NATIONAL HEALTH SERVICE BILL.

HL Deb 17 October 1946 vol 143 cc346-94

4.9 p.m.

Order of the Day for the House to be put into Committee read.

Moved, That the House do now resolve itself into Committee.—(The Lord Chancellor.)

On Question, Motion agreed to.

House in Committee accordingly:

[THE EARL OF DROGHEDA in the Chair.]

Clause 1 agreed to.

Clause 2:

Central Health Services Council and Standing Advisory Committees.

(3) The Minister may, after consultation with the Central Council, by order constitute standing advisory committees for the purpose of advising him and the Central Council on such of the services aforesaid as may be specified in the order, and any committee constituted under this subsection shall consist partly of members of the Central Council appointed by the Minister after consultation with that Council as being persons of experience in those services and partly of persons, whether members of the Central Council or not, appointed by the Minister after consultation with such representative organizations as the Minister may recognize for the purpose.

(4) It shall be the duty of a standing advisory committee constituted under this section to advise the Minister and the Central Council upon such matters relating to the services with which the committee are concerned as they think fit and upon any questions referred to them by the Minister or Central Council relating to those services, and, if the committee advise the Minister upon any matter, they shall inform the Central Council, who may express their views thereon to the Minister.

LORD MORAN moved to leave out subsections (3) and (4) and insert: (3) The Central Council may, if the Minister so approves, appoint standing advisory committees for the purpose of assisting them in such manner and subject to such conditions, if any, as they may direct, in the exercise of their functions under subsection (1) of this section in regard to all or any matters relating to particular services provided under this Act. Any such standing advisory committee may consist either wholly of members of the Central Council or partly of members of the Central Council and partly of other persons being persons of experience in the particular service or services with which the committee is concerned.

The noble Lord said: In moving the Amendment which stands in my name, I trust that my inexperience in Committee procedure may not obscure whatever merits this Amendment may have. At the beginning of my remarks I associate myself with what the noble Lord, Lord Llewellin, said on the Second Reading. I am very anxious to make this Bill of some worth, and I do not wish to be associated with any Amendments which he called "wrecking Amendments." I am moving this Amendment simply for the purpose of strengthening the Central Health Services Council. When this Council was proposed by the Minister it had a very tepid welcome from the profession. I think the profession felt that it was simply another of the old advisory committees which in the past Government Departments have set up and which have sometimes seemed, no doubt wrongly, to be largely for the purpose of persuading people that the best brains of those connected with the particular profession were being sought. In spite of misgivings the Negotiating Committee desired, with regard to this new Advisory Committee, that it should be as strong and as influential as it could be, and they were successful in that the Chairman was to be appointed by themselves and also that they would be able to report annually—a printed report on their proceedings.

In many ways, I think the Minister is perfectly justified in claiming that this is not a committee comparable to the old advisory committees of the past, but as time passed it was found that the Central Health Services Council had become swollen. It contained forty-one members, and not only was it unwieldy in that respect. It was apparently the result of later trying to please various sections. Here I must say that this Bill has been singularly free from that fault of trying to meet sectional interests at the expense of the community. In this particular example I think it was perhaps a little unfortunate that the committee was allowed to grow to forty-one in number. The second thing that seems to prevent it from effectively working was that it was proposed, apparently to overcome its large number, that there should be a number of standing advisory committees. These standing advisory committees were to be appointed by the Minister, and to report direct to him, though, at the same time, they would report to the Council.

The difference between the Bill as it stands and my Amendment is that in the Bill, as I have said, the Minister appoints standing committees and they report direct to him. In my Amendment the Council appoints these standing committees—they are really sub-committees in my Amendment—and they report through the Council to the Minister. Is that, or is that not, a vital distinction? I think it is vital because it is obvious that any Minister who is faced with a committee of forty-one and who has an alternative committee of eight or nine experts, will naturally turn to the experts, deeming the matter too detailed to be dealt with by a large body If that should happen, obviously the Central Health Services Council will simply become one of the old advisory committees. In other words, there is a general feeling throughout the profession, and the General Negotiating Committee are quite unanimous, that if the Bill is passed as it stands the standing committees will do the work and the Central Health Services Council will largely be robbed of its chief function. Does it matter whether this is done or not? Would it be just as well for the standing committees to do this work as for the Central Health Services Council to do it? I think the first question we have to ask ourselves is why in the profession was this Central Health Services Council put up at all? The answer to that is that there is a general feeling that if the experience of those in the profession, who are actively engaged in the practice of their profession, could be brought to the service of the Ministry of Health, there would be a great gain to the country. At the present time, those actively engaged in the practise of their profession play very little part in administering the service, and it was hoped this Central Health Services Council would be a means by which those engaged in active practice could take an active part, not only once or twice a year, but in every important thing that came before the Minister of Health concerning health.

The Minister of Health in another place has tried to define what this Central Health Services Council could do, and what the standing committees could do, and he raised as an example that the Central Health Services Council could not give him advice on putting up a gynæcological service. May I just take his example? I ought to say that a practising gynæcologist and a practising obstetrician are generally one and the same person. At the present time, there is a dispute in the profession; the British Medical Association feels that every single practitioner on the Register should have the right to attend midwifery cases. The Royal College of Obstetricians and Gynæcologists feel that only a practitioner who has had special training should be allowed to attend confinements. Supposing this dispute—and both feel very strongly on this point—has to be referred to the committee of gynæcologists the answer is not in doubt, but it would not bring conviction to the profession generally. Surely a matter like that is a matter which should go to the Central Council to adjudicate between these two sections of the profession. Therefore, I say it is extremely difficult to say in advance what the standing committees should deal with and what the Central Health Services Council should deal with.

One last point in that connexion. The Minister, when he deals with general practitioner matters, has got into the habit, and the right habit, of consulting the British Medical Association. He has not yet established an equally healthy habit of consulting the bodies which represent the consultants and the specialists in this country. If this Bill is going to be a success we must associate the profession with it and we must make the profession feel they are responsible for its success. If you have this Central Health Services Council imbued with the feeling that the success of the whole scheme depends upon it, then I think there is some chance, with the profession behind it, that it will work really well. If the Council starts from the beginning with the feeling it is being by-passed and has very little say in the matter, then you will have the feeling that the Minister is indeed consulting a few specialists and not really a body representing the profession. I beg to move the Amendment.

Amendment moved— Page 2, line 5, leave out subsections (3) and (4) and insert the said new subsection.—(Lord Moran.)

4.17 p.m.

THE LORD CHANCELLOR (LORD JOWITT)

My Lords, the Amendment moved with such a weight of authority as this Amendment carries with it must obviously deserve very serious consideration, but, having given it consideration, we do not feel it is an Amendment that we ought to accept. I have to sit twice a week nowadays on a body which consists of not quite twenty members, and we find that the only way we can possibly get through our business is to refer a very large number of more or less specialist or technical questions to sub-committees with power to act. I do ask your Lordships to consider whether we have not here got the best set-up. We have got a Central Health Services Council and there is a power in the Minister to appoint standing committees, but before appointing standing committees he has got to consult with the Central Health Services Council. There may be many of these standing committees of course, and they may advise on all sorts of technical questions, and it may frequently be necessary to act with some speed. Therefore, we have provided that the standing com mittees shall report to two people. They may report direct to the Minister but they shall also send a copy of their report to the Central Council, so that the Central Council, in their turn, have a chance to consider the report of the standing committee and make such observations as they think appropriate upon it. I submit to your Lordships that that really is a better set-up than a Council of forty-one which, if only by reason of its very numbers, is bound to be rather an unwieldy body.

Let me take an illustration. The noble Lord gave one with regard to which I say at once that where you have got something which is a matter of dispute within the profession, it would obviously be improper for the Minister to act merely upon a sectional report of the specialists upon that subject, without waiting for the report of the whole Council on the report of the standing committee. But suppose it is a question simply with regard to some matter of dentistry. Is it really necessary that we should wait for the report of the forty-one members, of whom, for instance, two are registered pharmacists, one a midwife, two registered nurses, and two persons who are experienced in private service, and so on. Is it not right in a case like that that a standing committee should have the right to report to the Minister direct, sending a copy of their report to the Central Health Services Council, so that if there is any wider aspect of this thing which conflicts the Health Council themselves shall be able to pass the report of the standing committee?

That is the set-up which we have embarked upon here. It is really not in the least that we want to embarrass or disregard the services of the Central Health Council. We entirely agree that it is of the utmost importance that we should make it really effective and bring it into play, but it is in the nature of things rather an unwieldy body. We submit that our set-up is the right one, that the standing committee should report both to the Minister and the Central Council, so that the Central Council can make what observations it likes on the report of the standing committee. It is for that reason, and not because we want to belittle the authority of the Central Council, that we do not see our way to accept this Amendment.

LORD MORAN

The noble and learned Lord, the Lord Chancellor has made a point of detail. We are absolutely agreed that the Central Council should not deal with details. The only point is whether the Central Council should decide what detail is, and should then refer it to the committees. We are only asking that this Central Council should be a body which would appoint its own sub-committees and, like every other body, deal with detail in that way rather than by this unusual procedure by which committees which are not really sub-committees are appointed by somebody else. However, in view of what has been said by the noble and learned Lord, I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

THE EARL OF MUNSTER

On Clause 2 there is just one point about which I should like to ask the noble and learned Lord, the Lord Chancellor. The duties and responsibilities of the Central Council can be found in subsection (1) of Clause 2 and in subsection (5) of the same clause. They are obliged to make an annual report to the Minister, and that report will be laid before Parliament with such comments as the Minister sees fit to make. That is followed by a proviso which says that the Minister, after consultation with the Central Council, if he is satisfied that it would be contrary to the public interest to lay such a report before Parliament, may refrain from so doing or may refrain from laying part of that report before Parliament. I wonder if the noble and learned Lord can tell us what it is which might be found in the annual report of the Central Council which it would be contrary in the public interest to lay before Parliament.

THE LORD CHANCELLOR

It is difficult to conjecture, but the sort of thing we have in mind is this. There may, of course, be matters connected with war. That is an obvious illustration. There might also be a question of a rather promising discovery made with regard to a great disease, say, cancer, and I can well understand it being undesirable in the public interest to let it out too soon. However, apart from rare cases of that sort I do not think that this proviso will have to operate, so long as peace remains.

THE EARL OF MUNSTER

I take it that if particular information was not published, the Minister in his comments to Parliament would say that he had withheld one part of the report.

THE LORD CHANCELLOR

Yes.

Clause 2 agreed to.

Clause 3 agreed to.

4.25 p.m.

Clause 4:

Accommodation available on part payment.

4. Where there is provided in any hospital, as part of the hospital and specialist services, accommodation in single rooms or small wards, the Minister may make any such accommodation, which is not for the time being needed by any patient on medical grounds, available for patients who undertake, or in respect of whom an undertaking is given, to pay for the accommodation such charges, designed to cover part of the cost thereof, as may be prescribed, and the Minister may recover those charges.

THE LORD CHANCELLOR moved to leave out "prescribed" and insert "determined in the prescribed manner" The noble and learned Lord said: This is a little more than a drafting Amendment. I wish to leave out "prescribed" and insert "determined in the prescribed manner." I do not actually want to prescribe the amount but the method by which the amount should be arrived at. I beg to move.

Amendment moved— Page 3, line 34, leave out ("prescribed") and insert ("determined in the prescribed manner").—(The Lord Chancellor.)

On Question, Amendment agreed to.

THE EARL OF MUNSTER moved, at the end of the clause, to add: "and where there is provided in any hospital any such accommodation as aforesaid such accommodation shall be maintained and shall not be converted into larger rooms or wards." The noble Earl said: This Amendment of mine is really one to seek some information from the Government. Under Clause 4 as it stands at the moment the Minister may in the case of single rooms make them available for persons who are suffering from some serious illness or disease in certain circumstances, all of which are enumerated in the clause. What I am anxious to ensure is that the voluntary hospitals, and indeed the nursing homes, which already have small single rooms should not find, after the passing of the Bill, on instructions from the Minister, that the small rooms are to be abandoned, that the walls of the cubicles, if I may so describe them, are to be knocked down and the rooms are to be made into one large ward.

I agree every time, and there can be no dispute about this between us, that the health of the people in hospitals is absolutely vital, and if a small private room is necessary for a particular case of illness, then the Minister should have power to grant it. However, what I am concerned about is that the powers which the Minister now possesses are so large that he can decide to abolish all the small rooms in Guy's Hospital, in St. Mary's Hospital, and all the other hospitals and convert them into one large ward. As I say, my main purpose is to get information on the point from the noble and learned Lord. I beg to move.

Amendment moved— Page 3, line 35, at end, insert ("and where there is provided in any hospital any such accommodation as aforesaid such accommodation shall be maintained and shall not be converted into larger rooms or wards").—(The Earl of Munster.)

THE LORD CHANCELLOR

I think I can give the noble Earl the information he wants. Whilst on one hand I am sure he would agree that it would be quite impossible to tie the Minister's hands in regard to reconstruction and alterations that may be necessary, there is no intention on the Minister's part on a wholesale scale to knock down cubicles and go in for a principle of large wards. I should imagine privacy plays a very important part in the curing of these cases. I can give an assurance that these rooms will not be converted, or otherwise sacrificed, unless this is found really necessary in the interests of the services provided by the hospital as a whole, or in the wider interests of the whole co-ordinated hospital service. As the noble Earl will agree, we cannot foresee what is going to happen, and there may be cases where it does become necessary. I cannot, therefor, tie myself absolutely, but I can reassure him on the point that we have no intention of making a series of small rooms into one large room except where that is necessary. The noble Earl cannot really expect us to tie our hands in the matter, and I hope after that assurance he will be content to withdraw his Amendment.

THE EARL OF MUNSTER

I am naturally obliged to the noble and learned Lord, but I still have a great fear that on account of the enormous shortage of hospital accommodation at the present time the Minister may find himself in the position that he is forced to go into many of these hospitals and remove the whole of the private accommodation and turn small rooms into one large ward. However, in view of the noble and learned Lord's assurances, which I naturally accept, I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

Clause 4, as amended, agreed to.

Clause 5:

Accommodation for private patients.

(2) The Minister may allow any medical practitioner serving on the staff of a hospital providing hospital and specialist services to make arrangements for the treatment of his private patients either at that hospital or at any other such hospital, and may make available for that purpose the special accommodation aforesaid, and in that case the charges prescribed under the last foregoing subsection shall not include the cost of any services rendered by the medical practitioner, and regulations may prescribe the maximum charges to be made and recovered by any such medical practitioner in respect of the treatment of his private patients under this subsection.

THE LORD CHANCELLOR

My Amendment to this clause is the same as that which I moved just now—to leave out "prescribed" and insert "determined in the prescribed manner", in order that we may specify the manner and not the actual amount.

Amendment moved— Page 3, line 41, leave out ("prescribed") and insert ("determined in the prescribed manner").—(The Lord Chancellor.)

On Question, Amendment agreed to.

4.30 p.m.

LORD LLEWELLIN moved, in subsection (2), to leave out "serving on the staff of a hospital providing hospital and specialist services" The noble Lord said: This Amendment, upon which the one following it on the Order Paper is consequential, is to leave out the words "serving on the staff of a hospital providing hospital and specialist services." If this Amendment is agreed it will allow a doctor to follow his patient into a hospital even though that doctor is not a specialist on the staff of that hospital, and—more important than that—allow a patient to continue under the same doctor. That is the point of view from which I look at it. If a patient who is admitted to hospital has been attended by one doctor, it is important that that patient should be allowed to have that doctor attending him or her even though he (the medical practitioner) may not be serving on the staff of that particular hospital.

This is an Amendment to which we attach very great importance, because what we all want to do is to ensure that patients have the doctors who suit them best, and the doctor who suits a patient best is surely the one who knows that patient's past history and who has his or her confidence. He should, therefore, go on attending that patient even though he may not happen to be on the staff of the hospital. If this Amendment were not carried, any patient who wished to continue with a specialist not on the staff of the hospital to which he might be admitted would have to go into a nursing home and pay extra fees. But these patients will have paid fees which would entitle them to hospital treatment, so I think they ought to have the benefit of their own doctor even though he, the doctor, is not serving on the staff of that particular hospital. I am not, I hope, one who ever wastes the time of your Lordships' House. That is the short point of this Amendment, which is an important one. We regard it as important from the point of view of the patient, and I very much hope that the Government will be able to accept it.

Amendment moved— Page 4, line 4, leave out from ("practitioner") to ("to") in line 6.—(Lord Llewellin.)

LORD SALTOUN

I should like to support my noble friend's Amendment, which relates to a difficulty felt by a great many hospitals in their work to-day. As I expect my noble and learned friend knows, it is very often covered by hospitals making all medical practitioners within a certain range honorary members of their staff. As that practice is quite common in hospitals, I hope the fact will serve to induce the Government to accept this Amendment.

LORD HORDER

From the purely medical angle I should like to give an emphatic support to the noble Lord's Amendment. It is greatly in the interests of the patient, both on personal and on medical grounds, that continuity should be preserved when the patient leaves his or her home and is transferred to an institution. The medical practitioner who has had charge of the case up to the moment of transfer is really the only person who can, in the patient's interest, continue that treatment whilst the patient is in an institution.

THE POSTMASTER-GENERAL (THE EARL OF LISTOWEL)

I think we ought to be quite clear of the position under the Bill. A doctor who chooses to remain outside the public service (which is the doctor with whom the noble Lord opposite is dealing) can give institutional as well as domiciliary treatment to his patients. That is not ruled out. From the patient's point of view, the patient can receive institutional treatment—he can have an operation, for example—from a doctor who remains outside the public service.

VISCOUNT CRANBORNE

Where?

THE EARL OF LISTOWEL

In a nursing home.

LORD LLEWELLIN

What about in hospitals?

THE EARL OF LISTOWEL

I am coming to that. The effect of this Amendment would be that a specialist or a general practitioner who chose to stay outside the public service and not to take any part in it would be able to use, for his own private work, hospitals provided at the public expense. I do not think that this would be an unfair parallel. Suppose a solicitor who was a member of a private firm were to ask permission to do his own work for his own clients in an office used by the legal adviser to a Government Department in a Government building: I do not think that that would be regarded as a fair and equitable claim. But I think it ought to be made perfectly clear that any person who wishes to have an operation and whose medical adviser is on the staff of any hospital—and of course that covers the great majority of the cases that are likely to arise—will be able to receive the treatment he needs in that hospital. There would, therefore, be precisely that continuity of treatment for which the noble Lord opposite is asking.

VISCOUNT CRANBORNE

I cannot feel that the House will be very satisfied with the answer they have had from the Government on this point. What the noble Earl, Lord Listowel, said in effect was that it was unfair that a doctor who had not opted to join the State scheme should have the advantages accorded to a doctor who had so opted. But he did not say anything at all about the patient. The patient has made his contribution to the State scheme and presumably he has the right to enter a State hospital. The noble Earl may say that he can enter a State hospital and that he then has to have the State treatment, but I cannot feel that we should agree he should be limited in that way. As the clause stands, as I understand it, the Minister may allow any medical practitioner serving on the staff of a hospital providing hospital and specialist services to make arrangements for the treatment of his private patients either at that hospital or at any other such hospital, but the other man—the man who is not a member of the State service—cannot even make arrangements for his patients to be treated by some body else at the State hospitals; he is completely outlawed. The noble Earl does not seem to agree. That may or may not be so, but that is what it says here.

I suppose a doctor who stays outside the State scheme can make some communication of some kind to enable a doctor who is on the staff to take the patient in or to recommend that the patient should go in. I feel, however, that that is—I was going to say an in tolerable position, but I certainly think it is an utterly unjustifiable position. Suppose noble Lords opposite—say, the Lord Chancellor or the Leader of the House—were to be taken ill, what would they do? If they did not happen to have a State doctor, they might have their private physician. They would send for him and call him in for consultation. He would have a complete knowledge of their past medical history, he would have the personal relationship and would have information as to their private idiosyncrasies, if they had any. He is the man who would know about them. He decides that unfortunately they are so ill that they have to go into hospital or into a nursing home. If they go into a nursing home they have to pay very large fees and they get no advantage from the contributions which they have compulsorily made to the State service. If they do not go into a nursing home, they have to go into a hospital, and from the moment they reach the doors of that hospital they are separated finally and completely from their own physician. I cannot believe that the people of this country are intending, when they set up their State service, that there should be that divorce between the physician and his patient.

I am bound to say that we take a very strong view about this. We are in favour of a State service but we do not believe that there should be this continual whittling down of private practice so that in effect it is really useless. We feel very strongly about this, and unless we get a very satisfactory reply I am afraid we shall be obliged to press this matter to a Division.

VISCOUNT MAUGHAM

May I add one word from the point of view of the legal mind, having a large knowledge of solicitors and how they carry on their business? I am unable to see the slightest analogy in the case that my noble friend Lord Listowel has presented to your Lordships and the case before us to-day. As the Leader of the Opposition has just said, the whole point in favour of the Amendment is that it protects the private patient. Anything more undemocratic than the answer that the private patient, if he sticks to his doctor and intends to go on taking his advice, cannot go to a nursing home, I never heard. A rich man may well go to a nursing home, but we know perfectly well that the vast majority of the people who have to go to hospitals, either for surgical or for medical treatment, which may involve their being there for weeks, are poor people who cannot possibly pay for the sort of service—the excellent service, no doubt—that you would get in a nursing home. It is for that reason that I suggest the Government had better reconsider their position on this point and accept the Amendment.

VISCOUNT ADDISON

May I intervene for a moment, having personal knowledge of this matter? I think the noble Viscount who spoke just now was under some slight misapprehension as to what the existing facts are. As to the point made by the noble Lord below the gangway about medical practitioners in a district being attached to a hospital, that is quite common. Those men would be on the staff of the hospital, they could take their patients in, and no question would arise. They would be on the staff of the hospital and would be entitled to make use of the services. The point embodied in this Amendment is quite different. At the present time, when patients are sent into hospitals they are treated in the hospital by the staff of the hospital. That is the case now. I have not the slightest doubt that it is happening at this moment in several hospitals in London and throughout the country. The hospital has its regular staff. Very likely under this measure that staff will be very much enlarged by numbers of medical practitioners using the hospital in accordance with the provisions of the Bill, and they will thereby become members of the staff of the hospital. But a hospital is an organization, like other institutions, run by the staff, and the staff know the nurses and the nurses know the staff. When medical practitioners outside send their patients into the hospital they do not follow them in themselves. The patients are treated in the hospital by a member of the staff of the hospital, and that is what is proposed.

VISCOUNT MAUGHAM

Which makes the arrangements mentioned in the clause.

VISCOUNT ADDISON

I have not the slightest idea what the interjection of the noble and learned Lord is, but I am stating the facts as they are and as they have been for a long time. They have never given rise to any complaint. If a medical man wishes the patient to go into a hospital, the patient goes in, and he is treated by arrangement with the medical man who sends that man in. He does not follow him in himself and become thereby a member of the staff of the hospital. What is here proposed is that for the purpose of private nursing a particular medical man will send his patient in, follow the patient in, and become thereby a member of the staff of the hospital. As a matter of fact, you cannot run hospitals on that indiscriminate basis; it is not a business-like arrangement. Under the Bill all the medical men with responsible practices will no doubt be attached to the hospitals and be on the staff, and will be entitled to follow their patients in and make use of the facilities. But the practice which is now in existence is satisfactory, and I have never heard it complained of anywhere. I am quite sure that the Amendment as now proposed would dislocate the arrangements of the hospitals up and down the country, and it is not reasonable in itself.

VISCOUNT CRANBORNE

I do not think the position is quite that, and I know the noble Lord will correct me if I am wrong because he has much greater experience than I have. What he said at the beginning of his remarks was that it is probable that any local doctor of standing would be a member of the staff of the hospital. The point I wish to ask is this: Suppose there was a local doctor of standing who devoted himself entirely to private practice: would it be possible for him to be a member of the hospital now?

VISCOUNT ADDISON

No. So far as a medical man of standing in the locality is concerned, he is not now a member of the staff of the hospital unless so elected. If he had been selected and elected, then he would be. But he would not necessarily be so simply because he happened to be a competent medical man. It depends whether he had been elected or not.

VISCOUNT CRANBORNE

The noble Lord himself said—I do not want to labour this point too strongly; I know it is so in my own countryside but I am not experienced in an urban district—that any doctor of real standing would be on the staff of his local hospital.

VISCOUNT ADDISON

Yes.

VISCOUNT CRANBORNE

That was all right in the days of private practice. He might be a man engaged in private practice and yet be on the staff of the hospital. Now, as I understand it, the position will be that if a doctor is entirely devoted to private practice he will not be allowed to be on the staff.

VISCOUNT ADDISON

That does not follow at all. It does not make any alteration in that respect. They will be on the staffs of the hospitals as they have been hitherto.

THE EARL OF MUNSTER

Might I ask this question? Does this clause cover surgeons as well?

VISCOUNT ADDISON

Certainly.

THE EARL OF MUNSTER

Let me tell the noble Viscount a story which occurred to myself. Many years ago I had an operation on my toe. I went into a small private ward of a hospital but I was not operated upon by one of the surgeons of that hospital. I got my own surgeon to operate on me in the hospital. After the passing of this Bill that will become illegal.

VISCOUNT ADDISON

All I have to say is that there would be special arrangements pertaining to that hospital. I have known hospitals for forty years, and I know that the arrangement I have described is the ordinary normal arrangement which works quite satisfactorily, and it will not be altered by this Bill.

VISCOUNT SWINTON

As I understand it, it is said that the thing will work on in much the same way; we shall go on exactly in practice as we do at present. If that is so, what is the point of this clause at all? What it does is to draw a distinction between the doctor serving on the staff of the hospital and the patients of that doctor, and a doctor not so serving and his patients. Surely the only object of this is to give a preference to the doctor and the patients of the doctor on the staff of the hospital. The clause says: The Minister may allow any medical practitioner serving on the staff of a hospital providing hospital and specialist services to make arrangements for the treatment of his private patients.… Surely that is giving a special preference to the doctor on the staff of the hospital and the patients of that doctor, which is not accorded to the doctor and the patients who are not on the staff. What I cannot understand is how that is maintaining the existing position. If there is to be no alteration, then should have thought there would be no clause. But the very effect of this clause is to give a special privilege. I am not so much concerned with the doctors as with the patients, but if a particular class of patient happens to be the patient of a particular class of doctor he gets preference, and that is what seems to me to be unfair.

VISCOUNT ADDISON

It really is not unfair in the least. I should have thought this would have been regarded with thankfulness and appreciation by noble Lords opposite. What it does is this. Notwithstanding the fact that these hospitals are paid for out of public funds and so on, this goes out of its way to see that it shall be open to the members of the staff of that hospital to bring in private patients, and, if need be, to have a private ward and charge fees. Those are facilities which this extends.

A NOBLE LORD

Only if the doctors are on the staff.

VISCOUNT ADDISON

I am aware of that. In regard to many hospitals, this is not possible at the present time. It is only open now to the members of the staffs of the hospitals, it is not open to other people. In the special and very interesting case which has just been described to me, what took place was quite unusual, though it may no doubt have been quite a normal arrangement for that particular hospital. In ninety-nine cases out of a hundred patients are treated in the hospitals by members of the staffs of the hospitals. This gives facilities to the men on the staffs of the hospitals to have these advantages with regard to the treatment of their private patients, but it does not throw it open to all the world to have the same advantages, as if they were members of the staff of the hospital. That would not be reasonable.

LORD SALTOUN

I think that the noble Lord may perhaps have misunderstood me. The practice to which I have referred is that if anybody who is not a member of the staff wishes to send in a patient we make him an honorary member.

VISCOUNT ADDISON

When that is the case then no question arises; the doctor is a member of the staff and has the facilities.

VISCOUNT MAUGHAM

On a point of law, may I say that the relevant words here are "practitioners serving on the staff." The word "serving" shows that it does not apply to a person who is made merely an honorary member.

THE MARQUESS OF ABERDEEN AND TEMAIR

Will the Leader of the House say what is going to happen to the hundredth case?

VISCOUNT ADDISON

The procedure in the hundredth case would be as it is now. The practitioner who had a patient would make the necessary arrangement with the hospital, send the patient in, and the patient would be treated by the staff of the hospital. That is what is done now in thousands of cases every week.

LORD LLEWELLIN

I cannot help thinking that there is some misapprehension on this matter and at the moment I do not know who has got the position right. The words used are "serving on the staff." Does that mean a person working full time in the hospital—a full-time doctor on the staff.

VISCOUNT ADDISON

Oh, no.

LORD LLEWELLIN

So it can include anybody who gives or provides any services for the hospital and so is considered to be on the staff. Another point over which we are likely to be confused arises in connexion with the words "private patients." What we have to remember when we talk about these sums being paid out of the taxpayers' money is that they are also, as I gather, to be paid to a considerable extent by the amounts each of us will in future stick on an insurance card. By doing this, we shall come into this health scheme and shall be entitled to the services which it provides. The question which has been raised is whether the ordinary patient will be penalized if he wants to continue with his own doctor, who does not happen to have gone on to the list, but yet wants to go into hospital, while his doctor does not happen to be a member of the staff. There is, I think, some misapprehension upon this matter. What I should like to do, if your Lordships will allow me, is to look at these words again in the light of the discussion which we have had this afternoon, and to consider between now and the next stage of the Bill what the position is. I feel that there may be some misunderstanding between us, and we would like to reconsider the matter. Therefore I ask leave to withdraw this Amendment.

Amendment, by leave, withdrawn.

Clause 5, as amended, agreed to.

4.55 p.m.

Clause 6 [Transfer of hospitals to the Minister]:

THE EARL OF LISTOWEL

The wording of this clause as drafted is too wide and it would, in fact, defeat the intention of the clause. It would transfer to the Minister property of local authorities which is not part of the hospital. For instance, it would result in transferring to the Minister a site which has been bought for the purpose of building a hospital upon it, but has not been used for that purpose. The Amendment which I now move alters the wording of subsection (2) to put that right, and will afford protection to the local authorities.

Amendment moved— Page 4, leave out lines 40 and 41 and insert ("the purposes of those hospitals or any of them or for the purposes of securing accommodation for persons in the area at any hospital not vested in the authority.")—(The Earl of Listowel.)

LORD LLEWELLIN

I think that this Amendment seems quite right, and we on these Benches have no criticism to offer.

On Question, Amendment agreed to.

THE EARL OF IDDESLEIGH moved, after subsection (4), to insert the following new subsection: ( ) In the event of the transfer to the Minister of any voluntary hospital which has denominational associations that link it with a particular religious organization, regard shall be had so far as practicable, in the general administration and in making appointments to the hospital management committee and to the staff of that hospital to the preservation of its character and associations.

The noble Earl said: It is generally agreed that the hospitals associated with various religious denominations have in the past performed, and are still performing, substantial services for the benefit of the health of the country. I need only instance such hospitals as The Retreat (the mental home provided by the Society of Friends), the generously supported Jewish hospitals, and the numerous Roman Catholic hospitals large and small, which are staffed by communities of religious women, communities whose devotion to the sick of all creeds is particularly valuable in these days when there is such a serious shortage of recruits to the nursing profession.

Your Lordships will readily understand that the proposals on which this Bill is based caused considerable apprehension among those who, like myself, have some responsibility for the management of denominational hospitals. That apprehension has, to a great extent, been allayed by a pledge which was given on behalf of the Ministry of Health in another place. Your Lordships will find the actual words of the pledge in the Commons Official Report, Volume 422, Column 402. I am now asking your Lordships to insert the Ministerial pledge in the Bill itself, and I would advance the following reasons in favour of my Amendment. But first I want to make it quite clear that I am not in any way distrusting the Minister. On the contrary, I am absolutely confident that he and, I think I may reasonably assume, his successors, will observe the pledge which he has given to an exact and literal degree in this matter. I am certain that no Minister of Health would fail to consider it desirable to ensure the co-operation of the denominational hospitals, and that co-operation can only exist if they are permitted to retain their special features.

I have to remember, however, that the Minister is devolving his functions as regards 'hospitals upon the Regional. Boards, and I would ask your Lordships, to consider this. When a lady or a gentleman is appointed to a Regional Hospital Board an idea of the duties and rights of members will be obtained from a perusal of the Bill. A member is most unlikely to read through the debates that take place in this Chamber, or in another place, in order to ascertain what has been pledged by the Minister. Therefore, the members of Regional Boards may be quite unacquainted with the pledges made to the denominational hospitals, and it may be the very painful duty of the denominational authorities to remind the Boards of those pledges, and even—it might happen—to appeal over the heads of the Regional Boards to the Minister to secure observance of his undertaking. I am sure that your Lordships will agree that that would entirely prejudice, perhaps destroy, the hope which we entertain of fruitful, frictionless, friendly co-operation between denominational hospitals and the Regional Boards. We base our hopes of co-operation upon a complete understanding by both parties of their respective rights and duties under the Bill. That understanding can best be achieved by making the matter perfectly clear in the Bill itself. The co-operation can then be achieved in the manner that we all desire. I beg to move.

Amendment moved— Page 5, line 16, at end insert the said new subsection.—(The Earl of Iddesleigh.)

THE LORD CHANCELLOR

I have very considerable sympathy with this Amendment. As the noble Earl rightly pointed out, the Minister has already given an undertaking broadly on those lines, and I can understand that not unnaturally the noble Earl, and those who think with him, want that undertaking in the Bill. The Minister, obviously, cannot sacrifice medical considerations but sc far as practicable, other things being equal, it is obviously right that we should maintain and uphold the denominational character of those hospitals. I assume that that has its influence in a curative effect on the patient. What I suggest to the noble Earl—if he will allow me—is that I will undertake to look at this matter with my advisers between now and the Report stage and see how far I can go to meet the noble Earl. I am not quite satisfied with his words, nor with the place at which he proposes to include this Amendment, but I am hopeful that I may be able to devise a form of words in the appropriate place which will satisfy the intention of the noble Earl.

LORD LLEWELLIN

A very large number of us were also in favour of this Amendment, and on behalf of myself and others who other who think in the same way, may I say that I am much obliged to the noble and learned Lord, the Lord Chancellor, for what he has just said. This may not be the right place to insert the Amendment, and it may well be that the Government would like to consider the wording. It is important to have the assurance which the Minister has given, actually included in the measure so that all those administering it, in the provinces or wherever they may be, may be able to see it in the Bill. I am very much obliged to the noble and learned Lord for the attitude which he has taken and so, I am certain, will be a large number of religious denominations up and down the country.

THE EARL OF IDDESLEIGH

In those circumstances I shall, of course, be happy to withdraw my Amendment.

Amendment, by leave, withdrawn.

Clause 6, as amended, agreed to.

Clause 7:

Endowments of voluntary hospitals

7.—(1) Where any voluntary hospital to which the last foregoing section applies is, before the appointed day, designated by the Minister under this Part of this Act as a teaching hospital or is one of a group of hospitals so designated, all endowments of the hospital held immediately before the appointed day shall on that day, by virtue of this Act, be transferred to and vest in the Board of Governors constituted under the following provisions of this Part of this Act for the teaching hospital.

(2) All such endowments shall vest in the Board free of any trust existing immediately before the appointed day and shall be held by the Board on trust for such purposes relating to hospital services or to the functions of the Board under this Part of this Act with respect to research as the Board think fit, and the Board may dispose of any property comprised in those endowments and hold the proceeds thereof on trust for any of the said purposes: Provided that the Board shall, so far as practicable, secure that the objects of any such endowment are not prejudiced by the provisions of this section.

(4) All endowments of a voluntary hospital to which the last foregoing section applies, other than a hospital to which the foregoing provisions of this section apply, being endowments held immediately before the appointed day, shall on that day be transferred to and vest in the Minister by virtue of this Act free of any trust existing immediately before that day; and the Minister shall establish a fund, to be called the Hospital Endowments Fund, to which he shall transfer all such endowments.

(5) Regulations shall provide—

1. (a) for the control and management of the Hospital Endowments Fund by the Minister and for conferring on him any powers required for that purpose, including powers to sell or otherwise dispose of any assets of the Fund and to carry the proceeds into the Fund;
2. (b) for enabling the Minister to apply, to such extent as may be prescribed, the assets of the Fund for discharging any liabilities transferred to him under the last foregoing section from the governing body of such a voluntary hospital as is mentioned in the last foregoing subsection or transferred to him under this section;

5.5 p.m.

THE MARQUESS OF READING

The Amendments standing in my name were admittedly put down in the nature of a reconnaissance, in an endeavour to capture some further information. In view of the Amendment standing in the name of the noble Viscount, Lord Maugham, which is next but one on the Paper, and which seems to give promise of a more serious engagement, I will not move my Amendments but will rest my remarks on the Amendment standing in the name of the noble Viscount.

VISCOUNT MAUGHAM moved, at the end of subsection (4), to insert: Provided that, in the case of any endowment of which a special application or appropriation shall have been directed or declared by the donor, the Minister shall, so far as practicable, secure that the directions of the donor shall not be prejudiced by the provisions of this section

The noble and learned Viscount said: Having regard to the answer of the noble and learned Lord, the Lord Chancellor, to the Amendment of the noble Earl, Lord Iddesleigh, it seems that the Amendment in my name has a reasonable prospect of being favourably received. At any rate it must be explained. Clause 7 of the Bill is rather curious, and noble Lords will observe that in effect subsections (1), (2) and (3) relate to teaching hospitals. The first does so expressly, because it mentions, in line 3, that where the hospital in question is: a teaching hospital or is one of a group of hospitals so designated, all endowments of the hospital…shall… by virtue of this Act, be transferred to and vest in the board of governors constituted under the following provisions of this Part of this Act for the teaching hospital Subsection (2) says that all such endowments shall vest in the Board free of any trust.

In passing, before coming to my Amendment, I must point out that, so far as I know, that is a wholly unexampled instance—or will be when the Bill is passed—of the powers of Parliament. I do not believe that Parliament, in a wide sense, has ever disregarded the terms of a trust and made it a sort of statutory power for certain organizations to commit a breach of trust. The draftsman of the Bill has realized that that is a very exceptional circumstance, and at the end of subsection (2) has included a safeguarding proviso: Provided that the Board shall, so far as practicable, secure that the objects of any such endowment are not prejudiced by the provisions of this section. Whether that is satisfactory or not, is a question upon which I will not embark, but I frankly admit that there may be cases where it will be necessary to affect the trusts which relate to the endowments. The alternative would be to leave the matter in the hands of the Charity Commissioners, who may in such cases administer the charitable trusts—because they would be charitable trusts—in accordance with what is known as the doctrine of cy-près, even if some alteration were needed. I can see reasons, however, why the promoters of the Bill desire to have the matter in their own hands but have left themselves with an obligation to preserve, as far as possible, the objects of the endowments.

The actual words of the Bill are to secure that the objects are not prejudiced by the provisions of the clause. But then we come to subsection (4), and it is not very clear at first sight that the draftsman in subsection (4) is not dealing any longer with teaching hospitals, but is dealing with all the voluntary, non-teaching hospitals in the country. With regard to those the draftsman says that all the endowments of such voluntary hospitals as those, the non-teaching ones, which arc, of course, the vast majority of hospitals in the country, to which the last foregoing section applies, other than a hospital to which the foregoing provisions of the section apply"— shall be transferred to the Minister. At first sight there seems to be trouble here because of the comma after "applies." The meaning, however, undoubtedly is that all the endowments of a voluntary hospital, not being a teaching hospital, being endowments held immediately before the appointed day, shall, on that day, be transferred to and vest in the Minister free of any trust existing immediately before the appointed day, and the Minister shall establish a fund to be called the Hospital Endowments Fund to which he shall transfer such endowments. So that, in the Bill as it stands, there is nothing in the world to prevent the charitable objects of the donors being absolutely and wholly disregarded and treated as if they did not exist.

I am almost certain that that is due to inadvertence. The object is nearly always disclosed in some document or will of the donor, and it cannot be intended hat they should be disregarded in the case of voluntary hospitals though followed in the case of teaching hospitals. Accordingly, I have put down in my Amendment a proviso that in the case of an endowment of which a special application or appropriation shall have been directed or declared by the donor, the Minister shall—and I have borrowed the words "so far as practicable" from the previous subsection, though I insert them with some diffidence and regret—"secure that the directions of the donor shall not be prejudiced by the provisions of this section." I venture to suggest that there is an overwhelming case for such a provision. I would also add the hope that those persons (and I hope there are not many in this House) who think that the will of a donor should be disregarded where the Government think fit, or that trusts, which are conditions of charity, are matters of small importance—I hope there are not very many who think so, because to this moment the Legislature has always treated trusts imposed by donors as being sacred—at any rate may be impressed by the fact that, unless there is some such provision as this, duly carried out by the Minister, large gifts of charity for the benefit of the hospitals will cease.

Take the not uncommon case of people who, for some special reason give a large sum—£10,000 or more—in order to endow a ward for a special ailment, say, diabetes (I know of such a ward), or who desire to endow certain beds in a hospital for a specific purpose, for people of a particular trade or coming from a particular district, such people in future will no longer make gifts of this kind to any voluntary hospital unless they have reasonable confidence that the Minister, who is in charge of this great enterprise, will, so far as practicable, observe and carry out the objects which a donor has declared. In these circumstances—if the Minister is in any doubt about it—I do call upon everybody in this House to support this Amendment. I beg to move.

Amendment moved— Page 6, line 46, at end insert the said proviso.—(Viscount Maugham.)

THE MARQUESS OF READING

Perhaps I may take this opportunity of adding a few words to what the noble and learned Viscount, Lord Maugham, has said on this matter, more especially as it was a point on which I ventured to lay some stress during the Second Reading debate. Some of your Lordships may remember that I there gave an example of what I had in mind, where a particular locality had made a benefaction to a local hospital in memory of a particular local hero who had given his life in the course of the great war, and I ventured to ask—I think perhaps not unreasonably—what was to be the destination of those funds, or what was to be the authority controlling the disposal of those funds, once this new scheme had come into operation. Some answer was supplied by the noble Earl, Lord Listowel, and the point was further touched upon, in his final speech, by the noble and learned Lord on the Woolsack. The upshot of both those replies was that, although no doubt the Minister would be prepared to give favourable consideration to returning such sums, or devoting equivalent sums to the purpose for which they had originally been given, in the Bill itself there was no actual direction of any kind that the wishes of the donors of those funds were to be observed and that the money was not to be appropriated for purely different purposes, having no sentimental or other connexion with the motive which had led the original donor to make the gift.

It is very difficult to see either the legal or the moral aspect of that particular outlook. I do very much hope that, on consideration, the Government will come to the conclusion that such gifts as are covered by the terms of the Amendment now proposed by the noble and learned Viscount will really be incorporated in the Bill; that the very real apprehension of many people will thus be allayed, and that the matter will not be left, as it should not be left, merely for the consideration of the Minister, as to whether or not those specific provisions are ever to be put into force.

5.19 p.m.

LORD LLEWELLIN

If I may add one word before the noble and learned Lord replies, I would only say that, in order to achieve what I think is right, this Amendment has been drafted in the mildest and most inoffensive way. It reads: Provided that, in the case of any endowment of which a special application, or appropriation shall have been directed or declared by the donor, the Minister shall, so far as practicable. … That means, of course, not to cut across the whole of his scheme, but so far as practicable the Minister shall see that the money is applied to the purpose for which it was given, whether for a war memorial, such as was mentioned by the noble Marquess who has just sat down, or for some other purpose in a hospital. So long as the money can be used in that way I think it is right it should be, and this does not completely bind the Minister. I hope, and sincerely hope, the noble and learned Lord will be able to give us satisfaction on this point. This Amendment, at any rate, does say that in any practicable case it shall remain as the testator or donor gave it and hoped it would be applied. I very much hope that the noble and learned Lord will be able to say that he can accept these or similar words in this part of the Bill.

LORD SALTOUN

As my own Amendment is coming in a few moments with practically the same intention as that proposal by the noble and learned Viscount, perhaps your Lordships will allow me to say now what I should otherwise have said upon my own, although, with paternal blindness, I do, ignorantly, no doubt, prefer my own. There are two further points which I think might be made. In the first place, I come from Scotland which has been described as the home of mortification, but it amounts practically to this—there is hardly a corner of the world today where some Scotsman is not toiling and denying himself in order, amongst other things, to leave some benefaction to some spot in his native land. I was at variance with my noble friend Lord Elgin about the work of his Commission which was so much discussed at one time in your Lordships' House. At that time I was doing work which brought me into touch with many Scottish wills, and I do not quite know what the resolution of the committee has been, but I believe that educational endowments have fallen off very much since that time. I am afraid that endowment for hospitals will fall off very much if this clause becomes law in its present form without some Amendment like that of my noble and learned friend.

Another point is this. These endowments are not always clear endowments—so much money for the hospital. There is nearly always a purpose expressed. It not only covers a hospital; there is generally some condition expressed, and the trustees, who are in charge of these various endowments, are charged with the trust. I happen to be in that position myself, and I look on myself, in a sense, as a guardian of the grave or a memorial. It is my duty to see the purposes of the trusts are carried out. I accepted the trust on these conditions, and it is my duty to see they are fully carried out. Parliament can do anything up to a point, but I remember reading a fairy story about a battle between a king and a fairy who changed the king into every conceivable animal, but the one thing the fairy could not do was to make the king say what he did not want to say. I am in that position to-day because I am a trustee of a hospital which has certain benefactions. It is perfectly true that His Majesty's Government and Parliament may take these things away, but they cannot take them away with my consent unless I am reasonably satisfied that the purposes of the trust, which I have taken over as a solemn and great duty, are carried out. I do not think I should be compelled, or that Parliament should try to compel me, to transfer these securities away from the trust. It is a very difficult moral point, and it is one that I have often seen coming in the distance. I am putting this to the Government quite seriously, and I sincerely hope they will do something to meet the position to secure to trustees that the duties that they have solemnly undertaken will not be disregarded after the passage of this Bill.

THE DUKE OF MONTROSE

I am a chairman of a trust for a war memorial hospital, and I am profoundly disturbed by some of the remarks made by the noble Viscount, Lord Maugham, who moved the Amendment and by the noble Marquess. This hospital was erected as a war memorial by people to their loved ones who died in the last war. They were most anxious that this war memorial should continue for ever, and in order to do that they entrusted it to the security of a trust. Now it seems to me by this clause that the security of a trust, which I have always believed existed and continued for ever, can be completely overturned and upset by some clause in a Bill. I always understood that the security of a trust would be for a definite purpose and could not be overturned except by an action at law. But here we are, and it seems to me that you can overturn a trust by passing or approving a clause in a Bill. Is that so? I am profoundly disturbed by it if it is.

THE LORD CHANCELLOR

I think there is no doubt you can, by Act of Parliament, disturb any trust you like. You can, by Act of Parliament, completely disregard the wishes of the donors and so on. Whether you should, or should not, is a very different question, and it would obviously ill become me as President of the Chancery Division to suggest that this thing should be lightly or wantonly undertaken. I agree with the noble Viscount, Lord Maugham, that quite obviously if we disturb a trust we are embarking upon a very serious thing, and it behoves us to watch very carefully exactly where we are going. As this is the first of the Amendments dealing with endowments, and as I rather gather that there is some little misapprehension about the matter, may I explain to your Lordships the underlying principles? The noble Viscount, Lord Maugham, said in his remarks, and he said quite frankly, that he wanted to put into this clause which deals with the voluntary hospitals some words which will be broadly analogous to the corresponding provision in the earlier clause which deals with teaching hospitals. But there is this profound difference between teaching hospitals and non-teaching hospitals, that whereas with regard to the teaching hospitals there is no taking away and redistribution of funds contemplated and the existing funds remain—albeit with the teaching hospitals the board of governors is changed and not its constitution. In regard to the voluntary hospitals, it is of the very essence of this scheme that there should be a redistribution. It is the very essence of the scheme.

Now let me just give your Lordships some figures. They are not intended to be accurate figures, they are estimates, but I think they are estimates which are likely to be about right. We are embarking on a scheme here which is probably going to cost the public Exchequer something of the order of £150,000,000 a year—approximately that figure. That £150,000,000 is being found as follows: Approximately £30,000,000 comes from the contribution under the insurance scheme, the 10d. a week; probably some £10,000,000 will come from local authorities, and the balance of £110,000,000 will come from the Exchequer. The Exchequer will, therefore, have to find £110,000,000. Of the £150,000,000, if I may give you one other figure, I estimate that approximately £90,000,000 is the part of the £150,000,000 which will be expended on hospitals. Believe me, if you go to the Chancellor of the Exchequer and put upon him a burden of £150,000,000 a year and you tell him that he is only going to have £30,000,000 in the insurance fund, he is apt to be a bit restive. The inevitable reactions of the Treasury officials in the early days of this thing were: "If you are going to call on us to find out of public funds this vast sum of money, at least you ought to let us have in return for our doing this the various endowments in the fund to put against our obligations." In the early stages that was raised, and in the later stages in our discussions we got the Chancellor of the Exchequer to agree that he would forgo that claim, and that he would let the endowments—I am not talking about the teaching hospitals—of the voluntary hospitals remain for hospital purposes.

I attach great importance to that, for this reason. I am most anxious that the hospitals should have some cushion between themselves and the rigour of Treasury control. I do not want them to have to go round and get some authority for every single penny they are going to spend. I would like them to have some little nest egg to which they can go from time to time. But observe this. You have two sets of hospitals at the present time, quite separate, the voluntary hospitals who have endowments, and the municipal hospitals who have no endowments. You have further this fact, that amongst the voluntary hospitals some in certain areas are very well endowed, and others are very inadequately endowed. Therefore it seems to us right that there should be, so far as the endowments of voluntary hospitals are concerned, a redistribution of the funds which they have got so that all the hospitals, those which were previously voluntary and those which were previously local authority, which are now going all to form part of a common service, should all be able to share in the proceeds. What do we estimate they are worth? This is only a guess. It is probable that the capital value of the endowments is of the order of £50,000,000. So that at three per cent. you would get something of the order of £1,500,000 a year. That is the sort of figure you are dealing with. I think even that figure probably contains a not inconsiderable element of the endowments of the teaching hospitals, which we are not here considering.

Is it right that we should start our new system with one set of hospitals with what I may call pocket money—I am not speaking disrespectfully—with a cushion, if you like, and another set without? After all, can we not fairly say if we could go back to the donors, most of whom are dead, of course: "We are carrying out your wishes. We are providing out of public funds in carrying on the hospitals." The effect of the noble Viscount's Amendment would be absolutely to smash up the scheme. It would make the redistribution of funds impossible. There is hardly an endowment which has been given to a hospital which has not been given to some specific hospital, a hospital anywhere you like, but to some specific hospital. If I am not to be allowed to take that endowment away and put it in the pool and thereafter distribute it, then, as I say, the whole scheme does not work. We are quite deliberately, by Act of Parliament, suggesting that the right and honest course, in view of the fact that we are now prepared to expend out of public funds a far larger sum of money than is involved in these endowments on maintaining the hospitals, is to take this endowment fund not in relief of the taxpayer but in order that it may be something additional to the hospitals, so that the hospitals shall have this cushion between themselves and Treasury control. Some of it will go to what were municipal hospitals, and some of it to voluntary hospitals which are almost entirely dependent on subscriptions. The rich hospitals with large endowments will suffer, but in return for being deprived of part of their endowments they will get the benefit of a far larger expenditure of public money in keeping up the hospital. In these circumstances it seems to us that this is a case in which we could with good morals do what we undoubtedly can do legally—namely, by act of Parliament—that is take away and redistribute in order that we may have this equality all round in the way I have suggested.

Supposing we were to accept this Amendment—and I am not boggling about: precise words for the moment because other words might be thought of—"any endowment of which a special application or appropriation shall have been directed or declared by the donor." Ninety-nine per cent. of the endowments would come under that, and the effect of this Amendment would be that this scheme of redistribution would become absolutely impossible; and if the scheme of redistribution becomes impossible, then I think it quite inevitable that the Treasury will take this line, and perhaps ought to take this line. They will say to a hospital which is richly endowed: "You are so well off that you need not have a large amount of public funds," and the whole idea of this cushion will go. I, as I suppose the principal protector of charities in this country, submit that what we are doing here is the right thing to do. So far as the teaching hospitals are concerned, there is no distribution; we leave to them their endowments. So far as the non-teaching hospitals are concerned, we take away all the endowments, we put them into a special fund, we thereupon distribute them and we do not allow the Treasury to have any regard to the existence of that fund in saying what those hospitals are to receive. That is our principle.

There is another class of case where you get something of this sort. You get a sum of money which has been subscribed to a hospital on a condition. It may be a condition that a mass be said for the soul of the departed, or something of that sort. I should think, and anybody would agree, that in a case of that sort that condition ought to be followed and observed as far as possible. Endowments are, of course, defined, although I think that some of your Lordships have not studied the definition. At the bottom of page 8 an endowment is defined as "property held by the governing body of the hospital or by trustees solely for the purposes of that hospital." Where you have got an endowment with a gift over, that, I think, would constitute an equitable interest which is dealt with at the bottom of page 9. Therefore, what we intend to do is this. So far as we can, in redistributing that which we have brought into this fund, we shall have regard to particular cases of that sort, and we shall always try to see by the directions which will govern the redistribution that those conditions of that sort are, so far as possible, observed.

If I were asked to sty that I should not take into the fund these sums of money merely because they all have some special application, then I would say the whole scheme was unworkable. Therefore, I cannot do anything which would lead your Lordships to suppose that we could accept any such provision as that. I cannot in any way put the non-teaching hospitals in the same category as the teaching hospitals, though I will undertake that in so far as it is possible in particular cases such as those I have indicated, the wish of the donor which accompanied the gift—it is very often done in endowing a cot or something of that sort—shall be given effect to. Apart from that, I must ask your Lordships to allow me to appropriate these funds. I justify it as a matter of good morals because I point out that I am paying out of public funds a sum vastly greater than the sum I am taking, and even the sum which I am taking is not a sum to be used for the benefit of the Exchequer but a sum which is to be distributed round all the hospitals. I cannot contemplate that in the future hospitals which all form part of one public service shall find themselves some with and some without some mitigation and some cushion of the sort I have indicated. Therefore I regret to say I cannot accept this Amendment.

THE DUKE OF MONTROSE

I am afraid that the remarks of the noble Lord do not at all case the disturbance to my moral feelings on this question. This idea of taking endowments intended for a special purpose and putting them into a special endowment fund in order that they may be shared by all seems to my mind to be rather close to the practice which existed in olden days. When bodies were buried in those days, they were the property of the family, and then there came along the body snatchers who took the bodies in order that they might be used for the public service in the hospitals. Is there very much difference between snatching bodies and snatching funds which are put up to provide a war memorial hospital in memory of loved ones who have died? To my mind it is getting very close.

LORD SALTOUN

I could not help sympathizing with the noble and learned Lord's explanation, but at the same time there is one difficulty. I am thinking of a case where somebody has left money to provide a small hospital for a valley which is cut off by the snow in winter. To deprive that hospital of considerable funds would be to make entirely nugatory the original intention of the benefactor.

THE LORD CHANCELLOR

Does the noble Lord follow the point? His hospital will get very much larger funds. It will get from the Chancellor of the Exchequer sums vastly greater than those taken away from it.

LORD SALTOUN

What I am anxious about is that trustees may be reasonably satisfied that the purposes of the trust are being carried out. I am perfectly certain that if the noble and learned Lord Chancellor was himself a trustee and was speaking as a trustee, he would not have entirely acceded to the argument with which he concluded his remarks, because he would not have been entitled to consider such things.

LORD LLEWELLIN

One remark made by the noble and learned Lord seemed to me completely to hit the point. The words that we propose here are not going to wreck the whole of his redistribution of these endowments. They are not intended to do so. If the noble Marquess had moved his Amendment, it would have had that effect if agreed to, but I do not believe that these words do that and they are not intended to do so. The noble and learned Lord told us that he thought 99 per cent. of these things were given for hospital purposes. Of those amounts, how many of them are given in such a way as to be for a general hospital purpose and not just for one bed or for one particular thing? Some people may donate money for staff quarters or something of that sort, but that is very rare. It is generally left to the hospital, and because of the additional Treasury grant that is going to these hospitals, there is no prejudice if you divide it up. There is no prejudice in taking away these funds if at the same time you are giving more funds, and you can do that, in my view, if this Amendment is carried.

THE LORD CHANCELLOR

May I ask a question? Suppose there is a sum of money left, for instance, to the Reigate Hospital. Is the noble Lord saying that in these circumstances we are quite right to take that away, but that if it is left, for instance, to a nurses' home at the Reigate Hospital we are quite wrong?

LORD LLEWELLIN

If it is left for the general purposes of the hospital—purposes which will be equally well maintained, and perhaps more abundantly maintained, by a Treasury grant—then I say that the directions of the donor are not prejudiced because the hospital goes on in the same way or even in a larger way. The object of this Amendment is to ensure that, for instance, hospitals, or some parts of hospitals, given as war memorials are continued. In any case, the words here are only "so far as practicable". We feel we ought to get something like that into the Bill.

As I said originally, we thought this was a very mild Amendment and one which the Government could well accept. Even if the noble Marquess had moved his Amendment, we were not prepared to support so drastic an Amendment, which we thought went to the root of the whole matter. Perhaps the noble and learned Lord would look at this again to see whether there are some words which will have the effect of preserving these particular gifts which may not otherwise be preserved—contributions from people for the purpose of war memorials and things like that. If we could get some words to ensure that those features and factors were preserved, I think it would meet what a lot of us have in mind. This Amendment was not meant to upset the whole of the redistribution scheme, and if the noble and learned Lord thinks it does that, then it has probably got the wrong words. But if he will say that we could attempt to find words, perhaps between us, which would do what I think both he and a lot of us want to do—namely, to preserve these special features—then I think it would be a good thing if we could talk it over and see what we could do to achieve that.

THE LORD CHANCELLOR

I shall be glad to have a discussion with the noble Lord to see if I can find some words to help him, but I must have it made quite clear what exactly he wants to do. At the present moment, I do not follow.

VISCOUNT MAUGHAM

I think it is just as well that we should talk it out here and see what we really are dealing with. With great respect, I was unable to follow the reasoning of the Lord Chancellor in this particular case, even though it was put with the utmost clarity and skill. We were first told that we should look upon the matter as if we were suggesting that the endowments in question, if they were preserved to the very limited extent suggested in this Amendment, would be some addition to the charge on the Chancellor of the Exchequer and would horrify him because he would have to find an additional £110,00,000 a year. A little later on we were told something absolutely in contradiction of that. It was pointed out that the effect of leaving the endowments of a particular hospital to benefit that particular hospital would be a reduction in the amount of money granted to the hospital by the Exchequer. We have got to face that point.

It is no good blinking the fact that if a generous donor gives £500,000 to a particular hospital, he puts that hospital in such a position that it will need less from the Exchequer. That is perfectly true. It has been true in the past that if additional sums were given by somebody outside, the hospital needed fewer voluntary donations per annum to keep it going. The voluntary presents will not now come in, the Exchequer has got to keep it going, and we are facing that. But it is absolutely without foundation, I submit, to suggest that the Amendment is going to have the result of putting a greater charge upon the Exchequer. It is keeping the endowments for the hospital for which the endowments were given and declared, either by deed or will. It is enabling the will of the donor to be carried out without in any way adding to the total sum that the Exchequer has got to find to keep the hospital going. There is absolutely nothing—and I am willing to discuss this before any company of lawyers in the land—in the Amendment here which says that the money can be taken away from the endowments and wasted. It is true that if you can imagine endowments given for the purposes of providing, shall we say, port wine for the staff, it might very well he in that case that the endowments would be no use to the Exchequer and would not help the conduct of the hospital. But these are not the type of endowments with which we are dealing, nor out of the £50,000,000 which they amount to is there more than a microscopic part which is not given, and intended to be given, for the benefit of that hospital.

All this Amendment does is to say that so far as a man has given sums, either by deed or will, for the benefit of a particular hospital, or a cot in a hospital, or a ward in a hospital, or for the nurses who work the hospital and who have got to be kept going, they shall remain for the benefit of that hospital because that is what the donor wanted. If a Scotsman gives a sum for Edinburgh you may think it very ridiculous that he does not want it to go to Aberdeen; he has given it to the Edinburgh hospital. If I have given a sum to a hospital—for instance, the King's College Hospital, with which many of us are connected—I do not want it to go to St. Bartholomew's. It may be silly, it may be illogical, but it is human nature, and you cannot alter that by Act of Parliament. I will no longer put it in an egotistical form, but if John Doe has given £10,000 to a particular hospital on the south side of the river, naming it and stating how the money should be applied for the benefit of patients of that hospital, he wants it to continue there and nowhere else.

It is simply talking in the air to say that when it goes into the Hospital Endowments Fund, which is established under subsection (4), the desire of the Government is that they should disregard the fact that this particular donation has been given to a particular hospital. I do not hesitate to admit at once that the people who administer the total funds, and who administer the Exchequer funds for the benefit of a particular hospital, will give less to it if it already enjoys the benefit of large endowments. That cannot be helped. That is a reason—not a very good reason, but it is a reason—why we should not give further endowments after this date to a particular hospital, because it may help the Exchequer. I think that sensible people have seen that, but the corollary to that is that with regard to past endowments they do not hurt the Exchequer in the least if they are retained for the benefits declared by the donor, and that is a principle which I think should be preserved. I do not believe it is correct to say that to do that strikes against the scheme in any way at all. I do not mind the endowments, if you like, being vested in particular trustees or given a name which you may call the Hospital Endowments Special Fund under which the funds, in the hands of whoever you like, have got to be applied in the way in which the donor said they were to be applied. That is all machinery, but I do insist that when people have given money for a particular purpose that purpose should be carried out, and I think your Lordships will be well advised to insist on that.

I am very sorry to differ with the Lord Chancellor on this matter, but when he says that morality approves of these gifts being taken away and thrown into the pool I am unable to agree with him. I think it is a breach of trust, and not the least to be reprobated because it is a breach of trust which is supposed to be sanctioned by Act of Parliament.

5.55 p.m.

VISCOUNT SAMUEL

The Amendment now before the House raises a question of great substance and touches a principle of real importance. The House may feel itself in some difficulty as to the course which it should now take. For my own part, I find myself in agreement with the suggestion of the noble Lord, Lord Llewellin, and not with the observations of the noble and learned Viscount, Lord Maugham. The point at issue has been clarified by the noble and learned Lord, the Lord Chancellor. It is clear that it is a new point which arises in connexion with this Bill, and in relation to the hospital system as it has been hitherto all through the centuries and as it has now become in our own times. The voluntary hospitals were almost the only means of dealing with the sick throughout the country ever since early centuries, and they have been supported by voluntary funds and endowed for that purpose. During the last century or so the new system arose, first of Poor Law hospitals, which have been converted in our own time into municipal hospitals, and now the two systems are to be amalgamated.

The Lord Chancellor tells us that the purpose of the plan is to provide what might be called a comforts fund to be given in addition to the per capita grants, or whatever system may be adopted, in which I understand municipal and voluntary hospitals are to be considered equally. If these ancient endowments which were given to the local hospital when it was the only one in the town are to be reserved to that hospital, that would mean that all over the country you would have the old voluntary hospitals with a number of comforts and amenities secured to them arising out of the ancient system in which they were the sole hospital authorities, while all the municipal hospitals throughout the country would be bare and barren of these additional comforts.

I do not think that that would really be fulfilling the purposes of these ancient and worthy donors of these endowments. What they cared about was that the sick should be well cared for and happy, and they would not care very much whether the hospital had the name of Saint So-and-so, or whether it had the name of the Manchester Central Hospital, or whatever it may be, unless of course the question of denomination and religious endowments come in, which have already been dealt with this afternoon in connexion with this Bill. Therefore, it seems to me that we are fully entitled to endorse a change of trusts which arise out of the different circumstances that prevail in our own time, and when the noble and learned Viscount, Lord Maugham, says the trust must always be absolute and never be varied—

VISCOUNT MAIJGHAM

I have not said anything of the sort. If the noble Viscount reads my Amendment he will see that it says "so far as practicable."

VISCOUNT SAMUEL

I was not referring to the noble Viscount's Amendment, but to his first speech, in which I thought I heard him say that trusts ought to be invariable, and that, so far as he knew, this was the first occasion on which Parliament had ever overridden trusts established for a particular purpose. If I misunderstood the noble Viscount I am sorry.

VISCOUNT MAUGHAM

The noble Viscount has entirely misunderstood me. Nobody is better aware than I that you can, with varying circumstances, vary trusts. I mentioned cy-près, under which Courts have acted for generations.

VISCOUNT SAMUEL

But the Charities Acts are affected in this. The Charity Commissioners have power to deal with medieval and other charities the purposes of which are no longer valid. In their ignorance, some of those medieval benefactors thought that it would always be possible to distribute loaves of bread to the poor—not foreseeing present circumstances in this country—and there are other similar and more important examples that could be given. I suggest that we ought to be careful that we do not put in any special Amendment which, although the words "so far as practicable" are included, would hardly cover the general scheme as a whole. It would be practicable not to take away endowments and leave a hospital without other funds for comforts and so forth.

If some words could be inserted that would have the effect of ensuring that what was done was done without detriment to the general principles embodied in the purposes of the schemes, and with the intention to fulfil so far as possible, in the circumstances, the wishes of the donors, I think that that might be acceptable to the Government. For example, if it were merely a question of a particular hospital being termed for all time "The 1914–18 War Memorial Hospital" or something of that kind, obviously that sort of trust ought to be fulfilled. Or if it were made a condition that particular beds were to be named after particular donors, that condition equally should be fulfilled. For the sake of clarification and in order that the intentions of Parliament should be made quite plain to all Regional Committees and local administrators, it might be desirable to put in a carefully devised Amendment on these lines.

VISCOUNT CRANBORNE

Perhaps I may be allowed to say a few words, although there is not really very much that I can add, for we have had a very full discussion. With the speech that has just been delivered by the noble Viscount, Lord Samuel, I find myself in very general agreement. Of course, like a great many other people in this House I dislike raiding endowments. In principle I think it is bad. One knows that people give money for special purposes which they would not have given but for that purpose, and it does not seem right to take it for some other use. Therefore, I have very great sympathy with what was said in this connexion by the noble Viscount, Lord Maugham. I think that we all sympathize with it as a general declaration of view, but it seems to me that it is perhaps not possible to interpret this quite so widely as he did in his last speech. I would rather look at the matter as one influenced by the purpose of the donor.

The Lord Chancellor has spoken of the question of the establishment of a hospital at Reigate. Suppose there was no hospital at Reigate and a man gave, say, £100,000 to put up a hospital there. That would be a donation for a special purpose. But suppose that, as the result of the Government scheme, there was going to be a very good special hospital erected in Reigate. In these latter circumstances, I should have thought that the purposes for which the money was given were in fact being ful filled. Therefore, if you took the £100,000 and put it into the pool you would not be going against the purposes which actuated the gift. If, on the other hand, a man had a son killed in the war and he were to say: "I am very unhappy, but I would like to feel that someone benefited by what has happened. I therefore propose to give £50,000 to be used for the very special purpose of a memorial to my son," I think it would be wrong and wicked to take that money and use it for a different purpose. But I cannot believe that it is not possible to find some means of differentiating between these two cases. I would like to suggest, if I might, that the representatives of the Government and the Leaders of the other Parties should get together between now and the Report stage of the Bill and see if this could be done. I do not believe it would be impossible. I have not tried to devise a form of words myself, but I believe it would be a mistake if something on the lines I have suggested were not done. This is a matter on which people feel very strongly and one in which deepest feelings are engaged.

THE MARQUESS OF LONDONDERRY

There is just one question which I would like to ask the noble and learned Lord, the Lord Chancellor. It relates to a matter upon which my mind is rather fogged at the moment. I would like him to explain for my benefit and that of other noble Lords who may be in doubt as I am, if when an endowment is maintained in a hospital the contribution which the Exchequer would make for the expenses of the institution would be a lower one. I think the Lord Chancellor said that in the case of the well-to-do hospital which had funds of its own the contribution which the Exchequer would make would be lower. We have heard of such things as comforts, cushions and pocket money. I really do not know to what the noble Lord was referring when he spoke of those matters. I understood, however, that he said that if a hospital is very well endowed and can produce an income every year the Exchequer would provide a lesser sum for the benefit of that hospital than if the circumstances were otherwise.

THE LORD CHANCELLOR

That is not so. I am sorry if anything I said has misled the noble Marquess. Possibly I did not make myself clear. As things are if you have a hospital so well endowed—if there be such a hospital—that it can do without current subscriptions, and without making any charges, under the scheme of this Bill what would happen is that its endowment would be taken away and the Chancellor of the Exchequer would then have to make a contribution to that hospital, to the extent that would enable it to function as a hospital. He would have to pay all necessary expenses and the hospital would get an adequate share. Where I think I clearly misled the noble Marquess was when I pointed out that the Amendment of my noble friend, Viscount Maugham, would probably have the effect of saving the Chancellor of the Exchequer from paying some money, because if we left that hospital all that money (it being, ex hypothesi a hospital which had enough for its own purposes) it would be inconceivable that the Chancellor of the Exchequer would make any grant to that hospital.

I want to make it quite plain that I regard this pooling of money in the Fund and redistribution as an absolutely essential and vital principle of this Bill. I am not going to lead your Lordships to suppose that I can weaken for one moment on this question. I took the Reigate Hospital as an illustration. If money is left for the Reigate Hospital our intention is that that money shall be taken, put into the pool and distributed among other hospitals. Otherwise, you would have this position: that some hospitals would get comforts funds while some would not. That we regard as wrong. If there is any special case which a noble Lord has in mind; if, for instance there are cases in which you have got, as you do sometimes, a gift attached to a condition, and, in order to maintain the gift you have to keep up a garden or something of that sort—the instance given by Viscount Samuel I accept fully—may I say that I am very ready to see noble Lords in all quarters of the House and to consider whether I can devise some words to carry out what I think they desire, always provided that they are confined to special cases and that they do not seek to go so far as to say that any money merely left and because it is left to a particular hospital, should therefore be exempted from the pooling and redistribution which we think is absolutely vital to the Bill. Sub ject to that, I shall be very pleased, between now and the Report stage, to see if we cannot devise some form of words limited to special, peculiar and particular cases, which will not strike at the root of the proposals of this vesting in the Fund.

LORD SALTOUN

May I ask one question? I listened very carefully to the words of the noble and learned Lord. Do they import that the £100,000 might be taken from the Reigate Hospital and the hospital closed, or do they mean that the hospital cannot be closed? I understood from him that the Government would be bound to keep that hospital going.

THE LORD CHANCELLOR

What is suggested is that the hospital should be kept going, "so far as practicable," or something of that sort. If it became unnecessary to maintain a hospital there owing, for instance, to shifting of the population it would be foolish to keep it there. If that did not happen, and I see no reason why it should, the hospital would be kept on.

THE DUKE OF MONTROSE

Feeling has been strongly for and against this transfer of endowments to public funds, and I think I may say that, so far as this side of the House is concerned, we have a very large following throughout the country on this. I wonder if it would be possible to withdraw the clause for further consideration. If it cannot be withdrawn, I would appeal to the noble Viscount who leads this House to let us divide on it.

VISCOUNT MAUGHAM

Having regard to the views expressed by the noble Viscount, Lord Cranborne, I confess with some regret and hesitation that I shall ask your Lordships to allow me to withdraw my Amendment, on the understanding that we have full discretion to review the whole matter on the Report stage, if satisfactory words cannot be found to meet the points of so many members in this House.

Amendment, by leave, withdrawn.

6.13 p.m.

LORD LLEWELLIN moved, after subsection (4), to insert: (5) There shall be excepted from the transfer to the Minister authorized by the last preceding subsection of this section all endowments created and the unexpended balance of all money received in the period between the passing of this Act and the appointed day by the governing body of a voluntary hospital or by trustees solely for the purposes of that hospital and any endowment or balance so excepted from transfer to the Minister shall be transferred to the hospital management committee constituted under the provisions of this Act for that hospital or for the group in which that hospital is comprised, with an obligation to apply the same in accordance with the directions, if any, of the donors and, in the absence of directions, for the benefit of the hospital for which the endowment was created or to which the money was given.

The noble Lord said: This Amendment: deals with a different point. We have been discussing what is to be done with past endowments. As this Bill comes before us, there appears, in Clause 59 a provision that hospital management committees may receive gifts after the appointed day. The provision says: A Regional Hospital Board and the board of governors of any teaching hospital and a hospital management committee shall have power to accept, hold and administer any property upon trust for purposes relating to hospital services … That does not come into operation until the appointed day, when the Regional Boards and the hospital management committees come into being. That means that we have been discussing the past period; the future, after the appointed day, is dealt with under Clause 59. My Amendment deals with the interim period, from now until the appointed day. I know that those who in the past have done a lot of good work collecting money for hospitals still want to be able to collect sums for such things as additional comforts.

The noble and teamed Lord, the Lord Chancellor, has used several different terms, and I do not know quite what is the right one, but it is that additional freedom to spend small sums without a whole lot of control. These collectors feel that if we stop short now and say: "No; if you give this money to your local hospital now, it will go into the Endowment Fund" such gifts will not come in. Most people who give that kind of sum—that £100 or £50—give it to their own local hospital. If you once dry up that flow of gifts the collectors believe that it is most unlikely that it will ever start again. The effect of my Amendment is to provide for the interim period, and to say that once you have this equalizing, up or down, of past endowments, then from that: time you can start to build up a little fund, without waiting until the appointed day. That is the purpose of my Amendment. I will not say much about the words, except that I saw what I wanted put down; and I thought that it looked pretty good when it was produced for me, Whether the noble and learned Lord, the Lord Chancellor, and those who advise him, will think it is good or not, it is not for me to say. At any rate, I do hope that we shall accept my proposal for the interim period. I beg to move.

Amendment moved— Page 6, line 46, at end insert the said new subsection.—(Lord Llewellin.)

THE LORD CHANCELLOR

I have very considerable sympathy with the noble Lord about this matter. I admit that I think it unlikely that between the passing of this Bill and the appointed day charitably-disposed people will leave money to the hospitals, if they know that on the appointed day it will be taken into a fund and pooled. In nearly every case the donor has in mind a particular hospital with which he is in some way associated. I do not like the language of the noble Lord—I mean the language of this Amendment. Endowments, of course, include money; and one of the things we all know about money is that it cannot be earmarked. If money goes into a particular fund, you cannot ascertain which particular piece of money is expended on a particular object. With regard to current subscriptions, therefore, it would be extraordinarily difficult to say whether any particular sum of money can be expended or not. What happens, is that the money goes into the bank and is expended.

With regard to cases of the sort which the noble Lord has in mind, I think that I can meet him. I do not think that he is talking about current subscriptions, but about cases of somebody leaving a fund—perhaps £10,000 Consols—to a hospital. The noble Lord wants to provide that if that is done between the date of the passing of the Act and the appointed day, that sum of money, of which the hospitals would use only the income, is not taken away and split up; in short, that it is treated as it would have been under Clause 59, if it had been given after the appointed day. That is not unreasonable, and I shall ask the noble Lord not to press his Amendment now, but to let me go to the Minister and see if I can get authority to devise between now and the Report stage some form of words which I shall be pleased to discuss with the noble Lord. Perhaps we may be able to hammer out an appropriate form of words to meet what I think is a real point, and an important point.

LORD LLEWELLIN

I am very much obliged to the noble and learned Lord, the Lord Chancellor. It is exactly that kind of case which I wanted to meet. It will be met after the appointed day, and I want it met between now and the appointed day. Otherwise, a lot of people might change their wills. And even if they die after the appointed day the gift would be out of the will. I fully accept the suggestion of the noble and learned Lord, and I have no doubt that he and those associated with him will find some words between now and the Report stage. I beg leave to withdraw.

Amendment, by leave, withdrawn.

THE EARL OF LISTOWEL moved, in paragraph (a) of subsection (5), after "Minister," to insert "or any person authorized to act on his behalf, and for defraying out of the Fund such expenses incurred for the purpose of the control and management of the Fund as may be prescribed." The noble Earl said: The object of this Amendment is to enable the National Debt Commissioners to act as the Minister's agents in holding and managing investments forming part of the Hospital Endowments Fund. It also provides that the expenses of managing the Fund are to be charged to the Fund.

Amendment moved— Page 7, line 3, after ("Minister") insert the said new words.—(The Earl of Listowel.)

6.22 p.m.

LORD LLEWELLIN

Is not this wider than the Debt Commissioners? It says "any person." I am not quite certain of the position. I suppose the drafting of this Amendment is all right. Of course, the Minister does not usually do everything himself. Everything that his servants do in his Ministry is the act of the Minister, and that is how it has always worked. The term "any person" seems to be very wide. Who is "any person"? Is it any person he appoints? It is not necessarily limited to the case that the noble Earl gave us.

THE EARL OF LISTOWEL

I will certainly look into the wording. I imagine that the same wording is used as is used in other Bills.

LORD LLEWELLIN

I see. I have no objection, but it seemed very wide.

On Question, Amendment agreed to.

THE EARL OF LISTOWEL

The next Amendment is a consequential Amendment upon the preceding Amendment.

Amendment moved— Page 7, line 4, leave out ("him") and insert ("the Minister or any such person")—(The Earl of Listowel.)

On Question, Amendment agreed to.

THE EARL OF LISTOWEL

The next Amendment is also consequential. I beg to move.

Amendment moved— Page 7. line 6, leave out ("to carry") and insert ("for carrying").—(The Earl of Listowel.)

On Question, Amendment agreed to.

THE EARL OF LISTOWEL

The next Amendment is a drafting Amendment to bring the wording of this clause into line with the wording of Clause 6.

Amendment moved— Page 7, line II, leave out ("from the governing body ") and insert ("in connexion with the transfer ").—(The. Earl of Listowel.)

On Question, Amendment agreed to.

THE EARL OF LISTOWEL moved to add to paragraph (b) of subsection (8) "and for the apportionment of any rights and liabilities acquired or incurred for the purposes of managing the property and of any liabilities charged thereon." The noble Earl said: This Amendment provides that the rights and liabilities arising out of the management of property owned by a voluntary hospital as well as the property itself should be apportioned by regulations. I beg to move.

Amendment moved— Page 8, line 18, at end insert the said words.—(The Earl of Listowel.)

On Question, Amendment agreed to.

Clause 7, as amended, agreed to.

Clause 8 agreed to.

THE LORD CHANCELLOR

I am going to suggest that we have, I think, made fairly good progress. We are now getting on to a new topic and probably it would be to your Lordships' convenience if the House were now to be resumed. Accordingly, I beg to move that the House do now resume.

Moved accordingly, and, on Question, Motion agreed to; House resumed accordingly.