NATIONAL HEALTH SERVICE BILL.

HL Deb 23 October 1946 vol 143 cc590-640

House again in Committee (according to Order):

[THE EARL OF DROGHEDA in the Chair.]

Clause 42, as amended, agreed to.

Clause 43:

Powers of Minister where services are inadequate.

43. If the Minister is satisfied, after such inquiry as he may think fit, as respects any area or part of an area of an executive council that the persons included in any list prepared under this Part of this Act—

1. (a) of medical practitioners undertaking to provide general medical services;
2. (b) of persons undertaking to provide pharmaceutical services; or
3. (c) of dental practitioners undertaking to provide general dental services,

are not such as to secure the adequate pro vision of the services in question in that area or part, or that for any other reason any considerable number of persons in any such area or part are not receiving satisfactory services under the arrangements in force under this Part of this Act, he may authorize the executive council to make such other arrangements as he may approve, or may himself make other arrangements, and for the purpose of such other arrangements he may dispense with any of the requirements of regulations made under this Part of this Act.

3.25 p.m.

LORD LLEWELLIN moved to leave out "and for the purpose of such other arrangements he may dispense with any of the requirements of regulations made under this Part of the Act," and insert "provided that such other arrangements are within the authority conferred by this Act or any amendment thereof." The noble Lord said: My noble and learned friend Viscount Simon is unable to be here this afternoon; he is detained on an official engagement. Therefore, I beg leave to move the Amendment that stands in our joint names.

If your Lordships will look at Clause 43, you will see that it says: If the Minister is satisfied … as respects any area … that the persons included in any list prepared under this Part of this Act … are not such as to secure the adequate provision of the services in question … he may authorize the executive council to make such other arrangements as he may approve or may him self make other arrangements. With that we should all be in complete agreement. But when the clause goes on to say: and for the purpose of such other arrangements be may dispense with any of the requirements of regulations made under this part of this Act. then, in the view of some of us, that is going a bit too far. Because, after all, what would be the effect of that? As the Bill is drafted, there are provisions in it for regulations to be made which, in some cases, have to have the affirmative assent of each House of Parliament. In all the other cases they are liable to be negatived by Resolution in either House of Parliament.

And, of course, if these words are left exactly as drafted, the effect is that the Minister, if the arrangements were not thought adequate under the regulations, could quite well make a new regulation. There is nothing whatever to prevent his doing that, but, it seems to us to be a little steep that when perhaps the regulation has received the assent of each House of Parliament, the Minister should have power, the next week, if he likes, to alter that regulation. Surely the proper thing would be for him to come down and present to each House of Parliament a new regulation which would cover the point.

I fancy that these words may be rather wider than those who are sponsoring the Bill would wish them to be. Draftsmen are admirable people and they like to make the whole thing as watertight as possible. That is the reason why my noble and learned friend and I have put down an Amendment to leave out from "arrangements" to the end of the clause and to insert instead: provided that such other arrangements are within the authority conferred by this Act or any amendment thereof. That is our Amendment. I am not particularly wedded to its wording, but I do think, and I hope that the Government will think, that the words in the Bill as drafted are too wide for their purpose. Nobody will disagree that the Minister should make adequate arrangements. It is only a question of the method he ought to adopt. The Minister ought not to adopt a method which might allow him to go right outside the provisions of this Bill or right outside regulations assented to by both Houses of Parliament. For those reasons I beg to move.

Amendment moved— Page 39, line 36, leave out from ("arrangements") to the end of the clause and insert the said new words.—(Lord Llewellin.)

VISCOUNT MAUGHAM

I want to support this Amendment in a very few words. I have spoken with my noble and learned friend Lord Simon, who is, unfortunately engaged in public duty at the present moment, and he is strongly of the opinion that the words at the end of Clause 43 would have an effect which, as my noble friend Lord Llewellin has said, could not have been intended. It cannot be right that, inasmuch as regulations under the Act have to be made pursuant to a number of requirements, the Minister who makes them can under the provisions of Clause 43, if he thinks fit, without the authority of Parliament given either by a negative or by a positive Resolution, disregard—the current word is "scrap"—all the requirements which have been laid down under the Act and can do anything he pleases. Accordingly I support the Amendment which my noble friend has proposed.

THE MARQUESS OF READING

May I add one word in support of this Amendment? We are entirely in favour of as much elasticity as necessary being given to the Minister charged with carrying out the scheme proposed by the Bill, but this is really elasticity run riot. There must be some modification of the present words be fore we can entrust to any Minister the power to ride roughshod over regulations made under the powers contained in the Bill.

THE POSTMASTER-GENERAL (THE EARL OF LISTOWEL)

I think it would be as well to explain to the House the exact situation which the Minister had in mind when he included these words in Clause 43 which the noble Lord opposite is moving to omit. He is asking for an emergency power to meet certain exceptional circumstances. What sort of circum stances has he in mind? There might be, in a remote part of Wales or Scotland or in some remote country district in Eng land, an area without any dentist at all. In such an event the Minister would either himself or through the executive council have to supply a whole-time salaried dentist to serve the people living in that neighbourhood. He cannot do that by making a regulation under the Bill. I should like to emphasize the fact that this emergency power would obviously not be used except on the rarest occasions and would be limited to this specific purpose. I should also like to point out to the noble Lord that a provision of this kind is not without precedent. It has existed in a slightly different form for the past thirty-five years in relation to national health insurance. I do beg the noble Lords not to look at this thing from the point of view of giving the Minister arbitrary power to act without the authority of Parliament. That is not what is intended. It is solely desired by this provision, in the clause to enable the Minister to fill a gap which might occur in the health service.

LORD LLEWELLIN

I am afraid I do not quite follow the noble Earl's explanation. To take the instance he quoted, that if there was no dental practitioner in a particular area the Minister could not supply him by regulation. Of course he cannot because he would have to find a dentist and get him to go there, but I do not see that in order to get a dentist to go there he would have to dispense with any requirements of any regulation under this Bill. Of course the executive council ought to be able to make this known. It would be part of its function to do so. I cannot conceive why these last words overriding the regulations under this Bill are necessary if it is merely to see that there are enough medical officers or enough chemists or enough dentists in a particular area. I do not know what regulations you would have to get them there, but surely the regulations would all be designed to get the people there.

VISCOUNT MAUGHAM

May I add one word because the noble Lord, the Leader of the House, is going to reply and I want to say something for him to deal with? To my mind, speaking for my self, what I think is so dangerous in the last few words in Clause 43 is that the House of Commons and this House have no authority whatever to object. If the state of emergency which my noble friend Lord Listowel has mentioned arises it would be quite right that power should be given to the Minister to deal with the matter as one of emergency. If that were done it might be done under regulations which would be subject to the approval of each House of Parliament under Section 74. If you will give the Houses the right to criticize and, if necessary, to suggest Amendments in these emergency regulations, that would pacify most of us in this House. Where the regulations might extend beyond some thing previously authorized in the Bill and leave it entirely to the Minister with out enabling Parliament to express an opinion, that seems to me to be entirely wrong. I will only add this. There is nothing in the clause which seems to make the power one only exercisable in the case of an emergency. The word "emergency" does not occur in the clause and under this clause as it stands some thing might be done by which the Minister would authorize an executive council to make arrangements which might last for half a century.

VISCOUNT ADDISON

I was going to make a suggestion which I hope will meet your Lordships. I quite recognize the misgivings that these somewhat comprehensive words promote. The illustration which my noble friend gave is quite right because the Minister can only make regulations in accordance with the powers conferred on him under the Bill. In the appointment of a whole-time dentist he has no power in the Bill and could not do anything of that kind by regulation. However, I am very anxious to meet the misgivings of the noble Lord if we can, and the point he has raised is that these powers are very comprehensive. They enable the Minister to dispense with the requirements of regulations made in this Part of the Bill. What is desired is that he should be able to take action to deal with a particular shortage or emergency that has been discovered. I think we might perhaps consider whether we can frame words on Report which would meet the needs of this particular emergency other than by general application. That is really what is wanted. If the noble Lord will allow us to look into it, I hope he will withdraw the Amendment on that understanding.

LORD LLEWELLIN

I am very much obliged to the Leader of this House. Of course I will withdraw. Nobody wants the Minister not to have the power to deal with an immediate emergency of this sort. We certainly would be glad to avail our selves of his offer to look into the words and to meet us.

Amendment, by leave, withdrawn.

Clause 43 agreed to.

Clause 44 [Recovery of charges in respect of certain appliances and dental treatment]:

3.33 p.m.

LORD LLEWELLIN moved to add to the clause: (3) Regulations may provide that a person providing general dental services who, with the full knowledge and consent of the patient renders treatment or provides appliances at a cost in excess of the prescribed charges, shall receive a grant equivalent to the amount of the charges prescribed for corresponding treatment and appliances upon satisfactory proof of services rendered and appliances provided in accordance with such regulations.

The noble Lord said: My noble friend Lord Teviot cannot be in the House, and he has asked me to move this Amendment, which is to insert the words on the Order Paper. As I understand it, this Amendment means that as all of us will be contributors under the scheme, which, among other things, will entitle us, if we reasonably require them, to false teeth, we shall be able to get the teeth we want. People have to have utility sets of false teeth, as they have had utility furniture and utility other things during the course of the war. Some people may like to have, and reasonably like to have, the teeth in perhaps a colour to match the ones on their left wing, or some detail of that sort. For that reason they go to the dentist and say: "I would like not just this utility set, but something a little better." If the dentist says he can supply what is asked for, this Amendment purports to say that, although the patient who wants this extra refinement, if it can be called a refinement, naturally has to pay the extra, he should be able to get the grant in aid to cover what the utility set, if I may so call it, would have cost.

That is the point of the Amendment. I do not think we want everybody going around looking quite the same, whether in the matter of teeth or in any other respect, because that would make us a very dull-looking nation. The people who want the small extra should be able to get the grant in aid to such an amount as the set would have cost if they had not wanted that particular refinement. That is the purport of the Amendment, moved perhaps on behalf of the large number of people who have been subscribers to these health schemes and rightly ought to have that little consideration. I beg to move.

Amendment moved— Page 40, line 15, at end insert the said new subsection.—(Lord Llewellin.)

THE EARL OF LISTOWEL

I think if the noble Lord reads the clause carefully he will see that his point is already met. The clause provides for regulations permitting the dentist to make additional charges for (1) expensive appliances, which I imagine would include a luxury set of false teeth; and (2) such special dental treatment as may be prescribed—if, for instance, a person desires a gold filling. What happens in that case is that the dentist is authorized to make the extra charge which covers the cost of the article or treatment and the additional cost is recovered from the patient; but the cost of the standard treatment or appliance is recovered by the dentist from public funds. That is what is proposed under the clause, which is, I think, precisely what the noble Lord requires. The Amendment to which he is speaking in fact goes very much further, but if the noble Lord does not wish to support the Amendment as it stands I will not weary your Lordships by replying to it.

LORD LLEWELLIN

If the noble Earl assures me that it is already achieved in the wording of the Bill, I am quite content.

VISCOUNT CRANBORNE

Could the noble Earl say exactly where it is?

THE EARL OF LISTOWEL

It is sub section (2) of this clause.

LORD LLEWELLIN

The words are, "may be…recovered by the person providing the services." Does that mean recovered from the funds or recovered from the patient? That is the point.

THE EARL OF LISTOWEL

What is recovered from the funds is the standard cost of the standard treatment or appliance. That is, so to speak, the utility treatment which every one will get. If they want luxury treatment they will have to pay for it out of their own pockets, and the cost of the luxury treatment is recovered by the dentist from the patient.

LORD LLEWELLIN

I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

Clause 44 agreed to.

Clauses 45 to 47 agreed to.

Clause 48:

Provision of courses for medical and dental practitioners.

48. For the purpose of affording opportunities for practitioners providing any ser vices under this part of this Act to keep themselves informed of the latest developments in professional knowledge, the Minister may enter into arrangements with universities, medical schools and dental schools, and any other persons for the provision of courses which such practitioners may attend, and may, with the approval of the Treasury, make payments towards the cost of the provision of such courses and the expenses of practitioners attending such courses.

3.45 p.m.

THE MARQUESS OF READING moved, after "Act," to insert "and for nurses employed in connexion with services pro vided under any Part of this Act." The noble Marquess said: This clause, as your Lordships will observe, makes arrangements for the provision of courses for medical and dental practitioners. No doubt those practitioners will be grateful for the appearance of that clause in this Bill, because it will enable them to keep themselves up to date and to exercise the highest degree of skill and efficiency in the interests of their patients. Those practitioners would surely be the first to agree that their skill, and consequently their reputation and the recovery and comfort of their patients, depends to a very large extent upon the quality of the nursing service which is available for the assistance of the doctors themselves and for the actual direct care by the nurses of the patients. It cannot be expected that the nurses will maintain their standard of efficiency unless they too are given the chance to bring themselves up to date and to keep themselves up to standard by attending such courses as may be made available.

The purpose of this Amendment is the very simple one of including within the scope of the provisions for brining and keeping up to date the knowledge of medical practitioners a similar provision embracing the nursing service. I am encouraged in putting down this Amendment by the sight immediately following it on the paper of an Amendment in the name of the noble Lord, Lord Horder, who can speak on these matters, and I hope will speak on them, with far greater knowledge and experience than I can. However, I suggest that it is right in principle and it is something which not only would be welcomed by the nurses but to which they are entitled. If it seems to the Government representatives that the Amendment would not be most happily contained in this particular clause and could better be inserted in some other part of the Bill, that is a matter to which I attach no particular importance, but that it should appear at some point in this Bill I do think is of real moment to the nursing profession. I beg to move.

Amendment moved— Page 40, line 44, after ("Act") insert ("and for nurses employed in connexion with services provided under any Part of this Act").—(The Marquess of Reading.)

VISCOUNT MAUGHAM

I rise only to point out that it is purely permissive. If the Minister does not like to do it be need not do it. It simply gives him the power.

LORD HORDER

As the noble Marquess indicated, I am entirely with him in this Amendment; indeed, I think it is possible that if this Amendment were allowed, or some assurance equivalent to it were given, I need not move the Amendment which stands in my name. However, this does give me the opportunity of endorsing what the noble Marquess has said, and what we all surely know, in respect of the importance attaching to the nurse's work. Next to the doctors it will be the nurses upon whom the success of working this scheme will fall. It has struck many of us that there is totally inadequate reference to the work of nurses throughout this Bill. It is assumed that there will be a standing advisory committee in respect of nursing and regulations will no doubt be framed which deal with the nurse's contribution to the working of this scheme. All the same, bearing in mind the very great importance attaching to the nurse's contribution and the fact that here was one place at least where reference could be made to the nurse's training I was emboldened to put down the Amendment which follows that of the noble Marquess. The nurse is very keen upon her training; she is as keen upon being kept up to date with her work as is the doctor himself.

When this matter came up for discussion in another place the Minister—who was, I think, very tired and perhaps a little provoked, if I may judge by the context—said that this matter would adjust itself quite easily because there was always the hospital for the nurse to go back to "The hospitals are there," said the Minister, "and if a nurse wishes she can go into a hospital; there is no reason against it." That is a totally in adequate means of dealing with this very important question of the post-graduate training of nurses. At this moment there are courses for the training of nurses prepared under the aegis of authoritative in situations such as the Royal College of Nursing.

I know that the Minister was sympathetic towards the opticians in this respect, because, being pursued through this mood of aggravation by some dominant person on behalf of the opticians, he said, "I will look into this thing again"—"this thing" being the question of opticians being included amongst those practitioners rendering hospital services whose post-graduate (if I may use that word in respect of the opticians) studies should receive some attention. If the Minister can be sympathetic towards the opticians, I think he can be as sympathetic, if not more sympathetic, to wards the nurses. Although I am perfectly willing to leave the question of whether my Amendment is adequately dealt with by the noble Marquess's Amendment to the noble Viscount or the noble Earl, I do press that in this clause a specific reference should be made to the help which the Minister can give in the matter of refresher courses and other training studies for the qualified nurse.

VISCOUNT ADDISON

This short discussion has caused me to reflect how badly the Government are treated. For the first time in my life, here is the State going out of its way to make provision for medical men to have post-graduate training and to get refresher courses, and not even one noble Lord says, "Thank you." It is amazing! In our view, London offers a unique opportunity for developing post-graduate training. There is no place in the world which has equal facilities, and it is our intention to do whatever we can to help the medical profession and the teaching colleges so to develop. That is one of the reasons why this clause is in the Bill. I should have thought it would have evoked some sentiments of appreciation. But it has not, and that shows how badly our Public Relations Department seems to function! The only thanks we get is that we are asked to do something more.

LORD HORDER

The noble Viscount says the Government have not been thanked. I should like to repair that omission in order that more can be accomplished.

VISCOUNT ADDISON

These belated thanksgivings rather lose their spice! However, I will take it as read. Nurses are different from the practitioners dealt with in Part IV of the Bill. The practitioners under Part IV of the Bill are those who are paid, notwithstanding the Amendment yesterday, partly, I hope, by basic salary and partly by capitation fees. But however they may be paid, they are not whole-time servants and it is in order to help men who are not whole-time servants to get this training that this provision is inserted. Those who are whole-time servants, such as nurses and any medical men who are employed whole-time, will be provided with facilities and will be expected to undergo regular refresher courses. That is a very proper condition of the tenure of office of people of that kind.

What the noble Marquess is referring to is the nurses who are whole-time servants and who are not the type of part-time person meant to be helped by this provision, and who will in fact be helped. I can assure him that in the ordinary way it is the intention that those who are full-time employees of this character will be required to have refresher courses and that the same facilities will be made available for them. So far as this particular Amendment is concerned, it relates to a clause dealing with medical practitioners under Part IV of the Bill who are part-time and not employed whole-time. It is in order to assist that class of person that this provision is made. Therefore the noble Marquess's Amendment really is not appropriate, but the spirit of it will be carried out just the same.

THE MARQUESS OF READING

I confess I am much more concerned with the spirit than with the actual wording of the Amendment, and as the noble Viscount, the Leader of the House, gives us an assurance that it is the intention to provide adequate courses for the whole-time, fully-employed nurse, I do not propose to press this Amendment.

Amendment, by leave, withdrawn.

3.58 p.m.

LORD HORDER moved at the end of clause to insert: "(2) For the purpose of this clause 'practitioners' to include certain classes of nurses not otherwise covered in this respect." The noble Lord said: I am not satisfied that the purpose of this Amendment is covered by the assurance given by the noble Viscount, the Leader of the House. The noble Viscount speaks of the provisions for medical practitioners referred to in Clause 48, which is the clause under discussion, but it will be noted that Clause 48 refers to "practitioners" and not to "medical practitioners." There is obviously an intention to distinguish between practitioners and medical practitioners, because Clause 48 is to some extent consequential upon Clause 43, which refers to three classes of persons rendering services. The first is the medical practitioner, the second is the person undertaking to provide pharmaceutical services, and the third is the dental practitioner, who may or may not be a qualified medical man.

Coming back to Clause 48, it is quite obvious that it is not only medical practitioners to whom facilities are to be given for post-graduate teaching. That is all the more necessary, I think, especially as I referred to the half promise which the Minister made to include opticians amongst these practitioners providing any service under this Part of the Bill. The possibility of opticians being included with dispensers and dental practitioners makes it, I think, all the more important that a distinct reference should be made in this clause to similar facilities being afforded to nurses. I beg to move.

Amendment moved—

Page 41, line 7, at end insert— ("(2) For the purpose of this clause 'practitioners' to include certain classes of nurses not otherwise covered in this respect.").—(Lord Horder.)

VISCOUNT MAUGHAM

I rise to support this Amendment and to add one word in reference to the clause itself. The clause provides that: the Minister may.… with the approval of the Treasury, make payments to wards the cost of the provision of such courses and the expenses of practitioners attending such courses. That will enable provision to be made for the cost of doctors and dentists in relation to their expenses of attendance. Unless the Amendment proposed by my noble friend Lord Horder is accepted, the Treasury cannot make payment towards the cost of expenses of nurses attending such courses, however specialized the nature of their occupation may be and how ever desirable it may be that they should have the instruction to be obtained from such courses.

VISCOUNT ADDISON

We shall look into the question of definition raised by the noble Lord, but this relates to "practitioners"—however that word may be subsequently defined—who are not wholly employed, but who are partly employed—

VISCOUNT MAUGHAM

What makes it so limited?

VISCOUNT ADDISON

Do allow me to finish my sentence.

VISCOUNT MAUGHAM

I apologize humbly to the noble Lord for interrupting him, but when he is saying something as to the effect of a clause which seems to me, with all my experience of construing documents of this sort, to be inaccurate, the kindest thing I can do is to interrupt him there and to say that I humbly submit he is wrong. I am very sorry if it annoys him, but I think it is part of my duty.

VISCOUNT ADDISON

The noble Viscount did not in the least annoy me, and I am sorry if it seemed that I was annoyed, but I was, I thought, half way through a sentence. I accept, of course, that the noble Lord is infinitely more expert than I can ever hope to be in construing these documents, but I am advised that the word "practitioner" here relates to those who are employed part time under Part IV of the Bill, and the scope of the word will require to be defined. You will notice it says in the margin, "medical and dental practitioners." In any case, it clearly does not include nurses who are employed whole time by any board or hospital management committee; they are not included in this part of the Bill at all. As I have already assured noble Lords, the provisions of engagement for that type of person will be that they are required to have refresher courses periodically, and that will be carried out in a bona-fide manner. I think that really meets the point.

LORD HORDER

I would like to ask if I am not correct in saying that "medical and dental practitioners" in the margin is a misprint, and that it should be "provision of courses for practitioners." I was informed that "medical and dental" should be deleted.

VISCOUNT ADDISON

That may be so. As I have promised, I am going to look into this question of definition, and I will certainly do so, especially in the light of the admonition of the noble Lord below the gangway.

LORD HORDER

I am very reluctant to withdraw this Amendment, because I think there is still a good deal of confusion. If I could be assured that on the Report stage some of this confusion would be cleared up, I should perhaps be more willing to withdraw the Amendment. The confusion to which I have already referred, and would refer again, is the use of the term "medical practitioners" in some clauses and "practitioners" in others. As I say, I was informed that "medical and dental practioners" in the margin is a misprint, from which I conclude that recognition is given to practitioners who may not be medical practitioners but who are persons rendering services under the Bill. At present those practitioners not registered include a good many dentists and, I presume, most dispensers and persons undertaking to provide pharmaceutical services. Possibly when the Minister thinks again, as he has promised to do, he will include opticians. In view, therefore, of the building up of that group of non-medical persons rendering services under the Act, if that group still remains and is referred to in Clause 48, I think my Amendment should stand. But if this point could be brought up again at a later stage I am prepared to withdraw the Amendment.

VISCOUNT ADDISON

I can quite see there is confusion in the use of the word "practitioner," and I think it ought to be cleared up.

LORD HORDER

That is all I wanted to establish. I beg leave to withdraw my Amendment.

Amendment, by leave, withdrawn.

Clause 48 agreed to.

Clauses 49 to 52 agreed to.

Clause 53:

Grants to local health authorities.

(4) The council of every county and county borough, the Common Council of the City of London and the council of every metropolitan borough shall pay to the Minister in respect of the period beginning with the appointed day and ending with the thirty-first day of March next following, and each subsequent period of twelve months during the third fixed grant period within the meaning of the Local Government Act, 1929, a sum equal to the loss on account of the grants mentioned in paragraph 2 of the Second Schedule to the Local Government Act, 1929, discontinued by virtue of Section eighty-five of that Act, as determined in accordance with Part II of the Fourth Schedule to that Act, less such part of that loss as is attributable to grants for the welfare of the blind:

Provided that—

1. (a) where the said loss on account of the said grants has, in the case of the council of any county or county borough, the Common Council of the City of London or the council of any metropolitan borough, been increased or reduced by an amount certified by the Minister under regulations made under paragraph (b) of subsection (1) of Section one hundred and eight of the Local Government Act, 1929, the payment to be made by the council under this sub section shall be increased or reduced by such part of the amount so certified as is attributable to the said grants other than grants for the welfare of the blind;
2. (b) in the case of a county or county borough or metropolitan borough constituted since the thirty-first day of March, nineteen hundred and twenty-nine, the amount to be paid by the council thereof under this section shall be the amount certified by the Minister under the said regulations as the loss of that county or county borough or metropolitan borough on account of the said grants, less such part of that amount as is attributable to grants for the welfare of the blind;
3. (c) if the said third fixed grant period ends during the period beginning with the appointed day and ending with the thirty-first day of March next following or during any subsequent period of twelve months, the payments to be made by councils under this subsection in respect of that period shall bear the same proportion to the sums that would be payable in respect of a complete period of twelve months as that period bears to a complete period of twelve months.

4.8 p.m.

LORD ADDINGTON moved to leave out subsection (4). The noble Lord said: This is an attempt to see that the interim financial provisions of subsection (4) of Clause 53 are deleted and replaced by something which is a good deal simpler and much more generous to local authorities. I understand that the Government hope the new block grant arrangements will be in operation before the appointed day for the National Health Service Bill. Therefore, the interim financial provisions of subsection (4) will not be brought into operation at all. In that event this Amendment would not apply. But it does seem necessary to have a clause of some sort in the Bill in case it may not be possible to keep the time-table which the Government have in mind.

The serious objection to the present proposal is that in some areas of low financial resources the hospital facilities are not highly developed. It follows, therefore, that reduction in their rate of expenditure will be correspondingly small when the hospitals transfer to the Government. On the other hand, the block grant is weighted somewhat heavily in favour of those poorer local authorities. Therefore, any major reduction in the block grant I think will accordingly fall with particular severity on authorities who are really least able [...]bear it. If, therefore, there is to be some adjustment the local authorities do suggest that it should be one which does substantial justice to all the parties affected. If there is to be an interim period it will be very short. It is suggested that it would have been a generous gesture and one which would perhaps bring some financial benefit to the local authorities if the Government had been prepared to ignore the fact that there was reflected in these block grants during the interim period some assistance towards the rate-borne expenditure which would no longer fall on the local authorities. This course would have avoided much work and many calculations. These block grants are very complicated and they are by no means easy to work out. That is what my Amendment proposes. I have rather gathered that the matter is still under discussion between the representatives of the local authorities and the Government, and I hope, there fore, that noble Lords opposite will be able to obtain some more satisfactory arrangement than the one which is at present in force.

Amendment moved— Page 4, line 40, leave out subsection (4).—(Lord Addington.)

THE EARL OF LISTOWEL

The object of the subsection in Clause 53 which the noble Lord wishes to leave out, is to prevent local authorities from being paid twice for the same service. That, I think, puts the position in a sentence. A sum equal to the total amount of the old specific grants towards the health services which were discontinued by the Local Government Act, 1929, is included in the present block grant. There will be again under this Bill a specific health service grant towards the health services run by the local authorities, and those authorities would clearly be receiving double grant during any period in which both the new grants under the Bill and the existing block grants were being paid. If this should happen it seems only common sense that they should be asked to pay back the additional amount. We hope, as the noble Lord said, that this Bill and a Bill terminating the old block grant will come into force on the same date. In that case the subsection which he wishes to leave out will not be operative. But we do wish to keep it in the Bill because if the time-table were to go wrong the Exchequer would lose a sum of something like £4,000,000 a year. I should have thought that the proper procedure if certain health authorities feel that they are not receiving enough would be to negotiate with the Ministry with a view to new grants being made.

LORD ADDINGTON

The proposition is that under the clause some of these small authorities have to pay back a lot more than they are saved. Whether it is possible to adjust the amount so that what they pay back in respect of block grant is not greater than the amount they are saved on their services is a matter which I suggest should receive consideration. I think that a great deal of work and calculation would be saved if something could be done in this connexion.

THE EARL OF LISTOWEL

I think it is certainly a matter for discussion between the authorities concerned and the Ministry.

LORD ADDINGTON

In view of what the noble Lord has said I beg leave to withdraw my Amendment.

Amendment, by leave, withdrawn.

Clause 53 agreed to.

Clause 54:

Payments to Regional Hospital Boards, boards of governors, executive councils and other bodies.

54.—(1) There shall be paid out of moneys provided by Parliament to— (b) every board of governors of a teaching hospital such sums as may be necessary to defray the expenditure of the board being expenditure approved as aforesaid.

4.15 p.m.

THE EARL OF MUNSTER moved, at the end of subsection (1) (b), to add "by means of block grants based on an annual budget." The noble Earl said: This is a very simple Amendment. Clause 54 provides that there shall be paid out of moneys provided by Parliament to "every board of governors of a teaching hospital such sums as may be necessary to defray the expenditure of the board," as aforesaid. I want to amend that so as to provide for the payment to the boards of governors of teaching hospitals of the necessary finance by means of block grants based on an annual budget as was suggested in the White Paper. It seems to me that freedom to spend within the budget would ensure a very much easier way of going about the matter. It would also avoid frequent references not only to the Minister but also to the Treasury. I think it is the intention of the Government to do this but instead of having it done by regulation I would myself much rather see it put into Clause 54.

Amendment moved— Page 46, line 4, at end insert ("by means of block grants based on an annual budget").—(The Earl of Munster.)

THE EARL OF LISTOWEL

I think that the object which the noble Earl and the Government desire to achieve is the same, and the only matter about which they differ is the best way of achieving it. We have already accepted the principle laid down by the noble Earl. It is the intention of the Government that the finances of the boards of governors of teaching hospitals (and, incidentally of hospital management committees) should be based on an approved annual budget within which they would have complete discretion to spend as they thought fit. In other words, the hospital authorities would be free to allocate their income to purposes of their own choosing so long as they adhered reasonably closely to their annual budget. I am not saving that one of them might not overspend to a small degree in a particular year or that in another year they might not spend slightly less, but that would be the frame work within which they would work. We consider that our procedure is more proper. Arrangements for the preparation and submission of these budgets will be extremely complicated, and instead of overloading the Bill with detail, we think that it will be more convenient to deal with the matter in the regulations to be made under subsection (6) of this clause. I assure the noble Earl that regulations are really more convenient when the matter is one of great complexity and detail. And the Bill would become extremely voluminous and unwieldy if we were to put all these matters into the actual wording of its clauses.

THE EARL OF MUNSTER

I cannot say that I agree but nevertheless I will withdraw my Amendment.

Amendment, by leave, withdrawn.

Clause 54 agreed to.

Clause 55:

Accounts of councils of county boroughs, Regional Hospital Boards, boards of governors and executive councils.

55.—(1) Every local health authority being the council of a county borough shall keep account of the sums received and expended by them in the exercise of their functions as such an authority, whether under this Act or under any other enactment, and those accounts shall be made up and audited in like manner as the accounts of a county council and shall be kept separately from their other accounts; and the enactments relating to the audit of accounts by a district auditor and to the matters incidental to such audit and consequential thereon shall have effect in relation to the accounts which the council of a county borough are required to keep under this section as they have effect in relation to the accounts of a county council.

4.18 p.m.

LORD ADDINGTON moved, in subsection (1), to leave out "a county council" and insert "the council under the Local Government Act, 1933." The noble Lord said: This Amendment deals with the audit of the accounts of county boroughs. Some of these accounts such as those relating to education and public assistance are at present audited by the district auditor. But as regards other accounts, including the accounts covered by the service of the block grant, such as the present health service, the county borough has the choice of three methods of audit—the borough or elective audit, the professional audit, and audit by the district auditor. Out of eighty-three county boroughs, only nine have selected audit by the district auditor. And it cannot be said that these county boroughs have chosen that method entirely voluntarily. The vast majority appoint professional auditors, because elective audit is going out of existence in the larger towns, and they certainly will continue to do so.

These county boroughs are towns with large populations. The councils are in close touch with the electors, and are not given to extravagance. At the same time, by reason of the fact that they are the elected representatives of the people they desire to exercise reasonably wide discretion in the performance of their duties, and this discretion a district audit tends to confine within unnecessarily narrow limits. There are various examples of unnecessary fettering of discretion which, a district audit imposes, but I will not trouble your Lordships by citing any of them now. The services in relation to public health that are to remain with these local authorities are now to be limited in their scope.

We see no reason why the existing discretion of the county boroughs in regard to their audit should be taken away. There was a similar attempt to impose a district audit for the housing accounts of these county boroughs in the Housing (Financial and Miscellaneous Provisions) Bill, but at the request of the municipal associations the Government agreed to delete that provision. I hope that the noble Lords in charge of the Bill will be willing to follow that precedent, and take the provision out of this Bill also. I think that the question of imposing any particular form of audit on such important bodies as county boroughs, if it is to be tackled at all, should be dealt with as a whole, and not service by service, piecemeal in different fields. I beg to move.

Amendment moved— Page 46, line 41, leave out ("a county council") and insert ("the council under the Local Government Act, 1933").—(Lord Addington.)

THE EARL OF LISTOWEL

I am sure that the first point which will strike your Lordships is that in this Bill district audit is imposed alike on county boroughs and county councils. The noble Lord is pleading for special treatment for the county boroughs. It is the duty of the local health authorities to provide an important part of the national service, and towards this a substantial contribution is received from the Exchequer. In the case of similar services provided by the local authorities—for example, education services, including elementary schools, secondary schools and all schools financed out of public funds—the accounts are subject to audit by independent district auditors. What the noble Lord is suggesting is that county councils should be subject to district audit, while the councils of county boroughs which are doing exactly the same work should be exempted, and should have, I imagine, professional auditors of their own choosing. Surely that is undesirable because the councils would be in a different position from other authorities doing precisely the same work, and because as they are the people who are spending large sums of public money, this type of independent audit is appropriate. I hope very much that the noble Lord will reconsider his Amendment in the light of these considerations.

LORD ADDINGTON

I will not say that I am satisfied. It is a point about which these important bodies feel very strongly. They feel that they are important enough and possess sufficient discretion, to have their accounts audited in the way they think best. There are other services—I believe housing, for one—which are subject to similar grants and where the accounts may be professionally audited. In some ways, they do retain their independence. I am in the hands of the House, and as I do not seem in a position to press my Amendment, I will withdraw.

Amendment, by leave, withdrawn.

Clause 55 agreed to.

Clauses 56 to 59 agreed to.

Clause 60:

Power of trustees to make payments to Regional Hospital Boards and boards of governors.

60.—(1) Where property, other than property transferred to the Minister or to the board of governors of a teaching hospital under Section six or Section seven of this Act, is held on trust immediately before the appointed day … the trust instrument shall be construed as authorizing or, as the case may be, requiring the trustees to apply the trust property, to the like extent and at the like times, for the purpose of making payments whether of capital or income— (b) in the case of any other hospital, to the Regional Hospital Board for the area in which the hospital is situated.

4.25 p.m.

THE EARL OF MUNSTER moved, at the end of subsection (1) (b), to add "or to the hospital management committee of that hospital or of the group within which that hospital is comprised." The noble Earl said: I think that this Amendment is of some importance, but it is almost a drafting Amendment. Under Clause 59, as I understand it, the hospital management committees have power to receive gifts for purposes relating to hospital ser vices. It seems to me also that the power of trustees should be delegated in subsection (1) (b) of Clause 60 down to the hospital management committees. I beg to move.

Amendment moved— Page 50, line 22, at end insert the said words.—(The Earl of Munster.)

THE EARL OF LISTOWEL

The noble Earl said that his Amendment was based on the desire to make an improvement in the drafting of the Bill. I can assure him that we will look at it from all angles, and see, between this and the Report stage, whether any improvement can be made.

THE EARL OF MUNSTER

To give power to trustees, under Clause 60, to delegate not to Regional Boards but to the lower level of hospital management committees. With that assurance, I beg leave to withdraw.

Amendment, by leave, withdrawn.

Clause 60 agreed to.

Clauses 61 to 64 agreed to.

Clause 65:

Qualifications, remuneration, and conditions of service of officers.

65. Regulations may make provision with respect to the qualifications, remuneration, and conditions of service of any officers employed by any body constituted under this Act or employed by a local health authority or by any such voluntary organization as is referred to in the last but one foregoing section, and no officer to whom the regulations apply shall be employed otherwise than in accordance with the regulations.

4.27 p.m.

LORD HENLEY moved to leave out "a local health authority or by." The noble Lord said: Clause 65 is a very wide one. It authorizes the Minister to make regulations with respect to the "qualifications, remuneration and conditions of service of any officers employed by any body constituted under this Actor employed by a local health authority." The object of this Amendment is to exempt from the action of this clause a county council or county borough council. The County Councils' Association feel very strongly about the subject matter of this Amendment. They feel that the Minister already has powers under the Local Government Act, 1933, to deal with the qualifications possessed by medical officers of health for counties or county boroughs. The Association also feel that adequate machinery exists for negotiations between local government bodies and all classes of their employees.

There are a great many regulations laid down as to the salaries of various employees. The Asquith Agreement controls the salaries of medical officers, and national joint councils for administrative professional, technical and clerical services of local government authorities govern the salaries of all employees earning more than £700 a year. In addition to this, there are scales laid down for employees engaged in hospitals, and for the subordinate staff in hospitals. Recently, the National Joint Council for administrative and technical staffs have prescribed a national scheme of salaries and conditions of service for local government staffs. From the county council of which I am a member, I know that a great deal of trouble has been taken to implement these regulations. Negotiations have taken place between the county council and all the representatives of the employees under them. We have consulted, in the most friendly manner, the representatives of the National Association of Local Government Officers and the other bodies concerned. After a great deal of trouble, scales of salaries have been satisfactorily decided for all these employees.

And let me say here, that it is a very difficult problem to make these salaries fit in with one another. When you have settled the salaries of the health workers, you find that workers in other departments may not be satisfied, and alterations have to be made to bring them into line. These negotiations have been carried out by a very large number of the local government bodies throughout the country. Out of 1,530 local authorities, 1,232—that is, about 80 per cent.—have already adopted these scales and conditions of service. It seems to me that that is a very remarkable figure.

I think it is possible that the noble Lord in charge of this Bill may say that the object of Clause 65 is to deal with those few authorities who fail to comply with these regulations. I would point out, in answer to that, that machinery exists, and will no doubt continue to exist, whereby the authorities who do not conform to these scales and conditions of service may be brought before the National Arbitration Tribunal, and have the scales compulsorily imposed upon them. It seems to me that with all these regulations and arrangements the employees are very carefully safeguarded against the unfair or niggardly authority, and it also seems to me that no further regulations are necessary to enable the Minister to step in and interfere with the arrangements made by these authorities and the various negotiating bodies. It appears to me that the tendency of this clause is to go against: the principle adopted in the Whitley Councils of negotiating between employers and employed, and I think it would be very much better, in the case of the local health authorities, if this provision in this clause were removed. I beg to move.

Amendment moved— Page 51, line 25, leave out ("a local health authority or by").—(Lord Henley.)

LORD ADDINGTON

On behalf of the municipal authorities of the country who feel very strongly about this matter, I very warmly support this Amendment. I need not go over again the points so adequately dealt with by my noble friend Lord Henley. There are statutory requirements and negotiating machinery that already fully cover all the class of officers who come under this Bill. The clause extends the control of the Minister to a number of officers—practically nearly all the officers of the council—some of whose duties during part of the time would be concerned with some of the services rendered under this Bill. It would only be part of their duties. So that if the Minister could not fix their salary and conditions of service for a very small part of their time, it would make the position of the employing authority almost unworkable. I think these pro visions are quite unnecessary and extremely unwise, and I hope that the Government will be able to accept this Amendment.

THE EARL OF LISTOWEL

The effect of the Amendment in the name of the two noble Lords opposite would be to omit from the category of persons employed by health authorities under the Bill, and whose qualifications, remuneration and terms of service will be fixed by the Minister, those officers who are in the employment of local heath authorities. I should like to remind the noble Lord opposite that his Amendment applies also to their qualifications although I think in his speech he was dealing either exclusively, or almost exclusively, with their remuneration and conditions of employment generally.

As the noble Lord quoted some opposite instances, I think I ought to point out that the qualifications of the health officers of local health authorities are very often prescribed by the Minister. This happens now in the case of tuberculosis officers, maternity and child-welfare officers and venereal disease officers, and it has been found to be a convenient and useful practice for the standard of qualification to be settled centrally. There is no reason that I can see to suppose that it would not be equally efficacious in the case of people employed by local authorities as health officers under this Bill. I think there is great advantage in having a standard of qualifications laid down centrally.

To come to the question of remuneration and terms of service, with which I think the noble Lord opposite was mainly concerned, I do ask him to believe that there is advantage to the staff of local authorities in uniformity of pay and other conditions of service, which you would not get, of course, if the local authorities were fixing their terms separately or even by agreement, without having a complete agreement covering the whole field of the local authorities, because this uniformity facilitates transfer and promotion. I do not want any misunderstanding to arise about the actual part that the Minister would play in arriving at these conclusions. The Minister would not, of course, decide on the rates of pay or other conditions affecting the employment of officers by a local authority without the fullest consultation with the authorities concerned. I think the noble Lord imagines that that is a very small step in the right direction. I agree, but I am going further. The usual way in which such questions would be dealt with would be by negotiation between both sides through machinery of the Whitley Council type, which has very generally been used by Government services with the most satisfactory results and, of course, the local health authorities would be directly represented on the negotiating bodies. I do think, when all things are considered, that this would be the most satisfactory way of giving a fair deal to the staff of these local authorities, in so far as they are concerned with the health services, and I hope that your Lordships will agree.

LORD LLEWELLIN

There is one remark I should like to make on this particular clause, and it is that, perhaps as a pure matter of drafting, the clause has been drawn rather too wide. It says: Regulations may make provision with respect to the qualifications, remuneration and conditions of service of any officers employed by … a local health authority. That is extremely wide and means that you are giving the Minister power, under this Bill, to make regulations with regard to any officer employed by a public health authority. That is too wide. It ought to be limited to persons who are mainly so employed for the purposes of this Act. Then I think it would be quite proper, and it would run along the lines of "all persons employed by any body constituted under this Act," for which of course regulations will have to be made. I think it is far too wide if under this clause of this Bill you take power to provide by regulations for the qualifications, remuneration and conditions of service of everybody employed by what is termed a public health authority. For my part, I should like the noble Earl for the Government to look into that point and to see whether he could not largely meet the purposes for which this Amendment was put down by putting these words in with regard to the officers employed by local authorities.

THE EARL OF LISTOWEL

I think I can meet the noble Lord about that point. It is clearly the intention of the clause only to cover the health officers of local authorities, and, if it is too widely drawn, we will try to narrow it down.

LORD ADDINGTON

If I may make one observation, the noble Earl talked about qualifications. I think the qualifications of the health officers are distinctly laid down in the Local Government Act as at present. One of the points is that you have already got regulations somewhat statutory; in other words, negotiating machinery which covers these officers, and negotiating machinery which deals with them along with many other officers in a comparative position in the service of local authorities. A new set of regulations dealing with one class of officer only may upset the whole of the comparative salaries of those in the health service and other services in the same category. I leave that to the noble Lord who moved the Amendment.

LORD HENLEY

I am very glad to hear that this clause is confined only to the health workers of the local health authority, but I feel, even after that concession has been made, that the principle involved in this clause is a wrong one. After all, previously we have tended to rely upon Whitley Councils and arrangements similar to Whitley Councils for negotiations between employers and employed, and I do not see why we should go away from our adherence to that principle. It seems to me that we should stick to this Amendment very strongly. We should press it because, even with the restrictions that have been made, it is giving the Minister too much power to interfere in the business of the county councils. As has been already said, it is not that it will only apply to public health, but directly you begin to change the salaries and wages of the public health workers you immediately upset the balance of the whole of the scale that you have carefully arranged with all the employees of the county council.

On Question, Amendment negatived.

Clause 65 agreed to.

Clause 66:

Superannuation of officers.

(2) If the Minister and a Secretary of State are satisfied that any Act for the time being in force in Scotland or in Northern Ireland makes provision with respect to the superannuation of persons employed in health services in Scotland or Northern Ireland which is substantially similar to the provision made under this section, they may make regulations with respect to the rights and liabilities of any person so employed who leaves his employment and enters into employment in respect of which superannuation benefits are provided under regulations made under subsection (1) of this section or into the employment of a local health authority in respect of which superannuation benefits are provided under the Local Government Superannuation Act, 1937, as extended or modified by the regulations or under a local Act scheme as so extended or modified, and vice versa, and with respect to the rights and liabilities of the Minister, the Secretary of State and other authorities concerned.

4.42 p.m.

THE EARL OF LISTOWEL moved, in subsection (2), to leave out "so employed who leaves his employment" and insert "who leaves employment in Scotland or Northern Ireland entitling him to participate in superannuation benefits (whether provided under the said Act or otherwise)" The noble Earl said: The object of this Amendment is to confirm the pension rights of cert in health officers which would otherwise be prejudiced. The intention of subsection (2) of Clause 66 is that when the Scottish National Health Service Bill has been passed regulations shall provide for the preservation and safe guarding of the superannuation rights of the health officers in Scotland who transfer to England. As drafted at the moment, the subsection only enables this to be done in relation to officers employed in the health services in Scotland. It is hoped, however, that suitable entrants to the health services in England, whether central or local, might come also from the Scottish local government service and this Amendment has been drafted to cover these people.

Amendment moved— Page 53, line 26, leave out ("so employed who leaves his employment") and insert ("who leaves employment in Scotland or Northern Ireland entitling him to participate in superannuation benefits (whether provided under the said Act or otherwise)").—(The Earl of Listowel.)

LORD LLEWELLIN

This seems to us correct and in order, so far as I could hear the noble Lord above the hubbub that seemed to be taking place.

On Question, Amendment agreed to.

Clause 66, as amended, agreed to.

Transfer and Compensation of Officers.

67.—(1) Regulations shall provide— (a) for the transfer of officers employed immediately before the appointed day solely or mainly at or for the purposes of any hospital transferred to the Minister by virtue of this Act, to the Regional Hospital Board for the area in which the hospital is situated or, in the case of a teaching hospital, to the Board of Governors of that hospital, subject, in the case of honorary officers, to such exceptions and conditions as may be prescribed;

4.44 p.m.

LORD COZENS-HARDY moved, in subsection (1) (a), to leave out "hospital," where that word first occurs, and insert "one or more hospitals." The noble Lord said: Your Lordships are aware that in recent years a large part of the regular income of the voluntary hospitals has been obtained by contributory schemes. Where such a scheme is confined to a single hospital its staff will, under the Bill, be transferred under Clause 67. Where a group of hospitals has been associated in a contributory scheme its staff is not covered by the wording of the clause. I think it is generally agreed that the grouping of hospitals in contributory schemes has been the most efficient plan, and it has been adopted by the most progressive hospitals. I speak of these matters from personal knowledge as I happen to have been Chairman of one of the largest of these schemes for the first ten years of its existence. It had a life of seventeen years and had an income in that period of £4,500,000. That scheme, and all these schemes, have very experienced staffs and much of the time of these staffs is employed not on the actual organization of the collection of contributions but on personal touch with contributors and their needs.

The experience of such staffs should be of inestimable value to the bodies which, under the Bill, it is to be hoped will continue that close personal touch with the insured contributor and his requirements which is so valuable in cases of illness. No body of men or women, whether employed by a single hospital or by a great body to which a group of hospitals have delegated the work, could be more suitable for transfer under the new arrangement set up in the Bill. In another place the Minister has attempted to excuse the exclusion of officers of grouped hospitals by dwelling on the difficulty of drawing a line between those who can fairly claim to be solely or mainly employed for the purpose of these hospitals and those who cannot so claim. But the Minister has drawn the line, and I submit he has manifestly drawn it in the wrong place, a view in which I was very glad to have the support of my noble friend Lord Beveridge, in his able Second Reading speech. The Minister's reference in another place to the absurdity of giving the protection of this clause to such people as lawyers' clerks, who may from time to time be engaged on documents relating to endowments, seems to me to be very wide of the mark. The officers I refer to are employed on a whole-time basis solely or mainly for the purposes of a group of transferred hospitals. No one can seriously doubt that if not transferred to a new authority the officers of a single hospital scheme and of a multi-hospital scheme will be in the same position in suffering loss of employment, a loss directly attributable to the passing of this measure, and it seems impossible to justify giving the protection of this clause to the one set of officers and denying it to the other.

The grounds for this differentiation seem to be that technically the latter set are not officers of a transferred hospital but are officers of a body which a group of hospitals has joined in forming in order to exercise collectively the functions of a contributory scheme. If the hospitals in the group had continued to operate separate contributory schemes in competition with one another the officers employed on the competing schemes would have had the protection of Clause 67. In another place the Minister, whilst declining to entitle officers to transfer under this clause unless they were employed by a single hospital, promised to do his best to absorb them. I submit that they should be entitled to something more definite, and the object of my first Amendment is to give them a statutory right to transfer.

In another place also the Minister made great play about the cost of compensating such people, but in my submission their special experience and abilities, coupled with the Minister's assurances as to their future employment, should reduce to negligible proportions the number to be compensated under my second Amendment. In any event, surely the case should be dealt with on the basis of equity and not on a question of costs. I hope very much that noble Lords in charge of the Bill will feel able to accept the Amendment standing in my name, or to bring forward at a later stage wording to the same effect more acceptable to their advisers. I beg to move.

Amendment moved— Page 53, line 39, leave out ("hospital") and insert ("one or more hospitals").—(Lord Cozens-Hardy.)

LORD BEVERIDGE

I should like to support this Amendment, to which I referred in speaking on the Second Reading. When I was engaged in making the report on social insurance and allied services, which had something to do with bringing this matter forward, I saw representatives of these contributory associations a number of times. I was very much impressed with the excellent work they were doing, and also with their readiness to accept the probable extinction of what they were doing when it was merged into this much larger scheme. It is clear that what they did was of great value in accustoming the people of this country to the idea of paying for their hospital treatment before hand when they had the money. Certainly those associations did a great deal of valuable work. I suggest that those who were working not for one hospital alone, or for each of a number of competing hospitals, but were working for a group of hospitals who had decided to give up competition in favour of co-operation should not be penalized. That is the whole point of this Amendment, whether we are to going to draw the line between the people who work for one hospital only, and all the rest, or between the people who work for a group set of hospitals and all the people who are indirectly damaged by this Bill.

We realize that you cannot compensate everybody who suffers indirectly by every Act of Parliament, but the point of this Amendment is that the people employed by four hospitals together to raise money am as directly affected as the people who work for one hospital. I do not think I need go over again all the things that were said on this point in the other place. Those things have all been adequately covered by my noble friend Lord Cozens-Hardy. I very much hope the Government will feel able to show a conciliatory spirit on this small point. It is a small point, but it is one which gives the Government a great opportunity of showing a conciliatory spirit in drawing the line rather differently from where they have drawn it in the past.

LORD LLEWELLIN

May I just say one word on this? I do not think any body would want so far to extend this compensation as to compensate part-time officers, but I think, at any rate throughout the course of recent Parliamentary history, it has always been accepted that where by Act of Parliament you destroy a man's job you give him some compensation for it. It seems to me that that compensation ought to be given to these men, whether they have done this collecting work full time on behalf of one single hospital or whether, for reasons of economy and so forth, hospitals have grouped together and they have done it for the group of hospitals. There does not seem to me to be that distinction which should rule out one class of person from this compensation which the Government are quite willing to give to the other class. That seems to me to be the whole point of this Amendment.

I suppose the Amendment raises a question of Privilege. Other noble Lords will know more about that than I do, but I assume it will put an increased charge upon the Treasury. It is therefore an Amendment about which this House has to be careful. It is, however, a case where I think the Government can come forward and see that justice is done, not to a whole body of people who do not deserve it but to people who have been full time in this work and who will be losing their employment because of this Bill. For those reasons I wish to give support to the noble Lord who has moved this Amendment.

THE LORD CHANCELLOR (LORD JOWITT)

As the noble. Lord who has just spoken has said, this is, of course, a Privilege Amendment, not that that in any way precludes this House from acting. It is, however, a matter in regard to which this House always thinks twice before it does act. I think there is some slight misapprehension about this Amendment. It has been discussed as though the issue were that a man serving one hospital got compensation and a man serving four hospitals did not get compensation. That is not so. Under the Interpretation Act the singular includes the plural. Wherever you get the word "hospital" you may read, according to the Interpretation Act, "or hospitals."

The real point underlying this Amendment, if I may venture to say so, is not that at all; it is whether you should extend the power of transfer and compensation to persons who are not the servants or officers of any hospital at all. That is the real point. You have these voluntary associations and the problem is: ought you to extend to the officers of those associations, which are not hospitals, the same concessions and privileges as you extend to the officers of hospitals? We say you should not, and I think I can give your Lordships cogent reasons why you should not. In the first place, see how different are the two positions. The associations who have funds do not lose any of their funds. The hospitals do; the associations do not. Secondly, the associations, unlike the hospitals, do not in practice devote their money exclusively to hospitals; in fact they devote their money to various other schemes as well—schemes such as home nursing, ambulance services, convalescent homes, the supply of spectacles and all sorts of beneficial and useful purposes of that sort. They are not in any way limited to supporting hospitals. Further, a meeting of one of these associations in recent months adopted a report, if what I read in the Press was right, suggesting that they would continue to provide services supplementary to those provided under the new scheme. I have already used the word "trimmings," which I am afraid got me into some trouble—and it was an unfortunate word—but I would like to say that even after this scheme comes into operation there will be a very great need for these additional services to go on, and I sincerely hope they will. It will make all the difference if they do.

Therefore, I have got here an association, which does not lose its funds, which does not contemplate extinction and which is not going to be transferred to anybody. The problem is whether the servants of such an association as that—an association not being taken over—are to be placed in the same category as the servants of a hospital which is being taken over. We say they should not be. We say that the only principle upon which you can decide this matter is this. You must confine your compensation to those who are directly affected by the transfer and you cannot grant it to those who are indirectly affected, because once you attempt to grant compensation to those who are indirectly affected you may have to grant compensation to the employees of a business which, as things are to-day, supplies a hospital with all sorts of commodities and which, in days to come when there is some kind of central purchase, will not supply anything at all and which may have to discharge some of its employees. That is another illustration of an indirect loss.

What the Minister has said, and what I repeat, is this. He realizes there may in some exceptional cases be hardship and he has said that he will extend to those people the benefits of some priority in employment in those many spheres of activity which, either under this scheme or under the other scheme—the insurance scheme—will be available for people trained in this sort of work. But I think it would be—and I am really talking on the two Amendments, this and the succeeding one, rather than on this one, because this one does not matter a bit—a bad example to extend compensation to persons who are not servants of hospitals, who are not directly affected by any transfer but only indirectly affected and who, in view of the fact that the work of the Association is going on and that it will not suffer any diminution of its funds, should not be entitled to draw compensation as they would be if they were the direct servants of either one or more hospitals, who, of course, will be transferred to the Minster. Therefore I regret to say we really do not think it right—and this was gone into very carefully in another place—to extend the benefit of compensation to those persons who are only indirectly affected.

THE MARQUESS OF READING

May I ask the noble and learned Viscount a question? On what grounds does he say these associations will suffer no diminution of their funds?

THE LORD CHANCELLOR

There is no transfer of their funds under this Bill. There may, of course, be a diminution if the subscriptions fall off, but I have already said that I very much hope subscriptions on a substantial scale will continue.

LORD LUKE

The subscriptions are likely to fall off as a result not only of this scheme but of the other scheme contained in the National Insurance Act. These officers of the contributory schemes will be affected very greatly and will be out of employment. I had not intended to speak on this particular Amendment, but as the noble and learned Lord, the Lord Chancellor, has, as it were, taken them both together, perhaps I may now say a few words on them. The object, of course, is compensation. I would point out that these schemes are an integral part of the voluntary hospital system and that if the voluntary hospital system goes, these schemes will also go. There are a great number of very worthy people involved who will lose their employment, not only through the operation of this Act, when it becomes an Act, but through the operation of the National Insurance Act. I consider that it is unreasonable to leave them out when the employees of hospitals are catered for. Of course, I know there is the argument that there is no knowing where this may end, but if a line is to be drawn, then I agree with the noble Lord, Lord Beveridge, that it should be drawn below these people and not above them.

I think I am right in saying that in another place the Minister expressed rather more sympathy than the noble and learned Viscount did just now. He said that every effort would be made by the Minister and by the Minister of National Insurance to absorb these people into the new services, but surely that does not go very far. There will be some of them who will not be so absorbed and surely it is only common justice that those who are not absorbed should be compensated. These contributory schemes have been administered very ably and have been of immense benefit to contributors up and down the country and to the hospitals; they have looked after their contributors. I consider that they deserve better treatment at the hands of the Government than they are getting in the Bill as it now stands.

LORD COZENS-HARDY

I am sorry that the noble and learned Lord Chancellor has not felt able to go further in regard to this and to give a definite right of compensation to the class of officer I have referred to. If the scheme should, as is very unlikely to my mind, continue in the way in which the noble and learned Viscount has mentioned, then there would be no case for compensation at all; they would still he employed. I regret that the Government have not felt able to go further and I beg leave to withdraw my Amendment.

Amendment, by leave, withdrawn.

LORD LUKE moved, in subsection (1) (e), to insert: (iii) devoted the whole of their time to the governing body of a contributory scheme serving a group of hospitals for the purposes of functions which cease in consequence of the Act. The noble Lord said: On behalf of the right reverend Prelate, the Bishop of Sheffield, who is unable to be here because he is in Germany, I beg leave to move this Amendment. Having made my remarks on the other Amendment, I will say nothing further. I formally move the Amendment.

Amendment moved— Page 54, line 31, at end insert the said words.—(Lord Luke.)

THE LORD CHANCELLOR

I made my remarks also on the other Amendment, and I do not propose to say anything further.

LORD LUKE

In view of those remarks, and in view of the discussion that we have just had, I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

Clause 67 agreed to.

Clauses 68 to 71 agreed to.

5.10 p.m.

LORD LLEWELLIN moved, after Clause 71, to insert the following new clause: Notwithstanding any privilege, custom or rule of law the Minister and any council, board, committee or other authority constituted under this Act and their officers shall be compellable to produce in any action brought by any person or by the personal representatives of any deceased person against the Minister or such council, board, committee or other authority or officers, all such records, communications, memoranda and other documents as relate to such person or such deceased person or to the treatment or ser vices provided in respect of them.

The noble Lord said: This, in my view, is an important Amendment. By this Bill, we are vesting the whole of the hospitals in the Minister; they are henceforth going to be Crown property. From that it follows, as I understand the law, that the Minister, or any of the officers acting under the Minister, will be able in respect of them to claim the privileges and prerogatives of the Crown. I have looked at Clause 13 of this Bill, and that clause, it is quite true, makes the Regional Board, or the board of governors of the teaching hospital, the body who will be liable in respect of any liabilities, notwithstanding that they are exercising functions on be half of the Minister. Therefore, if a patient or anybody else has a cause of action against the hospital itself, then the Regional Board or the board of governors are made a party to the case. So far as that is concerned, I am correct, because the words of Clause 13 are Quite explicit—that despite the fact that they are exercising powers on behalf of the Minister they shall be liable as though they were acting as principals. I think that completely covers that point, but I do not think it covers the point with which my Amendment itself deals, and that is why I put it down.

My Amendment reads as follows: Not withstanding any privilege, custom or rule of law the Minister and any council, board, committee or other authority constituted under this Act and their officers shall be compellable to produce in any action brought by any person or by the personal representatives of any deceased person against the Minister or such council, board, committee or other authority or officers, all such records, communications, memoranda and other documents"— I believe I thought to have added here the words "in their possession, custody or power," which are the normal words— as relate to such person or such deceased person or to the treatment or services pro vided in respect of them. I do not believe that is covered by Clause 13 as drafted. I assume a case where a patient thinks there has been negligence on the part of a doctor and sues the doctor for negligence. I am one of the people who want to see that the patient has just as much chance in that action as he would have had had the hospital not been taken over by the Minister. I think that will be the view on all sides of the House.

I believe that if we do not have some such words, whether in a new clause or as additional words to Clause 13, when an action of that sort is brought it may be found that the hospital cannot be compelled to produce the records and memoranda relevant in the case. I ask only for the ones which relate to such persons or deceased persons or to their treatment, such as are produced in a normal action for negligence—the case record book and other records which are kept by the hospital and which are vital to the case being properly tried. I believe this is not covered by Clause 13. I am not seeking, of course, to go inside Ministries or do anything of that kind. All I am seeking is the production of the kind of document which the court could have compelled a hospital to produce, and which I think they should still produce although they may be part of the Ministry's hospital records. I think that is a point on which we shall all be completely agreed.

Between us we should make quite certain that some words—I do not say particularly mine—are included to safeguard patients who may have suffered from the negligence of some servant of the hospital. If there is a gap, I think it is a gap which we should all wish to bridge, and I believe nobody is keener than the noble and learned Lord, the Lord Chancellor, to see that in cases against the Crown there is much more facility for the subject than there has been in the past. He has adumbrated to us that he hopes to bring in a measure, but I think we ought not to wait for that; we ought to put words into this Bill. I beg to move.

Amendment moved— Page 57, line 9, at end insert the said new clause.—(Lord Llewellin.)

VISCOUNT MAUGHAM

The object of this Amendment is merely to secure that a plaintiff against one of the per sons mentioned in the Amendment shall have full discovery in an action or a proceeding against any one of these numerous bodies or persons who, as he imagines, has treated him wrongly in some way, so that he is entitled to legal redress. I am very unwilling to express an exact or reasoned opinion as to the effect of this clause and its necessity, but I think I am reasonably clear that it is very desirable to remove doubts in respect of the rights of the supposed plain tiff in one of the categories mentioned in the clause. Having regard to the curious nature of the position which the patient may occupy when this Bill has become law, the question as to precisely who is liable in a particular case, and the question of the nature of the discovery to which he is entitled, it would be just and reasonable that the Government—who have told us that their desire is that even after this Bill there should be justice—should consent to this clause or some modification of it, if necessary, being inserted in the Bill. Having said that, I will repeat that I think the clause is desirable, but at the same time I am not pledging myself to the extent to which it is strictly necessary.

THE LORD CHANCELLOR

This subject is one which I confess is rather near my heart. I entirely agree with the noble Lord who has moved this Amendment. I think it is very desirable that in proceedings against the Crown the litigant should have a very full measure of discovery, and I am inclined to think that there have been cases in the past where the litigant has not had such a generous measure of discovery as he should have had. I frankly hope that I shall live to be able to introduce the Civil Proceedings against the Crown Bill, and that I shall be able to give a very wide right of discovery when that Bill is introduced. Having said that, I must also say that I think we should realize at the same time that there is this to be considered. You may here get a conflict of private interest with the public interest. I think it is of the utmost importance that those who are concerning themselves with Government business, with public affairs, should have the right to communicate with each other on those affairs, in the ordinary course of events, freely and without fearing that the reports which they make to their superiors may be dragged out and examined in a Court of Law. I am sure the noble Lord opposite will agree with me about that.

I think that this is a matter of public interest. Only the other day I happened to have to consider a point with regard to reports in connexion with the Air Ministry. There was litigation between two individuals and one of them, quite properly, had certain of these reports in his possession. I had to consider whether we should or should not claim privilege for those reports. I advised the Minister as to what sort of principles he ought to apply, principles laid down judicially by the House of Lords, in quite recent times, in a judgment given by the noble and learned Viscount, Lord Simon. One wants to be very careful to balance these two points of view. This actual Amendment as it stands would not do. As drafted, it is so wide that it is in no sense limited to the purposes of this Bill. It would apply to any action brought against the Minister under a Housing Act or almost any sort of procedure. I am very willing to listen to, and to consider, arguments which may be put forward upon this matter. But really I venture to think that there is no danger of any trouble of the sort that seems to be feared occurring under this Bill as drafted.

There are four points in connexion with which a person who brings an action against the Crown may find himself in difficulty. First, instead of issuing a writ in the ordinary way he may find himself obliged to resort to a certain rather obscure form of proceedings. Second, he may find himself in difficulty because there is no action for tort against the Crown. Third, there is the difficulty about discovery. With regard to these three points I would ask the noble Lord to look at Clause 13, and to realize that the party who is responsible here as the employer of these various officers is the Regional Hospital Board. I do not think that there would be any difficulty in the ordinary way in bringing your action for tort against the Regional Hospital Board, and getting discovery from the Board. I think that the difficulty does arise, and always must arise, under what I now enumerate as my fourth head—the Crown's power to claim privilege for documents which are properly certified as documents which cannot be produced without detriment to the public interest. I think that is the only point upon which difficulty arises, and I consider that the Crown ought to retain that power.

I think that this is one of the matters which a Minister ought to look into himself. He ought to instruct his mind as to what the point is and see whether he is satisfied that it is against public interest that these documents should be produced either by reason of something which they contain, or owing to the fact that they may be documents of the class which ought not to be introduced because if they did come to be disclosed they would tend to prevent that free expression of opinion which is necessary in the public interest. That is my view. There was a well-known case against the Anglo-Persian Oil Company. They had in their possession some document which came from the Admiralty in which opinions were expressed as to the state of affairs in Persia. Now, although the litigation was between two private individuals—the company and somebody else—they were ordered by the Admiralty not to disclose that document, because the Admiralty took the view that its disclosure would be against the public interest.

This particular topic being the topic of health and of actions being brought against doctors and that sort of thing, may I say that I do not think that that sort of consideration is likely to arise. I think it is almost inconceivable that there would be any document of that kind which by it very nature it would be against the public interest to disclose. I think that there might be documents in the second category, documents belonging to the class which in the wider public interest ought not to be disclosed because it would tend to prevent people communicating freely and expressing opinions. I think that, in that connexion, it is right that the Crown should still have the right to claim privilege. I am very ready to do what I can if the noble Lord thinks that there is a special case and will tell me whether there is something I can do which, while safeguarding that broad general principle, will secure that in actions of this special character, confined to this Bill, there shall be as complete a measure of disclosure as possible. I shall be pleased to meet him, as I say, but I do feel that until I deal with this matter in a General Act—we shall of course have to review the whole subject when we come to the Bill to which I have referred—this right ought to be retained.

I say this whilst having sympathy with the noble Lord's object, while feeling it right that a man who is going to bring an action against a hospital after the appointed day, when it has been transferred, shall be in no worse position than a man who brings an action today before the hospital has been transferred. If it is suggested to me that there is some simple Amendment which I can make, I shall be glad to do so. On the other hand this Amendment is too wide. I feel that in the public interest I must retain that right which I have indicated.

LORD LLEWELLIN

I am sorry but I am not really satisfied with the noble and learned Lord's answer. I quite agree with him on the matter of the broad policy, but I am only dealing with a very small matter. If he will look at my Amendment, he will see that it is not very wide. It runs: Notwithstanding any privilege, custom or rule of law the Minister and any council, board, committee or other authority constituted under this Act and their officers shall be compelled to produce in any action brought by any person or by the personal representatives of any deceased person against the Minister or such council, boar committee or other authority or officers, all such records, communications, memoranda and other documents as relate to such person or such deceased person or to the treatment or services provided in respect of them. You will see that it is limited to "all such records" and so on. I want to add "in their possession, custody or power" and then go on "as relate to such person" and so on. It is limited only to the documents that arise in respect of one particular patient. It is very narrow if you look at the last part of it. I am certain that this is not covered by Clause 13.

THE LORD CHANCELLOR

Supposing that a document relating to some particular person was a report by one of the officials of the Ministry of Health to the Minister, made in the course of his duty. The noble Lord's Amendment would say that as a matter of course that must be produced. I would say that this is a matter where the Minister ought to consider whether the public interest demands that that type of document should be produced.

LORD LLEWELLIN

I do not think that that is satisfactory from the point of view of the patient. I would not be prepared to leave it that this should be a matter for the exercise of the general discretion given to the Minister. If you say a report made ad hoc after a case has been made to the Minister, we accept that. Perhaps he sent an inspector to a hospital where there has been a death. I am not suggesting a post-mortem document, which is perhaps much the same as a solicitor gets, but I am suggesting that we are not safe in leaving the right of a patient to be subject to the discretion of somebody who may say: "In this case we do not think that we will disclose the medical history sheets. They are, normally, to be kept in the hospital." It may well be that there is an action against a very popular surgeon, and the attitude taken may be: "Let us not disclose that document; it does not read too well," or something like that. That kind of thing is wrong and I am not prepared to leave the position like that. If the noble and learned Lord is prepared so to strengthen Clause 13 that the old rights of the Act not the new rights of a man from the Ministry, are upheld, that the documents that are properly there, and were there before the passing of this Act, shall still he held to be produced as be fore, he will meet my point. We consider this extremely important.

THE LORD CHANCELLOR

I thought that I had said that. I regard it as quite certain that that sort of medical history sheet can be, and must be, produced after this Bill is passed. If an action is brought against a Regional Hospital Board, the history sheet would be one of their documents. As a litigant, the Board would have to produce it. I am unwilling, however, to use words to cover the exceptional instance which I quoted. If the sort of case which the noble Lord has in mind is not covered—I believe it is—then I will gladly see that it is.

LORD LLEWELLIN

With great respect, take rather a different view. The clause only says that the Board shall be liable as though they were principals and that all proceedings for the enforcement of such rights or liabilities shall be brought by or against the Board in their own name. I do not think that this enforcement of a right or liability does include the disclosure of documents. And that is the only way my point would be covered. I want words put in, whatever the appropriate words are, which would mean that these documents which had previously always been compellable out of the hospital authorities shall still be compellable. I do not want it to extend to the doctor making a confidential report to the Minister. That will probably have nothing to do with the death of the patient, or the injury that the patient suffers. It may be a report on his death afterwards. I want the history, to see whether there has been negligence in the treatment of the patient, and whether an action lies against the Hospital Board or the surgeon or any other officer of the Board. I think that the noble and learned Lord wants to meet me, if he can.

THE LORD CHANCELLOR

I will gladly meet the noble Lord. If these provisions are not already here, I will put them there. The only reason I he state is that I think they are there now, and that nothing further is needed.

VISCOUNT SIMON

Would the noble and learned Lord, the Lord Chancellor, look into that a little further, and possibly consult with my noble friend and any other noble Lord whom he desires? The feeling that the patient should be fully protected in this matter is universal. I know, and the noble and learned Lord knows, that there are cases—border-line cases—in which official documents ought not, on genuine public grounds, to be produced. I will quote an instance, which is different from the one he has given. In the Army it is the invariable practice that a Commanding Officer annually makes a report in respect of junior officers in his battalion. I well remember taking the view that such a document ought not to be produced, on the ground that you could not expect a Commanding Officer to give an absolutely candid account of the shortcomings of Captain "So-and-so," if there were a prospect of a libel action by Captain "So-and-so" if the document were produced. I took that view, and it was adopted by the Courts; it is plain common sense.

But, in my humble opinion, there is no ground on earth to justify the Minister saying: "You had better claim privilege for that document, because if it is produced it will be rather unpleasant for you or for the Department. It will be much safer if it is kept out." That would be utterly wrong. I know that a great deal of trouble is taken in these cases to see that the Minister is properly advised, but I think that the point made by my noble friend is one of great public importance. The change in these organizations connected with hospitals should not result, almost by a side wind, in the man who believes that he has been aggrieved, and is perhaps harmed for life, losing what he is undoubtedly entitled to, full proof of what happened. Could not my noble and learned friend's ingenuity devise something to make that clear beyond doubt? In a concluding sentence perhaps I may be allowed to say that I am sorry that the noble and learned Lord, the Lord Chancellor, talked about the possibility of introducing the Civil Procedure Bill "some day." A good many people want it rather more urgently and definitely than that.

THE LORD CHANCELLOR

I am amongst them.

LORD LLEWELLIN

I think we all agree. For myself, however, I am quite convinced that this position is not covered by Clause 13. If I am wrong I should like to be shown where it is covered. I understand from the noble and learned Lord, the Lord Chancellor, that he will look into the matter, and that if he finds that it is covered, he will show me where. If not, we may try to speak together, and to find words that will cover it beyond a shadow of doubt. On that understanding, I beg leave to withdraw.

Amendment, by leave, withdrawn.

Clauses 72 and 73 agreed.

Clause 74:

Regulations.

74.—(1) No regulations shall be made under Section sixty-six or Section sixty-seven of this Act unless a draft of the regulations has been laid before Parliament and has been approved by Resolution of each House of Parliament.

5.38 p.m.

THE EARL OF MUNSTER moved, in subsection (1), after "under," to insert "subsection (1) of Section eleven of this Act such as determine the areas for which the Regional Hospital Boards are to be constituted, or".

The noble Earl said: I apologize for referring again to this question of the setting up of the Regional Boards. This Amendment and the next in my name seek to enable Parliament to approve the regulations setting up the Regional Boards by affirmative Resolution and not by negative. These Regional Boards, to which I attach so much importance, must be the basis of the whole future administration of the hospitals. At the present time, we do not know, and the noble and learned Lord says that he is unable to tell us, the type or size of the regions, or the number of people who will be living there. All we know about the regions is that they will each be attached to one of the university medical schools in the country. There are eleven of these schools, and it appears that many of the Regional Boards will be attached to the university schools. It is for that reason that we attach such importance to these Boards. I think we should be enabled to see them brought into operation by an affirmative Resolution.

There is one further point. We can be pretty certain that there will be only one set of these regulations which will come before Parliament, except when the Minister decides to amend them in any particular manner. It is important that Parliament should have the right to discuss these things fully, rather than that a prayer should be made in another place at a very late hour of the night when the matter will be inadequately discussed. It is for that reason that I beg to move this Amendment which I hope will appeal to the Lord Chancellor.

Amendment moved— Page 57, line 30, after ("under") insert ("subsection (1) of Section eleven of this Act such as determine the areas for which the Regional Hospital Boards are to be constituted, or").—(The Earl of Munster.)

THE LORD CHANCELLOR

I think I can satisfy the noble Earl when I tell him that the regulations about the Regions will be made separately. That being so, it really does not matter whether the Resolution is positive or negative. I think as a matter of general principle the negative procedure is right in this sort of case. I follow what the noble Earl says, that if it is embedded in a mass of other stuff it is difficult to get proper discussion. But it will not be. We shall have separate regulations dealing with this matter and that being so I think it better to adhere to the normal procedure of dealing with it by a negative Resolution.

THE EARL OF MUNSTER

I quite agree. On general questions I do not attach much importance to the difference between a negative and an affirmative Resolution. The only reason in respect of which I attached importance to this matter was that these Regional Boards are going to be the whole basis of the administration of the hospitals. They are really of vital importance. Naturally, in view of what the Lord Chancellor has said I shall not press this Amendment, but I hope that between now and the next stage of the Bill he may again consider this point. I beg leave to withdraw my Amendment.

Amendment, by leave, withdrawn.

5.44 p.m.

LORD LLEWELLIN moved, in subsection (1), after "under" to insert "subsection (7) of Section forty-two." The noble Lord said: This is rather a similar point in that it seeks to call for an affirmative Resolution and not a negative one. This concerns the provision of Clause 42 which we were discussing yesterday, and the regulations about which the noble and learned Lord and myself were going to have a talk. It is important that we should see how this Tribunal is going to act, and it is very important for the people whose whole livelihood may depend on how it is going to act. We should carefully scrutinize these regulations when they come to be made. I must admit it makes not a great deal of difference in this House whether an affirmative or a negative Resolution is needed because there is always ample time for us to put down a Motion negativing a regulation and have it called on at a quite reasonable hour. Were I still ill another place I should find some considerable inconvenience in the negative debate coming on at a very late hour—usually at night. In this House, of course, it does not really make a great deal of difference, except that when you are including some things which need an affirmative Resolution, surely one of them is the working of this Tribunal on which the whole livelihood of some of these medical practitioners will ultimately depend. I beg to move.

Amendment moved— Page 57, line 30, after ("under") insert ("subsection"(7) of Section forty-two").—(Lord Llewellin.)

THE LORD CHANCELLOR

This is really the sort of point about which we used to get very excited in another place. It does not matter very much here. I think the general principle in deciding whether a Resolution should be positive or negative is the one with which I have already dealt, and that is this. If it deals with matters of substance, especially one affecting some change in a Statute or something of that sort, I take the view that it ought to fall on to the positive side of the line. But if the matter is procedural I think the Resolution ought to fall on to the negative side of the line. That is a very rough division, however, and may not be final. Although this is important, it is essentially a matter of procedure. That being so, I should say that I think it properly falls on to the negative side. It would be a bad example if we started putting procedural regulations on to the positive side of the line.

LORD LLEWELLIN

I put this down before we had our discussion yesterday. I put it down because in the medical profession there is considerable apprehension as to the procedure under Clause 42 which we were discussing and I thought we might get some Amendments on that. In view of the noble and learned Lord's explanation, I beg leave to withdraw my Amendment.

Amendment, by leave, withdrawn.

Clause 74 agreed to.

5.7 p.m.

LORD ADDINGTON moved to insert as a new clause: It is hereby declared that no provision of this Act conferring any power or imposing any duty upon a Region-al Hospital Board, a board of governors of a teaching hospital or an executive council, authorizes the disregard by any of those bodies of any enactment or rule of law. The noble Lord said: This is a matter that concerns local authorities, both those municipal councils and the county councils on whose behalf Lord Henley put it down. It again concerns quite ordinary contingencies. For instance, if the chimney stack attached to the boiler house of a hospital emits smoke and creates a nuisance, surely it is not reasonable that the Regional Hospital Board should be immune from the ordinary procedure regarding nuisances of this nature? Or if the vehicles that are owned by the Regional Board are found on the road to be in an unworthy condition, and so constitute an offence against the Motor Vehicles (Construction and Use) Regulations, surely it is undesirable that the Board should be above the procedure of the ordinary law? For example, if the Board wishes to lay a pipe across the highway, is it again not liable in the ordinary way to comply with the procedure of the highway authorities? I think this clause is one which follows a similar one in the Civil Aviation Bill, and I hope that the noble Lord will be able to include it in this Bill. I beg to move.

Amendment moved— Page 58, line 15, at end insert the said new clause.—(Lord Addington.)

THE LORD CHANCELLOR

In my view this new clause is wholly unnecessary, because—and this may be some consolation to the noble Lord—as I see it, beyond any argument, if a Regional Hospital Board has a smoking chimney, or if it puts on the road some improperly-constructed vehicle, then by reason of the provisions in Clause 13 it is quite plainly liable in tort in the ordinary way, and would certainly be liable for any criminal offence. That being so, I do assure the noble Lord that this clause is really wholly unnecessary and I do not very much like putting this sort of clause into a Bill if it is unnecessary.

LORD ADDINGTON

If I have the assurance that it is covered in Clause 13, I withdraw the Amendment.

THE LORD CHANCELLOR

Yes.

Amendment, by leave, withdrawn.

Clauses 75 to 77 agreed to.

Clause 78 [Interpretation]:

5.49 p.m.

THE EARL OF LISTOWEL moved to insert in subsection (1): 'dispensing optician' means a person having the prescribed qualifications for the fitting and supply of optical appliances. The noble Lord said: This is consequential upon the Amendment your Lordships have already accepted in Clause 41. It is a question of definition. It defines a "dispensing optician." I beg to move.

Amendment moved— Page 60, line 5, at end insert the said words.—(The Earl of Listowel.)

On Question, Amendment agreed to.

THE EARL OF LISTOWEL

The next Amendment is consequential to an Amendment in Clause 41. It defines an "ophthalmic optician."

Amendment moved—

Page 61, line 13, at end insert— ("'ophthalmic optician' means a person having the prescribed qualifications in optics, including the measurement of errors of refraction, in orthoptics and in the fitting and supply of optical appliances.")—(The Earl of Listowel.)

VISCOUNT MAUGHAM

Before this is put may I make a suggestion to the Gov ernment—it is only a suggestion, and there is no Amendment down with regard to it. It is that the word "specialist" should also be defined. It occurs constantly in the Bill, and it will often be necessary to know whether a man is a specialist or not. I am a little uneasy on that point because I have known, more than once in my life, of general practitioners who have started as general practitioners and who have gradually become well known as skilled in particular operations or in particular branches of the medical profession, and have ultimately become specialists. But there is a period of seven years or more during which they are both general practitioners and specialists. I would suggest that in order to avoid that state of affairs there should be some definition which makes it reasonably clear that it is only if they do not undertake ordinary general practitioner's work that they are to be treated as specialists. However, that is only for consideration. I do not know what my noble friend, Lord Horder, would say as to the meaning of the word.

LORD MORAN

I think it would be very difficult indeed to define "specialist" There is not a definition. I am sure that what the noble Lord suggested would not be practicable, because it is certain that as there are only about half the specialist consultants we need for this purpose, there will be a long interim period—it may be ten years—during which a man will be both general practitioner and consultant. It has been suggested there should be a register of medical consultants. The General Medical Council went very closely into it, but I do not think it is likely to be pressed, because I consider it to be impracticable.

On Question, Amendment agreed to.

Clause 78, as amended, agreed to.

Remaining clause agreed to.

First Schedule: