§ 2.7 p.m.
§ House again in Committee (according to Order):
§ [The EARL OF DROGHEDA in the Chair.]
§ Clause 9 agreed to.
LORD HENLEY moved to insert as a new clause:
All property in the occupation of a Regional Hospital Board, a board of governors of a teaching hospital or an executive council shall be chargeable in respect of rates and the gross and rateable values shall be determined as respects such property within the county of London in accordance with the provisions of the Rating and Valuation (Metropolis) Acts, 1869 to 1940 and as respects such property elsewhere in accordance with the provisions of the Rating and Valuation Acts, 1925–1940
§ The noble Lord said: Local Government bodies have felt a dissatisfaction for some time owing to the procedure by which the Treasury makes contributions in lieu of rates in respect of Crown property. Their valuation officers feel a sense of frustration as they have no efficient negotiating power in dealing with the Treasury. The Treasury tend to adopt a take-it-or-leave-it attitude. They put forward their proposals and these cannot be referred to the local assessment committee. The rates paid by hospitals reach 397 quite a considerable sum, and it would be a serious loss to local authorities if those rates ceased to be paid in future or were not paid on an equitable scale. The local authorities feel that this method of settling the rates is inequitable and that they are not having fair treatment in this matter.
A similar clause to that which I am proposing to insert was passed in the Committee stage of the Rating and Valuation Bill of 1925, but it was later withdrawn and was never re-introduced. There is, however, in the Civil Aviation Act of 1946 a very similar clause, which reads:
It is hereby declared that nothing in this Act exempts any of the three corporations from liability for any tax, duty, rate, levy or other charge whatsoever, whether general or local.
That is not the only example I can give. Clause 47 of the Coal Industry Nationalization Act, 1946, says:
Nothing in this Act shall be deemed to exempt the Board from liability for any tax, duty, rate, levy, or other charge whatsoever, whether general or local.
Local Government bodies feel that as the provisions have been included in these various Acts they would like to have an assurance that a similar one will be included in this measure and that their interests will be safeguarded. I beg to move.
Page 12, line 38, at end insert the said new clause.—(Lord Henley.)
§ LORD ADDINGTON
I have a very similar Amendment on the Paper and I would like to say a few words in support of this Amendment on behalf of the Association of Municipal Corporations and other local government bodies. It does raise a question of principle. Not only does it arise in regard to hospitals under the present Bill but it will arise in connexion with any future proposal by the Government for the nationalization of such things as gas, electricity or transport. I suggest that it is a matter of policy that these hereditaments or properties should not be removed from the ordinary law in regard to rating. The noble Lord has just referred to the precedents in the Coal Industry Nationalization Act and the Civil Aviation Act. I would be very grateful, therefore, if the noble Lord who answers could tell us why those precedents have not been followed in this case and what really are the in- 398 tentions of the Government in regard to rating both of voluntary and local government hospitals.
The wording of this Amendment follows that of the Rating and Valuation Act of 1925. Under the Rating and Valuation Acts these properties are assessed by the officials who deal with the assessment of other similar properties and assessments are subject to discussion and appeal. Contributions in lieu of rates by Government Departments are not at all satisfactory to local authorities. There is no effective negotiation and no power of appeal. The amounts of these grants are considerably less than if rates had been assessed on the ordinary basis of assessment. These properties are likely to become more numerous, and if they do not pay their share of the expenditure other properties will have to pay more.
§ THE POSTMASTER-GENERAL (THE EARL OF LISTOWEL)
I hope I can satisfy the noble Lord, Lord Henley, and the noble Lord, Lord Addington, that in fact local authorities are adequately protected against loss of revenue arising from the effect of this Bill respecting property normally liable for the payment of rates. There is nothing whatever in the Bill to exempt executive councils, to which the noble Lord referred, from the payment of rates on premises occupied by them for the discharge of their official duties. This applies equally to the endowments of teaching hospitals whose endowment property, unlike the endowment property of general hospitals, will be passed to their boards of governors. Furthermore, if any new premises are given or bequeathed by will to a Regional Board, hospital management committee or board of governors of a teaching hospital after the appointed day when the Statute comes into operation, they also will be liable to assessment for rates in the ordinary way but, of course—and I think this is the case that both the noble Lords have uppermost in their minds—the voluntary or local hospital building that passes to the Minister will become Crown property and will therefore acquire immunity, common to other Crown buildings, from liability to rates. But the usual practice of making an ex gratia payment in lieu of rates will be followed and the net result of this, in view of the habit of rating voluntary hospitals at the present time in many cases at a specially low rate, will be that some local 399 authorities will actually be better off under this method of payment than they are now.
I think the noble Lord was building up a general case against the rating laws, and if he feels that the ex gratia system is inequitable it is really a case that should be made on a Bill for amending our present rating system. He gave as an illustration of the sort of protection he wanted the provisions of the Civil Aviation Bill. I think it is quite clear that the property of a public corporation, whether it be the British Broadcasting Corporation or of the civil aviation authorities, is in a different position from Crown property. I do not think, therefore, that the analogy is really accurate. I hope the noble Lord will be satisfied by this explanation of the position and that he will be willing to withdraw his Amendment.
That does not cover the Coal Industry Nationalization Act position.
§ THE EARL OF LISTOWEL
That again is an instance of a separate corporation, because the property taken over has not become Crown property.
I feel that there could have been very little risk run if similar provisions were put into this Bill. I am very glad to hear that the anomalous position of the voluntary hospitals will be set right in the future. I hope that statement will be strictly adhered to, because the present position is inequitable, although one likes to see the voluntary hospitals receiving some generous treatment in this matter, as they have done in the past. Provided there is any likelihood that the matter will be dealt with by a General Bill, I should be very willing to withdraw my Amendment.
§ THE EARL OF LISTOWEL
I should be misleading the noble Lord if I led him to think that we were in a position to introduce a Bill in the near future to amend the general rating law. As the noble Lord is aware, our programme is extremely crowded and I can hold out no such hope. I am sure that our present rating system is constantly under examination and, if it requires alteration, that alteration will be put forward in a Bill at the earliest feasible moment.
§ Amendment, by leave, withdrawn.
§ Clause 10 agreed to.
§ Clause 11:
§ Regional Hospital Boards Hospital Management Committees, and Boards of Governors of teaching hospitals.
§ 11.—(1) The Minister shall by order constitute, in accordance with Part I of the Third Schedule to this Act, boards, to be called Regional Hospital Boards, for such areas as he may by order determine, for the purpose of exercising functions with respect to the administration of hospital and specialist services in those areas; and the Minister shall secure, so far as practicable, that each area is such that the provision of the said services in the area can conveniently be associated with a university having a school of medicine.
§ (3) Every Regional Hospital Board shall, within such period as the Minister may by direction specify, submit to the Minister a scheme for the appointment by them of committees, to be called hospital management committees, for the purpose of exercising functions with respect to the management and control of individual hospitals or groups of hospitals, other than teaching hospitals, providing hospital and specialist services in the area of the Board.
§ (4) The Minister may approve, with or without modifications, which may include additions or exceptions, any scheme submitted to him by a Regional Hospital Board under the last foregoing subsection, and it shall be the duty of the Board to give effect to the scheme as approved by the Minister.
§ 2.45 p.m.
§ THE EARL OF MUNSTER moved, at the end of subsection (1), to insert "and when the Minister is satisfied that any areas for which Regional Hospital Boards are constituted should be varied, he shall by order determine to what extent such areas shall be varied." The noble Earl said: This Amendment which I have put down to Clause 11 can best be deciphered if your Lordships will first look at Clause 74 of the Bill, from which you will observe that any orders made under subsection (1) of Clause 11 of this Bill are subject to a negative Resolution. It may be necessary, after the original order has been approved by Parliament through this procedure of a negative Resolution, for the Minister to make some alteration in the existing regional areas and your Lordships will observe that under subsection (9) (a) of Clause 11, the Minister has power to make an amendment to those areas by order. In other words, the 401 amendment does not receive the approval of Parliament. It seems to me that if an order has been originally approved to set up a particular area it would be particularly unfortunate for the Minister to make other orders, with no Parliamentary approval, which could amend the original order.
§ At the same time I must once more refer to the question of the regional areas. This Bill has now been before Parliament for a period of nearly six months, and in the Second Reading debate in this House I made mention of the fact that your Lordships were completely unaware of the areas of any of these Regional Boards. I was supported in that proposition by the noble Earl, Lord Donoughmore, and also, I think, by the Archbishop of York. I would ask the noble Lord once again whether it is not really possible for your Lordships to have some indication of what the Regional Boards will look like. As for the Amendment, I cannot help feeling that it is one which should certainly receive the support of His Majesty's Government, unless there is some hidden reason for the Minister to make new orders redefining regional areas without the authority of Parliament. I beg to move.
Page 13, line 10, at end, insert the said words.—(The Earl of Munster.)
§ THE LORD CHANCELLOR (LORD JOWITT)
If it were a fact that the variations which the Minister is to make will not receive the approval of Parliament, I would certainly agree with the noble Earl, but that is not the case. The Minister has power to make an order varying, and if the noble Earl will turn to Clause 74 on page 58, he will see, in subsection (4) the words:Any order made by the Minister under this Act may be varied or revoked by a subsequent order of the Minister made in like manner and subject to the like condition as the original order.I am assured, and it is the fact, that the order varying the regions will be subject to Parliamentary approval in exactly the same way as the order constituting the regions. That being so, it is really unnecessary to move this Amendment.
§ LORD LLEWELLIN
I think that makes a matter abundantly clear which ought to have been made clear—namely, that we could not just have the one order and then within a week or so alter it without 402 the same approval that was required for the original order. The Lord Chancellor's explanation, if I may say so, is quite satisfactory.
§ THE EARL OF MUNSTER
I am much obliged to the noble and learned Lord, and I beg leave to withdraw my Amendment.
§ Amendment, by leave, withdrawn.
§ 2.50 p.m.
§ LORD ADDINGTON moved, in subsection (3), after "for" ["for the appointment by them of committees"] to insert "the exercise of their functions with respect to the administration of hospital and specialist services in their area including." The noble Lord said: This is an attempt to secure co-ordination, and so to promote the general object of the Bill. There is a question of co-operation between the three different portions of the National Health Service—namely, the hospital specialist services, the local health services, provided by local authorities, and the general medical services. To provide a complete and unified service for the public, these three portions must surely act in the closest co-operation. No provision is made for this in the Bill nor, with the exception of the obligations placed upon local authorities under Clause 20, is there any provision to ensure that one portion of the service knows what the other is doing, although full information is surely essential to co-operation and harmony. The local authorities are under obligation to submit their proposals to the Minister, and to serve copies on any organization providing the health services in their area, including the Regional. Hospital Boards who are charged with hospitals and specialist services, and the executive councils, who are charged with functions in relation to general medical services. If the Regional Hospital Boards and the executive council were placed under a similar obligation, information by which co-operation could be secured would be obtainable and no one portion of the Health Service would be in the dark. I venture to believe that such a provision would help the efficiency of the service, and I hope therefore it may be possible to accept it. I beg to move.
Page 13, line 20, after ("for") insert the said words.—(Lord Addington.)
§ THE EARL OF LISTOWEL
I am sure we all share the noble Lord's desire for effective co-ordination between the different portions of the new Health Service. What the noble Lord wishes to do in this Amendment is to widen the scope of the schemes that Regional Boards must submit to the Minister's approval. I am sure he will agree that it is undesirable to waste time and effort on any unnecessary formalities. That is not improving co-ordination, but it is more commonly called "red tape" I can assure the noble Lord that the preparation by Regional Boards of the fuller and more detailed schemes he has in mind, which, of course, would have to be followed by the discussion of such schemes by officials at the Ministry of Health, would really hamper official administration by adding just that element of red tape. It is an unnecessary formality. What we all have in mind is the satisfactory planning of hospital and specialist services in each area by the responsible Board—and this is the alternative we offer him—by informal consultation and exchange of views between officials of the Ministry and officials of the Board. This, I am sure, will be the most effective way of obtaining the result we all desire.
§ VISCOUNT BRIDGEMAN
If I might intervene for one moment, I think one of the objects my noble friend had in mind in putting forward this Amendment—if you read it with the next Amendment in his name—is that the existing local authorities, as well as the Regional Boards, should have plenty of time to discover what is intended by the new scheme and that by previous discussion we should avoid friction and teething troubles. I may be trespassing in referring to the next Amendment, but it does seem to me to be the point in my noble friend's mind. There was no question in his mind of red tape, but merely to make certain that the local authorities, who have a great deal of experience and good will in this matter, were able to co-operate in the working of these schemes and were not taken unawares at the last minute by arrangements on which they could have advised.
§ THE EARL OF LISTOWEL
With the noble Lord's permission I will deal with his point on the next Amendment.
§ LORD ADDINGTON
I cannot say that the reply was satisfactory. This does not mean red tape, but only an addition of consultation, and consultation at the present moment is much better than leaving it to informal talks which may or may not take place at the Ministry. I beg leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.
LORD ADDINGTON moved to insert after subsection (3):
(4) A copy of every scheme submitted to the Minister under the last foregoing subsection shall be sent to every local health authority within the area of the Regional Hospital Board by whom the scheme is submitted and every such local health authority shall be entitled to make representations to the Minister in relation thereto.
§ The noble Lord said: This covers very much the same point. It merely means that the local authorities shall be in possession of copies of the scheme which are submitted to the Minister so that they may have all the information at their command which would enable them to achieve co-ordination. It is a matter perhaps of machinery rather than anything else. I beg to move.
Page 13, line 25, at end, insert the said new subsection.—(Lord Addington.)
§ THE EARL OF LISTOWEL
The noble Lord, Lord Addington, and the noble Viscount, Lord Bridgeman, both want to make quite certain that the local health authorities know exactly what plans the Regional Boards are making. The proposal in the noble Lord's Amendment is that they should have a chance of putting their views to the Minister before any regional plan has been finally accepted. I think that both the requirements of the noble Lord as set out in his Amendment are satisfied in the Bill, though in a different and, I venture to think, more convenient way than he has suggested. The noble Lord will remember that the Minister must include members of local authorities among the people he will appoint as representatives on these Regional Boards. They will therefore 405 know from the start what is being planned in relation to the services provided in the area by the Regional Boards, and they will also be able to influence the Boards in accordance with the wishes of the local health authorities. They will be in on the spot, and they will be in a better position than the local health authorities themselves in relation to the plans which are being prepared by the Board. They will probably act as liaison officers and will keep their colleagues in touch with what the Boards are doing. Of course, if the local authority members of the Board are dissatisfied with the final schemes—in spite of all their objections a scheme might have been drawn up to which they still took exception—they will be able to state their views with a much better understanding of the position than the local authorities. I hope, therefore, that with this detailed explanation of what will actually be done under the provisions of the Bill, the noble Lord will feel that his object is better attained than it would be by the acceptance of his Amendment.
§ VISCOUNT BRIDGEMAN
Could the noble Lord opposite say whether or not, among the representatives of the local authorities whom he mentioned just now, he will include representatives of non-county boroughs.
§ THE EARL OF LISTOWEL
I have no doubt that that is a matter which will be borne in mind by the Minister in choosing the representatives of the local authorities.
§ LORD ADDINGTON
I much prefer that the local authorities should get the scheme. It raises a question which will come up later, but there is really nothing in the Schedule to say it may not be representative of local authorities. There is nothing to say that they shall be members or closely in touch with the local authority. If the local authority could get the scheme so that they could consider it, it would be very much more satisfactory. Again, I am in the hands of the House with regard to this Amendment.
There is one question I should like to put upon this matter. I understood the noble Earl opposite to say that it would be possible for the local health authorities to make representations to the Minister at a later stage. That is to say their representatives on the Boards would report to the local 406 authorities the nature of the schemes and they would then be in a position to make representations to the Minister. Would they, under the scheme, have, as it were, a sort of authority to make representations, or is the position just that they could write a letter to the Minister if they liked to do so? There is a difference between the two things. Is it part of the scheme that they should be able to make representations, or are they just in exactly the same position as any other member of the public?
§ THE EARL OF LISTOWEL
It is an essential part of the scheme. I think that Lord Addington has perhaps overlooked the point that local authorities would be able to express their views before any scheme receives the endorsement of the Minister. If the noble Lord looks at the Third Schedule, he will sere that the Minister is obliged—it is optional—to consult with the local authorities as well as with the other organizations before the appointment of a Regional Board.
§ VISCOUNT SIMON
Would not the noble Earl and those with him agree that a point that may well be considered is whether the language of the Schedule, to which he has just referred, might not, later on, be a little strengthened. I thoroughly understand the point which he has made. After all, it merely states—I am looking at page 65—that the Minister shall appoint members as he thinks fit to a Regional Hospital Board and that, among others, the members shall include:(c) persons appointed after consultation with the local health authorities in the said area.I agree, of course, that that is some relief so far as it goes to the point made by Lord Addington. But, without in any way deciding it now, would not the noble Earl and those responsible for the Bill consider whether that language cannot be a little strengthened in order to give relief to what I think is a widespread feeling?
§ THE EARL OF LISTOWEL
I will gladly do as the noble Viscount suggests. The intention is that the representatives of the local authorities should be included on these Boards. I also understand the noble Viscount's point about the wording of the Schedule. I will look into it before the next stage of the Bill is reached.
§ LORD ADDINGTON
In the circumstances I do not think that I need proceed further, and I beg leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.
§ THE EARL OF MUNSTER
Before we pass from this, may I again renew my request to the noble and learned Lord opposite to give us if he can, on behalf of the Government, some information to indicate to the House, and particularly to us here on these Benches, what the size of these regional areas is going to be? I must really emphasize that for six solid months this Bill has been before Parliament. Applications for information on this have been made to the Government in this House and in another place, and we, as yet, see no signs whatever that the Government are in any way willing to give the House some information as to the size that these areas will be. I wonder if the noble and learned Lord, the Lord Chancellor, could give me a more satisfactory reply now.
§ THE LORD CHANCELLOR
I wish I could, but, to be frank, I cannot. There is a very great deal of negotiating to be done with regard to this matter, and it would be most foolish to attempt to do anything in a hurry. I, therefore, am not in a position at the moment to indicate what the regions would be. They are to be based on universities. We must be very careful, I think, not to have them too big. To have half a dozen regions in the whole country would, obviously, be much too big. Having said that, I regret that I am not in the position to give any indication about what is going to be done in this matter. I wish that I were.
§ Clause 11 agreed to.
§ Clause 12:
§ Functions of Boards and management committees.
§ 12.—(1) Subject to the exercise of functions by hospital management committees in accordance with the next following subsection, it shall be the duty of a Regional Hospital Board, subject to and in accordance with regulations and such directions as may be given by the Minister, generally to administer on behalf of the Minister the hospital and specialist services provided in their area, and in particular—
- (a) to appoint officers required to be employed at or for the purposes of any hospital providing such services, other than a teaching hospital;
- (b)to maintain any premises forming part of or used in connection with any such hospital;
- (c) to acquire on behalf of the Minister and to maintain equipment, furniture and other movable property required for the purposes of any such hospital.
§ (2) The hospital management committee of any hospital or group of hospitals shall exercise on behalf of the Regional Hospital Board for the area in which the hospital or group is situated, in accordance with regulation's and such directions as may be given by the Minister or the Regional Hospital Board, such of the functions of the Board relating to the control and management of that hospital or group of hospitals as may be prescribed.
§ (3) It shall be the duty of the board of governors of every teaching hospital, as from the appointed day, in accordance with regulations and such directions as may be given by the Minister, generally to manage and control the hospital on behalf of the Minister, and in particular—
- (a) to appoint officers required to be employed at or for the purposes of the hospital;
- (b) to maintain any premises forming part of or used in connexion with the hospital;
- (c) to acquire on behalf of the Minister and to maintain equipment, furniture and other movable property required for the purposes of the hospital.
§ 3.7 p.m.
§ LORD LUKE moved in subsection (1) to leave out all words after "area." The noble Lord said: In moving this Amendment I seek to readjust to a certain extent the functions as they are laid down as between the Regional Boards and the hospital management committees. The words in the Bill are that the Regional Boards are "generally to administer on behalf of the Minister the hospital and specialist services provided in their area" I think that perhaps it is a pity that it did not end there instead of going on to prescribe the various functions. However, the Amendment does not seek to finish the wording. The functions of the boards of governors of teaching hospitals are, it will be observed, similar in that they administer on behalf of the Minister. I would like to ask why should not hospital management committees or groups of hospitals have powers from the Regional Boards similar to those enjoyed by teaching hospitals from the Minister. After all, these bodies, whether Regional Boards or governors of teaching hospitals, or hospital management committees, will have been formed of trustworthy people 409 appointed by the Minister. No one on these bodies will be there except to his satisfaction. I should have thought, therefore, that we could have confidence in them to manage the affairs of hospitals efficiently.
§ Furthermore, the Regional Board will surely have their hands very full planning their regions, co-ordinating and generally giving guidance in their areas, and I should have thought that the Regional Boards would have been glad to see hospitals under their ægis functioning in a true administrative way—discharging their proper functions. From the hospital point of view taking the appointment of staff away from the hospital management committee, will, I think, without doubt, make further difficulties for the management in that it will tend to produce that divided loyalty which does not ensure efficiency. And we have coming in here again the factor of remote control. It is rather, as it stands at the moment, placing the non-teaching hospitals or groups at a disadvantage compared with the teaching hospitals. In fact, the logical consequence of this appointing of staff for teaching hospitals should be that the staff should be appointed by the Minister, and non-teaching hospitals have staffs appointed by the Regional Boards. It is a question of weighing the possibility of having a staff in regions with a sort of floating population capable of being moved at a moment's notice—this clearly would give hospitals a good deal of uncertainty and difficulty—against that of hospitals being able to get and keep a team together as at present—a method which has worked remarkably well.
§ Then there is the question of maintaining premises. I should have thought that the maintenance of premises was a matter which could well be in the hands of the hospital management committees and not in the hands of the Regional Boards. It seems quite unnecessary for the Regional Board to come down in a body to adjudicate when some repairs are necessary. Surely, hospital management committees would be capable of doing that. The same applies to the maintenance of the equipment.
§ To my mind, the crux of the matter is this: if the Minister wants responsible people to be members of the hospital management committee, he must give them suitable responsibility. I do not 410 know whether the Minister expects to attract the best people to the Regional Boards, but he surely wants people with experience, energy and initiative. I do not think that he will find such people willing to serve on these committees, where their function may be of a very minor order, excluding the responsibilities mentioned in paragraphs (a), (b) and (c). I maintain that under the governance of hospital management committees these non-teaching hospitals should be allowed to grow in stature, and in order to maintain local interest they must have real functions for local people to manage. I beg to move this Amendment.
Page 15, line 10, leave out from ("area") to end of line 18.—(Lord Luke.)
§ THE LORD CHANCELLOR
I think that it might be convenient if I reply at once to the noble Lord, because I am in complete sympathy with what he said. I have said before, and I say again, that I believe that the success of this scheme will depend almost entirely upon a very wide measure of delegation. We shall not get people to work on the hospital committees unless they have a real job of work to do; and therefore we must see that they have a real job of work to do. The real issue between the noble Lord and myself is how this is to be achieved—a matter of machinery. I want it to be done by regulation, which is a very flexible mode, but I want exactly the same things done as he wants done. In Clause 12 (1) are set out the powers of the Regional Board. They are very wide and all-embracing, and leave virtually nothing. In subsection (2) the noble Lord will see that the clause specifies that:The hospital management committee of any hospital or group of hospitals shall exercise on behalf of the Regional Hospital Board for the area in which the hospital or group is situated in accordance with regulations and such directions as may be given by the Minister or the Regional Hospital Board, such of the functions of the Board relating to the control and management of that hospital or group of hospitals as may be prescribed.What we have in mind is to prescribe by regulations that the hospital management committee shall do all things in regard to the running of the hospital under their jurisdiction but that they shall do them on behalf of the Regional Board, from whom they have delegated 411 powers. For instance, the appointment of officers—except perhaps senior servants, which would be a matter for the Regional Board—should be in the hands of the hospital management committee. Then, with regard to the running of the hospital, the incurring of expenses—that is all expenses other than those for the building of a new wing, or anything of that sort, which would obviously be a matter for the Regional Board—will be a matter for the hospital management committee. We anticipate that there will be duties prescribed by regulations, which will give the hospital management committees a very wide power indeed. This power, in fact, will cover practically everything, except such things as I have mentioned—great questions of major policy, which would, obviously, be a matter for the Regional Board.
We think, however, that in order to make the legal position quite plain, it is much better not to impinge upon the principle that the Regional Board is the authority, and the hospital management committee is merely the agent, acting on behalf of the Regional Board. It is like the case I have quoted before. A great landowner has an estate agent, and we all know that in practice very wide discretion is left to that estate agent to make all sorts of arrangements. He would refer to his employer only in very important matters. It is that sort of analogy that we anticipate here. I believe that we are right in not breaking the chain of authority, in having the hospital management committee as agent or representative of the Board. But it seems to me a matter of business administration that that committee should have the widest possible delegation of function. If they want to incur any expense they should not have to go all the way up the chain to seek the authority of the Regional Board. Such a process would mean quite hopeless administration. In principle, I can assure the noble Lord that the Minister intends to draft his regulations in such a way that all the matters which the noble Lord has mentioned will come under the jurisdiction of the hospital management committee, although, as a matter of law, the committee will be carrying out those functions on behalf of the Regional Board. If there is any dispute or discrepancy between the two the legal position will then be 412 quite plain—that the Regional Board are the controlling authority.
§ LORD LLEWELLIN
I think that the Committee will agree with the idea that as much power as can properly be left should be left to hospital management committees. With what the noble and learned Lord, the Lord Chancellor, has said on that, I think that we all agree. Yet, it seems to me that we still have it here the wrong way. Under the Bill as it stands, they are left no power. That will be the position until regulations prescribe differently. I believe that if we are to get the best men serving—and I think that we all want them to continue to serve on these hospital management committees—we have to make these committees a reality, and not just a kind of camouflage. Like some other noble Lords, I happen to be a member of one of the management committees, and I serve with different people with all sorts of interests and all sorts of political views. They are all good men, contributing their best, and I want to see them given encouragement. I believe that we should give them that encouragement much more by leaving this general power in the Regional Hospital Boards. I want to see them as a co-ordinated authority, looking after the whole field, but I do want it to be seen that there is a real job to be done by the hospital management committees, not only from the point of view of the good men, but from the point of view of seeing that Regional Boards are not over-burdened by small detail and to ensure that they do look at the picture as a whole.
They should not be responsible for cleaning hospitals, or for putting new tiles on the roof after a gale. These details, and such things as the provision of meals, should be left to the hospital. Whether it is right or wrong, it would have been much better, in my view, to leave those powers, in the Bill itself, to the hospital management committees. I am quite certain that unless we do something to Clauses 13 and 14—whether we do anything on this clause or not—we shall have these hospital management committees put in the position of being mere nonentities. I do not want to sabotage the service, but I personally would not be prepared to serve on one of these committees unless I felt it had some real powers. Under Clause 13, we see that the committees cannot sue or be sued. 413 That means that they cannot order the milk for the hospital. At least, they may order it, but the milkman may say: "I cannot sue you. I must have the order from the Regional Board. They are the people whom I have to look to for my remedy." That seems to me an absurd position. So I certainly think with regard to all matters prescribed for them to deal with, it should be clear that they are dealing as principals and that they should not have to refer back time after time to a Regional Board in respect of those small matters.
The same thing applies when we come to the next clause with regard to staff. In the Bill as drafted, it is laid down that the staff shall all be the staff of the Regional Board. I think that is probably right with regard to specialist or consultant staff. But when it comes down to the ordinary house staff in a hospital, if the hospital management committee is not going to be a nonentity then it must really be the employer of the staff it employs. It must have the right to engage staff, the right, if necessary, to dismiss staff, and the right to deal with staff generally. Whatever may happen with regard to this Amendment, in order to get the good men I should have liked to have seen the responsibility they are to have placed in the very forefront of the shop window and not prescribed afterwards by regulation. Unless we do something with regard to those other two clauses, believe me, the very large number of people whose services have been at the disposal of the great hospital movement of this country for ages, will not be prepared to come forward and take a part if they cannot enter into a contract, cannot even engage one of the staff of a hospital, or take any measures of that sort. So really I think if we want this hospital service to continue as a good service, and still to attract the best men, it is only reasonable to make these committees real management committees and not merely give them that name and let them have no authority at all. I should have hoped that the Government might have accepted the present Amendment, but if they cannot see their way to do that, something certainly ought to be done with regard to the other two clauses which I have mentioned to your Lordships.
§ VISCOUNT SIMON
Might I add one word from a slightly different point of view? I agree, of course, with what has been said by my noble friend. I am not seeking to repeat or to rival what he has to say on the general merits, but I would ask the Lord Chancellor just to look again at subsection (1) and subsection (2) in Clause 12, because, as he would be the first to tell us, these things will have to be construed afterwards, not according to anything we may say here, but simply according to the character of the language used in the Bill. When I compare subsection (1) with subsection (2) what I notice is this, that as regards subsection (2) the hospital management committee is given no positive duty under that subsection. It is described as being a committee which shall exercise on behalf of the Regional Hospital Board such of the functions of the board relating to the control and management of the hospital or group of hospitals as may be prescribed. If one turns to page 61, one will see that "prescribed" is defined as one would expect. It means prescribed by regulations made by the Minister after the Bill is passed. Those functions may, therefore, be either minute or extensive. But, at any rate, the matter is left for subsequent regulation. It is true therefore to say that in subsection (2) the hospital management committee is not given by Parliament any positive defined duty at all.
Contrast that with subsection (1). Subsection (1) provides that it shall be the duty of a Regional Hospital Board, acting of course, on behalf of the Minister, to do very important things—namely, to administer the hospital and specialist services. Then the subsection goes on: "and in particular—" Now lawyers, having had occasion to construe these difficult sections, know very well what importance is attached to the circumstance that a particular duty has been placed upon Authority A and how often that has the result, or is thought to have the result, that it cannot be discharged by Authority B. The duty which is in terms put upon the Regional Hospital Board in paragraph (a) is, in particular, the duty to appoint officers required to be employed at or for the purposes of any hospital. I do not think that I should for a moment quarrel with my noble friend's interpretation, but notwithstanding that that is 415 stated categorically, and stated in particular, as being the positive duty of the Regional Hospital Board, still on a careful construction of the whole thing, it is possible, if the Minister likes, after the Act is passed, to make a regulation which will authorize the transfer of a portion of that duty, and I think all the more so because of the preliminary words in subsection (1).
All the same, if you take the ordinary citizens, of whom there are a great many, who take a most keen interest in a hospital with which they have long been associated, they are likely to be confused if you put before them these two subsections with this contrast—the first which describes in positive terms what the Regional Hospital Board has, in particular, to undertake to do, and subsection (2) which really says that the hospital management committee shall have no duties at all except that they may be given some duties by the Minister by regulation made by him after the Bill has become law. My suggestion is this. I do not make it in any hostile spirit; I accept every word that the Lord Chancellor has said, and, as usual, he has explained it with the most admirable clearness; but I do think it rather a pity that the Bill should go on the Statute Book in that form. Is it not possible for him with his advisers to devise something which makes it plain on the face of it that the hospital management committee will really have something definite which they have to do, in addition to such matters as appointment of officers?
If noble Lords will look at the definition clause, they will see that the word "officer" includes a servant, it includes a weekly servant. It includes a porter, who is a very important person in the hospital. It includes a servant of every grade. Would it not be possible at least to put the Bill in such a form as will make plain, by its actual language, apart altogether from any lawyer's niceties, that with regard to hospital committees—which have had such a fine tradition and have given such great service to hospitals in the past—they are really going to have an important job left to them, and that it is not just a question of the Minister saying afterwards, "Oh, I do not think much of this hospital committee. I think on the whole that any regulations it may make should be subject always to the ratification of the Regional Board"? 416 That would be perfectly lawful under this clause, but I think it would be an unhappy state of affairs. I am sorry to intervene. I hope the noble Lord appreciates that I am really honestly only trying to help. I cannot claim to know as much about hospital management as I perhaps ought to know. But I am very much concerned that a great body of warm-hearted and sensible, business-like people should not, by the very language of the Bill, if they look at it, see their function as very hypothetical, whereas the Regional Hospital Board is given some positive duty. If I am mistaken I should like to know, but I should also like to know if in substance I am not right.
§ VISCOUNT MAUGHAM
May I add one word? I want to say that I agree entirely with what my noble friend has said with regard to the law and with regard to the true construction of subsections (1) and (2) of Section 12. I confess that when I read the clause I came to the conclusion that the principal part of the maintenance and matters of equipment, furniture and other things of that sort, were intended by the draftsmen to be the functions of the Regional Hospital Board. I was exceedingly glad to hear, and I am exceedingly glad to hear it explained in very plain language, that that was not the object of the clause. The truth as it appears to me is this—that the draftsmen ought to have put in the (a) (b) (c) that you find in subsection (1). He ought to have put these in subsection (2) as duties and services to be performed by the hospital management committee, subject, of course, to the regulations and directions of the Minister. So that, prima facie, the duty not only of appointing a charwoman but also the duty of appointing the principal officers of the hospital management committee should be performed by the people who have to work with them and who have to carry out the duties of these committees. If provision were made in subsection (2) in that way, subject, as I say, to the regulations and directions which might provide that some particular function of that kind ought to be performed by the Regional Hospital Board—
§ VISCOUNT MAUGHAM
—if that were done, that I think would put an end 417 to the criticisms that have been made of this clause. Like my noble and learned friend, my only desire is to help; to make the position of the hospital management committee one of great importance and, if I may say so, of dignity, and not to have the committee looking on their position as that of a sort of servant of a Regional Board which may be a hundred miles away and have no means of knowing anything of local conditions.
THE MARQUESS OF READING
May I add just one word in support of the noble Lord's Amendment, and in agreement with what has been so far said? I want, in particular, to call attention to what the noble and learned Lord, the Lord Chancellor, said in regard to the intention to deal with these matters by regulation in preference to dealing with them by the actual wording of the Bill. From the mere point of view of, if you like, expediency we have to consider the interregnum of something over a year before the earliest date by which this scheme can come into operation. In the course of that considerable period of time there is provision in the various clauses of the Bill for the making of a very large number of regulations. Presumably these will have to follow one another in process of priority, and it may be a very considerable time before those who are now giving their time to the voluntary hospitals, and may hope to continue to do so after the new scheme comes into operation, know what the position of a voluntary hospital is going to be. I suggest that it is most undesirable to protract that period until some regulation can be made, and that it is much more in the general interest of enlisting the widest possible support for the local hospital committees that they should know at the earliest possible moment and in the clearest possible terms, and by the best possible instrument, which is the Bill itself, exactly what the functions are that are going to lie before them in the future in order that, apart from all other considerations during this interregnum, their interest in the whole problem of hospital management may be stimulated and maintained.
§ THE LORD CHANCELLOR
Perhaps it would be convenient if I were to reply. I am grateful to all the noble Lords who have elucidated the matter. Of course, it would be possible to do what has been suggested; it would be easy to effect deliberately, but it has not been done, and 418 the Minister has explained in another place why. I am bound to say that on this matter I find myself in complete agreement with the Minister. After all, what we are doing is to build a co-ordinated service. I used before the analogy of a Commander-in-Chief who leaves to his Army Commanders a very wide measure of discretion and whose Army Commanders, if they are wise, leave to the regimental officers a very wide measure of discretion. The discretion should be very wisely given and, no doubt, wisely used. We have quite deliberately adopted this scheme. We have appointed Regional Hospital Boards, and we define the authority of the Regional Hospital Board in language which is pretty wide and then in the next clause we say that hospital management committees may exercise on behalf of the Regional Hospital Board—a very important phrase: on behalf of the Regional Hospital Board—certain functions which are to be prescribed. But they exercise these functions on behalf of the Regional Hospital Board.
I am most anxious to have no disputes in the nature of what I may call demarcation disputes. We have had quite enough of these in the past, and I do not want controversies to arise as to where to draw the line, because it is difficult to draw a line always, as to whether this particular exercise of the functions does rest with the hospital management committee or the Regional Board. The Regional Boards are the authority and I want them to be the unquestioned authority. But, equally, having said that, I want them to exercise their powers by leaving a very wide discretion to the hospital management committees. With respect to what the noble Lord, Lord Llewellin said, the fact that when you enter into a contract of service—with the charwoman, or the gardener, or the porter—the contract is made between the servant and the Regional Hospital Board, that does not seem to me to matter a bit. You may have authority on the hospital management committee to engage the servants and to dismiss these servants, but, to go back to my old analogy of the estate agent, when he is managing a large estate and engages a servant, that servant becomes the servant of the master. But the estate agent can engage servants, or dismiss them, or alter the terms of their employment, and so on. So it is to be 419 with the hospital management committee. Everybody they engage becomes the servant of the Regional Hospital Board, but it is suggested that the hospital management committee shall have a very wide discretion to engage or dismiss the servants with the exception, as I have said, of the senior servants and so on.
That is a scheme we have deliberately adopted. I believe it to be the best scheme. I believe it is a scheme which will ensure that there is, in fact, a very wide discretion; that there is this authority left to the hospital management committee. At the same time, I believe it is the only way of procuring a co-ordinated system. That is why we have quite deliberately adopted this principle of putting (a), (b) and (c) into subsection (1) and not putting (a), (b) and (c) into subsection (2), and making it plain that, in regard to the functions of subsection (2) they are to be exercised on behalf of the Regional Hospital Board. That has been done quite deliberately with our eyes open, and I am bound to say that, on reflection, I believe it to be the right course to take in order to secure on the one hand, a completely co-ordinated system and, on the other hand, real discretion for the hospital management committees to exercise their functions and powers. That is what we have done, and by that we must stand.
I am very sorry to hear what the Lord Chancellor had to say. I have always admired both his persuasiveness and his ingenuity, but I must honestly say that on this particular occasion I think the Government and their plans have been absolutely riddled by the debate which has taken place. I think the Lord Chancellor gave rather an unhappy analogy when he talked about the Commander-in-Chief because I should be very surprised to see a Commander-in-Chief who gave certain general orders and who said certain activities were broadly allotted through the divisional commanders when, in fact, he meant they should be left to the battalion commanders. It would certainly have an extremely discouraging effect upon the Army. In this particular case nothing that the Lord Chancellor had said alters the fact that in Clause 12 certain functions which are laid down in subsection (1) (a), (b) and (c), are allotted under the clause in particular 420 to the Regional Hospital Boards. That is what is said. That is what the two noble and learned ex-Lord Chancellors who have addressed us to-day say they think it means, and that is what it will be taken to mean by the general public.
The noble and learned Lord, the Lord Chancellor, said that is what it says, not what it means. He says it means something different, and it means that those functions are to be exercised by the hospital management committee, and that might possibly be prescribed by the Minister in individual cases. In general cases we do not know. The noble and learned Lord, the Lord Chancellor, said that he thinks the method of the Bill is much more convenient. It is much more convenient to the Minister, because it preserves to him complete freedom of action. But I cannot believe it is more convenient to the committee, and I cannot believe that it is good law. After all, we are not an assembly of party politicians; we are a revising body trying to improve the law. That is what our function is here. Here is a case where it is obvious that the clause as written does not represent what it is intended to mean, apparently. I hardly think your Lordships' House can leave the clause in exactly that condition.
§ THE LORD CHANCELLOR
I do not think the two distinguished ex-Lord Chancellors who spoke have said anything with which I do not cordially agree. You start off with the Minister; you then have a complete giving of authority to the Regional Hospital Board; and then you have in subsection (2) the power of the hospital management committee to exercise on behalf of the Regional Board such duties as may be perscribed. I am quite prepared to accept any proposition of law that I have heard to-day.
§ VISCOUNT SIMON
I am in the happy position of agreeing with everybody. The point is—and it is in substance what has been said by my noble friend—that the noble and learned Lord, the Lord Chancellor, in his first speech told us in very precise terms, and I am sure with the greatest accuracy, that what the Government mean to do is to give the hospital management committee the duty of appointing hospital officers. I do not dispute that when they do so they will do it on behalf of the Regional Hospital Board. However, with great respect to 421 the noble and learned Lord, the Lord Chancellor, and to those who drafted the Bill, the point is: Have you really drawn your Bill in the best way to make it plain that as a matter of fact that most important duty is going to be laid upon the hospital management committee? I do not think you have at aL, and I am afraid I think the analogies which I have heard are rather far-fetched. The truth of the matter is that I have never heard of a Commander-in-Chief reserving the right to decide who is to be the mess cook.
I only want to say one word more, and it is this. I would appeal to the Government to give the matter a little more thought. We are not anxious to press things too extremely in this House. We are only anxious to improve the drafting of the Bill, to make it mean what it in fact is intended to mean. We have had the highest legal authority to say that it is likely to lead to misunderstanding, and it confers powers upon the Minister which the Minister does not intend to use but which he intends to delegate to other people. Let the Government see whether they cannot redraft the clause to make it mean more what it is intended to mean. We do not want to press things, and I hope a Division on this question will not be necessary. Let the Government consider this matter further in the light of this discussion. That is surely reasonable, and I would urge them to adopt that course.
§ THE LORD CHANCELLOR
I am always very ready to respond. I will gladly give the matter further consideration, but I cannot hold out any hope that on further consideration we shall come to a different conclusion. As a matter of law, I apprehend it to be quite obvious that the Commander-in-Chief-would have the right to dismiss the mess cook, or to send him home. As a matter of fact, of course, if he interferes with the thing at all he would be a complete fool. As a matter of law it must be for the Regional Board, but as matter of good sense I cannot imagine the Regional Board being so foolish as to interfere in these small matters. In response to the request made I will gladly discuss this with my advisers again and see what they say in the light of the argument. However, I am bound to say that I do think, to keep the legal position plain, we ought to do it in the way we have done 422 it, though I sincerely hope we shall have such a very wide measure of devolution as completely satisfies the noble Lords.
§ LORD LLEWELLIN
This is really an important matter from the point of view of people who have served hitherto on the governing bodies of these hospitals making up their minds as to whether they are going on or will leave the whole thing. If it is left that nobody knows until some year or two years hence what powers are going to be left to the hospital under the regulations to be prescribed, then I do not believe in practice you will get people going on, because they are going to be left in a position of acting as agents, and so on; they cannot employ any officer of their own, and they cannot sue anybody. All these are going to be matters for the Regional Board. I just do not believe you are going to get the best out of this thing in such circumstances. I do ask the noble and learned Lord, the Lord Chancellor, to look at this again to see whether he cannot do something so that we may have set out on the face of the Bill the functions that the Minister, as the Lord Chancellor said, intends to give to these management committees, and so that the committees may be able to decide whether to go on or not. This is a point where we are only anxious to improve the Bill to keep the real live organization going in these hospitals and not have people who just say: "There is nothing to do, so I might as well have my name on the Board." Those are the only people you will get if you do not have something really definite for those people to do.
Perhaps I might say just one more word. If I may say so, I still think the words of the noble and learned Lord, the Lord Chancellor, unsatisfactory. I made an appeal to him to meet us and he said: "Well, if you ask me to give, the matter further consideration with my advisers I will do so, but I cannot hold out the slightest hope that there will be any alteration." I would like to know whether that is his considered view, because if that is his considered view, then I think we had better have a Division here and now and get it done with. As your Lordships know, I have always pressed Lordships on this side of the House to go to the limit of conciliation, and I think that is right for your Lordships' 423 House. However, it is not a very forthcoming attitude to say: "Well, I will give it further consideration, but I say now that that further consideration will not have the slightest result." I think the noble and learned Lord, the Lord Chancellor, ought to tell us whether he thinks there is any chance of alteration in regard to this point.
§ THE LORD CHANCELLOR
I only put in the words that I did because, if I may use a vulgarism, I am most anxious not to lead your Lordships up the garden path with a whole lot of hopes that I do not think will be satisfied. I will try, and whilst there is life there is hope. But I should not be right in holding out rosy prospects; it would not be honest to do so. I will try, and I do not say there is no hope.
§ LORD LUKE
I am glad to hear the noble and learned Lord's last words, even if I did not see much hope in the words he used before. I am willing to withdraw my Amendment, but with a reservation that when we come to consider it again I shall still think the point just as important. I beg leave to withdraw.
§ Amendment, by leave, withdrawn.
§ 3.50 p.m.
LORD MORAN had given Notice that he would move to insert the following subsections after subsection (2):
A hospital management committee which acts for a group of hospitals shall appoint and keep appointed a separate house committee for dealing with matters in regard to each hospital in the group in such manner and subject to such conditions as the hospital management committee, subject to any directions of the Regional Board, may direct.
For every hospital under a hospital management committee that committee (in the case of a hospital not included in a group) or the house committee for each particular hospital (in the case of a group of hospitals) shall be responsible for setting up or arranging for the setting up of a medical staff committee elected by the medical staff of the hospital. Any such medical staff committee shall have the right to nominate a reasonable number of their members to be members of the hospital management committee (in the case of a hospital not included in a group) or the house committee for each particular hospital (in the case of a group of hospitals).
§ The noble Lord said: I want to try to convince your Lordships, without taking up much time, that the Amendment respecting a medical staff committee is important 424 and that such a committee is the very foundation of the administration of the voluntary hospitals. There are, as your Lordships know, two methods of administration of hospitals. In the voluntary hospitals there is a medical staff committee, composed, as a general rule, of all the staff. In my own teaching hospital, there are forty members of that committee. It is the duty of each of those members (who are connected with every kind of special service) to keep their colleagues informed of any new equipment or any new development of knowledge, wherever it may occur, all over the world. It is a unique instrument for keeping the management of the hospital up to date in practical matters. When the members of the committee have been so informed and have decided whether their colleagues proposal is or is not justified, then a number of them sit on the board of management (eight actually at my own hospital) and try to convince the board that this or that should be done. That is the system in the voluntary hospitals. It a measure designed to afford technical advice to the board of management so as to keep the hospital up to date in its administration.
§ Compare this with the other system of administration, that in the municipal hospitals. There you have a single medical superintendent instead of the forty men on this medical staff committee. He does not have at his disposal any medical staff committee or any board of management; he refers to some remote control such as County Hall. How has he to convince them? He has to be a Pooh-bah who knows everything, not only in surgery and medicine but in every single specialty included in a hospital perhaps dealing with 700 beds. The contrast between a committee representing every specialty, giving technical advice to the board of management, and this medical superintendent, giving advice to County Hall on every branch and specialty of medicine, is so extreme that there is, I think, complete unanimity in the professional world that this medical staff committee is the only way in which to run a hospital. That is borne out by the fact that recently the most progressive municipal authorities, such as, for instance, the Middlesex County Council, have adopted medical staff committees.425
§ This is not an unimportant matter, it is a very important one because it goes to the very root of the efficiency of the administration of the voluntary hospitals. I was, therefore, when this matter was dealt with by the Minister on a similar Amendment in another place, very surprised to read that he was against the Amendment on the grounds that if a committee of this kind was set up there was no reason why other committees should not be set up, and this would give this special committee priority over all other committees. Of course it has priority; it is the very root of the hospital. When I read his reply, I must confess that I felt it did not do justice to the grasp he had shown of this Bill and of the fabric of my profession. I beg to move.
Page, 15, line 26, at end insert the said subsection.—(Lord Moran.)
THE EARL OF DONOUGHMORE
The noble Lord has spoken just now about the desirability of having a medical staff committee. I notice that his first Amendment also speaks of a separate house committee, but I presume he is discussing the two points together. This afternoon we have been discussing with great interest certain powers which your Lordships think should be conferred upon hospital management committees. I am now looking at it from a different point of view. I am anxious to know the intentions of the Government as to the powers that a hospital management committee would have in constitutional matters. They ought, of course, to have power to appoint a medical staff committee and they certainly ought to have power to appoint a house committee. All those of us who are familiar with the work of the voluntary hospitals know what valuable things they are. They ought also, I think, to have power to appoint other committees. My noble friend Lord Llewellin knows what a great deal of anxiety there has been lately in many hospitals on the subject of diet. You may have to appoint a diet committee—I do not know—but at any rate a hospital management committee ought to be trusted to arrange its own constitution in accordance with what it considers to be the necessities of the case.
Quite frankly, I do not care very much whether this is put in the Bill or not, though I should prefer to see it in, but 426 I hope the Government will tell us that the hospital management committees will be masters in their own houses to the extent of being able to perform their duties in accordance with whatever constitution they think is most desirable. This may have to be left to regulations, as we have heard before, but at any rate I think the position might be made clear to us before we pass from this clause.
§ THE LORD CHANCELLOR
There are two points here and I did not quite understand whether the noble Lord, Lord Moran, was speaking to both of them.
§ LORD MORAN
I did not mention the special case of the house committee because I felt that to be self-evident. It seemed to me that if there was a hospital it had to have somebody to express its wants and needs, and to put its own case forward. Therefore, I did not feel that any argument: was necessary to support that view. I dwelt upon the other matter because I thought it required more explanation.
§ LORD HORDER
I feel on this point very much as the noble Earl, Lord Donoughmore, feels. I would more willingly leave this matter to regulation than some of the matters concerning which your Lordships have expressed the other view—namely, that they should be mentioned specifically in the Bill. I am very familiar, as is my noble friend Lord Moran, with the value, it not the necessity, of a medical staff committee in connexion with any hospital, however small or however large; but not in an administrative capacity so much as in an advisory capacity. I would like an assurance from my noble and learned friend that it will be within the power of a hospital management committee to encourage the setting up of a medical committee for advisory purposes. I would be content with that as a principle.
The noble Viscount who leads the House said last week on another Amendment, which I hope is still in abeyance, that he thought the position would be satisfactory in that it Would conform to present practice. In this connexion, as the noble Lord, Lord Moran, has assured your Lordships, and as you must know from your own personal experience of the management of hospitals, because you are Chairmen and Presidents of hospitals up and down the country, a medical 427 staff committee is essential to the efficient running of a hospital. The exact relationship between that committee and the management committee is, I think, a domestic matter. In conclusion, I would add that I think the principle is vital. If it is not the intention of the Minister to disallow the formation of medical staff committees, I think an assurance to that effect would be satisfactory.
§ THE LORD CHANCELLOR
I am very grateful to the three noble Lords who have spoken on this matter. The first Amendment provides for the setting up of a hospital board to run the individual hospital which would come under the jurisdiction of the hospital management committee. I agree with the noble Lord, Lord Moran. It is so obvious that that must be done that it is really unnecessary for him to labour it at all, or for me to labour it in reply. That, of course, is the intention. I do not say that in every case it would be done; I am told there might be exceptions. For instance, in the case of a fever hospital working in connexion with a general hospital, it would be so closely associated that in that case it would not be necessary to have a special hospital board. Apart from rare cases like that, of course I agree that you must have a hospital board.
With regard to the other point, I entirely agree that it is essential to have these medical committees. I liked, if I may say so, the word of the noble Lord, Lord Horder, to "encourage" the setting up of these committees, rather than the word in the Amendment, to "arrange" for the setting up. After all, I take it that the initiative would come largely from the medical staff themselves, and all you want from me is an assurance that the initiative would not only be welcome but that we should regard it as a lamentable thing if it did not come. It is certainly true that we must have these committees. I am reluctant to mention it in the Bill. I would rather leave it to regulation and for this reason. First of all, we are going to have a good many committees set up. I imagine we may easily require one to deal with nursing problems, and another to deal with dietetics and a host of other matters. If I single out one in the Bill it will look as if there are not going to be any others. I do not think there is anything between 428 us here. I will give your Lordships the assurance for which you individually ask. I would, however, rather not mention anything with regard to this matter in the Bill but leave it to the regulations and, I may say, the good sense of everybody concerned to take those steps which we are plainly all agreed are necessary for the efficient functioning of the scheme.
§ LORD MORAN
I am very grateful to the noble and learned Lord for his explanation, but there was one point I think which was not made perfectly clear. There has been dispute as to whether "encourage" or "arrange" is the better word. What I really have in mind is that the voluntary hospitals already have the medical committees, and I am certain that they do not require much encouragement to go on. But the whole of the municipal machinery is exactly the opposite and I wonder whether the word "encourage" will be sufficient to overcome municipal reluctance, I hope I am wrong, but I think it is very, very important that we should bring municipal practice in accord with voluntary practice in this matter. However, in view of the noble and learned Lord's remarks, I beg leave to withdraw my Amendment.
§ Amendment, by leave, withdrawn.
§ 4.4 p.m.
LORD MORAN moved, at the end of subsection (3), to insert:
(d) to provide those facilities for medical teaching and research required by the university or medical school with which the teaching hospital is associated.
§ The noble Lord said: I am moving this Amendment because it is very important to allay the misgivings of those who are engaged in academic medicine all over the country. I remember when I was first at a teaching hospital the secretary of that hospital brought forward facts and figures to prove that in a teaching hospital a bed cost ever so much more than a bed in a municipal hospital, which was then called a Poor Law infirmary. The figures were devastating. It would appear that a bed in the teaching hospital was very expensive to run. Of course, we have moved a long way since those years, but it is still a temptation for people to feel that extravagance is being exercised if they think something more is being done than is necessary for the comfort of the patient. You must look in the future to these teaching hospitals. You 429 may have wards given over to metabolic investigations which will need special staff and a lot of things which cost money. It may be very easy in ten years' time for the management committee of that hospital to feel that the hospital is being extravagantly run. Those who are responsible at the present time, professors of medicine and surgery throughout the country, have signed a memorial on this point. They feel very much that if the functions of the hospital are not put down on paper, it may weaken their case when they come to argue about the necessary provisions for carrying out those two functions. I beg to move.
Page 15, line 38, at end, insert the said new paragraph.—(Lord Moran.)
§ LORD HORDER
I will not detain you for more than a few minutes, but it is obvious from the fact that my name is coupled with that of the noble Lord that I support this Amendment. I do so partly because the term "teaching hospital" has not been defined. It is stated in Clause 11 (8):The Minister may, after consultation with the university concerned, by order designate is a teaching hospital any hospital or group of hospitals which appears to him to provide for any university facilities for undergraduate or post-graduate clinical teaching.…In other words, there being no definition of the term "teaching hospital" it is all the more important that the university or the medical school—one or other of which we all agree should integrate teaching within its region—and the teachers in connexion with them, should have free scope and should be able to do their full work in their region.
Another point which makes it very necessary is that there has been of late a tendency to use this term "teaching hospital" somewhat indiscriminately. The number of so-called teaching hospitals has increased very greatly. There is a tendency, desirable no doubt, to form themselves into a media for medical education, but it is a tendency all the same which requires very strict vigilance on the part of somebody eminently qualified as to their merits. For those reasons I hope that provision will be made not tacitly but by some specified wording in the Bill.
§ LORD CHERWELL
As a professor in a university, although not in the medical faculty, I should like to support this 430 Amendment very strongly. You are all well aware of the absolute necessity for all departments in a university to be in close touch with an associated hospital. The whole of this Bill is centred round the university as far as I can make out. It would be absolutely futile to train people if they have no intention of working in these hospitals. In all this description of the teaching hospitals there is a great deal about the various forms of administration; so far as I can see, there is very little about teaching facilities, and even less about research facilities. All the progress that is made in medicine, I think I am right in saying, depends upon collaboration of the university departments, the departments of fundamental science, physiology and so on and the experimental departments—if I may so describe them—that is the departments in which these things are tested. In the case of penicillin, the first experiments were done in the Department of Anatomy, but they had to be tried out, and they were, in fact, tried out at the Ratcliffe Hospital with the success which your Lordships well know. I think it is most important in laying down the duties of the teaching hospitals that we should specifically put in that they must give necessary facilities for teaching and research.
§ THE LORD CHANCELLOR
I think that Here again we are all agreed on the principle. I suppose that the primary function of every hospital is to care for the sick, but I quite agree that every teaching hospital has an added function which, in the light of the future, is perhaps even more important. If medical science is to go forward, it is fundamental that there should be facilities for teaching and for research. I agree with the three noble Lords who have spoken that this is a case where it is proper to have it set out in the Bill that the duty of a teaching hospital is, among other things, to teach; and in teaching, I include research. I could not accept the actual form of words which has been suggested. I would hesitate to suggest that any university could ever be unreasonable but your Lordships will see that the terms of the Amendment are: "To provide these facilities for medical teaching and research required by the university or medical school." That, I think, is going a little too far. After all, if it involves a large amount of public money being expended, then clearly some 431 public Minister must be allowed to deal with it. As I have said I agree, in principle, and I will undertake, if noble Lords see fit to withdraw this Amendment, to consider the matter with a view to drafting suitable words to meet their wishes, and I will bring them forward at the Report stage.
§ Amendment, by leave, withdrawn.
§ Clause 12 agreed to.
§ Clause 13:
§ Legal status of Boards and management committees.
§ 13.—(1) A Regional Hospital Board and the Board of Governors of a teaching hospital shall, notwithstanding that they are exercising functions on behalf of the Minister, be entitled to enforce any rights acquired, and shall be liable in respect of any liabilities incurred (including liabilities in tort), in the exercise of those functions, in all respects as if the Board were acting as a principal, and all proceedings for the enforcement of such rights or liabilities shall be brought by or against the Board in their own name.
§ (2) All proceedings for the enforcement of rights acquired or liabilities incurred in the exercise of functions by a hospital management committee on behalf of a Regional Hospital Board shall be brought by or against the said Board in their own name.
§ 4.14 p.m.
§ LORD LLEWELLIN moved, in subsection (1), after "Minister," to insert, "and a hospital management committee shall notwithstanding that they may be exercising functions on behalf of the Regional Hospital Board" The noble Lord said: I do not wish to take long over this Amendment, because it follows to a certain extent a discussion which we had on an original Amendment moved by one of my noble friends. But here we are definitely at the parting of the ways. The question is whether these hospital management committees should be entitled to sue or to be sued, or are to be in the position of having to refer anything in that connexion back to the Regional Board. If the Regional Board is the only body that can sue or be sued, it means a complete lack of decentralization. That is clear because a whole lot of things will have to be referred back from the committee to the Regional Board, thus adding to the Board's own 432 difficulties in that it will have to keep a stricter hold than need be on small management details of the hospital. It would mean that if any small mistake is made by the committee then the Board would have to come into the picture.
§ So here we come down to the fundamental issue—are we intending to make these hospital management committees mere ciphers or are we going to give them some power? If we do not give them this power of suing or being sued they are just going to be mere ciphers. You might almost as well leave the conduct of things to some officer. If action is going to be taken in this connexion it is absolutely vital that it should be taken now for this cannot be altered by regulation hereafter, as is the case in connexion with a matter to which reference has previously been made. There being no power of altering this by regulation we have now to make up our minds whether these hospital management committees are going to be real entities or not. The Lord Chancellor has cited the case of an estate agent. In this case we want these people to have the independent right of being contractors for the little daily services of the hospital. We want them to have that as a right and not that these contracts should have to be dealt with by the Regional Boards, they being the only people who would be able to enforce them or against whom they could be enforced. This may seem a very small point but if you want the best men to sit on these committees then you have to put the committees in the position of being entities in the sight of the law. This they would not be, according to what is now proposed except as mere agents, and perhaps not even then because the matter has got to be in the name of the Regional Board, according to subsection (2) of the clause. I ask the Lord Chancellor to say that this at least will be allowed and that in the appropriate cases these committees will be able either to sue or to be sued.
Page 15, line 41, after ("Minister") insert ("and a hospital management committee shall notwithstanding that they may be exercising functions on behalf of the Regional Hospital Board").—(Lord Llewellin.)
§ THE LORD CHANCELLOR
This, as the noble Lord realizes, raises the same sort of point which we have had before and which we have very fully discussed. 433 I would remind your Lordships that when the hospital management committee are acting as principals, as they do from time to time in relation to research functions, or in relation to the administration of their own property (which they will share according to what they may get from the Pool), they can be sued in the ordinary way. It is only when acting as agents on behalf of the Regional Board that they cannot be sued. The argument which I have to put forward on this is the same as that which I advanced before. In a co-ordinated scheme such as this is, we must have a chain of authority. That chain involves the Minister at the top, the Regional Board, and the hospital management committee. The committees act on behalf of the Regional Board, and therefore the contracts which they make and the commitments they enter into become automatically contracts to which the Regional Boards are a party but it does not mean that the committees are to be mere ciphers any more than the estate agent, to whom I have referred, is a mere cipher, because when he manages the estate and fixes up a contract, that contract is a contract between a servant and the landlord. Be has the authority to engage and dismiss servants.
That is the position, and that is the position which we feel we must hold to. If your Lordships consider that this principle of ours is a wrong one, then your Lordships can of course take the opinion of the Committee upon it. But we think that in this co-ordinated scheme, it is necessary to have this arrangement with the hospital management committee acting as I have described on behalf of the Regional Board, and we provide further, as a corollary to that, that in the contracts they make on behalf of the Regional Board, the Regional Board shall be responsible and they will be capable of suing or being sued. If your Lordships think that some other arrangement is better, I think you should take a decision of the Committee. This matter having been very carefully considered in another place, the Minister having stood to his point and won it, I am not in a position to make a concession with regard to it.
This, as the Lord Chancellor has said, is absolutely the same point in essence as has been discussed before. I think that the Government press us very hard in this matter. 434 After all, the Lord Chancellor said there is a chain of responsibility from Minister to Regional Board and from Board to hospital management committee. The logical conclusion which members would draw from that is that the only really responsible person is the man whom the noble and learned Lord, the Lord Chancellor, called the Commander-in-Chief; that is, the Minister. Yet, after all, there are certain responsibilities on the Regional Boards; and if on them, why not on the hospital management committees? Once you say that Regional Boards may have certain powers and certain authority, I cannot see why you should not also devolve certain powers and authority on the hospital management committees. That is all we ask. We are not asking for very great powers; only powers to do their local work, and so on. I think that the noble and learned Lord, the Lord Chancellor, recognizes the force of the appeal. I will not say that he shares it, but I feel that this is a matter on which we ought to compromise. As the noble Lord, Lord Llewellin, has said, we are down here to the very crux of the problem, and if the Government are not able to give way, I am afraid that this is a matter on which we must divide.
§ LORD INMAN
May I say a word on this point? The noble and learned Lord, the Lord Chancellor, has undertaken to give consideration to Amendments moved by the noble Lord, Lord Luke. This Amendment follows naturally on the same principle, and I do hope that the Government will consider very carefully the terms of these Amendments. I happen to know that very strong feeling obtains in the country to-day on this important question. Numerous letters have reached me from various people, saying that they are discontinuing their voluntary hospital work because they feel that there will be no need to continue, if most of their powers are to be taken away. I should like to appeal to the Government to see if, between now and the next stage, some compromise acceptable to both sides is not possible, and I would appeal that discussions might take place with a view to that end.
§ On Question, Whether the said words shall be there inserted?
§ Their Lordships divided: Contents, 59; Not-Contents, 17:435
|Aberdeen and Temair, M.||Samuel, V.||Fairfax of Cameron, L.|
|Reading, M.||Simon, V.||Grenfell, L.|
|Salisbury, M.||Swinton, V.||Hatherton, L. [Teller.]|
|Templewood, V.||Hazlerigg, L.|
|De La Warr, E.||Trenchard, V.||Hindlip, L.|
|Drogheda, E.||Horder, L.|
|Dudley, E.||Aberdare, L.||Howard of Glossop, L.|
|Fortescue, E. [Teller.]||Addington, L.||Jessel, L.|
|Iddesleigh, E.||Amherst of Hackney, L.||Lawrence, L.|
|Lucan, E.||Balfour of Burleigh, L.||Llewellin, L.|
|Munster, E.||Balfour of Inchrye, L.||Luke, L.|
|Rothes, E.||Brassey of Apethorpe, L.||Meston, L.|
|Vane, E. (M. Londonderry.)||Carrington, L.||Moynihan, L.|
|Cecil, L. (V. Cranborne.)||O'Hagan, L.|
|Bridgeman, V.||Cherwell, L.||Rea, L.|
|Elibank, V.||Clanwilliam, L. (E. Clanwilliam.)||Sandhurst, L.|
|Hutchinson, V. (E. Donoughmore.)||Somers, L.|
|Cozens-Hardy, L.||Soulbury, L.|
|Long, V.||Cunliffe, L.||Teviot, L.|
|Margesson, V.||Denman, L.||Teynham, L.|
|Maugham, V.||Doverdale, L.||Tweedsmuir, L.|
|Jowitt, L. (L. Chancellor.)||Chorley, L. [Teller.]||Morrison, L.|
|Darwen, L.||Mountevans, L.|
|Addison, V.||Hare, L. (E. Listowel.)||Nathan, L.|
|St. Davids, V.||Holden, L.||Northington, L. (L. Henley.)|
|Lucas of Chilworth, L.||Pakenham, L.|
|Ammon, L.||Marley, L.||Shepherd, L.|
|Walkden, L. [Teller.]|
§ Resolved in the affirmative, and Amendment agreed to accordingly.
§ LORD LLEWELLIN moved, in subsection (1), after "Board," where that word occurs a third time, to insert "or committee" The noble Lord said: This Amendment is consequential on the decision which the Committee has just reached.
Page 16, line 1, after ("Board") insert ("or committee").—(Lord Llewellin.)
§ On Question, Amendment agreed to.
Page 16, line 3, after ("Board") insert ("or committee ").—(Lord Llewellin.)
§ On Question, Amendment agreed to.
§ LORD LLEWELLIN moved to leave out subsection (2). The noble Lord said: My remarks about the last two Amendments also apply here.
Page 16, line 4, leave out subsection (2).—(Lord Llewellin.)
§ On Question, Amendment agreed to.
§ Clause 13, as amended, agreed to.436
§ Clause 14:
§ Conditions of service and appointment of officers.
§ 14.—(1) All officers employed for the purposes of airy hospital providing hospital and specialist services, other than a teaching hospital, shall be officers of the Regional Hospital Board for the area in which the hospital is situated, and all officers employed for the purposes of a teaching hospital shall be officers of the Board of Governors of that hospital, and the remuneration and conditions of service of all such officers shall, subject to regulations, he determined by the Regional Hospital Board or the Board of Governors, as the case may be.
§ 4.30 p.m.
§ LORD LUKE moved, after "situated" in subsection (1), to insert "or in the case of officers other than officers of consultant and or specialist rank of the hospital management committee as may be prescribed" The noble Lord said: This Amendment involves, to some extent, the things which we have been discussing. In particular, some of the remarks I made on the Amendment which I previously moved are very relevant. I do not wish to repeat myself if I can help it; but there are one or two points with regard to this Amendment to which I would like to draw attention. It will 437 be observed that in the Amendment appear the words "as may be prescribed." In the clause as it stands these words do not appear. Therefore, in moving this Amendment the object is to enable the Minister to make regulations, because I understand as the clause stands at the moment, he cannot do so.
§ With regard to the question of staff, it may be argued that mobility, promotion and superannuation are more likely to be advanced if the staff are in contact with the Regional Board, but not with the hospital management committee. I would say, if that is the case, surely the region is not nearly big enough. On the question of promotion and superannuation, surely the health service as a whole should be the sphere in which they may seek promotion? Again, the teaching hospitals are privileged—quite rightly—in this matter. But is not the Minister's aim eventually to build up the hospital management committees with groups of hospitals, which may have a great number of beds, to the level and status of the teaching hospitals?
§ I would ask a question with regard to the personal feelings of nurses in this matter. Do they like personal relations with their management or do they like relationships with a Board that may be miles away? May I ask—quite pertinently I think—which system would be likely to promote the recruitment of nurses? This Amendment, as I take it, seeks to assist the Minister in the matter of recruitment, and I think possibly there is something in it which he might welcome. It unties his hands and gives him more discretion than he has under the clause in the Bill. I beg to move.
Page 16, line 12, alter ("situated") insert ("or in the case of officers other than officers of consultant and or specialist rank of the hospital management committee as may be prescribed").—(Lord Luke.)
§ THE EARL OF LISTOWEL
This Amendment does, of course, raise the general issue to which the noble Lord referred. Any particular case could very well be considered by the House on its merits. The noble Lord is afraid that hospitals will not have sufficient control over the own staffs if these staffs are in the employment of Regional Boards instead of being in the employment of hospital management committees. He wishes them to be in contract with the 438 management committees. I do not think that his fear is borne out by the actual provisions in the Bill as it stands. What the Bill lays down is that the whole of the medical, nursing and domestic staff in each hospital, save for a handful of specialists at the top, will be chosen, appointed, and, if need be, dismissed, by the -hospital management committee.
§ THE EARL OF LISTOWEL
I said it raises the general issue. I am not disputing that. I apologize. I withdraw.
§ VISCOUNT MAUGHAM
With all respect, may I ask the noble Lord whether he can make such regulations if Clause 14 (1) stands as it does—"all officers," etc., "shall be officers of the Regional Hospital Board for the area…"?
§ VISCOUNT MAUGHAM
But no power to make regulations contradicting anything of the kind. In other words, it does not say "subject to the regulations hereinafter mentioned, all officers shall be officers of the Regional Hospital Board." You can put it right as a matter of drafting, in order to carry out what you want, but it does not seem to me you have done it yet.
§ THE EARL OF LISTOWEL
I am sorry to differ from the noble and learned Viscount, who is such an authority on the construction of Bills, but I am informed there is power to make a regulation of this kind. What, in effect, would be done, as I said, is that the whole of the staff of each hospital, with the exception of a few people at the top—the higher medical and dental staff—would be entirely in the control of the management committees. So that there is no question that these committees will have to go to the Regional Board each time they want to dismiss one of their employees. Again, 439 as the noble Lord himself pointed out, there is, from the point of view of those actually serving on the hospital staff, a certain advantage in being technically the employees of a Regional Board. It will be easier for them to get a transfer to other hospitals in the same area, and, of course, give them a wider field for promotion or advancement in their own line of work. That, I think, is a practical advantage of not making these people the servants of individual hospital management committees. I hope that this will be considered as a particular case, an apart from the general issue in which your Lordships have already expressed judgment.
§ VISCOUNT MAUGHAM
I usually follow so clearly what the noble Earl says, but here, so far as I can see it, it is laid down in black and white in this clause that all officers—and if we look at the Interpretation Clause we see that the word "officer" means servant—are officers of the Regional Board, and nobody is an officer of the hospital management committees. Secondly, the remuneration and conditions of service shall be determined by the Regional Hospital Board—I am leaving out the board of governors of the teaching hospitals. Now it is said by the noble Earl—he said it was in the Bill, but he meant it would be prescribed—that all officers other than those of specialist or consultant ranks will, in fact, be considered to be officers of the local hospitals committee.
I do not think it can be done. I look at what you can do under the regulations in Clause 14, and I find that you cannot do anything of the sort. I do not know whether there is some general power. We have seen in Bills and Acts of Parliament before now a provision where by the Minister may, by regulation, alter the wording of the Act. I do not know whether there is some general power in the Bill as it is drafted to bring it into line with what we want, and with what the noble Earl says is going to be done. That is all we are attempting to achieve. I just do not believe that under this thing you can have any officers—I am not talking about your specialist staffs now at all, but your ordinary staffs that have to look after your hospitals: your gardener, your porter, your liftman, your cook, or your domestic staff 440 —as officers of anybody but the Regional Board.
The noble Earl says that makes their transfer easier; but a lot of the staffs up and down the country are disliking this because that they think it may make their transfers easier, and when they enter into a contract to serve a particular hospital because it is near their homes they would like to continue serving in that hospital near their homes and not be sent to the other end of the region. They like to know that if they enter into the service of this particular hospital that is the hospital where they are going to be employed, and that they are not servants of anybody who can transfer them. Say there is a region stretching from Bristol to Bodmin, if they want to live in Bristol they are not in danger at all, but if they are servants of the Regional Board they may have to serve in a hospital at Penzance. They do not like it much because they want to be near their homes. Believe me, that applies to nurses as well. It is a very human thing. I really believe we all want to see the same thing done, and why on earth we should not bring the Bill into line with what we all want to see, I, for the life of me, cannot understand. I think we should do it, because I do not believe you can effect what the noble Earl says you can in the Bill as it is at present drafted.
§ THE LORD CHANCELLOR
May I just say a word in relation to what the noble Earl has just said? Really, I think he is under a misapprehension. Whether these servants when engaged become servants of the Regional Board, which is the provision of the Bill, or become servants of the hospital management committees, neither the one body nor the other is entitled to transfer them about as if they were cattle. It depends on the particular contract of course, if a man enters into a contract with a Regional Board to serve as a porter wherever he may be placed, no doubt there would be a right to move him about, but if he entered into a contract to serve as porter at the X.Y. hospital, then he can only be called upon to serve at the X.Y. hospital and nowhere else.
The long and short of the matter is that this has gone over the old argument we have had before. As I see it, the position will be that these servants, when appointed, become, on the Bill as it is 441 drawn up—and "servants" extends to everybody—become servants of the Regional Hospital Board. It does not follow, because they become servants of the Regional Board, that they cannot be engaged or dismissed by somebody who has authority to act on behalf of the Regional Hospital Board. That, of course, is elementary, and the position here is that the hospital management committee will be given authority by the Regional Board to dismiss servants, but the servants, when appointed, will become servants of the Regional Hospital Board. That is the scheme of the Bill, and to cover the territory again would simply be to go back to the argument I am afraid we have had ad nauseam. If your Lordships take the view that this is a wrong scheme it is for your Lordships to correct it. But that is the scheme, and that is the position upon which the Bill has been drawn up. Only by that can we achieve a decentralization and devolution of function, and, at the same time, have a co-ordination which invests the Regional Board with the overriding authority over the activities of the hospital management committees, although I sincerely hope they will not have to override and they will be able to leave very wide discretion to the hospital management committee. Rather than these demarcation disputes, I would rather lay it down plainly that they have the right, in the last resort, to decide what shall be done.
THE EARL OF DONOUGHMORE
We are on the fringe of a very important matter. My noble friend opposite mentioned nurses. As your Lordships know, one of the very greatest anxieties in the hospital world at this moment is the fact that young women are not coming forward to join the nursing service. If the idea gets out that when they join the nursing service they are joining the regional service, then, I think, the difficulty will continue, if it does not actually increase. I do not much care whether this is put in the Bill or not, but I do hope the Government will make it clear that they appreciate the value—the sentimental value, but still the important value—ot keeping local interest in a hospital. Otherwise their difficulties in the matter of recruiting, especially of nurses and domestic staff, will continue. There is no blinking the fact that the situation is bad now.
§ VISCOUNT MAUGHAM
May I add one brief word? What the noble and learned Lord, the Lord Chancellor, has said, of course, is perfectly correct, but what he has not said is something I am going to say now. It is that on the Bill as it stands the hospital management committees have no power whatsoever to appoint a door keeper or a nurse or a cook or any other servant or any other officer right up to the top. Not one single person can they appoint on the Bill as it stands, nor may they dismiss a single one. If a porter gets drunk at a moment when he is on duty, there is no power under this Bill in its present form for the people in charge of the hospital to say: "Go away, we do not want you again."
Now the Lord Chancellor is perfectly accurate, as he nearly always is, in saying that all this he expects to be in regulations, but I cannot find any power to make regulations which go so far as that. My noble friend Lord Llewellin has said they certainly are not in Section 14 (2). I would add this. How can this House be expected to decide on such a vitally important matter as to whether hospital management committees are to be rulers in their own house, subject of course to regulations and to what the Minister may direct, when that is left in the air to be determined by regulations which we have not seen and about which we are told nothing? It may very well be that when the regulations do come out—it may be two years or five years hence—we shall hate them. Those who are anxious to keep the voluntary hospitals on foot, and to induce people to go and serve in them and to give their lives up for the benefit of the hospitals and the patients, may say that these regulations are miserable, that they are not at all suitable and they do not like them.
Why is there not anything in the Bill to show that the main management of the hospitals, other than teaching hospitals, is confined to the management committees of those hospitals? It can be hedged round with all sorts of provisions to make them act properly, but, as has already been said, there is not a single clause which we have so far reached which gives any power whatever worth having, any power of managing their institution, to a management committee. That is wrong. I would like His Majesty's Government to come to the conclusion that that is wrong 443 and to make it clear that they intend by this Bill to give the powers that are needed to the hospital management committees, subject of course to regulation.
THE MARQUESS OF READING
May I say one word, which is really by way of a question to the noble and learned Lord, the Lord Chancellor? The noble and learned Lord has said that this matter of engaging and dismissing staff will be provided for by regulations. In the first place, I do not see any regulation at present, as the noble Viscount, Lord Maugham, has just said. What I am also concerned about is this. If it be the intention to provide by regulation for matters of this kind, is it to be the policy that the terms of those regulations shall be permissive or mandatory? In other words, are you going to say to the Regional Hospital Boards: "You may delegate these functions, if you please, to such hospitals as you like" or is it going to be said that by those regulations these functions are to be delegated to local boards of management? There is a great deal of difference between the two provisions.
§ THE EARL OF IDDESLEIGH
I hope I may be permitted to ask a further question of the noble and learned Lord, the Lord Chancellor, arising out of his adumbration of the regulations that are to be issued. I understand that under those regulations the hospital management committee is to have the power of appointing and dismissing; but the noble and learned Lord mentioned that there was to be an overriding power in the Regional Board. I would be grateful to know what that means. Does it men, as I suppose, that in any case of dismissal the dismissed employee would have an appeal to the Regional Hospital Board? That is a point of very great importance, because I can see that it might greatly embarrass the hospital management committee, when dealing with a case for which dismissal is the obvious remedy, to know that the dismissed person will have the right of appeal to the Regional Hospital Board which may take a completely different view of the circumstances.
§ THE LORD CHANCELLOR
I cannot, of course, say what the regulations will be, because the regulations do not exist, and obviously the drawing up of the regulations will be a matter for the very greatest 444 care, after discussion and so on. The broad line, however, is this. In answer to the noble Marquess who asked me a question, I would say that the regulations will lay down that certain matters fall within the province of the hospital management committee. For instance, one will be the engaging and dismissal of staff at the hospitals, with the exception however—I do not know how this will be put in the regulation—of the senior staff. Nor do I suppose for a moment that there will be anything in the nature of an appeal to the Regional Board if the hospital management committee decides to dismiss some servant. That would be really interfering with the discretion of the management committee unduly.
§ VISCOUNT MAUGHAM
Forgive me for interrupting, but is there anywhere a provision whereby they are given that discretion?
§ THE LORD CHANCELLOR
No. The discretion is going to be given by regulation. I thought we all understood that. The theory is that the Bill makes it possible to make regulations and, although regulations seem to be very amusing to some of your Lordships, I really think there is much to be said for them. Every single regulation comes before your Lordships' House and the other place; any regulation can be annulled by a vote of this House if you think it is not reasonable. That method has the great merit of being flexible. There is no doubt that we are going to learn a great deal from experience in this matter. As I said before, we are going to make a great many mistakes, and there is very much to be said for having a flexible method for doing things.
May I just add this? I venture most respectfully to suggest to many noble Lords who know more about it than I do, that there is a danger of taking too parochial an outlook here. The noble Earl talked about nurses and specified—and I well know it to be true—the difficulty of getting nurses or domestic staff at the hospitals to-day. But, after all, that is a situation which arises under the existing system. I would venture to ask the noble Earl whether he does not think that with a new system whereby the nurse becomes the servant of the Regional Board—albeit she can, of course, contract to serve at a particular place if she so 445 desires—you will find that the difficulty which is so very acute to-day is to some extent lessened? I do not know, and the noble Earl does not know, but I would point out that the difficulty is a difficulty which arises under the system which we have to-day, which will be altered if we have our way under this Bill. Therefore, I ask your Lordships to say that the Government have come to a right conclusion here in saying that the power to dismiss and engage, which I agree is only given-by regulation, is to dismiss or engage servants who, when engaged, become the servants of the Regional Board, in the hospital management committee.
I do hope that members of the Government, and in particular the noble and learned Lord, the Lord Chancellor, will realize the very real difficulty we are in with regard to this Bill. We really are completely in the dark. Whenever we ask a question the noble and learned Lord, the Lord Chancellor, replies: "That will be in the regulations. The regulations will be issued after the Bill has been passed through Parliament and approved." We ask: "What exactly are these regulations?" and he says: "I do not know just what will be in the regulations. That will be for the future when the regulations are drafted. All I can say"—I and I quite agree that the noble and learned Lord cannot say any more at the present time—"broadly speaking, is that this will be true, or that will be true, or the other will be true."
It is on that sort of basis that we are asked to pass a Bill which is going to affect the whole of the management of local hospitals and larger hospitals. Everything is to be based on regulations we have never seen and the nature of which we do not know. Therefore I think the Government will understand it if we are genuinely anxious to put, so far as we can, into this Bill something which will give to it what we regard as an element of stability. What we are being asked to do at present is to give a completly blank cheque to the Minister. I do not think that is the job of Parliament. It is the job of Parliament, so far as it can, to pass legislation the effect of which it knows and of which it approves. That is the job we are trying to do here to-day.
446 There is no doubt that the great majority of noble Lords in this House believe it to be essential for the authority and the status of the hospital management committees that they should have the power to appoint and discharge their officers—their employees. We believe that to be essential and we want to it put into the Bill. It is a perfectly simple point and it is one which we regard as essential to the effective working of the system. We also believe it to be essential from the point of view of the hospital management committees themselves, because without it the committees will have no authority, and indeed will probably have very little existence because people would be unwilling to join in such circumstances. Also, as the noble Earl, Lord Donoughmore, has said (and he speaks with great authority and experience) it is probably essential for the officers themselves. It is for those reasons, and not because we are cantankerous, that we press this point. I am afraid we must insist, for the reasons I have given, that this shall be put into the Bill. I am sure the Government, whether they agree with us or not, will understand our motives, which are perfectly respectable and perfectly practicable.
§ THE SECRETARY OF STATE FOR DOMINION AFFAIRS (VISCOUNT ADDISON)
I am quite sure the noble Viscount's motives are as he describes them; nobody would ever think anything else of him. But really I must appeal to noble Lords to reflect upon what this will mean. The proposal here is that there shall be a regional system; within each region there will be a scheme' for health services, hospital services and so on; and within each region there will be a number of individual hospitals, as there are now. The House has received a specific pledge that the detailed powers and duties of these hospital management committees will be prescribed in the regulations. The alternative, as the noble Viscount has just pointed out, is to say in the Bill what they are going to be. I suggest to him that, as a matter of practical administration, the method we propose is infinitely the more sensible way of doing it. If this Amendment were accepted as it stands, it would mean that all officers in the whole of an area would be officers 447 of the individual management committees.
§ VISCOUNT ADDISON
All except the consultants. Just think what that means. There is the possibility here of a considerable region affording scope for the development of all medical services. If, as the noble and learned Lord Chancellor has pointed out, there is in the contract of service of, we will say, a porter or anybody else a clause that he will serve only at a certain hospital, that will be honoured and he will serve only at that hospital; you cannot move him about. But there are all manner of other services connected with hospitals which are rapidly developing and which I do not think would be included in the words "hospital and specialist services." You want to take a wider view than the small local hospital; you want to have a wider opportunity than a small local hospital affords and that is why we are developing the regional scheme. You will just torpedo the possibilities of the regional scheme if a number of Amendments of this kind are made to the Bill. They will make it workable and I really do appeal to noble Lords to show, not with standing their other misgivings, a little confidence in the bona fides of the Lord Chancellor. When he says he will put a thing into the regulations, he will of course do so. These Amendments will torpedo the whole scheme of regional development which is made possible in this way, and I appeal to noble Lords not to do it. It will not really serve any useful purpose, because you will get what you want in the regulations just the same. We are, after all, quite creditworthy persons.
§ LORD LLEWELLIN
There is no intention on our part to torpedo the regional scheme and the noble Viscount knows perfectly well, as an old Parliamentarian, that that suggestion is just a very good red herring. We have had an assurance, first from the noble Earl and secondly from the noble and learned Lord, Chancellor, that these officers, at some time in the future when the regulations have come out, will, although they are called officers of the Regional Board, be in fact officers subject to appointment and discharge by 448 the local management committees. They think they are officers of one body, but the power to dismiss them and appoint them will be vested in another. All we are saying is that on the face of this Bill you ought to show of which body these people are really officers—that they are officers of the local management committee. That is the honest thing to tell them, because that committee will be the authority which will appoint them and discharge them if this regulation comes out. You should not call them officers of one body when really they will be ordered about, taken on and discharged by another body. If we are to have the right kind of people coming on to these hospital management committees we want to show them, on the Bill itself, that they have some power and not make that power subject to regulation which (although the present Minister may, and no doubt will, follow the assurance given on his behalf by the Lord Chancellor) may at any time be varied by any other Minister. That is the only difference between us. It is not torpedoing the whole scheme in the least; it merely means that you are showing in the terms of the Bill itself that you have some confidence in the people who are on the management committees of these hospitals. That is all there is between us.
§ LORD INMAN
I think there are two aspects of this problem. The first is that many of us are in favour of definite powers being given to the management committees, but so far as this particular Amendment is concerned I can see definite advantages in the scheme as outlined by the Government. We are dealing now with a great number of small institutions and in many of those cases there is not sufficient work for, to take an example, a professional man like an accountant. If a number of accountants are appointed by the Regional Board, they can be spread through the region and can do the work which the local management committee would not be able to undertake by itself or by the officers appointed by it.
My noble friend the Earl of Donoughmore mentioned the question of nurses. We all agree that that is a vitally important matter. My own experience is that we have affiliated ourselves to various small hospitals and we have found that the nurses like to move about from one small hospital to another. I take it 449 that the Regional Board will have power under the Government scheme to appoint its nurses, and I submit to your Lordships that if a number of hospitals in a region can be advertised as having vacancies that is going to appeal to a far larger number of girls who want to enter the profession than if one single hospital, an isolated unit in one part of the country, advertised for nurses. The same is true of domestics and other officers. I think therefore that whilst I should be in favour of some definition being given that will make the management committees sufficiently strong to enlist the right kind of people to serve on those committees, there are definite advantages in the Regional Board having powers to appoint its own officers.
§ LORD BALFOUR OF BURLEIGH
May I ask the noble and learned Lord one question, because this does seem to me a smaller question than some which we have been discussing? Assuming that the regulations are made as have been promised by three noble Lords on the Front Bench, then these officers will be servants of the management committee. That seems a point on which we have got very definite assurances, with regard to the hospital management committee having its own officers. The Bill says they are going to be officers of the Board, but surely they are going to be officers of the management committee.
§ THE LORD CHANCELLOR
That is not quite right. The regulation, of course, cannot override the Act. The Act in round terms says that they will be servants of the Regional Board. All that will happen will be that by regulation the hospital management committee, on behalf of the Regional Board, will be given the power of engaging or dismissing and generally controlling.
There is one point which occurred to me. I think the argument has been advanced by the Lord Chancellor and by the Leader of the House that this is a retrograde step, but there are certain people, consultants and doctors, who under the Amendment would be tied to a particular hospital but under the Government scheme could range wide throughout the region. Obviously the word "officer" is an all-embracing word. It includes the young specialist, the hall porter and everybody. Certain of these 450 people, like the hall porter, will not want to range very wide however ambitious a porter he may be. The others may well wish to rise and become more important persons in the region. Would it not be possible in some way in the clause to differentiate between the types of officer? It is such a general word. Could not the hospital management committee at least control those members of their staff who would not wish to range but who would be part of the normal staff of the hospital? If one could do that and give a greater elasticity to those other officers who might naturally wish to have a wider scope, I should have thought we might have found a compromise on those lines. I do not know how far that is possible, but it seems that the word "officer" is the difficulty.
§ THE LORD CHANCELLOR
As it occurs to me on the spur of the moment, it might be possible to do this by setting down a scale of salaries, for instance, people employed at under £500 a year or something of that sort. There again that illustrates the advantages of doing it by regulation. I do not anticipate it, but there may be very considerable changes in the value of money. That again shows how much better it is to try to do this by regulation.
THE LORD CHAIRMAN
The question is that these words be here inserted… I think the "Not-Contents" have it.
§ VISCOUNT MAUGHAM
With the greatest respect, I think the noble Lord in the Chair did not hear that the question he put was met with the word "Content" from a number of Lords. We have not yet passed the question whether there should be a Division or not on Clause 14.
THE LORD CHAIRMAN
I thought I put the question clearly. I did not hear any noble Lord say "Content."
§ On Question, Amendment negatived.
§ Clause 14 agreed to.
§ Clauses 15 to 18 agreed to.
§ Clause 19 [Local health authorities]:
§ 5.15 p.m.
LORD ADDINGTON moved to add to the clause:
(4) A local health authority being a county council may, on the application of the council of any borough (including a metropolitan
borough) within the county by agreement delegate to the council of that borough either with or without restrictions or conditions, any of the functions of the authority under the provisions of this Part of this Act relating to the care of mothers and young children, the employment of midwives, health visiting, home nursing, vaccination and immunization, ambulance services, the prevention of illness, care and after-care and domestic help.
(5) If the council of a borough who have made an application under the preceding subsection are aggrieved by the refusal of the local health authority to delegate functions, or by any conditions or restrictions which the authority propose to impose, the council of the borough may make a representation to the Minister and the Minister after consultation with the local health authority may by order direct them to delegate to the council of the borough, either with or without restrictions or conditions, such of the said functions under this Part of this Act as the Minister thinks proper, and the local health authority shall comply with any direction so given.
The Minister may at any time by order revoke an order previously made by him under this subsection.
(6) Any expenses incurred by the council of a borough in the discharge of functions delegated to them under this section shall up to an amount not exceeding such sum as may be fixed by the local health authority or on an appeal by the Minister be repaid to the council of the borough by the local health authority
§ The noble Lord said: This is also an attempt to provide the most efficient machinery for the expansion of the public functions of the county council and so to benefit those who make use of it. I think there are three main points. First of all it does provide a maximum of local control which the noble and learned Lord in charge of the Bill was very anxious to avoid when he spoke to us at an earlier stage. The delegation of these functions to the local council on the spot will give a more efficient working than a county council which may be as much as forty miles away from the county town. In that way day-to-day decisions would be taken by the officers of that council on the spot rather than refer them a long distance to County Hall, where they would probably fall on an over-worked staff. It seems to me that this is a more convenient course. I believe that delegation from county councils has in a great many instances worked extremely well, although I am afraid I cannot speak officially on this matter. Secondly, it will do much more to attract voluntary service, and again very considerable attention was paid 452 to that point on the Second Reading of the Bill. We do want the continuance and expansion of voluntary services in the voluntary spirit in administering all these services. I believe that much more will readily be attained if they are in the hands of the local authority than if they are centralized in the hands of a county borough or a county council.
§ The effect of taking away these public health authority functions from the non-county boroughs as well as the metropolitan boroughs and some of the urban district councils, will be felt on the machinery of local government. The larger county boroughs for a great many years have provided the domiciliary services and also provided maternity homes. They have provided efficient ambulance services and have employed health visitors and domestic helps. There seems to be no reason why they should not be permitted to exercise these functions under powers of delegation and wider machinery, and allowed to carry them on with as little interruption as possible. It is the natural desire of the Minister to reduce the number of local authorities. It is not always the biggest local authority which is the most efficient. During these last few years, a large number of functions have been taken away one by one from the non-county boroughs and other local health authorities. I am sure that if this continues, it is bound to have a very bad effect upon the local government system. You will not get the people you want coming forward for election. If the two-tier system is to work successfully—I believe it is the intention of His Majesty's Government that that system should work uninterruptedly—a wide measure of delegation to those boroughs that can perform the functions is essential. It was emphasized by two important Ministers when they addressed one of the county councils at a luncheon not long ago that there must be a wide measure of delegation to these non-county boroughs who can perform these functions.
§ Again, it is submitted, that these minor local authorities are the foundation of our governmental system and they have been the nurseries of many future statesmen. Therefore, their function should be preserved. A word as to the form of this particular Amendment. I do not wish to take up much of your Lordships' time on this. This Amendment follows the form 453 of Section 194 of the Public Health Act, 1936, which did allow delegation to be arranged in this way. Under it the non-county borough council or metropolitan borough council would be able to ask for delegation of those functions which they consider that they are usefully able to perform. The degree of delegation can vary from place to place in accordance with circumstances, the experience already gained, and the actual arrangements already made between the non-county borough council and the county council. Any question of the reasonableness either of the request for delegation made by the non-county borough council or of the refusal of the county council to delegate is one which can be settled by the Minister. A county council can also make some regulations as to general control and very possibly they would arrange—as they very often do—that some of their own local members should be added to any committee which is exercising these functions delegated on their behalf. Under the Bill as it stands, delegation will not be possible at any future time to any metropolitan borough or to any non-county borough, however well they have been administering the services or however desirable the Minister may feel it to be at some future time.
§ I notice that there are two other points down on the Paper with which I am particularly concerned. I have included the municipal boroughs, but it is easy to see, I imagine, how if the Amendment which is to be moved later is carried that should be adjusted. Also, I feel that it would be quite easy to adjust my Amendment by including the urban district councils. I think the absence of power of delegation from the Bill is a most important matter. I hope that we shall be able to make the necessary insertion at this stage, bearing in mind that there is always the power of veto by the Minister who need not agree to the delegation if it does not fit into the scheme or with his particular wishes at that time.
Page 18, line 44, at end insert the said new subsections.—(Lord Addington.)
had given Notice that he would move Amendments to Lord Addington's proposed new subsections in order to provide that certain functions of 454 a local health authority being a county council might: be delegated to urban district councils as well as to borough councils. The noble Lord said: In rising to move this Amendment to my noble friend's Amendment, I wish to make it quite clear that there is no divergence of argument between us on this particular matter. The arguments which he has adduced with considerable force with regard to the borough councils apply with equal force to the urban district councils. And there is very little difference between the powers which already are available to the urban district councils and those available to those interests which are represented by my noble friend. I do not think it can be said with any fairness, taking it broad and large, that in either case these local bodies have discharged their functions inefficiently. No doubt there must be certain special cases where that remark does not apply, but on the whole I think the House would probably agree that the powers which have been delegated to these nurseries—as Lord Addington calls them—powers of democratic control, have been exercised extremely well and with great benefit to the people in the localities with which these bodies are directly concerned.
That leads me to reinforce what has already been said concerning these smaller local bodies, which in some cases cover very wide populations—in the case of the urban district councils for whom I am speaking there are a considerable number of populations well over 20,000 and some rising to very large populations indeed. The local authorities, naturally, are very closely in touch with those people whom their administrative actions concern. They know the local requirements. In many cases they know the people. There is no remote control such as may result: from the passage of the Bill in its present form. Therefore, I would venture to say that some action on the line now suggested would go far to do that which everybody in this House desires; that is, to ensure that these services, which can be delegated to these authorities, should be discharged in the most efficient way, with the greatest effect, with the greatest understanding, and with the greatest humanity. It is no reflection on the scheme of the Bill that we are asking for the extension, or rather the continuation, of the powers in the hands of these smaller local authorities. As Lord 455 Addington has said, if the county council object to the matter being put in the way that is now suggested, it is always, by the terms of the Amendment, left with the Minister to see that it is only in suitable cases that these powers should be delegated to these smaller authorities.
I should like also to emphasize the point already made with regard to the value of these small local administrative bodies. I will not repeat all that my noble friend has said, though I wish to underline it. I think that this is a point of substance in connexion with this matter. On the one hand, you would not lose anything in efficiency, and I believe that you would have real sympathy shown in the carrying out of the duties to be delegated. A great deal would also be done to ensure real democratic control and that real democratic education which all of us would like to have to see us through the difficulties of the present day. I desire therefore to support the Amendment of my noble friend and to move in addition the words standing in my own name.
Amendment to the proposed Amendment moved—
Subsection (4), line 3, after ("borough") insert ("or urban district").—(Lord O'Hagan.)
§ THE LORD CHANCELLOR
I hope that your Lordships will not begin to think that I got out of bed on the wrong side this morning. I have had all sorts of appeals made to me, and I am sorry to say that this is not one to which I can accede at all. The actual Amendment deals, I think, with the boroughs and the Amendment to it would extend it to urban districts. There is no noble Lord in this Chamber who has suggested that it should extend to rural districts. I do not know why not, because rural district authorities have some of these powers to-day—some of them. Of course it is true to say that some of these powers have been performed with considerable success, some with less success, and some with no success at all. But there has been a very great deal of overlapping and confusion. Now that we are imposing on local health authorities a wholly new set of powers, which we hope in the fullness of time will be performed and dealt with at health centres, we regard it as a matter of the first moment to see that we entrust these duties only—subject to one small exception, 456 which I will mention in a moment—to the major authorities; that is, the counties and county boroughs.
I have been a member of two successive Governments which considered this matter. We spent a great deal of time on this in the days of the Coalition Government, and equally we spent a great deal of time on it in the days of this Government. I believe that I am right in saying that both Governments came to the conclusion—and stated so publicly—that it was an absolutely fundamental matter that the powers should be kept in the hands of the three authorities. That being so, and having held this view over the last three or four years, I cannot give way, despite the eloquent appeals that have been made.
There is another Amendment coming on in a few minutes which I shall not anticipate, although I shall have to say something about it, because it does concern a local problem—metropolitan boroughs in London, as opposed to the County Council. May I, therefore, discuss this a little widely? Clause 21 of this Bill deals with new health centres at which the various services are going to be rendered, in accord with the proposals in Clause 20, which the Minister has approved. Then we come to the care of mothers and young children. To-day, there are 400 local authorities dealing with maternity and child welfare. There are 162 boroughs, 29 metropolitan boroughs, and 61 urban districts, out of 572, and 10 rural districts, out of 475, dealing with this That is the present pattern of maternity and child welfare. The provision for midwifery is the concern of counties and county boroughs. Here 39 boroughs and 4 urban districts have schemes. The reason for this—a mere historical accident—is that there was some delegation under an early Midwives Act which for long made such schemes impossible.
I turn next to health visiting. It is largely a new function, but in so far as it is done at all, this is done in two ways. It is done in the care of the gallant 400 authorities, as part of the maternity and child welfare service, or it is done as part of the tuberculosis service and, therefore, as part of the county and county borough services. There again you get complete dichotomy between the two. Home nursing, which is dealt with in Clause 25, is almost 457 entirely new, although there is power—(I believe under one of the Public Health Acts)—to provide a nurse for a person suffering from an infectious disease. That power, incidentally, is possessed by every single sanitary authority. Immunization is dealt with by county and county boroughs, so far as vaccination against smallpox is concerned, but for some strange reason the metropolitan boroughs deal with it in London. Immunization against diphtheria is dealt with by the 400 authorities I have already referred to. As for ambulance services—every single local authority has power to provide them.
That is the picture to-day, and if you study it you find a chaotic distribution of powers. When we realize that under the new set-up we very much hope that these services will be concentrated in the health centres—in the fullness of time, I do not suggest that it will be in a few years—it is absolutely essential that the larger authorities should have the powers. We have made one exception, with very considerable reluctance. That is, with regard to the care of children. Under the Education Act there are cases where the care of the "over-fives" devolves on what used to be called the Part III Authority. (I forget what the term is now.) There may be schemes of delegation, and where there can be such a scheme we have provided that there may be a similar scheme for the"under-fives"—which is sensible. But further than that, we cannot go. I realize that this is a matter of great importance. It arises on many of these Amendments and the question is "Aye" or "No." Do you think that we are right in confining these powers to the major authorities, the county and county boroughs—we believe that we are—or do you think it right to confer power, either directly or by delegation, on the minor authorities? If you think the latter, you will vote accordingly. There the matter stands, quite plain. It is not a matter on which I can give way. It is a matter for your Lordships to decide what course to take.
I rise to oppose this Amendment, partly based on my own experience as a member for a great many years of the maternity and child welfare committee of a county council, and partly because I have been asked to oppose it by the County Councils' Association. I 458 feel sure that these powers should rest in the hands of the major local authorities. If you take away the bits and pieces from the area which they are to serve' large urban areas or boroughs, you will spoil the continuity of their service. It is necessary for them to have centres from which to run these services, and no doubt those centres will be placed in the centres of population where transport is easy. I feel, therefore, that it would be a great misfortune to take these services out of the hands of the major local authorities.
I note that this Amendment is a permissive one, but I think that in the long run it would have a bad effect on the relations between the major authorities and the borough councils and perhaps the urban district councils, because energetic members of urban and borough councils would be continually itching to gain the powers in their own hands. They would lend to vilify the services honestly rendered by the county council. It is very important to maintain local interests in these services, but in the Fourth Schedule (paragraph 6 cr.: the Second Part) you already have a proviso that:The health committee of a local health authority may, subject to any restrictions imposed by the local health authority, establish such sub-committees as the health committee may determine.…The paragraph goes on to say that these health sub-committees shall have members from the local authorities for any areas forming a part of the area of the local health authority. I feel that that is a very much better way to run these services, under the authority of the county council.
It will enable the county medical officer of health to have a continuous purview over these services over the whole area, and he will be able to keep very much better control over them than if some of the powers are delegated to authorities over which he does not have such complete control. I think from his point of view that is also an important matter. You have already taken a way, or propose to take away, under this Bill very interesting services from the county medical officer of health; for instance, the hospital services. It would be a great pity to take away other services which supply him with some of the interest in his work. You do not want to pare away the job of a county medical officer of health until it becomes dull, monotonous and nothing 459 but routine. Such a tendency would result in your not getting such a good type of man for the post of county medical officer of health as you would if his activities were more varied. Then there is another argument. In the majority of cases, the county council is the authority for the medical services for school children, and it is very much better that these services should continue with the maternity and infant welfare services, which are also administered by the county council. I am sure that the county medical officers of health would be in favour of these sub-committees as suggested, and opposed to complete delegation to the bodies concerned. I understand that another objection to this proposal is that if a large number of schemes had to be submitted to the Minister for his approval, there would be a very great cause of delay in getting the whole purpose of the measure carried out quickly, and the services rendered without delay. Therefore, I am convinced that this Amendment should be opposed.
§ VISCOUNT BRIDGEMAN
I am afraid I cannot quite follow the noble Lord who has just spoken. Nor indeed can I follow completely the arguments from noble Lords opposite on this Amendment, compared with the argument used on the previous Amendment. I listened just now with the greatest interest to an argument for extreme flexibility. Whether that flexibility should be achieved by Amendment to the Bill or by regulation later on, let us leave for the moment. But in this case we are given an argument which appears to be for rigidity and not for flexibility at all. From the point of view of the larger and longer established county boroughs, with regard to which I would ask your Lordships' leave to say one word, I think you may get a variety of cases. You will get a certain number of cases where it may be quite true, from the point of view of the noble Lord who spoke last, that their services, or any individual service, could be merged with those of the larger authority. Well and good. Let us hope that common sense would prevail and that they would try to do that and not keep them separate. There may also be a number of county boroughs which, neither from the point of view of organization nor of sentiment—both of which I think your Lordships would agree are important—could be 460 sensibly or profitably incorporated into the larger set-up, except by proper powers to delegate. I will not labour the point whether that should be given in the Bill or come later by regulation. That seems to me to be the point as it affects the county boroughs and I put it forward for the consideration of the noble Earl opposite.
There is only one word which I should like to say about this Amendment. Of course, we are up against this main problem of centralization of government, which is inherent in the whole of this Bill. We all know that there are great advantages in centralization of government. It produces uniformity; no doubt in many cases it makes for easier administration, and I do not wish to ignore those advantages. On the other hand, there is, of course, the disadvantage that it does remove that local element in government which has been the whole basis of the English social system for a very long time. What we have to try to do, so far as possible, is to find a flexible system which gives the advantages of both sides. A great many of the questions which are mentioned in this Amendment—questions like the care of mothers and young children, the employment of midwives, health visiting, home nursing, vaccination, immunization and so on—are very suitable for local supervision by people who know the local conditions. I am sure that noble Lords have had many experiences which would bear out what I say. The difficulty, or one of the difficulties, of this Amendment in its present form, I must frankly say, seems to me to be that once the Minister has given powers to a county council, the county council can delegate those powers to a borough without further consultation with the Minister.
§ LORD ADDINGTON
As I understand the Amendment, each non-county borough has got to make separate application for delegation, and that delegation has got to be agreed to by the Minister, before the powers can be delegated to the individual borough.
It does not say that. As I see it, the proposed subsection (5)—I think this is the intention 461 of it—says that if the council of a borough who have made an application are aggrieved by the refusal of the local health authority to delegate functions it can appeal to the Minister. That is quite a different thing. But there is nothing, so far as I can see, in subsection (4) of the Amendment which says that the county council must obtain the agreement of the Minister before it delegates further.
I should have thought it would have been fair to say the Minister must agree to any further delegation, and that would give him complete ultimate control of the situation. After all, the purpose of this Amendment is to deal with special cases. In a certain county there may be a particular borough which has a semi-independent personality and which can deal with its own affairs better than as part of the county. As I say, these are special cases, and indeed may be rare cases, but they are cases worth considering, and if the Amendment had stated that by agreement with the Minister further delegation could take place, I should have thought that the Government could have had no complaint, because ultimately it is the Minister who decides. What I wanted to suggest was—I do not know what the noble Lord, Lord Addington, would feel about this—that if it were possible to insert words of that kind, then the Government might be willing to consider the matter further and accept the Amendment. Of course, they cannot do so tonight because they have not consulted the Minister, but they might be able to consider the matter further with a view to accepting the Amendment with that addition.
My point is that you should add at the end of the first line that a local health authority, being a county council, may by agreement with the Minister on the application of the council of any borough, delegate to the council of that borough whatever powers it is desired should be delegated. At present I do see the difficulty in which the Minister finds himself with regard to an Amendment of this kind, that, once he has given power to a 462 county council, the county council can delegate this power without further reference to the Minister himself. I think that is going too far.
Equally, if I may say so with all respect to the noble Lord, Lord O'Hagan, an Amendment which proposes the delegation of powers to urban districts I think is probably going a good deal too far. I suggest that what I have mentioned is a possible way out of the difficulty. It retains ultimate authority for the Minister and in special cases for special areas it does allow of a certain amount of flexibility, and that, after all, is in accordance with all the principles of our local government in the past.
§ THE EARL OF LISTOWEL
On behalf of my noble and learned friend, I think I can certainly say we shall give very willing and friendly consideration to the suggestion that has been made by the noble Viscount opposite. Of course, I must remind him that my noble and learned friend prefaced his remarks by saying that this was an integral part of our scheme of co-ordinating this service by means of the local authorities, and that was why we designated the county authorities and county borough authorities for this purpose. I am afraid that would he, to some extent, undermined if the proposal of the noble Viscount were accepted and delegation of powers was made from the original authority. I can assure you we will consider the point, and give a reply on the Report stage of the Bill.
Perhaps I ought to say one word. First of all I should like to make it quite clear that in moving this Amendment I have no intention of going against the theory that a certain amount of centralization and control of the service should be accorded. There is nothing antagonistic in our intention in moving this Amendment, but in view of what my noble friend, Lord Cranborne, said, I am not prepared to divide the Committee on the question of whether the urban district council should be included. By leave of the House I will withdraw my Amendment.
§ Amendment to the original Amendment, by leave, withdrawn.
§ LORD ADDINGTON
I should be very happy to endorse the suggestion that this matter should be further considered, and 463 I will put down an Amendment in some different words for further consideration on the Report stage. I would only add to the words of the noble and learned Lord that a great many powers have been added to major local authorities, who are taking a great many powers away from the borough councils, and, in certain exceptional cases with the consent of the Minister, there might be a more local control. In the circumstances, I beg leave to withdraw my Amendment.
§ Original Amendment, by leave, withdrawn.
§ 5.53 p.m.
LORD BALFOUR OF BURLEIGH moved to add to the clause:
(4) The application of this section within the Administrative County of London shall be subject to the following provisions:—
§ The noble Lord said: The Amendment in my name raises points different from any that have been raised hitherto, and, if I may say so to your Lordships, presents points of tremendous importance to the welfare of the people concerned. Unless we do something to alter the clause as it stands it will cut to the root of the quality of the whole of the local government in the metropolitan boroughs in London. I said on the Second Reading that this point must be decided primarily on the ground of the interest of the people concerned—that is, the women and the children, who are concerned in the maternity and child welfare services which it is proposed by this clause to transfer from the metropolitan boroughs to the London County Council.
§ Let me remind your Lordships that the London County Council is quite different from any other county council in the country, and that the laws relating to London's local government are entirely different from laws relating to local government in other parts of the country. You have only got to refer to the Town Clerk of any metropolitan borough and ask him to allow you to look at his bookshelf, to see the volume and body of the law which has been built up relating to London government. There are special Acts such as the London Building, London Public Health, and every sort and kind of Act, the reason being, of course, that the County of London is the only wholly-built-up county in the country. I am also prefacing what I have to say by reminding your Lordships that these functions relating to maternity and child welfare services have never been exercised by the London County Council. It has been recognized now over the last fifty years that these powers shall be delegated to the metropolitan borough councils, and, 465 What is more, the London County Council are on record as still being in agreement with that position.
§ Before I turn to the aspect of London County Council administration, I want to deal with the point which I promised your Lordships on Second Reading I would deal with. That is, the merits of the proposals as they affect the populations concerned. This is one of the most intimate services which is provided for the population. You have the doctors, not only the medical officer of health for the borough, but the medical officers of the clinics, the health visitors, the sanitary inspectors, and the housing officers of the boroughs. All are concerned with this intimate question of child-birth and infant welfare. On the other side of the picture you have the mothers and the children, and intimately connected with the boroughs you have the local borough councillors, who represent small wards, and the town hall of each metropolitan borough easily accessible to the people concerted. The duties which we are talking about are the care of the health of expectant and nursing mothers and infants, and the results achieved by the metropolitan boroughs in this field over the last fifty years and twenty-five years speak for themselves. I am not going to weary your Lordship with many statistics, but there are one or two points which we must have in mind to appreciate the value of the service now being rendered at this moment by the metropolitan borough councils. I have been connected with them for twenty-five years, and I confidently say they could not possibly be maintained at the same level of efficiency if the proposals of this Bill are accepted.
§ I am going to give you figures relating to Kensington. This borough I have been connected with, and I know most intimately. I do not want to say for a moment, although as a patriotic Kensingtonian I maintain that our services are the best, that we are the only borough. All Metropolitan boroughs do have very good services, and I only give you Kensington because I have the figures. At the beginning of this century the infant death-rate varied around 150; that is to say of every 1000 children born 150 died before reaching the age of twelve months. In 1919 the figure was 102, in 1938 it was down to 70, and in 1943–4 it was 52. Last year it was down to 49. Then there are 466 a whole lot of other points such as the maternal mortality. The maternal mortality is reckoned by the percentage of deaths of women per 1,000 births. In 1925 in Kensington it was 3.5; in 1945, that is after twenty years, it was under 2. I need hardly remind you that the diminution reflects not only the saving of lives of women but also a greatly diminished invalidity. It means that a tremendous addition is being made to the health and happiness of the home. There are many other services. There is the diphtheria immunization service of which the figures are quite startling. In 1935, only eleven years ago, we had 367 diphtheria cases notified, and 19 deaths from diphtheria. The council established the immunization service and the figures have dropped from 367 notifications to 29 notifications in 1944, and the deaths from 19 to none. There has not been one single death in the ten years of any child immunized by the council. Really that is a very remarkable record.
§ Then there are other things as well where the metropolitan boroughs, and Kensington in particular, have been efficient. Kensington was the first borough to set up acute rheumatism and rheumatic fever clinics in 1927, and was the first borough to appoint a health lecturer. The success of these services depend upon the intimate contact between the mothers and the Children on one side, and the doctors, the health visitors, and the town hall on the other. I assure your Lordships, and I know that what I am saying is sight, that if this proposal to transfer these services to the county council is allowed to stand, we cannot possibly maintain the same intimate contacts.
There is a history attaching to this which I think I am bound to tell your Lordships. I have in my hand an extract from the minutes of the London County Council of their meeting of 19th December, 1944, of which I am going to read you a few words. These are the recommendations of the relevant committee after considering the White Paper Command 6502 which was got out by the Coalition Government. It was decided unanimously by the London County Council at this meeting that the London County Council should be required by Statute to delegate to the metropolitan borough councils "the maternity and child welfare work at present undertaken
by the borough councils," with a certain small exception. Secondly, that:
Appropriate default powers should remain with the council in case of inadequacy of service. … The metropolitan borough health visiting services should, to the extent required, be used for domiciliary inquiries concerning London County Council hospital patients and school children. The council should be in a position to require information from the metropolitan borough councils as to the work done, or proposed to be done, by them under the scheme. … The school medical service should continue to be administered by the council in its capacity as local education authority.
That is remarkable not only for the details but for the fact that the resolution required that the Minister of Health should put this into the Bill and make it statutory.
§ The reason for that is not difficult to see. For over half a century the county council has been gradually abstracting services from the borough councils and taking them themselves. From the point of view of the great mechanistic services where uniformity of administration is necessary, it is of course right, but where local knowledge and experience are required this principle of decentralization should continue. So this agreement was come to between a body called the Metropolitan Boroughs Standing Joint Committee and the London County Council. It was agreed that these recommendations should be made to the Minister. That was followed by meetings at the level of the respective officers and a very detailed arrangement was come to which went before the London County Council on October 23, 1945. That means that the General Election had intervened, and I mention that in case your Lordships should think that the change in representation in the General Election or any election at County Hall had made a difference. In the minutes of these proceedings all the details carrying out that arrangement about which I have told your Lordships were confirmed in full.
§ It is worth telling your Lordships that there were present at this meeting of the London County Council no less than twelve Labour Members of Parliament, including the Lord President of the Council and the Minister of Town and Country Planning, both of whom are members of the London County Council, and these arrangements were passed unanimously. They were accepted on the recommendation 468 of a committee under the noble Lord, Lord Latham, which reported to the Council and the whole thing was settled unanimously; that was in the autumn of 1945. As I intended to mention the noble Lord, Lord Latham's name I took the precaution of letting him know that I was going to do so and expressed the hope that he would be here to explain to your Lordships what the attitude of the London County Council is on this matter. Unfortunately, the noble Lord is precluded from being here by other engagements which I am sure the noble Lord regrets and which I am sure also that the House regrets, because I do seek an explanation of why this arrangement which has been come to between the London County Council and the metropolitan boroughs has been set aside.
§ I have searched the proceedings in another place and I have found no explanation other than that given by Alderman Key. I desire to speak with the greatest respect of Alderman Key, who is Parliamentary Secretary to the Minister of Health, but I will tell your Lordships that Alderman Key was the Chairman of the Metropolitan Boroughs Standing Joint Committee which negotiated this arrangement with the London County Council and at that time Alderman Key said that the boroughs would be "left a hollow organization with no work to perform" if this was done. So I searched with great interest to see the reason why Alderman Key advised the House to accept this and the only reason I could find—and it is one therefore with which I am bound to deal—was that it was important not to separate the medical inspection of school children from the care of the under-fives. That of course is really the basis of this scheme throughout the country.
§ However, my submission to your Lordships is two-fold. First, that in London, which is entirely different, these functions have always been carried out by the boroughs; that should continue to be the case because they have done it so efficiently and because the remote control about which your Lordships have heard would not be so effective. Further, I do not think it is logical that, because the London County Council are the education authority and look after the over-fives, they should have the under-fives, the maternity and child-welfare arrangements. I do not think it is a logical 469 answer at all. It does puzzle me why, out of these twelve Labour members of Parliament who unanimously agreed to this matter in October, 1945, six should have voted against it in the House of Commons. I had the curiosity to look in the Division List to see whether any had voted the other way, in the hope that I would find they had shown suitable independence, but I regret to tell your Lordships that I did ndt find any voting in the other Lobby.
§ Lest it should be thought that the Metropolitan boroughs who are represented by these same gentlemen have Dome to any different conclusion, I must read to your Lordships a resolution which was passed by the same Metropolitan Boroughs Standing Joint Committee, though I suppose Alderman Key was no longer the Chairman of that committee. They resolved on July 17, 1946, only three months ago, that "the Standing joint Committee should reconsider the future of local health services in London with a view to inserting an Amendment to the Bill along the following lines, that the metropolitan borough councils should be the local health authorities in London." That of course goes further than my Amendment but in the same direction.
I would also like to say that resolutions are being passed by every metropolitan borough., including all the Labour ones, in the same direction. I have a whole packet of them here. I do not think I need detain your Lordships at this hour but here they are. Shoreditch
is strongly of the opinion that, in the County of London, the maternity and child welfare and health services now provided by the boroughs are of such a special personal and intimate nature that they are best administered by the borough councils as the authorities having the greatest knowledge of local conditions and being in the closest touch with the needs of the people living in their area.
that in connexion with the National Health Service Bill the Council is firmly of the opinion that so far as London is concerned the administration of the maternity and child welfare and ancillary services should remain under the control of the borough's council.
This letter from Hackney gives a great deal of information about the history of local government in London which is interesting because the noble and learned Lord, the Lord Chancellor, referred to the fact that "by some strange exception"
vaccination is dealt with by the metropolitan boroughs. It is not strange at all. It is because the metropolitan boroughs have always done this and it is in accordance with the whole history of local government in London. I have in my mind a whole string of similar resolutions from other boroughs. The noble and learned Lord went on to say that there was one exception in the Bill; that it was possible to delegate to district councils which were not educational authorities this power which I seek in the Bill. How ridiculous. These little district councils are being put in a more favourable position than these great metropolitan boroughs.
§ There we come to the question of what is a major or minor authority. One would think from the way they are treated in this Bill that the metropolitan borough councils were minor local authorities. I would remind your Lordships that they number among them Wandsworth, which has a population of 350,000 people, and Islington, with 321,000. The rateable value in Westminster is higher than in any other borough or city in England and Wales. Kensington, at the end of the war, in spite of heavy damage was tenth in rateable value and Wandsworth eighth of all cities and boroughs in England and Wales. Had it not been for the fact that London local government is a thing by itself, these great boroughs would have been made county boroughs long ago and those which were not made county boroughs, because they had not the 100:000 inhabitants or whatever was necessary, might have been drawn together and have had special arrangements made.
There is a great deal more that I could say, but one other thing to which I must refer is this. Alderman Key said:
The medical inspection and care of school children lies with the education authority, which is the London County Council. Our scheme brings the maternity and child welfare care in with that because it gives it to the same authority and therefore will lead to a more efficient service.
That is what we all want, but of course it absolutely begs the whole question merely to say: "We take it in with the education service and therefore it will be more efficient." It is a non sequitur. It all depends. Here in London the boroughs have not had the education but they have had this maternity and child
welfare service. I ask your Lordships to picture how it could possibly be as efficient to administer this thing from County Hall. I understand that the proposal, which is very vague, is to set up some divisional, area or district committees on which the borough councils will be represented. That sounds suspiciously like the Education Act and the school management representatives whom we have to appoint in the borough councils. I am not exaggerating when I say it is not easy to get people to act because they have not got anything in particular to do. The London County Council is a great bureaucratic machine. It appoints regional officers and they are bound by a code of administrative arrangements which is quite inflexible. I do not say it offensively, but you get a certain degree of Bumbledom. The number of members of the L.C.C. is 120 for 4,000,000 people. Of course the interests of the people are better looked after in these intimate services by councillors who represent small individual wards. The same thing occurs with public assistance; they have regional officers there. Control is remote and impersonal.
§ I would like some explanation of where the L.C.C. stand, and that is why I regret that the noble Lord, Lord Latham, is not here. He may tell us that the L.C.C. have changed their minds, but there has been no member of the L.C.C., so far as I know, who has come into the open and told us why they have changed their minds. Rumour has it that the noble Lord, Lord Latham, is such a dictator that he can secure these changes merely by expressing a wish. If that is so, I think this provision is a mixture of Hitlerism and Bumbledom which your Lordships would do very well to sweep out of the Bill. Before I say any more I would like to hear what the noble and learned Lord Chancellor is going to say in reply and therefore I beg to move.
Page 18, line 44, at end, insert the proposed new subsection.—(Lord Balfour of Burleigh.)
THE MARQUESS OF ABERDEEN AND TEMAIR
With twenty-four years' experience behind me as a member of the London County Council, I should like heartily to support the Amendment just proposed by the noble Lord, Lord Balfour of Burleigh. In any case, London 472 ought to have exceptional treatment, as it has had in the past. It has got experience of these services and it seems to me that the existing arrangements should carry on. This tendency towards centralization is really just another word for a word which is very popular amongst the Party sitting opposite—nationalization. We do not want nationalization for health services; we want local services, and for the simple reason that people who live in a locality will not take an interest in any of their services if you take away all their powers. You want public interest in the administration of health services as well as in other services. To my mind, this Amendment is entirely on the right lines to maintain efficiency as well as public interest in health matters. If health 'matters are not important, I do not know what is, and I consider it to be very important that every one in a locality should take an interest in local health matters. It seems to me that we are going on to centralization, which is exactly the opposite to democracy. If we are not now living in the days of democracy, when shall we? I thought democracy had come to stay, but having regard to present legislation, it looks to me as though it is going to be abolished. For that reason I suggest that this House should very seriously consider before refusing to pass the Amendment proposed by my noble friend Lord Balfour of Burleigh.
§ LORD JESSEL
The noble Lord, Lord Balfour of Burleigh, has covered the ground so well that there is very little for me to add. I might remind your Lordships that I have been personally connected with local government in London for over fifty years. I have seen it grow up from the vestries, of which I was a member originally, to the passing of the London Government Act of 1900. During that time, it has grown in strength and everybody who was in London during the war will recognise what wonderful administration and good services were performed by the London local authorities. I can well remember what was originally said about the Mayors and their chains, but at last London got accustomed to the idea, and now the Mayor is looked upon in every district of London as the head of the community and the Town Hall as the place to which to go and find out what is going on, and to get the necessary information. I 473 am not going to compare Kensington with Westminster or any other borough in London, but I will say that when you come to health statistics and administration in London you will find there is no portion of His Majesty's Dominions which is better administered.
There is one more point. Of course, I am dead against this proposal. I know all the local authorities, including the Metropolitan Joint Standing Committee, which, like the Cabinet, is unknown to the law but exists by mutual consent of all the borough councils. Mr. Herbert Morrison and I once had a quarrel over it and he tried to break it up because he said he did not think there was fair representation. However, he changed his mind and we have got on amicably in London ever since. That is a most wonderful and powerful body—at the present moment, there is a big Labour majority upon it and I think your Lordships should pay some heed to the resolution which it has passed.
There is one further point of importance. As your Lordships know, each constituency in London has two members on the L.C.C. According to the report of the Boundary Commission, that will be reduced from 144 (and that includes, may I remind the noble and learned Lord Chancellor, the Aldermen) to eighty, or, including the City, eighty-two. It will be a much smaller body. I wonder whether any of your Lordships have ever looked at the weekly agenda paper—or fortnightly as it is now—of the London County Council. The noble Earl, Lord Listowel, knows it, and I wonder how long it takes him to read it. I know that in these days it takes me three-quarters of an hour to read the Westminster City Council agenda. I should say it would take even the noble Lord, Lord Llewellin, who is so industrious, an hour and a half to read the London County Council agenda. How on earth can you go on pushing all these extra duties on them? The London County Council has enormous powers and a great deal to do, and I must say that on the whole it does it very well except when we get into political arguments. Finally, I base my appeal on what my noble friend said in his most eloquent speech, that London has always had separate treatment. I think you will agree after what was said by the noble Earl, Lord Munster, and by the noble 474 Marquess, Lord Reading, on the Second Reading, that London is entitled to it.
§ THE LORD CHANCELLOR
We have indeed had eloquent pleas for this exceptional treatment of London. I should have supposed that the answer to the question which is posed for our consideration is dependent upon how we thought the most efficient form of government could be secured. I am much too old and, I think I may say, too good a Parliamentarian, to be very much moved by the additional plea which the noble Lord made about some agreement. I am a Parliamentarian, and I do not care what takes place outside Parliarnent. Let the county council and borough councils agree on anything they like and sanctify it by a speech or anything like that. Whether they adhere to it or not I am completely indifferent. If, after considering the matter, I come to a conclusion in Parliament that they have come to a wise conclusion I shall support it. If I come to the other view I shall disregard it. Here we have had very wise men speaking about a subject which they know, and the expression of their opinion is one which obviously guides us, but any agreement they come to, whether the Lord President of the Council or a dozen Lord Presidents—
§ LORD BALFOUR OF BURLEIGH
I only adduced the agreement as evidence of the state of mind of these people at that time, and I am asking for the reasons why they have changed, which have never been told us.
§ THE LORD CHANCELLOR
It is not for me to say; I am not keeper of their counsels. I apprehend that the answer to that question is not a difficult one. As I understand it the position at that time—I have not gone into it—was that the London County Council were going to keep their hospitals, and being, I suppose, wise people, and not wanting too much on their plate at any one time, they said: "As we are keeping our hospitals and have got to administer them, we shall not have the time or the facilities to administer all these other things as we like, and consequently we will let them go." That is a wholly different background from the background of to-day. Now the London County Council are losing their hospitals; they are relieved from 475 that burden they had before, and they now have time to conduct these other matters.
§ THE LORD CHANCELLOR
At any rate, they have lost the duty of looking after their hospitals, and now they have lost that duty they will have time to deal with other matters. I will be quite frank with the noble Lord. In my consideration of this matter I set on one side altogether the agreement which was come to, which in any event is only relevant as indicating the opinion of experienced persons on the lay-out as it was then suggested. It does not in the least follow that those experienced persons would have the same opinion when you are dealing with a lay-out which is fundamentally different.
I now turn to consider what I venture to think is the only point of relevance—whether or not it is wise and in the best interests of this service to arrange for delegation. If I understand this Amendment, it has the effect of providing for the discharge of certain specified functions by the City and metropolitan boroughs in place of the London County Council. The functions to be so delegated are maternity and child welfare, child-life protection, home nursing, vaccination and immunization, and home helps. I think that is the substance of it. Under the Amendment, the county council have, as I understand it, to plan the service. They consult the City and the borough councils in so planning, and it is then for the City and borough councils to carry them out, receiving half the cost from the London County Council. I think that puts the Amendment shortly. The functions that remain with the county council will then be the provision of health centres—at which in due course, as I have said before, I hope most of these functions will be carried out—domiciliary midwifery, the ambulance service and the care and aftercare of the sick. We think it desirable to concentrate responsibility for the personal health services of local authorities in any given area in one local authority, and we do not think it wise to have divided responsibility in any particular area.
I do ask your Lordships to consider that carefully. I do not believe that is 476 wise. For instance, is it wise to place responsibility for carrying out maternity and child welfare in the hands of the City and metropolitan boroughs, whilst keeping the responsibility for domiciliary midwifery in the hands of the county council? Is it wise to leave the duty to provide health centres for general medical and dental services with the county council whilst you leave the duty of providing maternity clinics and infant welfare centres with the borough council? It seems to us—and when I say "us" I mean not only this Government, because after all this was discussed in the days of the last Government—that the delegation as proposed would increase administrative friction and difficulty and produce a loss of efficiency and of co-ordination. The Amendment the noble Lord moved goes far beyond merely reproducing the existing functions between the London County Council and the metropolitan borough councils. It imposes on the latter functions which they have never yet had.
§ THE LORD CHANCELLOR
Home nursing. That being so, it seems to us that this is a retrograde step. By all means let the County Council develop a regional basis on the lines which the noble Lord suggested they were doing. I was glad to hear it. But I do not believe it to be wise or sensible administration, no matter who agrees to the contrary, to have one body dealing with the under-fives and another body dealing with the over-fives. I do not think it is sensible. It is all very well to say this is a matter for local skill. So it is. What is far more important than that is the doctor who gets to know the family, who is the servant of one particular authority. Surely to goodness if we have a doctor to look after a child of four and a half, should not the same doctor be able to look after the child of five and a half?
I suggest to your Lordships that this division of responsibility is thoroughly bad. I look forward personally to the day—it will not be in the immediate future—where at health centres you will have facilities for carrying out all these functions, child welfare, maternity care, pre-natal care, and all that sort of function. I believe that to have some of them the responsibility of the County Council and have others of them the responsibility 477 of the borough councils would be bad. It would make for inefficiency, would lead to friction, and would be very much opposed to the best interests of the people of London. I am fully conscious of the fact that local government to-day is in a state of flux. Whether we like it or not, that is true. I have always been conscious of the danger of withdrawing too many functions from the local government lest at last you leave so little that you do not get the best people to do it.
I am fully conscious of that, and I am conscious particularly of the circumstances relating to London. The noble Marquess, Lord Reading, was going to concern himself with that, but I gather that his activities are being suspended, and. I think, if I may say so, that it is right that that should be so, for when there is a volcanic change going on in existing institutions, it is very difficult to make a plan. If you are working on the construction of a particular edifice, and the next day that edifice is knocked down by another earthquake, it becomes impossible to plan. Therefore, I think it is wise that the planning, which I hope is soon to be done, should be done when we have got over this state of violent change and have got back to calmer times. I think that that is right and inevitable. I do ask your Lordships to say that this division of functions between these bodies, some having one thing and some having another, is bad, no matter what agreement there may be to the contrary upon it. I ask your Lordships to say that it is bad, and to agree that it is right that it should be resisted.
§ THE EARL OF MUNSTER
I think I really must say a few words on this matter, if only for the reason that I was at one time a member of the London County Council. I do regret the passing over of this work which the borough councils have done so well in the past to the larger organization of the London County Council. I am not at all certain that I appreciate the full effect of the speech which the noble and learned Lord, the Lord Chancellor, has made in reply to Lord Balfour of Burleigh. He said, I understood, that a divided responsibility in any one area is not desirable. But there is divided responsibility the whole way through the Bill. It was the ground of the principal objection which I 478 raised on the Second Reading. An inpatient comes under the authority and control of the Minister of Health; an outpatient comes under the local authority. Immediately there is divided responsibility. To say that it would be divided responsibility in London to let borough councils continue to carry out these duties which Parliament, over many years, has distinctly and specifically given to them, seems to me quite wrong.
No one as far as I am aware—I do not think the Lord Chancellor has done so—has suggested that the borough councils have carried out these duties inefficiently. On the contrary, there have been strong expressions of complete faith in thorn. My noble friend Lord Balfour of Burleigh gave your Lordships some indication of the value of their work in this connexion in the figures relating to the reduction in the death rate of young children. If these responsibilities go to the County Council, we shall then have a position in which those who, in the boroughs, are now in close and intimate contact with the people, will no longer be in touch with them. The whole of the organization will be carried on by one central authority which I frankly admit I do not believe can carry out or discharge these functions as well and as suitably as the borough councils. I support the Amendment of my noble friend Lord Balfour of Burleigh, and I hope that His Majesty's Government will be able somehow to consider again whether it is not possible to delegate to the borough councils work which they have carried out to the satisfaction of everyone over a period of very many years.
THE MARQUESS OF READING
I wish to say only a few words for the reason upon which I laid some stress in the course of the remarks I made on the Second Reading. I do not desire to make reference to the larger aspect of London government with which the Lord Chancellor at one point of his speech was concerned. And may I say, as I have said before, that I should not have spoken on the particular aspect with which I propose to deal, if the Minister had not—at least by very direct implication—set me free to do so. This is a very different situation from the one which was dealt with in the last Amendment we discussed. London is on an absolutely different footing from 479 any other organization in this country. If it is sought to cast doubt upon the present Amendment merely because the last one was not accepted, I would only refer to the great difference between them, which is best illustrated by the fact that Lord Henley pointed out, on the Amendment on which he was speaking, that if that was adopted the county medical officer of health would be deprived of his activities. On the other hand, here you have exactly the converse. If you are going to take out of the hands of the medical officers of health of the metropolitan boroughs these maternity and infant welfare functions, you are going to take out of their hands one of the most important, if not the most important, of the functions performed by them. You will rob their occupation of a great deal of its interest, and you will not make that appeal to men of high qualifications which would be made if the whole of this field were open to them.
I hope that too much importance is not going to be attached to this doctrine of long-term planning, to the idea that you must have everything nicely planned and arranged, this sphere allocated to one authority and that sphere allocated to another. As has been said over and over again, here is a body of infant welfare and maternity work which has been built up in London, which has stood up to every test which has been applied to it with complete success, which does attract people to the service of local authorities, because that is their great interest, and which, if it is taken away and put into the hands of the London County Council, will take away one of the main incentives to people to come into local government and give their services to it. The Lord Chancellor has given us a picture of the Government's attitude. I can only say that it seems to me a very unfortunate one, having regard not merely to the interests of those people who desire to take part in municipal work, but to the interests of the people, who, after all, are the primary people to be considered—the mothers and children of London.
§ LORD LLEWELLIN
I think that those of us who do not know as much about London government as many of the noble Lords who have spoken, must have been greatly interested in what has been said during the course of this discussion. 480 This is a vast area, this field of London, to be administered in these matters entirely from the centre. The population in the London County Council area is certainly as large as, or larger than, the population of New Zealand—midway perhaps between the population of New Zealand and Australia. Here, I should have thought, was a case where the matter might not be made mandatory. I should have thought that this was one of those exceptional cases in which there might be agreement between the authorities (such as there seemingly has been in the past) as to who should do the job—agreement between the authorities and with the Minister.
§ LORD LLEWELLIN
Yes, I should have thought that we might have had that. I do not think that all county authorities should be dealt with in exactly the same way. Take the county from which I have the honour to come—Dorset. It is quite a small county with a small population. The problem of supplying maternity and infant welfare services there is nothing like so great as it is in this vast metropolitan city. I do not know whether at this stage we could have some assurance on this point. I am not sure whether it would content the noble Lord, Lord Balfour of Burleigh, who moved this Amendment so ably and who, I know, has these services so much at heart, if that course were adopted. I gather that he does not agree. However, be that as it may, I should have thought that you would probably get this agreement at any rate over a great part of these services, and that you could let people carry on to a great extent as they have done in the past. As I have said, I do not know about these London services half so well as those who have spoken, and it must be a matter for my noble friend who moved this Amendment to take whatever line he wishes.
§ LORD BALFOUR OF BURLEIGH
May I say one word in reply to the noble and learned Lord? I regret to occupy the House at this late hour, but it is a matter of such prime importance that I am not justified in letting it go. The noble and learned Lord, the Lord Chancellor, threw scorn on the value of the agreement between the London County 481 Council and the Metropolitan Boroughs Standing Joint Committee. He suggested that as the London County Council is going to give up the hospitals, they might say, "We will let the hospitals go to you; now we shall have time to look after maternity and child welfare services." May I offer another version of what might have been? Until the publication of the Government scheme there was no difference of opinion at all. When the Government said, "We are going to take your hospitals away," it is conceivable that the London County Council (who are proud of their hospitals) might have said, "We do not agree; we are going to fight you." It is then conceivable that, ultimately, they might have said "Well, if we must give them up, we must, but we will have maternity and child welfare services from the boroughs as a quid pro quo." My version is perhaps as likely to be right as that of the noble and learned Lord, the Lord Chancellor.
The noble and learned Lord found fault with the wording of my Amendment, and he says that the borough councils are asking for more than they had in the past. He says that I have put in home nursing. I am quite unaware of it. The services I want for them are those which they have always had, and which have been efficiently carried out. As for delegation, that would not satisfy me or the metropolitan boroughs; and I will tell you why. Over and over again, discussions between the London County Council and the metropolitan boroughs about a forthcoming Act of Parliament have taken place, and the London County Council have said, "Let it go through in the Act, and we will delegate to you." What has happened is that the matter goes in the Act, and there is no delegation. I will
§ give you instances—the Public Health Acts, the Town and Country Planning Act, 1932, the Public Health Act, 1936, Section 249, and the Education Act, 1902. This sort of thing has been going on for fifty years. The London County Council are taking over more and more of the services of the borough councils, and that is why there was the agreement that it should be put in statutory form in the Bill, because the metropolitan boroughs knew that unless it were put in the Bill it would not be carried out.
§ Those points are all side issues. I could not agree with the noble and learned Lord, the Lord Chancellor, more than when he says that what matters is the quality of the services. In another place, the Minister of Health said this: "No one denies the necessity for trying to bring as near to the homes of the people as possible responsibility for maternity and child welfare services." The noble and learned Lord, with his great forensic ability, made an astonishingly good case, considering that he had not in fact a leg to stand on. If I had a quarter of his ability, I would convince every one of your Lordships, including all the noble Lords who sit on this side of the House, of the truth of what I have said. I only hope that you will accept it as coming from somebody who for twenty-five years has had to deal with these matters. I know what I am talking about. We in the borough councils can do these things better, and have done, and that is what you are going to spoil if you transfer these functions to the London County Council.
§ On Question, Whether the said new subsection shall be there inserted?
§ Their Lordship divided: Contents, 35; Not-Contents, 15.483
|Reading, M.||Addington, L.||Hindlip, L.|
|Salisbury, M.||Amherst of Hackney, L.||Jessel, L.|
|Amulree, L.||Llewellin, L.|
|Fortescue, E. [Teller.]||Balfour of Burleigh, L.||Luke, L.|
|Iddesleigh, E.||Carrington, L.||Northington, L. (L. Henley.)|
|Lucan, E.||Cherwell, L.||O'Hagan, L.|
|Munster, E.||Cunliffe, L.||Remnant, L.|
|Fairfax of Cameron, L.||Saltoun, L.|
|Bridgeman, V.||Gifford, L.||Sandhurst, L.|
|Elibank, V.||Grenfell, L.||Teviot, L.|
|Hutchinson, V. (E. Donoughmore).||Hatherton, L. [Teller.]||Tweedsmuir, L.|
|Hawke, L.||Wolverton, L.|
|Maugham, V.||Hazlerigg, L.|
|Jowitt, L. (L. Chancellor.)||Chorley, L. [Teller.]||Mountevans, L.|
|Darwen, L.||Pakenham, L.|
|Addison, V.||Hare, L. (E. Listowel.)||Quibell, L.|
|St. Davids, V.||Holden. L.||Shepherd, L.|
|Lucas of Chilworth, L.||Waldken, L. [Teller.]|
|Ammon, L.||Morrison, L.|
§ Resolved in the affirmative, and Amendment agreed to accordingly.
§ Clause 19, as amended, agreed to.484
§ House adjourned at five minutes before seven o'clock.