by the Minister last year, called the Sanitary Officers (Outside London) Regulations, 1935, to limit future appointments of medical officers of health who are not restricted from private practice to a period of not more than one year at a time, and a similar limitation of the period of appointment has for some years past been imposed by administrative action in all such cases. It is hoped in this way to facilitate the appointment of medical officers of health restricted from private practice in all parts of the country in accordance with the intentions of Section III of the Local Government Act, 1933. I hope I have satisfied the noble Lord that, though progress may be rather slow, it is going steadily on. It never was contemplated that this reform should be carried out in a short time; but, provided the progress is steady, we feel that the purpose of the Act is being served.
LORD MERTHYRMy Lords, I have very few words to add. I should like to thank the noble Viscount for the information he has given me and for the completely detailed answer he has made to the Question I have asked. I am sure that some people, at any rate, will be glad to hear that there is no danger of the Ministry acting in any tyrannical way in this respect. Whilst I appreciate the points which the noble Viscount has raised, I think on the other hand there will be some people in the country who will be a little uneasy at the rate of progress. I have in mind, for example, an area in which there would be more than enough work for one whole-time medical officer to perform, and in which all the present part-time officers are on temporary appointments, the original permanent appointments having terminated since the passing of the Act. In that area, therefore, it seems to me the whole of these temporary appointments could now be terminated and a full-time man put in. That is a case 693 which I know exists. I beg leave to by leave, to withdraw my Motion.
§ Motion for Papers, by leave, withdrawn.