NATIONAL HEALTH SERVICE (SCOTLAND) BILL.

HL Deb 12 May 1947 vol 147 cc569-652

2.55 p.m.

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

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

On Question, Motion agreed to.

House in Committee accordingly:

[The EARL OF DROGHEDA in the Chair.]

Clauses 1 and 2 agreed to.

Clause 3:

Provision of hospital and specialist services.

3.—(1) As from the appointed day, it shall be the duty of the Secretary of State to provide throughout Scotland, to such extent as he considers necessary to meet all reasonable requirements, accommodation and services of the following descriptions, that is to say:—

1. (a) hospital accommodation;
2. (b) medical, nursing and other services required at or for the purposes of hospitals;

and any accommodation and services provided under this Section are in this Act referred to as "hospital and specialist services."

(2) It shall be the duty of the Secretary of State, in providing hospital and specialist services, to make available such facilities for undergraduate and post graduate clinical teaching and research as he considers necessary to meet all reasonable requirements.

THE DUKE OF MONTROSEmoved, after subsection (1) (b) to insert: (c) Clinics for otological and aural aid services.

The noble Duke said: The reason I moved this Amendment is that a large number of people suffering from deafness are anxious to be included in the benefits provided by the Bill. Therefore, in order to meet their desires, I propose to insert the words: "Clinics for otological and aural aid services," causing the present paragraph (c) to become paragraph (d). In support of this Amendment I may say that I sounded all the people in the Scottish Association for the Deaf, an organization co-ordinating all the Deaf Societies, all the Deaf Missions, all the Deaf Workshops, and all the organized agencies for the deaf; and they gave me their unanimous support. Likewise, I approached the National Institute for the Deaf, which represents all the different organizations, missions, and societies in Great Britain, so that in moving this Amendment I am speaking for all the deaf of the British Isles, and they are unanimous in their request to be included in this Bill.

I know that the Secretary of State for Scotland had two fears about it, The first was that he did rot wish to "clutter up" the Bill. I do not think anybody can say that my seven words will "clutter up" the Bill. The second objection he had was that he did not like including in the Scottish Bill something which had not been approved in the English Bill. The only reason it was not included in the English Bill was that my noble friend Viscount Cecil moved his Amendment in the wrong place. He moved the Amendment in Part IV and it should have been moved in Part II. Therefore I am asking for this Amendment to be accepted in Part II. As for the reluctance to include in the Scottish Bill something that has not been approved in the English Bill, I do not see any strength in that argument. After all, what is the object of having a separate Scottish Bill? It must surely be that the circumstances of Scotland are different and, because of that fact, Scotland has to be treated in a different way. Therefore I do not see any argument against this Amendment on that ground. I am not arguing against the principle of the National Health Service (Scotland) Bill. All I am asking for is the insertion of these seven words—"Clinics for otological and aural aid services" as paragraph (c) of subsection (1) of Clause 3.

Amendment moved— Page 3, line 5, at end, insert the said paragraph.—(The Duke of Montrose.)

3.3 P.m.

THE EARL OF ROSEBERY

I wish heartily to support this Amendment which has been moved by my noble friend the Duke of Montrose. The noble Lord, Lord Morrison, may remember that on Second Reading he said it was quite fortuitous that the English Bill came before the Scottish Bill. At that time I said that I thought that occasionally we might have a Scottish Bill introduced first, so that there could be argument on the Scottish Bill before the position was settled by an overwhelming number of English members who would say: "You cannot have this because it is not in the English Bill." That seems to me a very weak argument. I do not know how strongly the deaf in England put forward their case for inclusion in the English Bill, but, to my mind, there can be no reason for omitting the deaf from a Health Bill. When my noble friend the Duke of Montrose spoke on the Second Reading he made a most eloquent speech in support of the deaf. If we could only have those words put into the Scottish Bill, perhaps England—a little late—will do something to look after their deaf people.

3.5 p.m.

VISCOUNT CECIL OF CHELWOOD

I desire to do my utmost—which I am afraid is very little—to support the Amendment moved by my noble friend the Duke of Montrose. He justly said, as did the noble Earl who has just spoken, that there is no reason in the world why, because we made a bad mistake in England, we should make an equally had mistake in Scotland. The question is not to be determined by any consideration of that kind at all, nor by the kind of departmental dislike—which there always is—to have anything changed which has already been approved in a Department. I hope that your Lordships will treat this question (because it is a very serious and important one) entirely without reference to any considerations of that kind. I shall be extremely brief in the observations which I am going to make, the more so because some of your Lordships may remember that I made one or two speeches on the same kind of topic in connexion with the English Bill.

The issue is extremely simple. The whole point arises because of the age-long neglect of the treatment of the deaf in this country. That is the real point, and the only point of importance. There is no doubt that that has been so. So far as I can remember, there has never been anything done by public authorities on behalf of the deaf as such. My noble friend the Duke of Montrose cited the names of a number of institutions which support this plea. Those institutions are private institutions. Though such institutions are admirable, and are wholehearted in their support for justice for the deaf, they do not represent anything like the public support without which—particularly with the present Government—nothing can be done. I do not know why it is that there has been this neglect of the deaf, but the result has been disastrous. There is no doubt that in, I think one may say, the whole realm of medicine, there is no part which has shown such little progress as the treatment of the deaf. Within the past few months a great advance has been made—or at any rate we hope that a great advance has been made—in the treatment of a particular kind of deafness. But, with that exception, it is not untrue to say that substantially the deaf have seen no advance in their treatment since the Roman Empire was at its height. The only thing that was done was to sneer at them whenever opportunity served, and to give them a speaking tube.

As a result, it is no exaggeration to say that everybody who has been into the question knows (I am speaking only the literal truth) that in the great majority of cases deafness is incurable. I do not mean to say that there are not some cases where something can be done, but in the great majority of cases deafness is incurable. You can mitigate it sometimes, but not very often. But you can never cure it. Undoubtedly, that is due, partly to the dreadful neglect which there has been, and partly, no doubt, to the extreme complexity of the machinery of the ear. I do not know whether any of your Lordships have ever looked at a medical diagram of the inside of the ear. If you have you will know (my noble friend who leads the House will certainly know) the immense complexity of the machinery which deals with the question of hearing. And not only is it very complex, but, because of its nearness to the brain, it is very difficult to deal with by way of surgical operation or surgical treatment. In addition, there is the little sympathy which the deaf have received, of which I need say no more.

One other thing, however, I should like to say, and here your Lordships have an opportunity of doing something important and useful for the deaf. Granted that deafness is incurable, what you can do is to assist the partly deaf people who, of course, constitute the immense majority of those we call deaf. You can help them to utilize such power of hearing as they have in order to hear the speech of other people, and otherwise to make those deaf people useful members of society. For that purpose we have seen the growth in the last few years of a considerable number of aids for deafness. They are aids of a new type, depending, roughly speaking, on the principle of the microphone and the telephone; that is, utilizing electric force in order to multiply the sounds which are made by speech and to convey them to the deafened ear. That has been of immense value to a number of deaf people. At intervals during the last few years we have been told that the Government were going to do something about it. They have not done anything yet. They appointed a Committee and the Committee considered (I believe at great length and I have no doubt with great ability) the possibility of producing a new instrument which would be not only effective but relatively cheap—because at the present time the cost of those instruments is such as to make them quite unobtainable by anybody who is not fairly well off. However, nothing has been done.

The point is this: that in the manufacture of those instruments, the manufacturers get no assistance from science except what they can themselves produce. If you are blind, or if your eyesight is defective, you go to an occulist. The occulist examines you very carefully and ascertains what is wrong with your eyes. In the majority of cases he writes you out a prescription—a prescription which, I admit, is always quite unintelligible to me—which you take along to an optician, who thereupon produces a pair of spectacles which are of some assistance. No such thing happens with regard to the deaf. If you go to an aurist he tests you and tells you what it is you are suffering from, but then, if he is an honest man, he says that he is afraid he can do nothing more.

You may then say: "But there are these instruments. Which instrument would you recommend?" He will tell you that he has great admiration for those who produce the instruments; that there is this, that or the other instrument, and certainly some of them are likely to be of use. But he does not say that your particular deafness requires a particular kind of instrument, or that you might try a particular way of dealing with it. He does not say that you might be amenable to what they call bone instruments. That would be the kind of advice he might give, but no such advice is given. I am not complaining of that. No one could be more courteous, more skilful or more well instructed than the aurists whom I have visited on my own behalf and on behalf of others; but they do not regard it as any part of their duty to prescribe the deaf aids that are required.

That is a very serious defect. Normally, if you go to a hospital, there is no special provision for dealing with these cases; and in point of fact you have almost a complete divorce between the people who make the instruments and the men of science who know all about what ought to be done mechanically—if it can be done. That seems to me to be a serious defect, and it has had one result which I will mention only in a phrase, because it is well known to many of your Lordships. Round this honest and honourable business of the manufacture of deaf aids has grown up a whole jungle of wicked fraud and deception of the worst kind. I need not elaborate on that, because many of your Lordships know all about it, but it has partly arisen from this complete separation between the scientific leaders of opinion on deafness and the manufacturers of deaf aids.

Even teeth are treated better than ears. We all know that a dentist performs operations, whether they be agreeable or not. He also frequently has to say: "I am afraid that what you really want is a new set of teeth." He then lays down what kind of teeth you require, but he does not make them; they are made by a separate set of business people who operate, as I understand it, under the orders of the dentists but without in any way competing with them. That is a state of things which I think ought clearly to prevail in the case of deaf aids. What is needed is skilled otologists, as I believe they now prefer to be called, somewhere in the centre to see not only what is wanted for the patients, but that all school children are examined for any sign of deafness which can he dealt with in the very early stages. In addition, it is necessary that the manufacture of these deaf aids should be carried out ably and honestly.

I hope that before this Committee stage ends we shall be given some indication as to what has happened to the Government machines. I hope that instrument will be a great thing, but, as we all know "hope deferred maketh the heart sick," and my heart, I am afraid, is getting rather sick at the total failure of these instruments to appear. That is the case. The Government now have an opportunity of including aid to the deaf in this great new system of health which they are establishing in Scotland, as it has already been established, so far as Act of Parliament can establish it, in England. We ask—and I do not think we are asking very much—that it shall be clearly laid down on the face of this new Statute that one of the duties of the new authorities to be created shall be to deal with this question of the deaf. It is not right or proper to leave these people, many of them helpless, absolutely without assistance from the State in treatment for their deafness.

I do not think I need say anything more to your Lordships on the subject. I am glad my noble friend the Duke of Montrose has moved the Amendment in this form. I do not ask for any special treatment for the deaf beyond what we give to the blind or even to those who suffer in respect of their teeth. I do, however, think that they are entitled to the same amount of assistance. I ask strongly that provision for them shall be made in this Bill, and that deafness shall not be left merely as a kind of sideshow to be dealt with by the hospitals to be established under the terms of the Bill. I desire to see it made specifically one of the duties of the new authorities. I do hope, if my noble friend persists in this and goes to a Division, that he will give me the opportunity of voting in his favour.

3.19 p.m.

VISCOUNT LEVERHULME

On one or two previous occasions it has been my privilege to support the noble Duke of Montrose when he has raised matters in your Lordships' House concerning the welfare of the deaf and the hard of hearing. I am sure the noble Viscount who has just spoken will share my pleasure, as a mere Sassenach, in being able to try to do something for the hard of hearing in the country of the noble Duke, because I know of nobody who works harder for that cause, wherever the deaf or hard of hearing are to be found, whether in England, Wales or Scotland. This is not the occasion to enter upon that thorny question as to whether blindness or deafness, or defective vision or defective hearing, is the worse affliction. But I think that we can agree that when it comes to legislation the eyes and the ears have an equal claim for consideration. In his very interesting speech the noble Viscount covered the ground so fully that there is little I can add.

I quite agree that the development of hearing aids is nothing like so great as that which is possible with lenses, in the case of spectacles, but great strides have been made recently, and are still being made. Last June when I was in America I was greatly impressed with a consultation that I had with a leading otologist there. I went to his clinic, where he spent an hour measuring my hearing with an audiometer, and he told me the type of aid he thought would suit my particular case. He then got in touch with the maker, and made sure that I went back to see him afterwards, when I spent another hour with him to see whether any further adjustments could be made. I mention that only because I am sure we are entering upon a better phase, and advances are being made. I think the day will come when it will be part of the aurist's job to prescribe an aid, in very much the same way that the oculist prescribes lenses for spectacles, although I think the parallel is not exact. If the Amendment proposed by the noble Duke is accepted, I think that medically speaking and scientifically speaking it will make this Bill more up-to-date, and I earnestly hope that His Majesty's Government will give very careful consideration to the points which the noble Duke has made, and will make later on.

LORD SALTOUN

On a previous occasion His Majesty's Government gratified us all by explaining the interest they are taking in this question of deafness, and when—I hope I am right in using the word "when"—they do produce a good aural aid at a reasonable price they will have done a service to everybody in the country who is deaf. As the Bill will not be complete unless the noble Duke's Amendment is inserted, I hope they will make a big swallow and accept it. The clause says: … it shall be the duty of the Secretary of State to provide throughout Scotland, to such extent as he considers necessary to meet all reasonable requirements … That does not mean that a lot of things must be provided immediately. It merely means, if these few words about deafness are inserted, that the treatment of deafness is part of the Government's plan; and if that is included now, the deaf people will know they are to be looked after. If it is left out, then on any future occasion the Government will be able to say, "It was an unfortunate thing, but at the time the Bill was passed we could not include it." I beg His Majesty's Government to make a big swallow now and accept this Amendment. If they do so, the result will be that they will, in due course, accumulate a mass of experience which will greatly improve the treatment of the deaf in all future times. This is really a foundation stone in the improved treatment of the deaf, and I sincerely hope that the noble Lord who is to reply will weaken on this point.

LORD MORRISON

I have seldom—in fact, never, during the time that I have been in your Lordships' House or in another place—heard a discussion in which I agreed so entirely with the points that have been put forward. And yet the only answer I am going to make is to doubt whether this is the way to do what is sought. The noble Duke referred to "cluttering up" the Bill. He suggested two possible objections. One was that it was not in the English Bill, and the other was that if it were put in it would "clutter up" the Bill. I have not heard either of those objections. The real point, so far as I understand it—and the point upon which all noble Lords are agreed— is that the time has come, and is indeed overdue, for a great campaign throughout this country to give much more prominence to the diseases of hearing, to deafness and partial deafness.

It is in that connexion that the noble Lord has done such magnificent work in arousing public opinion in this matter. Almost all other ailments have received great prominence, but in regard to deafness I have often wondered why it is—perhaps it is because it is not accompanied by any real physical pain—that there seems to be a slowness on the part of anyone to start moving. 1 want to make it clear at the outset—and I am sure I am speaking on behalf of the Government—that what I am going to say with regard to the Amendment which has been so ably moved (and perhaps it would be for your Lordships' convenience that I should make a general statement covering the whole question of deafness as it arises) is that this Government are very keen indeed that much more attention should be given to this matter of deafness. The noble Viscount, Lord Cecil of Chelwood, has referred—as indeed did the noble Duke in his speech on a previous occasion—to the frauds which have been perpetrated upon the public for many years, and to the number of people who have made large fortunes out of swindling and preying upon the afflictions of people.

That is a question upon which I do not think the Government will hesitate at all. If they were prepared in this case to give private enterprise a tree hand (this is surely a matter upon which all of us would agree, whatever our political views might be, calls for Government interference) the only way in which I can see that the Government could interfere would be by the ordinary process of prosecuting the people who are doing that sort of thing. That is very difficult, and it is almost impossible to catch the people responsible. Alternatively, the Government could do what they have decided upon—and that brings me to the point tae noble Viscount, Lord Cecil, emphasized—which is, to do something themselves, and to enlist the aid of scientists to make a real deaf aid which can be relied upon and supplied to the public at a reasonable price. I am advised that, from my point of view, there is nothing in this Amendment, and I would obviously have a much easier task if I could get up and say, "Yes, I will agree to put these words in." But how would that help if it does not start the campaign which I think noble Lords have in view, of trying to make the public conscious of the seriousness of this matter?

I speak with some considerable knowledge of industrial conditions, and I know the terrible handicap of workmen who are physically fit themselves but handicapped, particulary when working amongst machinery, by the fact that they are deaf. There is a reluctance on the part of employers, because of the increased danger of a man suffering from deafness, to do anything to help. That brings me to this point. The noble Earl, Lord Selkirk, interrupted me on the last occasion, when we were discussing the Second Reading of this Bill, and said that I was endeavouring to explain to the House that it was generally accepted that this was a better Bill than the English Act. I think the noble Earl will remember that he interjected to say that the blue print of a Bill would not necessarily mean an improved health service. The same remark applies here; if you put a few words in this Bill they will not make all that difference.

It was announced in another place last week that in anticipation of the new service a Government order for the manufacture of large quantities of these aids had been placed. The contracts covered an initial supply of 50,000 instruments, of which Scotland will have a fair share. The noble Viscount, Lord Cecil, complained about the delay in this matter. The delay was due to the fact that two of the valves needed in this instrument were not manufactured in this country. It was very difficult to get them for any reasonable sum.

VISCOUNT CECIL OF CHELWOOD

Perhaps the noble Lord will allow me to say that the difficulty of getting them was due to the fact that the Government would not allow them to be imported.

LORD MORRISON

I am pleased to be able to inform the noble Lord that the Government have made arrangements for manufacturing these valves in this country, and the arrangements are well advanced: so much so that by the time this Bill comes into operation it is anticipated that the supply of deaf aids will have risen to 50,000. In that connexion may I invite noble Lords who have taken part in the debate to-day to see and test these aids for themselves? If they would be good enough to give their opinion—and I should be glad to arrange the test—it would be of great value to the Government and to those responsible for the manufacture of the aids. These 50,000 instruments have been ordered and are to be made wholly in Great Britain, except that a few valves are to be imported from America while preparations are being made for the manufacture of the valves in this country.

It is anticipated that a considerable number of these instruments will be ready for the inauguration of the new service. I think it can be claimed that this is a demonstration of the Government's earnest intention to promote facilities for the benefit of the deaf and hard of hearing. In addition, immediately this Bill is passed preparations will be made to establish throughout Scotland centres where these deaf aids can be serviced. The noble Viscount, Lord Cecil, referred to the scandal in connexion with the repair and servicing of instruments. The setting up of these centres should enable people to feel that they can go and have their instruments serviced and be sure of being dealt with honestly and fairly.

Perhaps your Lordships would like to have further reasons why it would be inadvisable to put into the Bill the words that the noble Duke, the Duke of Montrose, has moved. In the future, under this Bill, there will be a public responsibility for the health of the people of this country and of Scotland, in the widest sense, and not merely confined to specific ailments. Subsection (1) of Clause 3 places on the Secretary of State the duty of providing hospital accommodation, medical, nursing and other services required in hospitals, with the services of specialists; or clinics, or services elsewhere. The definition of "hospital" makes it clear that the term includes clinics and out-patient departments maintained in connexion with hospitals proper. Subsection (3) of Clause 3 makes it clear that the duty of the Secretary of State includes the provision of appliances. The service provided under this clause will necessarily include provision for hearing aids, and provision will be made not only in hospitals but also at out-patient departments, clinics and health centres.

This clause does not seek to specify the various kinds of aids that are to be dealt with under it. It is quite impossible to single out deafness for special mention. Widespread as deafness may be, there are many other diseases of greater importance, and it would be out of the question to specify all the complaints for which aids are to be provided. One might mention rheumatism, cancer, tuberculosis, mental diseases and so on. Cancer is one of the great killing diseases of our time. There was on the Statute Book a special Act of Parliament dealing with the arrangements and treatment necessary—the Cancer Act of 1939—but that Act is now repealed and the disease finds no mention in the present Bill. That is an argument for not putting in deafness. The reason why cancer is not mentioned in this Bill is because of the desire to make it clear that the Government's concern is for the general treatment of all kinds of ailments.

The noble Duke, the Duke of Montrose, made reference to ophthalmic treatment, but there is no mention in the Bill of sight, any more than there is of hearing. The noble Duke also argued that there should be imposed on the executive councils responsibility for providing appliances supplementary to the main provision in Clause 3. He suggested that if it is appropriate to make supplementary provision for the treatment of the eyes it is equally appropriate to make such provision for the deaf. This is entirely a false analogy. Opticians are not trained in the treatment of eye diseases, and consequently the service provided by them is not complete, or not so complete as if the work were done by a specialist. However, if, as the Amendment proposes, executive councils were to include in their arrangements the service of medical specialists, they would be duplicating, not supplementing, services which the Secretary of State is developing through the hospital organization.

I suggest to your Lordships, and in particular to the noble Lords who have taken part in the debate on this Amendment, that the adoption of the Amendment would not speed up the provision of facilities for treating aural disorders, but, by dissipating effort, and in other ways, would postpone the establishment of a satisfactory system. I apologize for speaking at such great length on this particular Amendment, but the noble Duke has a number of Amendments on the Paper, and I thought it would be better if I made a full statement now so that the Committee might be in possession of ail the facts of the position. I close by repeating that I am, if I may so put it, "all the way" with the noble Duke in his desire to help the deaf. I admire immensely the very great fight that he is putting up for them. I think that he is winning in his fight and that he is doing much that is helpful.

But I hope the noble Duke will realize that I have spent a great deal of time, since the Second Reading, trying to assimilate the full facts of this matter. I have spent time in studying it, not with any desire of hindering him but rather with a view to trying to help him if possible. I am convinced that the Government, in the campaign they propose and with the powers to be given to them under this Bill, will achieve so much that the noble Duke who has been such a pioneer on behalf of people afflicted in this way will have no reason to regret the course we have taken, and that he will find that every effort is being made in Scotland to see that Scotland leads the way in this branch of healing, as it has done in so many others.

3.43 p.m.

THE DUKE OF MONTROSE

I have moved this Amendment to a clause which deals with the provision of specialist services. As the noble Lord knows, there is a great deal of exploitation of the deaf, and the only way to stop it, I suggest, is to set up clinics where they can get impartial service. I should call the stopping of exploitation by setting up clinics for giving impartial service a specialist service. This particular clause deals with specialist services and there is nowhere in the Bill that I can see, except in this clause, where this Amendment could be inserted. I should like to know whether the noble Lord will accept my Amendment or not.

LORD MORRISON

I was hoping that, as the result of the considered statement which I have just made, the noble Duke would not seek to press his Amendment. As I endeavoured to explain to him, apart from the matter of wording, I am advised that, far from improving the Bill, on the contrary it might make matters more difficult than they are at present, and that the Amendment would not be helpful in achieving what the noble Duke is anxious to do and what we are all. trying to do— that is, to improve conditions relating to the deaf.

VISCOUNT CECIL OF CHELWOOD

May I be allowed to say a word here? I am most grateful to the noble Lord, Lord Morrison, for his statement, but it seemed to me that it was a speech directed almost entirely to supporting the Amendment, until at the very end when the noble Lord seemed—under the influence, perhaps, of some of his less wise advisers—to make a sudden turn and to say that he was against the Amendment. I had hoped that he was going to conclude by saying that he was in favour of it and would agree to its insertion in the Bill. That, at any rate, would have been something. The Amendment, I suggest, could not possibly do any harm, and its insertion would be something by way of recognition of the debt which is owed to the deaf. That debt would, to an extent, be discharged by the insertion of this Amendment. Surely that would be a good thing to do in the circumstances.

VISCOUNT ADDISON

May I be allowed to intervene and to make an appeal to noble Lords? There really seems to be a little misunderstanding here. I do not think that there is any difference between us about what we want to accomplish, but the fact is that if this Amendment were put in it would then become a statutory obligation on the authorities to provide those special services. The fact is that you could not provide them, because the people needed to staff them do not exist. There are, of course, a number of specialist aural surgeons, but there are nothing like the number of trained people in this branch of treatment that there are, for instance, in ophthalmology. If you made this a statutory obligation you would be putting upon the authorities something which unfortunately they would not be in a position to develop; they could not carry out the law laid down in this respect.

If I may say so, the method which the Government have suggested is really the better way of dealing with it, as my noble friend Lord Morrison has already explained. The Bill does not catalogue all the ailments for which there are to be special services. The whole thing is comprehensive. As I say, if you were to make this a statutory obligation, you would not be any further advanced because you could not get the necessary staff-there are simply not the necessary numbers of trained people to do the work. That is why we are appealing to noble Lords to agree not to insert this Amendment. If they will take advantage of the offer which my noble friend has made, and will examine the things which are now being made and are already on order (and that, I suggest, is the best test of our sincerity), I think they will be satisfied that we are taking the right steps. I do hope that this Amendment will not be pressed to a Division.

THE EARL OF ROSEBERY

I wonder if the Committee would permit me to say a word or two at this point, in order to ask my noble friend the Duke of Montrose not to press this Amendment. We all listened very carefully to my noble friend, Lord Morrison, although I am bound to say that at one time he rather confused me because I was not sure whether he was talking about ears or about eyes. In fact, I rather thought he was talking about eyes and not about ears. From what he told us, the Government apparently want to be led by the feeling in the country as regards this matter of the treatment of ailments affecting hearing. I should have thought that the Government could have led themselves in this matter. The noble Lord also gave us some hope that there might be a Bill later which would be concerned with the deaf. The noble Viscount the Leader of the House is here, and if it is true that the deaf are to be specially cared for in some short Bill, perhaps he will give us some information. I have no doubt that the Government will say that there is no time just now for such measure, but I can think of many Bills that might be delayed without much harm to this country, so that something might be done which would greatly assist the deaf.

If we could have an assurance on the Report stage that something concrete—a matter not of words but of deeds—will be done, we should be very grateful. We do not want to see these appliances which have been spoken of—we can take them for granted. I know that they are very expensive. I must say that I do not quite appreciate the statement of the noble Viscount, the Leader of the House, about there not being sufficient people to staff this service. Them may not be sufficient people to provide the staffs necessary to carry out the whole of this Bill. The noble Viscount the Leader of the House has said that it is quite impossible to insert this Amendment. I would be quite prepared to accept that statement if we could have something further on the Report stage—something more concrete. If the noble Duke is in agreement with me on this matter, I would ask him not to press his Amendment.

VISCOUNT CECIL OF CHELWOOD

May I just be allowed to say that we discussed all this on the English Bill? We were continually being told to leave it to the Report stage, and we were assured that the Government would then see to it that what we wanted would be done. Then the Departments proved too strong for the Government, and they were not allowed to do anything. That is what will happen again now. I beg the Committee to put in this Amendment, for it can do no harm to do so now. If it can be shown that the Amendment would do harm, we can strike it out on the Report stage. If it is put in now, it will be a definite declaration that Parliament really desires something to be done to help the deaf. That is all we can hope for.

VISCOUNT ADDISON

I again appeal to noble Lords not to make this a statutory obligation upon the authorities. I am sure that it would be an obligation which they could not carry out. It is no good putting it in the Bill in this way. With regard to the matter to which the noble Earl has referred, I will certainly look into it and ask my noble friend to give it his attention. I think that if my noble friend Lord Morrison could arrange for some of these appliances to be seen by noble Lords—possibly he could arrange for a demonstration to be held in the House—it would be of value. It is no good putting a general obligation upon the authorities which they are not in a position to carry out. That is the only point, and it really is quite sound. I will look into the other matter, I do not know about it.

LORD REA

I hope my noble friend will not submit to the blandishments of the noble Viscount the Leader of the House. It is all very well to say that this could not be carried out, but has the noble Viscount: read the Bill? It is only imposing a duty to such an extent as the Secretary of State for Scotland considers necessary to meet all requirements. To suggest that to make such an insertion in an Act of Parliament is to put an impossible obligation on a Department is really trifling with the House. We are a little tired of being told, "Oh, don't put anything in the Bill, but wait. The Government are going to provide it." This is becoming a public scandal, and it is time that something was definitely done. If we were to pass this Amendment it would make it clear to the Department concerned, and to the officers who are so anxious that no duty should be put upon them, that this House means that something shall be done for the deaf in a reasonable time.

THE DUKE OF MONTROSE

Clause 1 of this Bill states quite clearly that this is to be a comprehensive national service. Then why hesitate to put in the seven words of my Amendment? The noble Lord referred to cancer and tuberculosis. If those people want a clinic, why should they not have one.

VISCOUNT ADDISON

They have one.

THE DUKE OF MONTROSE

Well, if other people want one, why should they not have one, if this is a comprehensive service? It is simply trifling with the House.

LORD MORRISON

I endeavoured to explain that if you include one you are excluding the others. You either include all of them, or put in none of them. I pointed out that this Bill repealed the Cancer Act because when this Bill is passed that Act will no longer be necessary. It is not necessary to put in a special reference to cancer, but that does not mean that treatment for cancer is being abolished. It means that it is no longer necessary in a general health service to mention specific diseases, because such a health service includes all of them.

On Question, Amendment negatived.

3.53 P.m.

THE EARL OF SELKIRK moved, at the end of subsection (2) to insert "after consultation with the universities and the Royal Medical Corporations." The noble Earl said: This Amendment deals with subsection 2 of Clause 3. This is a very important subsection, and the intention of the Amendment is to strengthen it and to give the Secretary of State, who accepts duties in it, the means of carrying out those duties. The noble Viscount, Lord Addison, has just said that it is no good putting general obligations into the Bill which the Government are not able to carry out. The intention of this Amendment is to assist the Secretary of State in carrying out obligations he has here undertaken. I want to emphasize that the degree to which this Bill interferes with medical schools is very much greater than has been represented from the Government Bench. In another place it was said, on behalf of the Government, that the Bill does not affect teaching. The noble Lord, Lord Morrison, said there was no mention of it in the reasoned Amendment which was moved in another place. In fact, the reasoned Amendment refers to the fact that the Bill gravely threatens the training of students and research, so this is a matter which has been of some general concern.

I would like to say one or two words to show just how this Bill does affect teaching. The hospitals form a pyramid with the Secretary of State at the top, and entirely separated from that are the medical schools. It is of very great importance that there should be intimate and close touch between the medical schools and the hospitals. Where do we find that contact? We find only one point at which there is an absolute and assured contact, and that is on the boards of management of individual hospitals or groups of hospitals. There are two other committees of an advisory nature upon which representation may be made, but there is only one assured place. Quite rightly, the Government realize that there is a very considerable gulf, and they have endeavoured in some measure to close that gulf by this clause, in which the duty is laid on the Secretary of State to provide facilities for teaching in his hospitals. I am suggesting that he should add, "after consultation with the universities and the Royal Medical Corporations."

I want to emphasize the extremely intimate nature of a teaching hospital and the medical school that goes with it. If I may draw an illustration, I will take one by quoting from the Goodenough Report on page 13. The interests of both patients and students are served if, in the framing of policy and the conduct of the hospital's affairs, the two functions of a teaching hospital, namely, the care of the patient and the furtherance of teaching and research, receive equal emphasis,"—

I repeat "emphasis"— being regarded as complementary and mutually reinforcing,

What do we find? We find, in fact, that the intimate contact does not exist, and I am going to ask the noble Lord how he thinks that this general obligation in subsection (2) is to be performed.

The Secretary of State is clearly not qualified to express an opinion on medical schools, which is a highly technical matter. From whence is he going to seek his advice? In the Scottish National Health Service Council there is no representation of teaching, so he cannot go there. In the Regional Hospital Board there is very slight representation, and there may be none of teaching at all. Where else is he to seek advice as to how he is to perform the duties laid down by Statute under this clause? The noble Lord may say that he will turn to the Department of Health. I am going to say two things in that regard. The first is that the Department of Health are not qualified and should not attempt to advise on teaching matters; that is a matter for the universities themselves. If it is not a matter for the universities, then I would ask the noble Lord why the explanatory memorandum specifically states: The Bill leaves untouched existing responsibilities for medical education.

In this matter the Secretary of State should lean directly on the universities to provide him with advice as to how medical education should be conducted. Otherwise the statement in the memorandum attached to the Bill cannot but be regarded as misleading in substance. I would add that there is no reference here to health centres. Is that included in subsection (2)? Finally, I would repeat again very strongly that the Secretary of State must get advice from somewhere. Where is he to get advice? I suggest in my Amendment that the proper method is to have consultation with and receive advice from the universities and the Royal Medical Corporation on how to perform these essential duties which are an integral part of medical education.

Amendment moved— Page 3, line 17, at end insert the said words.—(The Earl of Selkirk.)

4.0 p.m.

LORD MORRISON

So far as I understand, there is nothing in this Bill to debar the universities or any other body from a direct approach to the Secretary of State on any difficulty which is not resolved at the regional level. The Amendment which the noble Earl has moved seeks to require the Secretary of State to discharge his duty of making available facilities in the hospital service for teaching and research only after consultation with the universities and the Royal Medical Corporations. That is, in effect, what will happen, for the Secretary of State's duty under this subsection will, of course, not be carried out by himself personally, but by the Regional Hospital Boards acting as his agents, and the Regional Hospital Boards are already advised on this aspect of their work by the Medical Education Committee set up under Clause II (3) of the Bill. That Committee include university nominees, and the Royal Medical Corporations will also be represented in regions where those Corporations have responsibilities in this field. I am a little uncertain as to why the noble Earl has put down this Amendment, because it seems to me to cut across the machinery of the Medical Education Committee which is provided in the Bill at the suggestion of the universities themselves. In those circumstances, I regret I am unable to accept the Amendment.

THE EARL OF SELKIRK

I thank the noble Lord very much for what he has said, but I am afraid that I do not follow the logic of his case. He has stated specifically that the universities may have direct access to the Secretary of State.

LORD MORRISON

Yes.

THE EARL OF SELKIRK

Then why should the Secretary of State not consult the universities in the provision of facilities for medical education? Is it not a quibble to refuse a very simple Amendment of this sort? May I also ask this question? The noble Lord says that the Secretary of State may approach the Regional Boards. The Regional Boards do not exist. The Secretary of State has to approve this scheme, and he has to do that without advice from anybody. Surely it is simple and straightforward for him to accept advice from and to have consultation with the universities and the Royal Medical Corporations. After all, the Medical Education Com- mittee exist, but they are only advisory, and they must be filtered through the Regional Hospital Boards before they reach the Secretary of State at all. It is very long-distance administration.

The point that I am trying to make is that the connexion between medical education and hospitals is very intimate, and that if you break that up—as I have endeavoured to explain has been done—you must ensure, so far as possible, that a very effective coupling is put in its place. I have said that that coupling is weak; that there is a big gulf existing between the hospital system on the one side and medical education on the other, and it is very loosely bridged at the present time. I am not suggesting that my Amendment is a strong one, but I should like the noble Lord to think about it. To some extent, it helps the Secretary of State in the discharge of his duties. I would remind the noble Lord that we have recently been told by the Leader of the House that it is no good imposing a general obligation which the Secretary of State is not able to carry out. I say this—and I say it without fear of contradiction—that, as the position stands at the present moment, the Secretary of State cannot carry out these obligations, because he has no one to advise him who is thoroughly competent to do so, without shifting the responsibility for education which he has said he would not do. I would like the noble Lord to think of this matter again.

LORD MORRISON

I can only say to the noble Lord that perhaps he misunderstood me when I said that there was nothing in this Bill to debar the universities or any other body from a direct approach to the Secretary of State. I added some other words of which perhaps the noble Earl did not have time to take a note. I said "on any difficulty not resolved at the regional level." I am sure that the noble Earl will now understand that I do not mean that this continuous discussion should go on with the universities on all questions, but merely on questions not resolved in the ordinary way. There is nothing in this Bill to prevent, in exceptional cases, the universities or any other body from a direct approach to the Secretary of State. That is the explanation. I can only add that I am advised that the machinery of the Medical Education Committee provided in this Bill was put in at the suggestion of the universities themselves, and, therefore, I repeat that the reason is a little obscure as to why the noble Earl should attach any considerable importance to this Amendment.

THE EARL OF SELKIRK

I am grateful for what the noble Lord has said, which I think amounts to this: that the universities may approach the Secretary of State at any time when they find their facilities unsatisfactory.

LORD MORRISON

That is so.

THE EARL OF SELKIRK

In those circumstances, I beg leave to withdraw my Amendment.

Amendment, by leave, withdrawn.

Clause 3 agreed to.

Clause 4 agreed to.

Clause 5:

Accommodation for private patients.

5.—(1) If the Secretary of State, having regard to his duty to provide hospital and specialist services, is satisfied that it is reasonable so to do, he may set aside in any hospital vested in him and providing such services special accommodation for patients who undertake, or in respect of whom an undertaking is given, to pay such charges as may be determined in the prescribed manner, being charges designed to cover the whole cost so far as falling to be defrayed out of moneys provided by Parliament of the accommodation and services provided for the patient at the hospital, including an appropriate amount in respect of overhead expenses, and the Secretary of State may recover those charges:

Provided that no accommodation shall be so set aside unless there will remain available, as part of the hospital and specialist services, for other patients at least as much accommodation as was immediately before the appointed day available free of charge or at hospitals vested in local authorities, being accommodation which became part of the hospital and specialist services on that day:

4.5 P.m.

THE EARL OF ROSEBERY moved, at the end of the first proviso to subsection (1) to insert: but subject to so much accommodation remaining available for other patients, the special accommodation previously used for patients who undertake to pay shall be so set aside.

The noble Earl said: The Amendment which I move is one which I very much hope the noble Lord will accept. There is one point particularly which I should like to bring to his notice, and that is that the endowments in the Scottish teaching hospitals are being taken away from the hospitals by the Government, which is not the case in England. A number of these endowments must have been specially given for the help of patients whom one might call private patients—people who can afford to contribute. In taking away those endowments, I think the noble Lord might have consideration for the wishes of so many people who have given money to those hospitals. There is another point. The noble Viscount, the Leader of the House, in speaking on another Amendment this afternoon, talked about the lack of staff—the impossibility of there being enough staff to help the deaf. I would say to the noble Lord: If you do not accept this Amendment, what will happen will be that you will have a mushroom growth of private nursing homes which will compete with your hospitals—and I should think compete successfully—for nursing and other staff. Therefore I think that if you do not accept this Amendment you will harm your own Bill. I beg to move.

Amendment moved— Page 4, line 17, at end insert the said words.—(The Earl of Rosebery.)

LORD MORRISON

I much regret that I am unable to accept the Amendment just moved by the noble Earl, which is similar to an Amendment which was voted upon and rejected on the Report stage in another place. The Amendment seeks to secure that hospital accommodation used for paying patients before the appointed day shall be set aside under Clause 5 of the Bill for use by patients paying the whole cost of their treatment. The Secretary of State has said that he intends to set aside a limited amount of accommodation for the purposes of this clause. He cannot, however, bind himself so as to set aside as much accommodation as was previously used for paying patients, because some of that accommodation may be more appropriate for use by patients paying, not the whole cost under Clause 5, but only the extra cost for single rooms or small wards under Clause 4. Apart from that, the Secretary of State could not bind himself to set aside under Clause 5 the precise accommodation previously used for paying patients; because in a regionally planned service that particular accommodation might be especially needed for other purposes, while suitable accommodation elsewhere could, with greater convenience to all concerned, be earmarked for private patients. The Amendment would bind the Secretary of State to do both these things, and therefore I am unable on his behalf to accept it, but I add as a postscript that I am also advised that the drafting is defective and this actual wording could in any Case not be accepted.

THE EARL OF SELKIRK

I should like to make one point. The noble Lord has said that he would be bound by this Amendment to set aside precise accommodation for this particular purpose. If he looks at the Amendment carefully, I would suggest that he will see that that is not the case. What the Amendment says is "so much accommodation"—that is to say, the Secretary of State is entirely free to set aside any accommodation, or re-adapt accommodation for different purposes. That was one of the points which was raised, and that point is fully met. I do not think the Secretary of State ever said that he does not intend to set aside so much accommodation as is available, and the purpose of the Amendment is to ensure that it is provided in the Statute. As to the second point with regard to the drafting, I should have thought it was quite clear that there can be no doubt about the provision of special accommodation of those who had undertaken to pay. I do not know what the difficulty in regard to the drafting is, but I should have thought the meaning was quite clear. Finally, there is the point that if people can afford to pay there is no very good reason why advantage should not be taken of it: to relieve the taxpayer, who receives so little consideration these days.

THE EARL OF ROSEBERY

I thank the noble Lord for his reply. I regret that the Amendment was not couched in the proper phraseology, which I may say causes me surprise, because I submitted it to what I thought was sufficiently expert judgment. However, I bow to the noble Lord's ruling, and I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

Clause 5 agreed to.

Clause 6 agreed to.

4.10 p.m.

Clause 7:

Endowments of voluntary hospitals.

(6) Regulations may provide, notwithstanding anything in the foregoing provisions of this section, for enabling the application, to such extent as may be prescribed, of property comprised in any endowment to which subsection (2) of this section applies to the discharge of any liabilities transferred to the Secretary of State from the governing body or trustees of a voluntary hospital under the last foregoing section or to a Board of Management under either of the last two foregoing subsections.

LORD TWEEDSMUIR moved, at the end of subsection (6) to insert: Provided that the liabilities to be discharged shall be liabilities incurred for a similar purpose to that for which the endowment was given by the donor.

The noble Lord said: This deals with the important question of the future of endowments. I think the wording of the Amendment is such as to make it perfectly plain, and I will say only a few words on it. As the Bill now stands, it would permit of an endowment intended for the use of a specific hospital being converted to the discharge of liabilities of a foundation of a different kind; in other words, the express purpose for which the donor provided the money would not be served. If the money is left to a hospital which deals specifically with nervous disorders, the donors in the past have had an explicit assurance that the money would be used for that particular purpose. Under the present wording of the Bill the donor would have no such assurance. The money might, in fact, be applied for the use of a totally different foundation, such as one dealing with tropical diseases. It appears to me that if the Bill stands in its present form the future of endowments is going to be an extremely bleak one. Machinery will be set up that will at first discourage them; then the number of donations will dwindle, and finally they will disappear. I move this Amendment purely as a safeguard. It is one which I consider eminently reasonable, and I hope the noble Lord who replies will be able to see his way to accept it. The wording is designed to reassure intending donors that if they make endowments for specific medical purposes to a specific foundation, although the money may not be applied to that specific foundation, yet that specific medical purpose will be respected, and his money will be applied in accordance with his wishes. I beg to move.

Amendment moved— Page 7, line 44, at end insert ("Provided that the liabilities to be discharged shall be liabilities incurred for a similar purpose to that for which the endowment was given by the donor.")—(Lord Tweedsmuir.)

LORD MORRISON

I have in my possession a very lengthy reply to the Amendment which the noble Lord has moved, but it may save your Lordships' time if I summarize the position. The difficulty is that little detailed information is yet available about the kind and extent of assets and liabilities possessed by voluntary hospitals in Scotland. Before this information has been collected, the Secretary of State cannot see his way to debar himself from access to particular classes of assets. That is why this particular provision is left to be made by regulations and is not incorporated in the Bill itself. When the full information has been collected, the Secretary of State will proceed to make regulations, and in so doing he will bear in mind the points of view that have hem urged upon the Government in both Houses of Parliament and, just now, by the noble Lord. If, thereafter, the Secretary of State proposes in the regulations to make what appears to Parliament to be an improper use of the power conferred by the clause, then either House has in its own hand the remedy that it can annul the regulation. As the noble Lord will see, the suggestion is that this is a matter which ought to be dealt with by regulations, which will have to be submitted to Parliament and which can be confirmed or annulled by either House. In the circumstances, I hope the noble Lord will consider that this is a satisfactory methed of dealing with the point.

LORD SALTOUN

Before we leave this subject, I would like to raise one point. When we were dealing with the English Bill the noble and learned Viscount, the Lord Chancellor, gave me an assurance on one aspect of this question, and I should very much like to have it repeated in respect of this Scottish Bill. Scotland is a country which has always been enriched by the generosity of its children, and there are many places where money has been given for the express purposes of maintaining a hospital in a particular locality. When we dealt with the English Bill, I asked the noble and learned Viscount, the Lord Chancellor, whether the Act would be so construed and so used as to take away these benefactions, and also to take away from the locality the hospital which those benefactions had been given to preserve. The reply I received was that this would not be so unless there were a shifting of population that would justify such a step, and that while the old conditions remained the hospital would be maintained. I should be obliged if the noble Lord could give me a similar assurance in regard to this Bill.

LORD MORRISON

I am afraid I am not in a position to give the noble Lord assurances in this matter. I have already explained that it is desirable that this matter should be dealt with in the regulations, and if anything improper appears in the regulations I feel sure the noble Lord will lose no time in putting down a Motion in this House that the regulations be annulled. I am advised that that is the proper time to do it, and not during the passage of the Bill.

VISCOUNT ELIBANK

I do not think that answer is quite satisfactory, if I may say so. What we wish to know to-day is that these endowments, or monies which have been given for a certain purpose will be used for that purpose. I have a case in mind where monies were given for the purpose of building a new hospital. We want to know that such monies will be devoted to the purposes for which they are given. The noble Lord in his reply has given no indication that that will be the case. All he has told us is that regulations will be drawn up. He has not given us even a slight indication that what the noble Lord, Lord Tweedsmuir, is seeking in his Amendment is likely to be embodied in the regulations. To tell your Lordships' House that these regulations will be laid before the House, and then they have to be considered by the House after the Secretary of State has decided what shall appear in them, is, as we all know, to say something which usually means nothing at all. The regulations are laid before your Lordships' House, or they are laid before another place, and they have to be accepted in toto or not; and we know that if one or two points are not satisfactory they are accepted in toto. I therefore feel that the reply which has been given by the noble Lord to my noble friend is not one which is acceptable.

LORD SALTOUN

May I add one word on this point, because I think it will reinforce my point with the noble Lord, Lord Morrison? I took charge of a trust under the obligations of the benefaction. Under this Bill I am supposed to transfer all those funds to the Regional Board. If I already know that the purpose of those funds is to be maintained under the Bill and carried out by His Majesty's Government, I may do so with a clear conscience: but to be asked to transfer these funds to the Regional Board and not to know what is to be done with them when they are transferred is to put a pressure on me, as an honest man, to which I do not know that I can submit. I think you will take them, but you will not take them over my signature unless I am satisfied I am carrying out my trust. When I put the point as it affects me—and as I am sure it would affect the noble Lord if he were in a similar position—I am sure he will see the force of my argument. Perhaps at a later stage he will give me an assurance on that point.

LORD MORRISON

I can quite see the force of the noble Lord's argument, but the difficulty is—and this is the whole of it—that little detailed information is yet available about the kind and extent of assets and liabilities possessed by voluntary hospitals in Scotland. Before this information has been collected it will be very difficult indeed for the Secretary of State to debar himself from access to particular classes of assets. That is the reason why this particular provision is left to be met by regulations and is not incorporated in the Bill itself.

LORD SALTOUN

If I might interrupt the noble Lord: have not the Department of Health in Scotland had the accounts of almost every hospital in Scotland under the emergency hospitals scheme during the war? They have seen all our investments, and if they have not got the information they should have it.

LORD MORRISON

I am afraid I cannot answer that question. All I can say is that that is a matter between the Department and the noble Lord. If the Department say they have not got the information and the noble Lord says they have, far be it from me to take any action in the matter. I think the noble Lord had better get in touch with the Department and see what they have to say about it. I am advised that the real difficulty is that little detailed information is available about the extent of assets and liabilities possessed by voluntary hospitals in Scotland, and that is the reason why this particular provision is left to be met by regulations and is not incorporated in the Bill itself.

LORD TWEEDSMUIR

I am Obliged to the noble Lord for his answer, which I understand from his own lips he boiled down from a very compendious and substantial document. I must say that I do not derive a tremendous amount of satisfaction from knowing that we cannot have this in the Bill, and that it is merely to come into the purview of Parliament by resolution. I would like to put this to the noble Lord. We should feel very much happier about this state of affairs if we knew that when this was made a matter of Resolution it had to be an affirmative Resolution, rather than bringing up an Order to be negatived by a negative Resolution. I would be grateful if he would signify assent or dissent, and whether he would let us know about that on the Report stage.

LORD MORRISON

I am quite willing to give the noble Lord an answer to that question on Report stage, but whether it will be favourable or otherwise I will not say. At the moment, I frankly confess I am not able to give him an answer. May I say again that under Clause 7 endowments must, pending the coming into operation of a scheme, be held for the purposes for which they were given? I think that answers the question which the noble Lord, Lord Saltoun, put to me.

LORD TWEEDSMUIR

I am grateful to the noble Lord far that reply, and in those circumstances I beg leave to withdraw my Amendment.

Amendment, by leave, withdrawn.

Clause 7 agreed to.

Clause 8:

Hospital Endowments Commission.

8.—(1) The Secretary of State shall constitute in accordance with the Second Schedule to this Act a Hospital Endowments Commission.

(2) It shall be the duty of the Hospital Endowments Commission to frame and submit to the Secretary of State schemes for the government and management of endowments transferred to Boards of Management under subsection (2) of the last foregoing section, for the transfer in appropriate cases of such endowments to other Boards of Management or to Regional Hospital Boards constituted under the following provisions of this Part of this Act, and for the application of the capital or income of such endowments to such purposes as the Commission think fit.

(7) The powers of the Hospital Endowments Commission shall terminate on the expiry of five years from the appointed day:

Provided that the Secretary of State may from time to time by order direct that the said powers shall continue for a further period.

THE DUKE OF MONTROSE moved, in subsection (1), after "Commission," to insert "in Edinburgh." The noble Duke said: Clause 8 provides that a Hospital Endowments Commission shall be established by the Secretary of State. I presume there will be a good many endowments to be handled, and I move that that Endowments Commission shall be seated in Edinburgh. There is a general feeling that too much Scottish administration is sent down to Whitehall, and it would be much more satisfactory to have this Endowments Commission seated in Edinburgh, where it would be in close touch with the various Scottish Endowments.

Amendment moved— Page 9, line 3, after ("Commission"), insert ("in Edinburgh").—(The Duke of Montrose.)

LORD MORRISON

I was a little doubtful when I saw the noble Lord's Amendment as to whether that was his point, because I thought that what he wanted to ensure was that the meetings of the Commission should always be held in Scotland, and that it should be a Scottish body. Now I am assured that that is the position. If the noble Duke is anxious to be assured that the Commission will be a Scottish body, meeting in Scotland, he need have no hesitation on that score, because the Bill relates to Scotland only, and obviously the Commission would hold its meetings in Scotland. I am not prepared to say that it would always hold them in Edinburgh, because I think the noble Duke will agree that circumstances might arise at some time when it would be necessary to meet in other parts of the country apart from Edinburgh.

THE DUKE OF MONTROSE

Do I understand that the whole of this Bill would be administered in Scotland?

LORD MORRISON

That is so.

THE EARL OF SELKIRK

What this clause says is that the Secretary of State shall constitute a Commission, and the noble Duke says it should be in Edinburgh. This clause has nothing to do with where it sits, and I cannot see any objection to constituting the Commission in Edinburgh, because that is where I presume it would be constituted. It seems to me, therefore, small matter to accept the Amendment.

LORD MORRISON

It was the noble Duke himself who said that his object was to secure that this Commission should meet in Scotland and not out of the country. He is perfectly satisfied on that.

THE DUKE OF MONTROSE

My idea was that the Commission should operate in Scotland, but I understand the noble Lord to say that the whole Bill and the whole administration will be seated in Scotland.

LORD MORRISON

That is so.

THE DUKE OF MONTROSE

In those circumstances I beg leave to withdraw my Amendment.

Amendment, by leave, withdrawn.

THE EARL OF ELGIN AND KINCARDINE moved, in subsection (2), after "fit" to insert "provided always the scheme is framed to provide for the interests of hospital and specialist services." The noble Earl said: The purpose of this Amendment is to help in the work of the Endowments Commission. May I say that I welcome very strongly the action of the Secretary of State in appointing this Commission and in following the lines adopted by a predecessor of his in the review of educational endowments? The policy differs from that adopted under the English Bill in this respect, but speaking with some experience of the operations of the Educational Endowments Commission—on which this Commission seem largely to be framed, although not following exactly the interpretation of that Commission—and having had the responsibility of the Chairmanship of that Commission for eight years, I feel that I may bring forward two points in which the work of that Commission was strongly criticized. They are brought about by the conditions which follow in this clause, that in framing their schemes the Commission must have special regard to certain things. It was on that point that the Endowments Commission were very strongly criticized.

We were told that although the endowments had been given for a special purpose the scheme which we adopted and brought forward reorganized the whole of those conditions, and allocated the endowments for other purposes. But we were always able to satisfy the lawyers that we had fulfilled the condition, which was that we must have special regard to these things. I feel that there is a difference between the Educational Endowments Commission and the Commission proposed to be set up in this Bill. Education endowments cover a very wide field. A large number of those endowments were obviously anachronisms, and the general policy adopted by the Commission was to produce a scheme which gave great latitude to the new governing body. But here in this Commission we have endowments dealing specifically and only with one service—that is, the hospital and health service; therefore I feel it would help the general working of the scheme and the solution of the problem if these words that I have put into my Amendment preceded the production of their scheme. It deals to a certain extent with the point recently raised by the noble Lord, Lord Tweedsmuir, in his Amendment to Clause 7. But, quite frankly, the whole of Scotland will look to the retention of those endowments for the provision of hospital and such services, and will not expect them to be swept away, as is possible under the literal terms of this Bill, to some completely different service. It is for these reasons that I beg to move.

Amendment moved— Page 9, line 13, after ("fit") insert 'the said proviso.—(The Earl of Elgin and Kincardine).

LORD MORRISON

The noble Earl, Lord Elgin, who is well known as the Chairman of the Educational Endowments Commission, on the results of whose work the present Bill is partly based, seeks by this Amendment to secure that the Hospital Endowments Commission shall be required to have special regard to the interests of hospital and specialist services (among other things). The chief objection to the Amendment, apart from the drafting difficulty, is that it would require the Commission to pay more attention to the interests of the hospital and specialist services than to those of others which have to be taken into account. In particular there is the question of the intention of the founders of the endowments. Regard for this latter factor has all along been a feature with regard to administering hospital endowments. It is because we must bear in mind the spirit of the intention of the founders of endowments that I am unable to accept this Amendment.

THE EARL OF ROSEBERY

I wonder if the noble Lord would consider if his answer is not rather splitting hairs. The obvious intention of the noble Earl, Lord Elgin, was that the endowments funds should in the future be administered as they are at the present time. It may be true that the noble Earl, Lord Elgin, narrowed the line a little by employing the terms he did in his Amendment, and there may be some besides specialist services which will included in the endowment; but the real reason we want this Amendment is to prevent outside bodies robbing the endowment funds in the same way, for instance, as the Road Fund was robbed. We want to be absolutely satisfied that the Endowments Commission will not depart from the views and the wishes of the people who originally subscribed the endowments. In his answer the noble Lord intimated that the Government wished to keep within this line. If that is so, and he does not agree with our phraseology, would it be possible for him to put down some Amendment in his own name which would conform to what the noble Earl, Lord Elgin, desires?

LORD MORRISON

I should be very surprised if it were possible, under the terms of this Bill, for money from endowments to be used for purposes quite outside the scope of the Bill. The point at issue in this matter seems to be a very narrow one; the noble Earl, Lord Elgin, wishes to give first priority to the hospital and specialist service; on the other hand, the Government's attitude is that the first consideration shall be the spirit and the intention of the founder of the endowment.

THE EARL OF ELGIN AND KINCARDINE

It is not a question of preference. It is a question of tying assurance that monies which have endowed to hospital services should remain available for those services. It is a definite provision—and these preferences come afterwards—so long as the fund is retained "to provide for the interests of hospital and specialist services." That is the actual provision, according to my Amendment.

LORD MORRISON

I can only say that it would not, in fact, be possible for the Commission to transfer endowment monies away from the hospital and specialist services. Under subsection (2) they must either leave the endowments to the boards of management who initially inherited, or transfer them to other boards of management or Regional Boards. Under subsection (4) Regional Boards or boards of management are empowered only to use the endowment "for such purposes relating to hospital or specialist services of to the functions of the Regional Hospital Board or the board of management with respect to research as they think fit." That assurance ought to satisfy the noble Earl, and I hope it will.

THE EARL OF ELGIN AND KINCARDINE

It comes nearer to what I was aiming at. I have had sufficient experience of these things to know that when a Commission are told to have special regard to matters it means that they must think about those things, and having thought about them they may form a completely different scheme for a completely different purpose. That was right with regard to the Educational Endowments Commission, but I feel that the situation in regard to these endowments is quite different, and that we ought to have an assurance such as the noble Lord has now given us. I do not feel quite satisfied, and if he will agree to look at this again, and, possibly, give us a further reassurance on the Report stage I will not press this Amendment at this moment.

LORD MORRISON

I shall be happy to look at this again, and if the noble Earl would raise this point again, either on the Report stage or on the Third Reading, I will see whether it is possible to strengthen the assurance which I have just given to an extent which leaves no further room for doubt.

Amendment, by leave, withdrawn.

THE EARL OF ELGIN AND KINCARDINE moved, in subsection (7), to leave out "five" and insert "ten." The noble. Earl said: My second Amendment is also based on my experience of the work on the Educational Endowments Commission. The Commission were appointed for a period of three years, with the same pro- vision as is contained in this Bill for extension if required. We had five annual extensions and, therefore, we were in operation for eight years. But we were unable to accomplish the task before us. As a result of that experience I feel that the period of five years suggested in the Bill is insufficient for the Endowments Commission under this Bill, and that it should be extended. I have this further reason—and this is a point which was raised by the noble Earl, Lord Selkirk—that after the demise of the Commission powers are handed to the Secretary of State. My view, again based on my experience—although it was an unenviable experience—is that this leads to a good deal of criticism. I feel that the Endowments Commission did useful work, but they were not allowed to finish their work.

I think in this case it is most important that the Commission, and not the Secretary of State, should have the responsibility of finishing the job. Therefore, I suggest that a longer period should be inserted in the Bill. That is my reason for suggesting that "five" should be left out and "ten" inserted. I think it is wrong, on principle, that one individual, the Secretary of State, possibly on account of the difficulties connected with some of the endowments, should have the responsibility placed upon him, after the lapse of five years, of saying: "This is to be the destination of a particular endowment." One or two of the endowments which came under review by the Educational Endowments Commission were very long and intricate and many inquiries were needed. We spent months over some of them and some had to be left in a state of suspended animation. That was most unsatisfactory, and I strongly urge that the period of this Commission's life should be extended.

Amendment moved, Page to, line 7, leave out ("five") and insert ("ten").—(The Earl of Elgin and Kincardine.)

LORD MORRISON

I hope that the explanation which I have to give to the noble Earl will bring home to him that the Secretary of State and the Government, so far as Scotland is concerned, have learned something from the Educational Endowments Commission, and hope to improve upon that in the case of the Hospital Endowments Commission. The noble Earl suggests that ten years ought to be the period of life instead of five. Of course, there is another angle from which to look at this. It seems desirable that the Hospital Endowments Commission should get on with their work as soon as possible. The period of five years ought to be enough for this purpose, and if the kind of contingency which the noble Earl has envisaged did arise it would always be possible for the Secretary of State to continue the Commission in office for a further period. That was not possible with the Educational Endowments Commission. There was no power to continue them in operation by Order, as there is in the case of the Hospital Endowments Commission. That, it seems to me, makes all the difference. The maximum life of the Educational Endowments Commission was laid down from time to time by Statute, and, as I say, there was no power to continue them in operation by Order. But there is such power in the case of the Hospital Endowments Commission. It might have a bad effect for a Commission to be appointed and be informed that it would continue in office for ten years. I think it might be far better to hurry them along, so to speak, and seek to prevent them becoming dilatory. This could best be done, I suggest, by putting in the period of five years. For these reasons I hope that the noble Earl will not wish to press his Amendment.

THE EARL OF SELKIRK

May I ask a question upon this? Is it the Government's intention to use the Endowments Commission for dealing with all endowments of hospitals? That is a very important point, and we ought to know the answer. As the Bill stands at present there are all sorts of points at which the Secretary of State can step in and—as the noble Earl, Lord Rosebery, has said-do with endowments exactly as he thinks fit. That was the reason why in the last Amendment, moved by the noble Earl, Lord Elgin, there was an endeavour to restrict the use to which the Secretary of State could put the endowments. In the first place the Secretary of State may step in and appropriate any endowments in Scotland for liabilities. In the second place he may take a Report of the Commission and modify, change, alter, add to or subtract from it, in any way he likes. He may, after five years, terminate the Endowments Commission and then do exactly what he likes. I think the Secre- tary, of State is sensitive about this point, I think he realizes that the powers which he has secured for himself are rather great, and the only answer he has is to say that there might be a question of deadlock. There is one example of a breakdown which he can quote, but that it is unlikely to happen in the future.

The powers which at the present time the Secretary of State has over endowments are very great indeed. I am sure that he is most anxious to keep faith with the benefactors. He has said that, and I am sure that he means it. At the same time I think it is proper to remember that many of these endowments are handed up in church collections and I feel that there is something a little improper in saying that church collections should go to pay what amounts to a political tax—or should go to be paid under a political head. It would be a great pity if the fullest possible use were not made of this Commission. The Secretary of State should not cut short its life. If the noble Lord can say that it is the intention of the Secretary of State to ensure that all endowments are dealt with before he terminates the Commission, it will be an assurance of some value.

LORD MORRISON

We have now narrowed down this discussion to a very small point. I am advised that the Commission will be expected to review all endowments except those which are not to be diverted. The Orders of the Secretary of State approving his actions are subject to annulment by Parliament. The narrow point we have arrived at is whether "ten" should replace "five," or whether "five" should stand. I think there is very little in it, because, as I have already explained to the noble Earl, Lord Elgin, it is possible, under the Bill as it now stands, for the Secretary of State to continue the Commission in office for a further period. He is empowered to do that. If the period of five years should prove insufficient for the Commission to complete their task it will be possible, as it was not possible in the case of the Educational Endowment Commission, for the Secretary of State to continue the Commission for a further period.

THE EARL OF SELEIRK

It is certainly possible for the Secretary of State to do so, but is it the intention of the Secretary of State that the Endowments Commission should be expected to complete their work, or does the Secretary of State wish to do it himself?

LORD MORRISON

I should doubt whether the Secretary of State has any hard and fast notions on that. It is difficult to know how long this task will take but the Secretary of State fears that if you put down a period of ten years it will encourage the Committee to proceed with this work, which ought to be proceeded with as expeditiously as possible, in a somewhat dilatory way.

THE EARL OF ELGIN AND KINCARDINE

I do not really think there is anything in that argument. I am quite certain that any Commission appointed would want to get on with the job as quickly as they could. I can speak with strong personal experience. I do not think there is a great deal in the noble Lord's other point that the provision enabling the Secretary of State to extend the life of the Commission by Order makes it very different from the condition under which the life of the Educational Endowments Commission was also extended. That was not by Order; it was by Statute, and that was, perhaps, rather more of a safeguard than otherwise. The provision of extending it by Order means that the responsibility at the end of five years for saying whether or not the Commission should continue is the Secretary of State's and nobody else's. I should say that the other procedure was safer from the point of view of Parliament. That put the responsibility on Parliament, and not on one individual. Therefore, I am not convinced in any way by the argument produced by the noble Lord. I still feel quite strongly that the Commission should have adequate time to do their work, and that the Commission should be the people who do the work.

On Question, Amendment negatived.

Clause 8 agreed to.

Clauses 9 and 10 agreed to.

Clause 11:

Regional Hospital Boris, Medical Education Committees and Boards of Management.

(4) Every Regional Hospital Board shall, within such period as the Secretary of State may specify, submit to the Secretary of State a scheme for the appointment by them of boards to be called Boards of Management, for the purpose of exercising functions with respect to the control and management of individual hospitals or groups of hospitals vested in the Secretary of State and providing hospital and specialist services in the area of the Regional Hospital Board.

(5) Before submitting a scheme under the last foregoing subsection the Regional Hospital' Board shall consult any university with which the provision of hospital and specialist services in the area of the Board is or is to be associated.

THE EARL OF ROSEBERY

I trust that some time this evening the heart of the noble Lord opposite will melt, and that he will grant us at least one Amendment. So far he has been adamant, but in a most courteous manner. This Amendment is quite a simple one. We feel that consultation with the university alone is not enough, and this Amendment is designed to ensure consultation with local health authorities and boards of governors of hospitals.

Amendment moved—

Page 13, line 44, after ("Board") insert: in addition to consulting local authorities having jurisdiction under the Public Health (Scotland) Act, 1897, and the existing governing bodies of the voluntary hospitals to be included in such scheme.

LORD MORRISON

I thank the noble Earl for his appeal to me, and I can only say that, as he will agree, up to now I have been batting on a sticky wicket. I hope an improvement may now begin to be apparent. The Amendment moved by the noble Earl seeks to require the Regional Hospital Board, before framing schemes for the grouping of hospitals under boards of management, to consult local authorities and governing bodies of voluntary hospitals as well as universities, with whom consultation is already required. As the noble Lord has indicated, he feels that wider consultation should also be specified. I am quite prepared to give a promise to consider an appropriate Amendment before the Report stage. I am advised that the Amendment as it is at present drafted will not do, because it would bring in the town councils of small boroughs which have had no health functions since 1929.

On the other hand, it might be just as important for Regional Boards to consult with associations of voluntary hospitals and local authorities as to consult the particular hospital or authorities. If the noble Earl would allow me to consult with the Department and put down an Amendment covering the sense of his Amendment, and submit that Amendment either to himself or to one of his friends to seek their approval, I would be pleased to bring it forward on Report stage.

THE EARL OF ROSEBERY

I thank the noble Lord. We are quite content that he should produce an Amendment as he suggests, and I beg leave to withdraw my Amendment.

Amendment, by leave, withdrawn.

Clause II agreed to.

Clause 12:

Functions of Regional Hospital Boards and Boards of Management.

(2) Every Regional Hospital Board shall, within such period as the Secretary of State may specify, submit to him a scheme for the exercise on their behalf by Boards of Management of hospitals or groups of hospitals within their area of functions relating to the control and management of those hospitals or groups of hospitals, and any such scheme may include provision as to the following matters:

(a) the appointment of officers required to be employed at or for the purposes of any hospital controlled and managed by a Board of Management;

LORD SALTOUN moved, at the end of subsection (2) (a) to insert: other than a hospital providing facilities for under-graduate or post-graduate clinical teaching.

The noble Lord said: This Amendment reflects the anxiety of the teaching hospitals that their appointments should remain in their own hands. The noble Lord is as well aware as I am, and as proud as I am, of the magnificent service of the teaching hospitals to Scotland, but I do not know if he realizes the anxiety of the teaching hospitals at the present time about the quality of medical teaching. That quality is magnificent, but on the way in which it is continued depends the doctoring of the future. They are very anxious that the present state of affairs should not be changed. The situation is not the same as under the English Act. It is the Regional Board now, and not the teaching hospital, that is going to have the say. I think that so far as this is concerned the teaching hospitals have a very strong case, and I hope the noble Lord will be able to accept this Amendment, which I am very happy to move.

Amendment moved— Page 15, Line 20, at end insert the said words.—(Lord Saltoun.)

LORD MORRISON

If the noble Lord and the House would agree, I would like to discuss this Amendment together with the next two Amendments standing in the name of the same noble Lord, because they all cover the same point and it would be convenient to discuss them together. The noble Lord's Amendments cover one particular aspect of the proposals in the Scottish Bill for dealing with teaching hospitals. As I explained in my Second Reading speech, the Scottish Bill diverges from the English Act in that it does not make a sharp distinction between teaching hospitals and non-teaching hospitals. All hospitals alike are administered by boards of management acting as agents of Regional Hospital Boards. The endowments of all voluntary hospitals are treated alike. Where, in fact, a hospital provides facilities for clinical teaching, that is recognized by including on the board of management nominees both from the university concerned and' from the teaching staff.

The precise functions to be exercised by boards of management are not laid down in the Bill, but will be settled in schemes to be submitted by the Regional Boards under Clause 12 (2) for the approval of the Secretary of State. The Secretary of State expects that Regional Boards will delegate the appointment of officers quite extensively to boards of management, especially those of important hospitals. But he must resist any attempt to insert in the Bill itself provisions which would interfere with the flexibility of the administrative arrangements to be made in the light of experience. The principal teaching hospitals may require arrangements different in degree from hospitals where a smaller amount of teaching is carried on. The appointment to a teaching hospital of members of the clinical staff whom the university will wish to appoint also to teaching posts is a matter in which the university must have an important voice. This is secured by the university's participation in the advisory appointments committee which will be set up under Clause 14 of the Bill in connexion with any such appointment.

Whether the actual appointment to the clinical post is made by the Regional Board, or by the board of management as its agent, does not appear to me to be a material factor in this connexion. It is true that the university have direct nominees on the board of management, but these nominees form a minority. Similarly, there are members on the Regional Board appointed after consultation with the university, who may be expected to look after the interests of medical teaching. On the other hand, if the board of management of a teaching hospital were to appoint all the clinical staff of the hospital, this would mean that the Regional Board would not have the decisive voice in most of the major appointments of the region; because in the key hospitals which undertake most of the teaching the senior physicians and surgeons are very often consultants for areas much wider than those served by the particular hospital in which they hold their primary appointment.

To avoid raising doubts in the noble Lord's mind, it might be well to mention that the procedure outlined for the appointment of persons to hold clinical posts at a hospital along with teaching posts at a university—a procedure involving the setting up of an advisory appointments committee under Clause 14—will not necessarily apply to the most senior teaching appointments: for example, Clinical Chairs at universities, the holders of which are normally also in clinical charge of hospital wards. Clause 14 is so drafted that these appointments could be excluded from that procedure, and the Secretary of State intends to discuss with the universities the precise arrangements which he will make in cases of this kind.

LORD SALTOUN

I am obliged to the noble Lord for his answer. I think he has in his last few words met my point. It would be an unthinkable position that, say, the University of Aberdeen should not be able to appoint a Professor of Surgery without consultation with the Regional Board. As I have understood the noble Lord, it would be impossible for such a situation to arise, and the universities will have a free hand in their own house.

LORD MORRISON

I can only repeat the last sentence to which the noble Lord referred—namely: The Secretary of State intends to discuss with the universities the precise arrangements to be made in cases of this kind.

LORD SALTOUN

I am much obliged to the noble Lord for his answer, and for his good will on the matter: With the permission of the House, I will withdraw my Amendment, but I should like to hear something further on this subject on the Report stage, because I think it is very important.

Amendment, by leave, withdrawn.

Clause 12 agreed to.

Clause 13 agreed to.

Clause 14:

Conditions of service and appointment of officers.

(2) Regulations may make provision with respect to the appointment of such classes of the medical or dental officers employed on the staff of any such hospitals providing hospital and specialist services as may be specified in the regulations, and such regulations shall, without prejudice to the generality of the foregoing provision, provide—

(b) for the constitution, on the occasion of each such vacancy, of an advisory appointments committee consisting of—

1. (i) persons nominated by any Regional Hospital Board concerned;
2. (ii) persons nominated by any Board of Management concerned;
3. (iii) in the case of an appointment involving specialist duties, specialists nominated from among their own number by the members of a national panel constituted in accordance with regulations for the purpose of making such nominations; and
4. (iv) in the case of an appointment involving teaching duties, persons nominated by any university concerned;

LORD TWEEDSMUIR

The Amendment which I now move is a very brief one in every sense of the term. In Clause 14, page 16, line 47 there appear these words: "… among their own number by the members of a national panel …" This Bill gives no definition of a "national panel" at all. The purpose of the Amendment is to substitute the word "the" for the word "a". We are left entirely and completely in the dark about this matter. From the present wording, it is very hard to say whether the word "a" means that there will be one national panel or that it will be one of a number of them. If there is to be one, let us be specific and use the word "the". As to these national panels, what, may I ask, are to be their powers, and how are they to be constituted? We are entitled to get some further information on those points before we accept this clause as it stands, quite apart from the point as to whether or not they are to be singular or plural. I beg to move.

Amendment moved— Page 16, line 47, leave out ("a") and insert ("the").—(Lord Tweedsmuir.)

LORD MORRISON

I am afraid that I am not able to answer the last questions of the noble Lord, which seem to me to be rather outside the very narrow scope of his Amendment. I had some little difficulty in understanding exactly what it was that the noble Lord had in mind. I thought the purpose of his Amendment was to make it clear that there should be only one national panel for this purpose, and not several. I think I am right in that. If the noble Lord wished to make it clear that there should be only one national panel, I can tell him that it is certainly the intention that there should be only a single panel, and if the regulations attempted to provide otherwise they could be annulled by either House of Parliament. As a matter of drafting, the Secretary of State is advised that it would be incorrect to make the Amendment, for the paragraph would then refer to "the national panel" although no national panel will be in existence until it has been constituted in accordance with the regulations. I hope that I have cleared up the point and the difficulty of the noble Lord.

LORD TWEEDSMUIR

I am much obliged to the noble Lord, who has released a small ray of light into the gloom surrounding this particular matter, and I beg leave to withdraw my Amendment.

Amendment, by leave, withdrawn.

THE EARL OF SELKIRK moved, at the end of subsection (2) (b), to insert: but so that there shall be an equal balance in the number of persons forming the committee between the university representation and the other representation.

The noble Earl said: This is an Amendment to Clause 14 of the Bill and in particular to paragraph (b) (iv) of that clause. That deals with the appointment of teaching staff in the hospitals and, by extension, necessarily to the universities. By the manner in which the noble Lord handled the first question which I raised in regard to the universities, I have been confirmed in my opinion that the import- ance of the alteration in the status and position of the universities under this Bill is not fully appreciated. I will give a simple illustration of what I mean. Under statutory obligation, with regard to supplying teaching facilities, the Secretary of State is content to exercise those functions through a Regional Board on the advice of another organization. I do not think that that shows a very keen appreciation of the burden of these statutory functions. That is the first point.

I now come to this clause, the real implications of which I think are also not fully understood. Its meaning is that, in regard to any clinical appointment, the only assurance that the university will be represented at all is that there will presumably be one appointed representative on the advisory committee. That is the only assurance which is given in this Bill. I am afraid that I am not content to accept the statement from the noble Lord that the Secretary of State will discuss this matter with the universities. May I say that, as the noble Lord knows, he has already discussed that several times with the universities, and the universities are still discontented with the arrangements which have been made. I am not absolutely wedded to the words that have been put down here, but I am bound to say that the present arrangement is entirely unsatisfactory. It means that a university cannot appoint anyone—cannot even accept (and this is the extreme case) a regius professor until he has been through the procedure of this Advisory Committee and been appointed by the Regional Board. That is a completely unsatisfactory position. I would like, if I may, again to refer to the quotation which I made before, of the extreme importance of the closest co-operation between teaching and care of patients. It was emphasized that what is required is an equal balance between teaching and care of patients, and that is the correct way in which the conduct both of the hospital itself and of the appointment of teachers should be conducted.

But there is in this a very much deeper point, and I would like to refer to one statement which the noble Lord made when speaking on the Second Reading. He referred to the fact that there would have to be central negotiation—that is with the Secretary of State—on matters of remuneration. That introduces an entirely new element. Does that mean to say that the Secretary of State wishes to have a dominant say in the appointment of teachers in our free universities? It is nothing more nor less than that which is being claimed, in a somewhat invidious manner, by the clause as it stands at present. I am afraid that this is a matter on which I hold very strong opinions. The universities must be free to make their own appointments. If anyone wishes to claim autocratic powers, one of the first things he will seek to do is to get the power to appoint professors and teachers at universities. That is, in fact, substantially what will happen under this clause. The universities attach very great importance to the way in which they can make their appointments.

The Amendment which I have suggested is a very modest one, if I may say so. It suggests simply that there shall be a balance on the advisory appointments committee in which the university and other interests will be represented about equally. To my mind that is a very moderate request, but it does ensure that in the appointments the universities have a very real say. I would like to add that it is not only in the senior posts that the universities are interested; they are interested also in ensuring that all the people in the assistant posts who may have to carry out teaching are competent to do their job. There is not a great distinction between what might be called "clinical ability" and "teaching ability," but there is some distinction. The qualities for teaching are not necessarily conscientiousness and hard work; they are an ability to grasp and hold the attention of pupils so that they will learn from the leadership given by the teacher. Those are important points.

It is consistent with this that the universities have searched all over the country for the very best men for the post. There can be no two opinions on that. In circumscribing them in this way, I suggest that the Bill is undermining the strength of the Scottish medical schools at a time when it is very dangerous to do so. The noble Lord himself very correctly said in the course of Second Reading that the Scottish medical schools hold a high and unequalled position in the medical schools of the world. I am sure it is not the wish of the Secretary of State, or of His Majesty's Government, that this should be in any way impaired, but I do say, without hesitation, that the universities are very worried about the way in which this clause is at present framed. I hope the noble Lord can see his way to make some alteration to this clause. I beg to move.

Amendment moved— Page 17, line 6, at end, insert ("but so that there shall be an equal balance in the number of persons forming the committee between the university representation and the other representation").—(The Earl of Selkirk.)

5.18 p.m.

LORD SALTOUN

I should like just to support everything which my noble friend the Earl of Selkirk has said. It really hangs on what I have already said, and I sincerely hope the noble Lord, Lord Morrison, will accept this Amendment.

LORD MORRISON

The noble Earl has put up a very strong case with regard to this Amendment, much of which would not be remedied if his Amendment were passed. My difficulty is that I have to decide, not upon the case the noble Earl has put up, but upon the actual wording of the Amendment which he is endeavouring to insert in this Bill, the Amendment being that there should be an equal balance in the number of persons forming the committee. There may or may not be a great deal in what the noble Earl has said, but it does not seem to me that this Amendment would make the case any better; indeed, I think it would make it weaker merely to insist on a rigidity in which there should be an equal number. The Secretary of State takes the view that the university element on the advisory appointments committee in such a case should be in keeping with the relative importance of the teaching duties as compared with the whole work of the post. Thus, if teaching duties are to take up only a small part of the person's time, a relatively small university representation on the committee would seem appropriate. On the other hand, if the clinical duties of the hospital post were relatively less important than the teaching duties, then it might be appropriate that the university should nominate more than half the members of the selection committee.

If the Amendment which the House is considering were accepted, it would have the result that in every case the university representatives would be half of the committee; not more and no less, however important or unimportant the teaching duties in relation to the clinical duties. I would also add that there is nothing in this Bill affecting the rights of universities to appoint and pay their own teachers. Where these teachers are simultaneously to hold clinical responsibilities to the hospital organization, the hospital authorities claim the right, as recommended by the Goodenough Report, to have some say in the selection of the individuals to hold the dual posts. I hope in those circumstances the noble Earl will not import this amount of rigidity into the Bill by insisting, no matter what the circumstances, that there shall be an absolute balance.

VISCOUNT ELIBANK

The noble Lord has said that he is greatly impressed by the noble Earl's arguments; in fact, he seemed to agree with his whole thesis. As the noble Lord proceeded he told the House that the Amendment which the noble Earl had moved did not really meet what the noble Earl wanted, for certain reasons. But when the noble Lord ended his speech he stated virtually that he rejected the Amendment altogether. I was hoping, having listened to his line of argument, that before he sat down he was going to suggest to the noble Earl that the noble Earl was right, and if he would leave the Amendment the Government, on the Report stage, would produce something which would meet the noble Earl's point of view more aptly than the Amendment at present before your Lordships' House. I should like to hear from the noble Lord whether that is possible, and whether he can reconsider the Amendment, with the object of bringing into it the views of the Government, rather than having the Amendment withdrawn and allowing the whole matter to lapse.

LORD SALTOUN

Before the noble Lord replies, I may say I am getting a little confused between the hospital and the university. I suppose there is no possibility under this Bill of the situation arising that a member of the teaching staff in a university could fail to have free access to the hospital with which the university is connected. That is the question in my mind.

LORD MORRISON

Obviously, I am not in a position to answer that question off-hand, but it will be given considera- tion. I am perfectly sure that noble Lords opposite realize the position in which I am placed. I am not here as a direct representative, but merely as a Lord in Waiting in your Lordships' House to pilot this Bill through. In regard to what the noble Viscount has said, I can only say that if this matter is raised again on the Report stage, without making any promises at I will do my best to answer. I am unable to make any promise that any concession will be made, but the noble Earl does not need me to tell him that. He can raise this matter again if he so desires. I cannot say more than that.

THE EARL OF SELKIRK

I must say that I am most disappointed with what the noble Lord has said, because he is trying to water down this Amendment with reasons which, frankly, are rather woolly. He has said it is too vague and general, and it might produce too many university men or too few university men.

LORD MORRISON

I said it was rigid.

THE EARL OF SELKIRK

The noble Lord said he wanted to make the representation on the selection committee exactly representative to the clinical duties and teaching duties. One could go on arguing like that indefinitely, and get nowhere. I may recall to my noble friend what I said about the chasm which exists between the proper contacts. This Bill provides no more than the right to appoint one man to an advisory committee. I do not call that a contact at all. Would not the noble Lord undertake to put down an Amendment of his own, because we are told that all the Amendments we put forward are badly drafted? It is not our business to draft, and it is very easy to say that somebody else's Amendment is badly drafted. I think the noble Lord agrees that there is a case for adjustment here and I would ask whether he could not undertake to make some alteration. I must say that I shall ask your Lordships to see that the clause does not leave this House in this state; it must be strengthened. Will the noble Lord put down another Amendment on the Report stage?

THE EARL OF ROSEBERY

I would like to support my noble friend. We all realize that the noble Lord, Lord Morrison, is a Lord in Waiting, endeavouring to pilot this Bill through, but surely the people who are responsible for producing this Bill, and for instructing him about it, must have had some idea that an Amendment of this sort would be put in, and they must have realized that there would be a considerable amount of animadversion about Clause 14 as it stands. Apparently they thought we were going to accept this without ever being given any concrete reply by the Secretary of State or his representatives to any Amendment that might be put up on this clause. I must say that this is most unsatisfactory, and I hope that my noble friend, if he does withdraw this Amendment, will see that some Amendment to improve this position will be put down on Report stage. If on that occasion the noble Lord, Lord Morrison, says it is unsatisfactory or wrongly worded, then on the Third Reading something will have to be decided.

LORD MORRISON

Provided that the noble Earl understands clearly that I am not committing myself to anything, I am quite willing to meet the noble Earl and discuss this further, to see whether we can arrange for an Amendment to be put down. It could be an Amendment from the Government side, or an Amendment in the name of the noble Earl. I am quite willing to meet him with the officers responsible for drafting this Bill in order to discuss this—to-morrow if he likes—with a view to going into It thoroughly. So long as the noble Earl understands that I am not taking the responsibility of committing myself, I hope we may find it possible to do something in the direction the noble Earl desires. If he will be prepared to accept that, I will do my best to see that it is implemented.

THE EARL OF SELKIRK

If I understand that the noble Lord will make representations to the correct quarter, I will withdraw my Amendment.

Amendment, by leave, withdrawn.

Clause 14 agreed to.

Clause 15:

Health Centres.

15—(1) It shall be the duty of the Secretary of State to make such provision in such areas as he may deem necessary for the establishment, equipping and maintenance of premises, which shall be called "health centres," at which facilities shall he available for all or any of the following purposes:—

(b) the provision of general dental services under Part IV of this Act by dental practitioners;

LORD MORRISON

This Amendment is a Government Amendment. Together with the next two consequential Amendments it remedies a drafting defect in Clause 15 (I), by making it clear that health centres provided by the Secretary of State can include facilities to be used by education authorities for school health service purposes. The kind of provision envisaged is clinic accommodation, which could be used for sight testing, skin treatment and treatment of minor ailments, which in the early years of the new service will continue to be provided for groups of children by education authorities as part of the school health service. I beg to move.

Amendment moved— Page 17, line 28, leave out ("services which local health") and insert ("health services which local health or education").—(Lord Morrison.)

On Question, Amendment agreed to.

THE EARL OF SELKIRK moved, at the end of subsection (I), to insert: Provided that a health centre shall not be established solely for the provision of general dental services.

The noble Earl said: This is a small point which concerns and gives interest to people of the dentists' profession. They are very anxious—and I think one can appreciate their eagerness—that in the event of health centres being set up, they should not be set up for the express purpose of serving dentists, and dentists alone. I feel great sympathy for this point of view. This is a comprehensive service, of which all are expected to be an integral part. They are very glad to take part, but they do not wish to be segregated from others who practise in other aspects of the medical profession, and to be put by themselves. If the noble Lord could insert these words, I do not feel it would be unduly restrictive, because I do not think the Secretary of State would normally wish health centres to be solely for the purpose of dentistry. I know it would give great satisfaction to the dental profession.

Amendment moved— Page 13, line 33, at end insert the said proviso.—(The Earl of Selkirk).

LORD SALTOUN

Another very strong reason for supporting this Amendment is that dentists, under the national health service, as I understand it, can do only the work they arc directed to do by the doctor. That means that by the time the dentist has got half way down your gum, if he finds he must go the whole way down he has to stop, seal off, and go and fill up a form. I have just come into contact with a woman who has been in agony for three years. I said: "It is time you paid off your doctor. Up you go to my dentist.' The job was done at once, but the dentist told me that if he had had to do that under the national health service, and had drilled the tooth and found he would have to kill a nerve, instead of killing the nerve he would have had to fill up a form. It is, therefore, very important that dental services should be associated with medical services, to give them a little more authority.

LORD MORRISON

If the noble Earl and the noble Lord who have spoken on this Amendment will listen carefully, as I am sure they will do, to the reply I am going to make, I think they will find it satisfactory. In terms of Clause 15, health centres may provide facilities for all or any of six purposes; that is, general medical practice, general dental practice, pharmaceutical services, specialist: and out-patient services, local authority services, and the publication of health information. This Amendment would secure that a health centre should not be established solely for general dental practice. It is the Secretary of State's intention that health centres should provide as wide a range of health facilities as is possible and appropriate in the circumstances of each particular area. He intends that in the majority of cases there shall be provision under all six of the heads set out above, although the attitude of the local authorities concerned, and the provision already in existence for their clinic services, will determine the extent to which facilities for these services will be provided at health centres.

The Secretary of State has given repeated assurances to representatives of the dental profession in Scotland that the establishment of a chain of centres providing for dental treatment alone is no part of his plans. In practically every case, dental provision will be associated at least with provision for general medical practice, and in the tentative plans for health services which are now being worked out in the Secretary of State's Department, provision for dental treatment is always associated with provision for medical treatment in this way. At the same time the Secretary of State is not able to accept a provision in the Bill which would debar him from dealing with the exceptional case which might arise from setting up a dental centre in an area where special conditions obtain—as, for example, where there was no early prospect of a health centre being provided for medical services, but where there was an urgent need for improved facilities for dentists to carry on their work. The Amendment would debar the Secretary of State from making special provision for dentistry— in exceptional cases of this kind, and it is therefore unacceptable. If it were not that power was required to deal with the exceptional case, I should have been able to accept this Amendment, but in the circumstances I hope your Lordships will feel that the explanation I have given and the assurances given in another place, which I have repeated, are satisfactory.

THE EARL OF SELKIRK

I thank the noble Lord for what he has said. On the understanding that these powers will be used only to create a separate dental centre in very exceptional circumstances, I will accept what the noble Lord has said, and beg leave to withdraw my Amendment.

Amendment, by leave, withdrawn.

LORD MORRISON

The next two Amendments are the consequential ones I mentioned.

Amendment moved — Page 18, line 2, leave out ("services which local health") and insert ("health services which local health or education").—(Lord Morrison.)

On Question, Amendment agreed to.

Amendment moved— Page 18, line 4, after ("health") insert ("or education").—(Lord Morrison.),

On Question, Amendment agreed to.

Clause 15, as amended, agreed to.

Clauses 16 to 20 agreed to.

5.32 p.m.

Clause 21:

Proposals for provision of services by local health authority.

21.—(I) Every local health authority shall, within such period as the Secretary of State may specify, submit to the Secretary of State proposals for carrying out their duties under the next following six sections of this Act, including their duties as local supervising authority for the purposes of the Midwives (Scotland) Acts, 1915 and 1927.

The Secretary of State may specify different periods under this section for proposals relating to different duties.

THE EARL OF ELGIN AND KINCARDINE moved, after subsection (I), to insert: (2) Subject to the provisions of this section proposals submitted to the Secretary of State under the immediately preceding subsection may make provision for the local health authority entering into any arrangements with a view to securing the local co-ordination of any of the services referred to in section two of this Act, and for incurring expenditure in connexion with any such arrangements.

The noble Earl said: Clause 21 purports to deal with proposals for the provision of services by local authorities. The purpose of this Amendment is to secure that, so far as possible, it is left to local authorities to look after the services. The desire is to maintain local interest in hospital services and also to maintain the principle of properly elected representation of local health authorities on the various boards and committees proposed to be set up under the Bill. As it is proposed in the Bill, Clause 21 does not in any way give local authorities power to enter into any arrangements of this kind to secure local co-ordination of the services which is so necessary to secure the efficiency of the local health service.

I understand that discussions have taken place between the local authorities, the County Councils Association and the Secretary of State, on this matter and that Clause 30 is designed to meet this point; but my contention is that it fails to do so. Clause 30 is merely a permissive power to local authorities to make financial contributions towards the expenditure incurred by the Regional Boards. The primary consideration is to give to the local authorities power to provide in a scheme for the setting up of a co-ordinating committee, and the financial provision, if it is required at all, is quite a minor point. I beg to move.

Amendment moved— Page 21, line 13, at end, insert the said subsection.—(The Earl of Elgin and Kincardine.)

LORD MORRISON

I think the noble Earl has summed up the position in connexion with his Amendment by saying that Clause 30 fails to do what he requires. This is a very difficult Amendment for a layman to discuss. I understand that the form of words adopted in the Amendment is a form which was urged upon the Secretary of State by the Fife County Council. Probably the Clerk to the Fife County Council was the draftsman. The Government's draftsman, however, advised that from the drafting standpoint it was unacceptable—for a number of reasons. In the first place, any provision which purports to authorize a local health authority to enter into arrangements of this kind is unnecessary, because that is something they can do without express statutory power. An attempt to put power specifically in the Bill throws doubt upon their power to enter into other kinds of arrangements in connexion with the health service. In the second place, the clause deals with the machinery for the submission of proposals, and not with the content of these proposals. In the third place, the clause relates only to services provided by local health authorities under certain clauses of the present Bill. It is impossible to include in it a subsection which purports to refer to a very much wider range of services.

That is the opinion of the Government's draftsman but it is not the opinion of the Fife County Council, and therefore your Lordships will have to make up your minds, on the somewhat scanty information I have given and from your Lordships' own knowledge, whether the draftsman of the Fife County Council is more likely to be correct in his interpretation than the Government's draftsman. It is a very difficult matter, and, quite frankly, I can act only on the advice given me, and say that I am prepared to put my money on the Government's draftsman.

THE EARL OF ROSEBERY

The noble Lord does not know the Clerk to the Fife County Council if he says that. Those of us who do know that gentleman know that the noble Lord is making a very bold statement when he says he is prepared to back the opinion of the Government's draftsman against that of Mr. Mitchell. We have been given no lead in this matter; the noble Lord says he does not know which is the better opinion but he is prepared to assume that that of the Government's draftsman is the better. Would it not be better still if this matter were postponed to the Report stage, and if the noble Lord, Lord Morrison, and the noble Earl, Lord Elgin, got together, perhaps with a representative of the County Council and someone from St. Andrew's House? We could then have some considered opinion before us.

LORD MORRISON

I think the noble Earl's suggestion is an excellent one, I did not give many reasons, but I have beside me pages and pages of very learned matter dealing with this difference of opinion which has arisen between these two great men. Perhaps the noble Earl would be good enough to meet me, together with the Government's draftsman, to-morrow, and to go through with us the material which has been submitted in contravention of the opinion of the gentleman from the County of Fife. If after that he is still dissatisfied, and is still of the opinion that Clause 30 would not operate as the Government say it would, then it would be quite in order for him to revert again to the subject on the Report stage. I hope that in these circumstances the noble Earl will withdraw his Amendment.

THE EARL OF ELGIN AND KINCARDINE

With that assurance—except that I am afraid I shall not be able to meet the noble Lord to-morrow, because my duties with the Fife County Council demand that I should be in Fife—I am quite prepared to withdraw my Amendment.

Amendment, by leave, withdrawn.

Clause 21 agreed to.

Clause 22:

Care of mothers and young children.

22.—(1) It shall be the duty of every local health authority to make arrangements for the care, including in particular dental care, of expectant and nursing mothers and of children who are not attending a school under the management of an education authority and who have not attained, or are deemed under section thirty-three of the Education (Scotland) Act, 1946, not to have attained, the age of five years.

5.41 p.m.

THE EARL OF SELKIRK moved, at the end of subsection (I), to insert and of young persons (as that expression is defined in and for the purposes of the said Act).

The noble Lord said: This is a very small point. Clause 22 lays down that it shall be the duty of every local authority to make arrangements for the care—particularly dental care—of three special categories of persons, those categories being expectant mothers, children of school age, and children up to the age of five—that is, below school age. The purpose of the Amendment is to extend this by including the words "young persons". I am advised that that would cover the ages from fifteen, or from school-leaving age of sixteen, to eighteen. I understand the pupils at junior colleges will get dental treatment under arrangements made with the local authority. The junior colleges have not started yet and will not start for a considerable time, and even when they do they will probably not include all young persons up to the age of eighteen. It does seem, therefore, that young persons between sixteen and eighteen are not covered and I submit that they should be covered. I beg to move.

Amendment moved— Page 22, line 16, at end, insert the said words.—(The Earl of Selkirk.)

LORD MORRISON

The kind of provision which local authorities will make under this scheme will, of course, be related mainly to expectant and nursing mothers and young children. The kind of provision required by adolescents between fifteen and eighteen would be quite different. At the present day, young people, when they leave school, are outside the scope of any organized medical service. In future, they will be entitled to the services of a general practitioner. The kind of treatment provided for school children would be neither necessary nor appropriate in the case of these older boys and girls. The Bill provides a general dental service for the whole population. In order to ensure that the population do not suffer through any shortage of dentists, the Bill also places a supplementary duty on local authorities to provide dental care as part of the maternity and child welfare services. Education authorities have a duty to provide dental treatment for all children in junior schools, including adolescents up to the age of eighteen attending junior colleges. Moreover, the Secretary of State has said that he will be happy to consider in consultation with the dental profession, when the time comes, whether some arrangement can be devised under which preference can be given to adolescents seeking dental treatment. I hope that reply will satisfy the noble Earl, Lord Selkirk.

THE EARL OF SELKIRK

I thank the noble Lord for what he has said, but I do not quite follow the force of his argument when he says that it is neither necessary nor appropriate to provide such treatment as I have mentioned, and then adds that the Secretary of State will not provide for those who are not already covered by school dental schemes. The two things do not seem to tie up. I should be glad if the noble Lord would look at that point again. I do not wish to press the matter unduly, and I beg to withdraw my Amendment.

Amendment, by leave, withdrawn.

Clause 22 agreed to.

Clauses 23 to 33 agreed to.

Clause 34:

Arrangements for general medical services

(2) Regulations may make provision for defining the personal medical services to be provided and for securing that the arrangements will be such that all persons availing themselves of those services will receive adequate personal care and attendance, and the regulations shall include provision—

(b) for conferring a right on any person to choose, in accordance with the prescribed procedure, the medical practitioner by whom he is to be attended, subject to the consent of the practitioner so chosen and to any prescribed limit on the number of patients to be accepted by any practitioner;

(d) for the issue to patients or their personal representatives by medical practitioners providing such services as aforesaid of certificates reasonably required by them under or for the purposes of any enactment.

LORD SALTOUN moved to leave out the first two lines of subsection (2) (b), and insert: (b) for protecting the right of any person who has complied with the prescribed procedure to choose or change the.

The noble Lord said: If I should carry this Amendment I should feel rewarded for a whole year's work, because it tries to deal with a very deep-seated and widespread grievance and one that is very deeply felt. If one of your Lordships has someone ill to whom you owe affection or duty and are not quite satisfied with the diagnosis of the doctor, or if you are yourself not satisfied with your doctor, you can—with the greatest difficulty—change your doctor. It is a very difficult thing to do, but it can be done. But the ordinary patient under the national health scheme is not in that position, and that is a matter which ought to be dealt with. It is one of the hardest things in the world even for a private patient to change his doctor; and my experience has shown me that this is felt as a grievance, and felt very deeply.

People in every walk of life have told me on many occasions of their passages with a very much overworked doctor. They have told me the diagnosis and the whole history of the case and I have been satisfied that in many instances these people are perfectly genuine and are suffering from a real grievance. The only way to deal with the matter is to give the patient the power to change his doctor. The words I have put down would achieve that. I do not think there is the slightest danger that the right would be over exercised. You can safeguard it in any way you like. I will not waste your Lordships' time by enlarging upon this and I beg to move.

Amendment moved— Page 27, line 9, leave out lines 9 and I0 and insert the said new words."—(Lord Saltoun.)

LORD MORRISON

I am very much obliged to the noble Lord for helping us to get along quickly. I hope that he will forgive me if I do not make a detailed reply to this Amendment, but simply say that if noble Lords are anxious that some form of words should be included in the Bill to make it clear that a person can change his doctor, a promise can be given that a suitable Amendment will be devised for the Report stage. The present Amendment, I am advised, as it is worded has drafting defects which make it unsuitable. It is, of course, not desirable that a person should change his doctor frequently. As I say, if noble Lords responsible for this Amendment will accept this promise, I will see that an Amendment is put down for the Report stage. If they desire to consult with me before then about the wording of that Amendment I will do my best to make myself available to them.

THE EARL OF SELKIRK

May I just say a word about this? The Bill speaks of "conferring a right" on any person to choose a medical practitioner. We have always had a right in this country to choose any doctor we like—we do not require statutory authority. I do not see why it should not be put in less offensive terms.

LORD SALTOUN

It is with very deep satisfaction that I thank the noble Lord, Lord Morrison, for his assurance, and beg leave to withdraw my Amendment.

Amendment, by leave, withdrawn.

5.52 p.m.

LORD TWEEDSMUIR moved, at the end of subsection (2) to insert: (e) for ensuring that the remuneration of general practitioners shall be by way of capitation fee subject only to such supplementary basic salary as may be prescribed by regulation.

The noble Lord said: I think that the vast majority of people, both inside and outside Parliament, will agree that extra ability, extra skill, and extra work must be rewarded if we are to maintain the high standard of medical service which Scotland has always had. I know that there are certain devotees to the idea of a full-time State-salaried medical service. The Minister of Health said in another place that the time is not yet ripe for it. In the view of noble Lords who sit on these Benches, the time never will be ripe for it. Unless the greater part of the medical practitioner's remuneration is by way of capitation fee then his skill, knowledge, and industry will not be, and cannot be, reflected in his reward, nor will there be any spur to his endeavour. These, we think, are not unimportant considerations.

In our view, the capitation fee should be the basis of the reward, and what is referred to as "basic salary" should be an adjunct. What will this element "basic salary" be? How will it be calculated? We shall be very grateful if the noble Lord can give us any information about it. Is it, for instance, going to be a sort of consolation prize for those doctors who do not possess the public confidence sufficiently to build up substantial lists of patients, or is it to be paid to all practitioners, at the same rate commensurate with present earnings, in which case it might be rather an extravagant measure, for a successful general practitioner with a very big list of patients would be in receipt of a very substantial income. I am moving this Amendment believing that many noble Lords are with me in thinking that it will have the effect of ensuring that a right and proper equation between reward and merit shall be maintained. I beg to move.

Amendment moved— Page 27, line 24, at end insert the said new paragraph.—(Lord Tweedsmuir.)

LORD MORRISON

When the English Bill was discussed, both in another place and in your Lordships' House, Amendments designed to exclude any salary element from remuneration of general practitioners, except in special local circumstances, were fully discussed. One such Amendment was carried against the Government in this House, but was deleted by another place. In the discussion on the Scottish Bill an Amendment of the same kind was rejected in another place. The principal argument against the inclusion of such a provision in the Bill is that it is undesirable, and contrary to the best practice in connection with national health insurance, to incorporate in the Statute itself any limiting provisions about the method of remuneration to be adopted. This was the reason given by another place for their rejection of the Lords Amendment to the English Bill, and it was accepted in your Lordships' House when it returned.

It has frequently been stated, on behalf-of the Government, that it is not proposed that the salary element should be the main part of the remuneration. The main part of the remuneration will be by capitation, and the salary element will be a smaller part. The arguments in favour of a salary element in remuneration are: first, that it would reduce, to some extent, competition for patients. It will be especially important in health centre practice that co-operation rather than competition among the doctors should be encouraged. Secondly, it would make it easier for a young doctor to start in practice, by ensuring at least a minimum remuneration during the time while he is building up his practice and attracting patients. Thirdly, it would provide a variable element in remuneration, which could be increased to attract doctors to under-doctored areas and perhaps also to take account of special experience or qualifications. The idea of a salary element in remuneration was not invented by the present Government. The 1942 Draft Interim Report from the Medical Planning Commission sponsored by the British Medical Association, which put forward proposals for a system of general practice based on health centres, suggested that remuneration should consist in part of "a basic salary with special additions for special qualifications and length of service." The 1944 White Paper issued by the Coalition Government stated that there was "a strong case for basing future practice in a health centre on a salaried remuneration or some similar alternative which will not involve mutual competition within the centre."

Of the replies to the questionnaire issued to all doctors on behalf of the British Medical Association, after the publication of the 1944 White Paper, 62 per cent. favoured either salary alone or a basic salary in health centre remuneration, as against only 23 per cent. who favoured straightforward capitation fees. Even for practice conducted outside health centres, 5o per cent. of the replies favoured either whole-time salary or a basic salary element, as against 44 per cent. in favour of capitation fees alone. In Scotland, especially, there is really no need at all for the medical profession to discuss the inclusion of a basic salary element of remuneration, for the grants paid to the practitioners in the Highlands and Islands Medical Service over the last thirty years are, in fact, little different from basic salaries. The question whether basic salary need be a universal element in remuneration, or whether there may be circumstances in which it can be dispensed with altogether, is essentially a matter which has yet to be discussed between the Government and the medical profession. Pending these discussions with the medical profession, it is not possible to make any further statement on the subject.

THE EARL OF SELKIRK

Whilst we are very grateful to the noble Lord for his statement, it does seem to me that he has not met the main charge. The main charge is that under this Bill, as at present drafted, a State-salaried medical profession could be set up. I do not think that the noble Lord will deny that. There is nothing in this Bill to prevent the whole of the general practitioners in the profession being State-salaried personnel. We have, it is true, had a statement from the noble Lord and from the Secretary of State that it is intended that there should be a capitation element. Would the noble Lord be willing to accept an Amendment stating that the capitation element will exist in the payment of general practitioners? I think that that is an important point—it is certainly one to which the British Medical Association attach very great importance. I would like to make this clear. We are told that at the present time negotiations are proceeding. If the general practitioners' stand out—and it would need only about 500 or 600 in Scotland to stand out—the whole scheme falls to the ground.

Would it not be better to give them something in which they are really interested, in order to attract them to come into it, and to give them at least some measure of assurance that they are not going to have merely a basic salary? Payment in the Highlands and the Islands Scheme is partly by basic salary, but it is also very substantially by a capitation fee from crofters, local authorities, and panel patients. I would emphasize that the position in Scotland is entirely different from the position in England.

If this were the best solution for England, almost naturally it would not be the best solution for Scotland. The noble Lord laughs, but I will give the reason. The position is entirely different. In figures given in 1942 there were 33,000 doctors registered and trained in England, but there were 40,000 practising doctors. In Scotland the number trained was 19,000 and the number practising was 7,000. That indicates that whereas in England the task is inevitably to attract doctors from outside to under-doctored areas, in Scotland the task is to make the home market more satisfactory and attractive to these men who are being trained there. I put that point because it is important. I would suggest, if the noble Lord can give way, that this would present a more attractive proposition to the medical personnel, and a large number of our people would remain in Scotland in order to pursue their profession in that area.

LORD MORRISON

Whatever merits the noble Lord's argument may have, I would not be prepared to agree with him that this House is the authority to decide this question at a time when the medical profession itself is committed to discussions with the Government. Surely it would not be tactically wise for this House to intervene and, by a decision, make a statement on something upon which the medical profession may be far from unanimous. Therefore, I would ask the noble Lord to consider whether it would not be better for this House to wait until these discussions have taken place before making a decision on this issue.

LORD TWEEDSMUIR

I am very grateful to the noble Lord for the shower of facts he has released on the subject of a basic salary. He also told us that conversations are proceeding between the Government and the medical profession. It seems to me a very odd time for discussions to proceed.

LORD MORRISON

If I said the conversations were proceeding, I did not intend to do so. I said that it was essentially a matter which has still to be discussed between the Government and the medical profession. Both sides understand the matter has still to be discussed.

LORD TWEEDSMUIR

I misunderstood the noble Lord. I am obliged to him for the rain of facts which he has given, and as we have received some assurance from him that a capitation fee will be the main part of the doctor's remuneration, I beg leave to withdraw my Amendment.

Amendment, by leave, withdrawn.

Clause 35 agreed to.

Clause 36

Prohibition of sale of medical practices.

(2) Any person who sells or buys the goodwill or any part of the goodwill of a medical practice which it is unlawful to sell by virtue of the last foregoing subsection, shall be guilty of an offence and shall be liable on conviction on indictment to a fine not ex-ceeding—

1. (a) such amount as will in the opinion of the court secure that he derives no benefit from the offence; and
2. (b) the further amount of five hundred pounds;

or to imprisonment for a term not exceeding three months, or to both such fine and such imprisonment.

THE EARL OF SELKIRK moved, at the end of subsection (2), to insert: Provided that no offence shall be committed by a medical practitioner or his personal representative who sells his house by bona fide public auction.

The noble Earl said: This Amendment seeks in some small measure to relieve the very narrow bonds which are placed by this Bill on general practitioners. One of the noble Lord's own supporters in another place referred to this clause —subsection (3) of Clause 36—as "a disgraceful piece of workmanship." I entirely endorse that view. It is an extremely complicated measure which ties up the general practitioner's house in a manner which is seriously to his disadvantage. This Amendment seeks in a small way to alleviate that burden. It is taken straight from words which the noble Lord, Lord Morrison, uttered in the course of the Second Reading. It will be extremely interesting to see whether ministerial statements carry any weight whatsoever, or whether they are allowed to disappear as a breath of air disappears on the seashore. After all, the words we speak here to-day will soon be forgotten by everybody. There will be very few people except students of literature—

LORD SHEPHERD

Politics.

THE EARL OF SELKIRK

I had better withdraw that. There wit be very few people, except students of history, who will ever look to read what is spoken here. But the Statute has an entirely different Unless tills is put into the position. Unless this is put into the Statute what does it mean? As the Lord Advocate said in another place, it is no good quoting somebody as saying that something happened or was to happen. That is not a plea that can be made, and we have the Lord Advocate's assurance that, theoretically, it would be possible to bring an indictment many years after the transaction. That means that when a house has been sold to another general practitioner, whether by auction or not, it is possible at any time in the future to bring an action and for a person to be prosecuted for a breach of this clause. I could say a great deal more about it, because I feel that this is a quite unreasonable burden on a general practitioner. I was talking to a law agent the other day, and he said that if any general practitioner or widow of a general practitioner came to him he would say: "Sell your house to anyone except another doctor. "This is a very serious matter. It means to say that, of all people in the world, doctors are going to find it more difficult than anyone else to settle themselves in practice and buy a house. I submit that that is a most unreasonable position. The noble Lord says he is anxious to help young people to start. No doubt that is true, but anything that is certain to prevent them getting hold of material with which to practise is a very serious thing.

Amendment moved— Page 30, line II, at end to insert the said proviso.—(The Earl of Selkirk.)

LORD MORRISON

This is the second round of a contest which the noble Earl and I have had upon this point. It arises from the fact that under this Bill a sum totalling £66,000,000 is provided, to be shared between the doctors in Scotland and the doctors south of the Border, in respect of the consequent loss of the capital value of practices. It is necessary for the Bill to include provision making sure that a kind of black market in doctors' practices cannot arise. This is achieved by Clause 36, subsection (3) of which strikes at the sale of doctors' houses at a price which includes any element for goodwill of the practice if that sale is made knowingly to another doctor for the purposes of his practice. The Amendment proposes that the Bill should declare that no offence shall be committed where a doctor's house is sold by bona fide public auction. The noble Earl raised this on Second Reading, and I replied giving him an assurance—which I gather he is not so keen to accept. It all boils down to what is the value of a Parliamentary assurance.

In the first place, the Amendment is unnecessary. The same question was raised in another place, and in reply, on Report stage, the Lord Advocate—who is the person responsible for the initiation of all criminal proceedings in Scotland—said that it seemed to him that: where a doctor's house is sold at a genuine auction sale there could be no danger of prosecution. The fact that a sum was paid at such a genuine auction by a purchaser who had no prior agreement with the seller, would negative any suggestion that the price contained an element of goodwill. The Lord Advocate could not conceive of a genuine auction where the parties had no kind of prior agreement, in connexion with which there could be any suggestion of prosecution. On the other hand the sale of a doctor's house at an inflated price is one of the devices which might most readily lend itself to illegal transactions. The insertion of a provision such as proposed in the Amendment would raise real difficulties, for it would be a temptation to people who wished to defeat the law to make a private arrangement and then cover it by a public auction with every appearance of good faith. Difficult legal questions as to the meaning of such an imprecise expression as "bona fide public auction" might well arise, and lead to complicated and extensive litigation.

The noble Earl asked me the direct question: If my sentiments are as I expressed them on Second Reading, why should this provision not be in the Bill? The short answer to him is that I am advised—and I think he will be if he seeks legal advice—that the Amendment would enable a coach and horses to be driven through the Bill. I know perfectly well that the noble Earl does not want that to happen, and, in view of the Lord Advocate's observations in another place, I hope that the noble Earl might be prepared to withdraw his Amendment. In conclusion, I would only say that I have spent a great deal of time upon this particular Amendment, because I wanted to see whether it was possible to accept it, but my final advice is that, if the Amendment were accepted, it would be almost impossible to prevent a coach and horses being driven through the Act. The Government are anxious that that should not be done, and that no encouragement should be given to enterprising people who try to get behind the law. I ask the noble Lord to support me in that desire and to withdraw his Amendment.

THE EARL OF SELKIRK

I find it most difficult to reconcile what the Lord Advocate is quoted to have said—that he finds it almost impossible to conceive of a case in which a prosecution would arise —with what the noble Lord says—that a carriage and four could be driven through the Act.

LORD MORRISON

No, no.

THE EARL OF SELKIRK

That is precisely what you said.

LORD MORRISON

That with the inclusion of the noble Earl's Amendment a carriage and four could he driven through the Act. That is what I said.

THE EARL OF SELKIRK

If I may respectfully say so, the Amendment which I have moved simply authorizes what the Lord Advocate says could not give rise to a prosecution. May I point out, in any case, that even when this Amendment went through, it would still be illegal to sell a practice. That still remains an illegal action; it still remains an offence. And I will mention one further example. It still remains an offence to rig an auction sale. Therefore, you are liable for two offences. All that my Amendment seeks to do is to make it a little easier for a doctor to get rid of his house, or to buy another one. May I give the noble Lord one specific example? I am taking this example from the Committee stage in another place. It was taken as an example, I think by one of the Government spokesmen. Suppose a house worth £2,000 were sold for £3,500. I do not know whether that is considered as substantially more or not, but it is common knowledge that any house worth £2,000 before the war would be a very good "buy" at £3,500 to-day.

Now look at it from the other angle. Suppose in ten years' time we review the inflated prices of houses in the year 1945, and suppose by the year 1955 (I do not suggest that with the present financial policy we shall) we drop to the housing values of 1938, or even earlier; would not to-day's prices, in the view of an ordinary jury, look extremely inflated? Would it not be easy to prosecute general practitioners who had in fact changed their houses during this inflationary period? Frankly I do not see why a carriage and pair could be drven through this Bill. After all, auction sales have been going on for a very long time —for several hundred years—and there are regular rules under which they should be conducted. Does not the noble Lord think that there may be other methods by which this difficulty can be overcome?

LORD MORRISON

I am sorry but in this matter I cannot agree with the noble Earl. There is no question that the auctioneer would probably be entirely innocent, and would not know anything at all about what happened. The offence might be committed far away from the auction sale. I am advised—and one can easily imagine the position—that in such a case as the noble Earl has mentioned it would be possible for a bidder to approach the buyer and arrange with him to bid up the property, and indeed probably find another bidder to support him, in bidding up to a certain agreed figure, which would cover not only the value of the property but so much for the practice. At any rate, this need not have anything to do with the auction sale at all. It could be carried out without the auctioneer having any knowledge that anything wrong was being done; so that factor does not come into the matter. But I am perfectly sure in my own mind that it would be possible for abuses to take place. I know that the noble Earl does not want any shady practices to go on in these matters, any more than any of the rest of us, and I am sure he would not wish to open a doorway to enable that sort of thing to happen.

THE EARL OF SELKIRK

The noble Lord is no doubt aware that the procedure which he suggests is already illegal. That amounts to the rig of an auction sale, and if the noble Lord proceeds in that way he will in due course be prosecuted for doing so. He does not require this Amendment to be prosecuted. He may be prosecuted in the ordinary way. What I wish to press is this. A general practitioner now would not dare to pat up his house for auction, because, if he did so and the house was bought at an inflated price by another general practitioner, he would be liable to prosecution. What does he do? He cannot tell the medical practices committee, because he does not know the price. It just means to say that a general practitioner is prevented from selling his house by public auction. I am putting this to the noble Lord because I think the position is most unreasonable. Auctioning is a very normal way to sell, and I do not see why a medical practitioner should be excluded from such a course that has been pursued on many occasions.

LORD MORRISON

May I make one suggestion to the noble Earl? I suggest that between now and the Report stage he should consult with legal advisers as to whether the words "bona fide public auction" are legally water-tight, see what those legal advisers say, and act accordingly on the Report stage.

THE EARL OF SELKIRK

In those circumstances, I will withdraw my Amendment, but I reserve the right to put it down on the Report stage if I think fit.

Amendment, by leave, withdrawn.

Clause 36 agreed to.

Clauses 37 to 42 agreed to.

Clause 43:

Disqualification of persons providing services.

(7) Regulations shall make provision—

1. (a) with regard to the procedure for the holding of inquiries by the Tribunal and for the making and determining of appeals to the Secretary of State under this section 639 and, in particular, for securing that any person who is the subject of an inquiry by the Tribunal under this section shall have an opportunity—
2. (ii) of being heard by the Tribunal or the person so appointed and of calling witnesses and producing other evidence on his behalf;

and that the hearing, whether by the Tribunal or the person appointed as aforesaid, shall be in public if the person who is the subject of the inquiry so requests;

6.20 p.m.

THE EARL OF SELKIRK moved, after subsection (7) (a) (ii) to insert: (iii) Of being informed at the time of the representation made by an Executive Council of the details of any charge or complaint that may have been laid.

The noble Earl said: This is a very short point on the procedure which is to be adopted in the tribunal before which general practitioners may be brought in the event of unsatisfactory conduct. The Amendment proposes what is the normal process of any criminal court (and, after all, this amounts, in effect, to a criminal case) that the persons accused should have the right to know exactly what the complaints are against them. That is very desirable in order that, if other things are subsequently divulged, they may know that they are not being charged over a wide and unlimited sphere. I feel that this is a reasonable proposition, and I would ask the noble Lord to consider it. I beg to move.

Amendment moved— Page 39, line 26, at end insert, the said sub-paragraph.—(The Earl of Selkirk.)

LORD MORRISON

I am advised that there is no doubt that the regulations to be made under the subsection will, in fact, provide for the person concerned being supplied with a statement of the complaints that are made against him. But if the noble Earl feels it is desirable to make this plain on the face of the Bill, I am prepared to give a promise that appropriate words will be devised for insertion on the Report stage. Here again I am advised that the wording of the noble Earl's Amendment is defective in drafting and does not come in at quite the right place in the clause.

THE EARL OF SELKIRK

I thank the noble Lord for what he has said and I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

THE EARL OF SELKIRK: moved, at the end of subsection (7) to insert: It is hereby declared for the avoidance of doubt that no admission or statement made by any person who is the subject of an inquiry by the tribunal under this section at a hearing by an Executive Council shall be admissible is evidence before the tribunal.

The noble Earl said: This deals with the same part of the Bill. It refers to part of the procedure which will take place before the tribunal, and endeavours to establish that any admissions made by a doctor under examination will not be used in that form before the tribunal at a later stage. In this country we do not use the process known in France as the juge d'instruction—the investigating judge; that has never been used here. No evidence is allowed except that which is taken before the tribunal itself. The tribunal can take evidence on oath in the ordinary course of events. I suggest it is proper that this protection in what normally would amount to a criminal procedure should be allowed. I think there are special reasons for it. The investigation undertaken by the Executive Committee is far more likely to be satisfactory and full if the man upon whom the investigation is being carried out knows that anything he says will not be used as evidence against him at a later date, and that the whole of the evidence has to be submitted in proper form to the tribunal. I beg to move.

Amendment moved— Page 39, line 43, at end insert the said words.—(The Earl of Selkirk.)

LORD MORRISON

The noble Earl has explained this Amendment so clearly that I do not think I need take up the time of the House in going into detail about it, beyond saying that I agree with him. It is essential that the hearing before the tribunal should be a completely independent inquiry into the facts. If the noble Earl will not press me to make any definite commitment, I am quite willing to consider the matter further before the Report stage. I would be obliged if he would leave the decision on this point to the Report stage.

THE EARL OF SELKIRK

I thank the noble Lord very much for what he has said, and I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

Clause 43 agreed to.

Clause 44 agreed to.

Clause 45:

Recovery of charges in respect of certain appliances and dental treatment.

45.—(1) Regulations may provide for the making and recovery by persons providing general dental services or supplementary ophthalmic services of charges in respect of—

1. (a) the supply, as part of those services, of any dental or optical appliance which is, at the request of the person supplied, of a more expensive type than the type which would normally be supplied, or the replacement or repair of any such appliance; or
2. (b) the replacement or repair of any dental or optical appliance supplied as part of the services aforesaid, if it is determined in the prescribed manner that the replacement or repair is necessitated by lack of care on the part of the person supplied.

THE EARL OF ROSEBERY moved, at the end of subsection (I) to insert— or (c) the giving of dental treatment which is more costly or elaborate than that provided in connexion with the general dental services if such treatment is provided at the request of the person treated and such person furnishes a certificate to that effect.

The noble Earl said: In moving this Amendment, which stands in the name of my noble friend the Earl of Selkirk, I want to try and put something into this Bill which would give some incentive to dentists to improve their work and make it more efficient. The dentists themselves feel this very much indeed. What we want to make quite clear is that, as part of the general dental services, a patient may receive more expensive or more elaborate treatment than that provided by the State, and at the same time receive a grant in aid. Unless this principle is accepted, the leading dentists will not participate, because they will not be prepared to accept remuneration on the normal scale.

Moreover, I should like to submit that if the patient desires to pay the higher fee demanded by such practitioners there is no reason why he should not be refunded by the State the amount which would have been paid had the treatment been afforded by a practitioner who was content to accept the standard rate of fee. Those of your Lordships who were here on the Second Reading may remember that I commented rather fully on this clause at that time. What this Bill does at the present time is to grade down the efficiency of the dentists at the expense of their clients, who will feel it in more ways than one! There is no incentive under this Bill. It turns the dentist into a general utility dentist with no incentive to improve his work or his amenities in any way. In fact, as I said before, if the dentist does try to improve his facilities it is more expensive for him. He will have only the same fee under this Bill and he is worse off by trying to improve his amenities and his dentistry than he would be if he were content to keep in the common rut. I know it is true Socialism to keep people on a dead level, and the only way to keep people on a dead level is to reduce effiiency—

LORD SHEPHERD

Not "dead."

THE EARL OF ROSEBERY

Not dead, but moribund. This may be Socialism, but it is bad dentistry. It is bad both for the dentists and for their patients. I beg to move.

Amendment moved— Page 41, line 14, at end insert the said paragraph.—(The Earl of Rosebery.)

LORD MORRISON

Subsection (2) of the clause as it stands in the Bill makes provision for charges being paid by the patient to the dentist in respect of special dental treatment to be prescribed in the regulations. The purpose of this provision is to meet the case where a patient asks for a form of treatment which is more costly or elaborate than is required on clinical grounds—for example, gold fillings, where fillings of a less costly material would be equally good from the clinical point of view. The intention is that in such cases—the nature of which will be settled in consultation with the profession—the patient should pay the dentist the extra cost of the method of treatment he chooses over and above the cost of the normal type of treatment in respect of which the dentist will receive payment through the service in the ordinary way. This seems to be what the present Amendment has in view. The Secretary of State is unable to countenance an arrangement whereby patients in the service would get better—and not merely more luxurious or more expensive—treatment by paying extra. Where the dentist is paid on a salaried or sessional basis at a health centre, the difficulty will not arise; and the more experienced dentists will obtain additional remuneration in other ways, by holding part-time appointments in the hospital and specialist service. In short, I think this Amendment is intended to make it possible to set up what I might call a dental Harley Street, and I regret I am unable to accept it.

LORD SALTOUN

Can the noble Lord give the House an assurance that any patient who wants gold filling can get it under the Bill, if he is willing to pay for it? I believe that nearly every other filling that has yet been discovered has chemical reactions which generally result in the destruction of the tooth to which it is applied. The only satisfactory filling, as far as I can make out, is gold filling. Therefore, I would very much like to get an assurance from the noble Lord that a patient who is willing to pay for gold can get it, because I do not understand that from his answer.

LORD MORRISON

I think the difficulty is that there are some dentists of whom it is said that they are better than others, and this would enable them to gain a reputation, just as many people know that they can get a much better practice if they manage to obtain a room in Harley Street.

LORD SALTOUN

I applied myself to the noble Lord's own argument, that gold filling in a tooth is much better.

THE EARL OF ROSEBERY

I will not detain the noble Lord any longer, because he seems adamant about this Amendment, which I should like to see passed. I do not at all agree with him about a Harley Street in Edinburgh. In the first place, perhaps I do not know so much about Harley Street as I should, but what I really want is that people should have the incentive to become more efficient. I understood the noble Lord to say that he was afraid that some people would get better dentistry than others. I am all in favour of that, because if some people get better dentistry than others the standard is raised, and you gradually get the other people getting better dentistry. That is the whole idea of enterprise, which I do not think is sufficiently thought out on many occasions on the Government Benches. It makes for better dentistry because dentists are only too happy to pass on anything they discover. What we want is to try and get better dentistry, if only for the few, because then the many will follow. In this Bill there is no such incentive. The noble Lord says that there is, but I am sorry to say I cannot agree with him. However, as he says he will not accept my Amendment, I ask leave to withdraw it.

Amendment, by leave, withdrawn.

Clause 45 agreed to.

Clauses 46 and 47 agreed to.

Clause 48 [Provision of courses for persons providing services]:

THE EARL OF SELKIRK

I do not know if the noble Lord can answer this question. Clause 48 states that certain courses are available for persons providing services under this part of the Bill. What I would like to know is why it is confined to this part of the Bill. Why are the services not operating for those under any part of the Bill? There may be a very good reason for it, and perhaps the noble Lord could refer to it on the Report stage.

LORD MORRISON

I do not know the answer to the noble Earl's question at the moment, but I will see that he does receive an answer to it.

Clause 48 agreed to.

Clause 49 [Functions of Secretary of State under Lunacy and Mental Deficiency Acts]:

6.35 p.m.

THE EARL OF SELKIRK had given notice to move, after subsection (6) to insert: (7) Periodical reports of the medical committee of the General Board on all hospitals visited shall be made to the Secretary of State and shall also be available to the General Board and to any Regional Hospital Board and board of management concerned.

The noble Earl said: The Amendment which I am proposing in Clause 49 deals with the reports of the medical commissioners of the General Board of Control. I should perhaps say that there is a clerical error in the Amendment, and it should read: "periodical reports of the medical commissioners," and not, "the medical committee." I hope the noble Lord will accept that minor correction. The memorandum on the Bill, and indeed most statements on this measure, indicate that there are very small changes in the existence, structure and position of the general Board of Control; but in actual fact the position of the Board is entirely changed by the Bill. I raised certain points on the Second Reading in regard to this matter, and I must confess that I was not entirely satisfied then, particularly because the noble Lord, Lord Morrison, made a very disturbing remark. He said that the medical commissioners would be acting in a dual capacity.

Now the whole basis of the Board of Control is that they are entirely independent commissioners who hold the Royal Commission. How can they act in a dual capacity, partly under the General Board of Control, and partly under the Department of Health? I was very greatly disturbed when I heard that, and the purpose of this Amendment—and it is an extremely small Amendment—is to emphasize the importance of the General Board of Control, who are responsible for the liberty of the subject and who are responsible for the whole wellbeing of the inmates of mental hospitals. If the noble Lord ever goes to a mental hospital—he may be visiting, no doubt as part of his duties in the Scottish Office—

LORD MORRISON

I am sorry to interrupt the noble Lord, but I would like to say that for over ten years I was a member of the visiting committee of one of the largest mental hospitals.

THE EARL OF SELKIRK

Then the noble Lord knows very well that if he goes to any mental hospital—particularly if he is a member of the visiting committee—the inmates will come to him repeatedly and say, "I am perfectly all right; will you please arrange for my discharge? "There is a very strong desire for liberty among all the people in those hospitals, and it is a most delicate matter as to when they are fit for discharge and when they are not, and one which, to my mind, should be decided by an entirely independent General Board of Control. I am moving this Amendment to emphasize the independent position of the General Board of Control. As I say, it has been emphasized that its functions are undisturbed, but I am afraid that I cannot accept that. Its functions are considerably disturbed, and I think further emphasis is required to bring out that it is an independent body and not simply the servant of the Secretary of State. The statement that the commissioners are dual in their responsibility is disturbing, and I hope the noble Lord will be able to enlarge upon that and possibly to deny it when he comes to reply. I beg to move.

Amendment moved— Page 42, line 41, at end insert the said subsection, as amended—(The Earl of Selkirk.)

LORD MORRISON

If my recollection is right, during the Second Reading I explained to the noble Earl that the responsibility of providing and running mental hospitals and mental deficiency institutions will in future rest with the Secretary of State. The General Board of Control will, however, continue to exercise all its existing functions relating to the liberty of the subject and the interest of the patient as an individual. Moreover, in perforating his functions relating to mental illness or mental deficiency the Secretary of State is required to consult the General Board of Control. In practice—and this applies to the question the noble Earl has asked—a system of dual appointments is envisaged whereby the medical commissioners—that is, the medical members of the General Board of Control—and also the medical officers employed by the Board, will at the same time hold appointments as officers of the Secretary of State. This will ensure that both the Board and the Secretary of State will discharge their respective functions with full appreciation of the whole position before them. Reports by these medical men of their visits to particular institutions will cover the interests both of the Secretary of State and of the Board. They will be reports both to the Secretary of State and to the Board. In the great majority of cases they will no doubt be communicated also to the Regional Board and the board of management concerned. There may, however, be exceptional cases where a communication to both Boards might be desirable. All these are matters of administration, and not matters for which provision can suitably be made in an Act of Parliament. With these explanations and assurances, I invite the noble Earl to withdraw his Amendment.

THE EARL OF SELKIRK

Would the noble Lord he willing to accept this Amendment with the deletion of the words, "and to any Regional Hospital Board and board of management." He has said that the reports will be communicated to the Secretary of State and to the General Board of Control. Now I am emphasizing this for this reason. It has been repeatedly stated that the position of the General Board of Control is unchanged; but in fact it is very much changed. Its members are now no longer independent members; they are to be employed partly in the Department of Health. There is no reason for that; they could continue to be entirely separate, and to make reports to the managers or to the proprietor of the hospital—formerly the local authority, and to-day the Secretary of State. Their relationship could have been exactly the same, but, deliberately and purposefully, their functions have been changed. I would ask the noble Lord to consider that point. This Amendment would, in some measure, ensure that they retained their independence.

LORD MORRISON

I am not able at the moment to answer the noble Earl's question as to whether I would accept such an Amendment, but if the noble Earl will put down such an Amendment on the Report stage I shall then be able to tell him whether I can accept it or not. I cannot go any further than that.

THE EARL OF SELKIRK

I am bound to say that I do not think that reply is very satisfactory. After all, anyone can put down an Amendment on the Report stage. I have been trying to emphasize something which I think is in the general interest—namely, the independence of the General Board of Control. I am very sorry that the noble Lord cannot see his way either to accept any part of this Amendment or to put forward an alternative suggestion.

LORD MORRISON

May I put it in another way? If the noble Earl will confer with me with a view to altering his Amendment, I shall be prepared to give consideration to it on the Report stage, if that does not commit me to acceptance of it.

THE EARL OF SELKIRK

I thank the noble Lord very much, and in those circumstances I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

Clause 49 agreed to.

Clauses 5o to 66 agreed to.

Clause 67:

Transfer and compensation of officers,

67.—(1) Regulations shall provide— (c) for the payment of compensation subject to any prescribed exceptions or conditions, by the Secretary of State or such local health authority as may be prescribed, to persons who immediately before the appointed day— (i) devoted the whole of their time to employment by the governing body of a voluntary hospital, a local authority, an insurance committee or any such other body as may be prescribed, or to any combination of such employments; and

THE EARL OF SELKIRK moved, in subsection (I) (c) (i), after "hospital" to insert: Or to employment by an officer of such body for work on behalf of such body or to employment by.

The noble Earl said: This is a small point. There are, at the moment, a certain number of permanently employed personnel engaged in hospital work who are employed by part-time chiefs, and I am asking the noble Lord to accept them as personnel who will be transferred or who, alternatively, will receive compensation. It is a reasonable request, and I would like the noble Lord to consider it carefully. These men are losing their jobs, not through any fault of their own, not through any chance of nature, but through the deliberate and calculated policy of His Majesty's Government. I think they are, therefore, worthy of consideration. To take a recent example, we have heard that the miners in Durham arc to be compensated to the extent of £50,000 because they were put out of work for reasons which had nothing to do with themselves. I think we all sympathize with that action, and appreciate the reasons for it. Equally, if a man loses his job through the calculated and deliberate policy of His Majesty's Government, he is, I suggest, worthy of consideration. I beg to move.

Amendment moved— Page 54, line 38, after ("hospital") insert ("or to employment by an officer of such body for work on behalf of such body or to employment by").—(The Earl of Selkirk.)

LORD MORRISON

I think the kind of case which the noble Earl has in mind as likely to arise is where a voluntary hospital employs, for instance, a lawyer in private practice as part-time secretary and where the lawyer in turn employs someone in his office full-time on the work of the voluntary hospital. Very careful consideration has been given to the basis for payment of compensation in respect of loss of employment caused by the major reorganizations of industries and social services which the Government are undertaking. For example, the National Insurance Act had to make provision for displaced officers of approved societies. The National Health Service Act made similar provision in England to that in the present Bill for persons engaged on hospital, local authority and insurance committee work. In all these cases compensation has been provided only for whole-time officers of the body whose position is affected, and not for persons employed indirectly. Persons who have been employed indirectly in this way have never had any contract with the body concerned, and have held no security of tenure under that body.

The problem at the start of the new service will not be a superfluity of manpower. Quite the contrary will be the case; it will be very difficult to find staff with the qualifications and experience necessary to administer the new service. In these circumstances, persons with experience in hospital administration need have no real fear that they will have difficulty in finding suitable employment in the new service. While, of course, the Secretary of State is unable to commit himself to find employment for particular individuals, he would certainly be prepared to do what he could in any cases of this kind that were brought to his notice, where the person concerned had difficulty in finding employment after the appointed day. I think there is little prospect that the principle of the proposed Amendment could be accepted by the Government in any circumstances. It is much too far-reaching for that. In any event it would be quite unjustifiable to do what the Amendment proposes, and to limit compensation for whole-time servants of part-time officers to persons working in the voluntary hospital field. A similar provision would be necessary at least for part-time officers with whole-time clerks to insurance committees.

THE EARL or SELKIRK

I thank the noble Lord for what he has said. May I take it that any man who, as a result of the lapsing of a particular job through the operation of this Act, finds himself without work may have his affairs referred to the Secretary of State? In those circumstances I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

Clause 67 agreed to

Clauses 68 to 76 agreed to.

Clause 77 [Arbitration]:

LORD MORRISON moved, at the end of the clause to insert: and at any stage in he proceedings in any such arbitration the arbitration may and shaft if so directed by the Court of Session state a case for the opinion of that Court on any question of law arising in the arbitration.

The noble Lord said: This is a Government Amendment which extends the procedure laid down in the Bill to be followed when arbitration is resorted to in cases of dispute. These cases arise mainly in connexion with the transfer of hospitals to the Secretary of State—for example, under Clause 6 (6) dealing with the apportionment of voluntary hospital property which is partly transferred. There may frequently be legal questions at issue in these arbitrations, involving the interpretation of the provisions of the Act. It is, therefore, appropriate that the arbiter should be able to seek the opinion of the court on any such question; and indeed that any party to the arbitration should be able to apply to the court for a direction to the arbiter to seek such an opinion. This is achieved by the addition to Clause 77 made in the Amendment. I beg to move.

Amendment moved— Page 59, line 12, at end insert the said words.—(Lord Morrison.)

On Question, Amendment agreed to.

Clause 77, as amended, agreed to.

Clauses 78 to 81 agreed to.

First Schedule agreed to.

Second Schedule:

Hospital Endowments Commission.

I. The Hospital Endowments Commission shall consist of a chairman appointed by the Secretary of State and such number of other members so appointed as the Secretary of State may from time to time determine.

THE EARL OF SELKIRK moved in Paragraph I to leave oat "Secretary of State" where that tern first occurs and insert: Lord President of the Court of Session.

The noble Earl said: In the course of the Second Reading of this Bill the noble Lord admitted that the powers of the Secretary of State were excessive and he more or less apologized to the House for the scope and powers which the Secretary of State was taking to himself under this Bill. He went on to say this: It has been asked over and over again whether it is possible to devise any system under which those who do not pay the piper will, still be enabled to call the tune. If somebody would be good enough at some time to answer that problem I should be very grateful.

In moving this Amendment, I am neither affecting the person who is to pay the piper nor reducing the power of the Secretary of State. If the noble Lord's statement was bluff I should be very glad to know it. This is, in fact, a perfectly straightforward request. The Endowments Commission, we all agree, are a most important Commission, in whose results the Secretary of State is personally interested, because they affect his property. If the Lord President of the Council appoints the Chairman of that Commission it will undoubtedly give the Commission independence which will add to the respect with which that Commission's results, duties, and work, will be viewed by the community, and to the confidence with which the Commission will be regarded in the future. I beg to move this Amendment.

Amendment moved— Page 63, line 12. Leave out ("Secretary of State") and insert ("Lord President of the Court of Session").—(The Earl of Selkirk.)

LORD MORRISON

This is the last Amendment and I would have been much happier, thankful as I am for the forbearance of noble Lords during these long passages, if I could have ended on a note of triumph by accepting the Amendment, but, alas, it is not so. Schedule 2 of the Bill proposes that the Hospital Endowments Commission which have to re-allocate the endowments of voluntary hospitals shall consist of a chairman appointed by the Secretary of State and that such number of other members shall be appointed as the Secretary of State may from time to time determine. The noble Earl, Lord Selkirk, has just put forward an Amendment to place the appointment in the hands of the Lord President of the Court of Session, while leaving the Secretary of State to determine the number of members. May I point out that there is provision in the Eighth Schedule of the Bill for the Lord President to appoint the chairman of the tribunal which deals with representations that individual practitioners should be excluded from the service. This, however, is not a parallel case, for the Council's advocate must be a practising advocate or solicitor, with not less than ten years' practice of a judicial nature. The Secretary of State does not think it would be proper to invite the Lord President to make appointments of this kind, of men who are not appointed because of their judicial knowledge but for their general training and experience in public life. That is the explanation I have to give to the noble Lord.

THE EARL OF SELKIRK

I thank the noble Lord for what he has said, but I assure him that next time he asks me to propose a solution I shall take it much less seriously.

Amendment, by leave, withdrawn.

Remaining Schedules agreed to.

House resumed.