HL Deb 15 May 1947 vol 147 cc745-62

Amendments reported (according to Order).

Clause 8:

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. In framing any such scheme the Commission shall have special regard to— (c) the interests of the hospital and specialist services. (7) The powers of the Hospital Endowments Commission shall terminate on the expiry of five years from the appointed day;

LORD MORRISON

My Lords, this Amendment and the two following con- sequential Amendments have been put down to meet the point raised by the noble Earl, Lord Elgin, on the Committee stage of the Bill. The noble Earl wished it to be made clear on the face of the clause that the purposes to which endowments could be allocated in the future by the Hospital Endowments Commission should be purposes within the field of the hospital services. I resisted the Amendment which the noble Earl had on the Paper, but on further consideration of the position it has been found possible to devise words which will secure the noble Earl's object as the Government understood it.

Amendment moved— Page 9,, line 13, after ("fit") insert ("being purposes relating to hospital or specialist services or to research into any such matters as are mentioned in section seventeen of this Act.")—(Lord Morrison.)

On Question, Amendment agreed to.

Amendment moved— Page 9, line 18, at end insert ("and").—(Lord Morrison.)

On Question, Amendment agreed to.

Amendment moved— Page 9, line 21, leave out from ("otherwise") to end of line 22.—(Lord Morrison.)

On Question, Amendment agreed to.

THE EARL OF ELGIN AND KINCARDINE moved, in Subsection (7), to leave out "five" and insert "seven." The noble Earl said: My Lords, this was a point which I raised in the Committee stage with regard to the question whether the Commission would have adequate time to fulfil their task. I said then that I spoke with some experience of the Educational Endowments Commission, which was given a period of three years to accomplish its task but which was actually re-appointed year after year for a period of eight years, and had not then finished its task. I believe my right honourable friend, the Secretary of State, who was also a member of the Educational Endowments Commission, and I are entirely at one on this occasion in saying that the proper body to settle this question is the Commission which is to be appointed. It is, therefore, a question of the estimate of the time necessary.

The noble Lord, Lord Morrison, replying to my Amendment on the last stage of the Bill, said that the period I then asked for—ten years—might lead to dilatoriness on the part of the Commission. I do not think that any Commission so appointed would be likely to be dilatory in their work, but possibly the period of ten years was an overestimate of the task. It is very difficult to know before-hand, and I am, therefore, quite willing to compromise and suggest a term of seven years instead of ten years, if that would be agreeable to the Secretary of State. From the discussions which I have had recently, I think that the Secretary of State and I are entirely at one on the principle that the Commission should finish its task. It is a question of the estimate of the period of time required. I beg to move.

Amendment moved— Page 10, line 7, leave out ("five") and insert ("seven").—(The Earl of Elgin and Kincardine.)

LORD MORRISON

I understand there is no objection to the compromise Amendment of the noble Earl, Lord Elgin, and I am quite willing that it should be accepted.

On Question, Amendment agreed to.

Clause II [Regional Hospital Boards, Medical Education Committees and Boards of Management]:

LORD MORRISON moved, at the end of subsection (5) to insert "and any other organization which appears to the Board to be concerned." The noble Lord said: My Lords, this Amendment has been put down in fulfilment of a promise which I gave to the noble Earl, Lord Rosebery, on the Committee stage of the Bill. That was a promise that suitable words would be found for insertion in subsection (5) of Clause II so as specifically to require Regional Hospital Boards to have wider consultations than with universities alone in framing their schemes for the constitution of boards of managements of hospitals or groups of hospitals. The form of words adopted is the same as that used in subsection (2) of the clause, with the necessary adaptation. The noble Earl, Lord Rosebery, has informed me that he is unable to be present this afternoon, but I understand that this form of Amendment has been agreed with the noble Earl. I beg to move.

Amendment moved— Page 13, line 46, at end, insert: ("and any other body or organization which appears to the board to be concerned").—(Lord Morrison.)

On Question, Amendment 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 consisiting 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;

THE MARQUESS OF LINLITHGOW moved, at the end of subsection (2)(b) to insert: the number of persons nominated under this sub-paragraph being, except in such circumstances as may be prescribed, equal to one half of the total number of members of the committee.

The noble Marquess said: My Lords, your Lordships were made aware during the earlier stages of this Bill of the anxiety with which certain of its provisions have been viewed by the universities in Scotland responsible for the medical schools and for the appointment of teachers in those schools. It would be out of place for me on the Report stage, I suppose, to repeat at any length the arguments already heard by the House, and I shall detain your Lordships for only a moment.

Your Lordships will, I am sure, agree that the point where the teacher and the student together come into contact with the clinical aspect of medicine and surgery—that is, the ward or the operating theatre, as the case may be—is the growing point of progressive medicine in knowledge and practice; and to damage in the least degree the effective interplay of functions that obtain at that critical point would be a big disservice to the future of medicine and so to mankind. The authorities and the teaching schools have been apprehensive that the effect of Clause 14, as originally drafted, might in practice be to deprive the universities of their proper share and discretion in selecting those persons who are to combine the functions of teaching with clinical exercise. The Amendment standing in my name will, I believe, go very far to remove the anxieties felt by the universities in this respect. I understand that three categories of appointments are concerned. The first and highest category is the appointment of persons to hold Chairs—that is, the professors—and the intention, I understand, is that those appointments should lie altogether outside the scope of Clause 14. I understand from what was said by the noble Lord in charge of the Bill in Committee that the Secretary of State intends to discuss with the university authorities the precise arrangements which will apply in the case of those professorial posts.

I come to the second category—appointments to the more important teaching posts, apart from the professorial appointments. That is the category to which my Amendment is principally addressed. Lastly, I come to the appointments to the teaching posts of minor importance, for which purpose the constitution of the appointing body will be prescribed by the Secretary of State under regulations. I understand that as regards that third category, and the method of appointment applicable to it, the Secretary of State will in every case place himself in touch with the university authorities before he finally decides the composition of the appointing body. I should be very much obliged if the noble Lord in charge of the Bill could see his way to confirm the accuracy of that. The university authorities, in their turn, will be found willing, I understand, to follow the suggestion in the Goodenough Report, that in making their appointments they should consult the Regional Boards and boards of management of hospitals. I have great hope that the noble Lord opposite will be willing to accept this Amendment. Its inclusion in the Bill would remove, at any rate, a large part of the anxieties of those university authorities who bear the very heavy responsibility of securing the continuing efficiency of teaching in the medical schools. I beg to move.

Amendment moved— Page 17, line 6, at end insert the said words.—(The Marquess of Linlithgow.)

LORD SALTOUN

My Lords, I hope that my noble friend will accept this Amendment. He knows as well as I do the tremendous part played by the universities in Scottish social life. Only yesterday your Lordship heard from the Benches opposite how very much more important those universities are in Scotland than they are in the South, although I doubt if my noble friend could name correctly the five Scottish universities. Four of them are very lively institutions, and play a very great part in health matters, and it is to their work that the efficiency of the Scottish hospitals to-day is really due. If the noble Lord can accept this Amendment, I am perfectly certain that it will be felt and recognized in every quarter of society in Scotland as a good thing, because there is no man so low or so elevated in society that he does not take a personal interest in the university with which he happens to be connected.

LORD MORRISON

My Lords, I am sure that your Lordships are grateful to the noble Marquess for the clear and concise way he has explained the position; it makes it unnecessary for me to speak at any great length. As he has pointed out, the Amendment provides that in the normal case of a dual appointment the advisory appointment; committee constituted to draw up the short list of candidates for the post should be composed half of university representatives and half of hospital representatives. Departure from this rule in "prescribed circumstances" is designed to enable regulations made in consultation with the universities to relax this rule where the teaching duties are relatively unimportant and a smaller university representation on the advisory appointments committee is appropriate.

I should like to take this opportunity to make it clear that subject to further consultations with representatives of the universities, the Secretary of State has in mind that regulations under this subsection will not apply in the case of the most senior teaching appointments—that is to say, University Chairs—even though the holders of those appointments are simultaneously to hold posts with clinical responsibilities in the hospital service. While the Secretary of State expects that the universities will be prepared in such cases to observe the recommendation of the Goodenough Committee that there should be some form of consultation with the hospital authorities before appointing these professors who are to have clinical responsibilities, he appreciates that some less formal machinery of consultation than the advisory appointment committee procedure may be appropriate. I should like to thank the noble Marquess for the trouble which he has taken in helping those responsible in the Department to resolve this very difficult and thorny question. On behalf of the Government, I have pleasure in accepting the Amendment which he has now moved.

On Question, Amendment agreed to.

Clause 17 [Research]:

THE EARL OF SELKIRK moved, at the end of subsection (1) to insert "or to the development of medical or surgical appliances including hearing aids." The noble Earl said: My Lords, I have great pleasure in moving this Amendment on behalf of my noble friend the Duke of Montrose, who regrets that he is not here to do it himself. As one who suffers relatively slightly from aural defect, I have not perhaps the same personal interest in this subject as a number of speakers who spoke on the Committee stage. I would like to say that, although this does not meet entirely what the noble Duke of Montrose had in mind, it is a step forward, and I think a right step forward. I understand that the noble Lord is able to see his way to accept this Amendment, and I beg to move.

Amendment moved— Page 18, line 29, at end insert ("or to the development of medical or surgical appliances including hearing aids").—(The Earl of Selkirk.)

LORD MORRISON

My Lords, I would like to echo the sentiments of the noble Earl, Lord Selkirk, in regretting that in this hour of comparative triumph the noble Duke of Montrose is unable to be here to know that he has at least achieved something in his historical fight on behalf of those who suffer from the affliction of deafness or partial deafness. I am pleased to be able to tell the House that the fact that I can see my way to accept the Amendment now moved by the noble Earl, Lord Selkirk, has been communicated to the noble Duke. This meets with his approval, although he regrets that he is unable to be here. I have pleasure in accepting this Amendment.

On Question, Amendment agreed to.

3.2 p.m.

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;

LORD SALTOUN moved, in subsection (2) (b), to leave out "conferring a right on any person to choose" and insert: "securing a right to any person to choose or change." The noble Lord said: My Lords, in moving the Amendment that stands in my name, I am pleased to understand that the Government are prepared to accept it. I am very grateful to the noble Lord opposite for his sympathy in this matter, and for his help in respect to it. I would also like to say that, while I believe it will be a very valuable and a great reform, I do not honestly think that the grievance to which it relates is so intense north of the Border as it is south of the Border; at any rate, the cases that have come to my knowledge have nearly all been English cases. I am glad to think that the fact of this step having been taken in our Bill will lead to the same privilege being laid open in the regulations made under the English Bill. We shall, therefore, be able to congratulate ourselves, not on having achieved a mitigation of a grievance in Scotland, but on having achieved the mitigation of that grievance in Great Britain, which I think is very important. The Amendment means, I take it, that there will be a reasonable method prescribed for a patient to change his doctor.

There is one thing I would like to mention in connexion with any regulations that may be made on that count, and it is that one of the conditions ought not to be that the patient has to give reason; because doctoring is such an intimate matter that it might be very difficult. In connexion with other Government Departments and Boards I have sometimes been asked to give reasons which were entirely inappropriate. I gave an instance in your Lordships' House some time ago of a case where a man had transactions which involved the Capital Issues Committee in respect of the purchase of some property. He was asked by the Capital Issues Committee what was the reason of the seller for selling. The answer to that question, if he had given it, might have involved him in a libel action. That was quite inappropriate. He answered that it was the business of the seller; he referred them to the seller, and had a very rough passage in consequence. In the case of doctoring, you should not ask the patient to give a reason if he wants to change his doctor; that is his concern. The machinery should be laid open to him, and it should be explained to him how he is to go about it. With those few words, and with gratitude for what I believe is coming from my noble friend opposite, I beg to move the Amendment.

Amendment moved— Page 27, line 9, leave out from ("for") to ("in") and insert ("securing a right to any person to choose or to change.")—(Lord Saltoun.)

LORD MORRISON

My Lords, the noble Lord will remember that on the Committee stage of the Bill I endeavoured to explain to him that it was always the intention of the Government to make it possible for a person to change his doctor from time to time, as well as to select his doctor in the initial Stage. But the words which the noble Lord proposed at that time were not suitable. The Amendment which the noble Lord now moves makes it quite clear that persons are to be entitled to change their doctor from time to time, and the form of words now proposed is acceptable to the Government.

On Question, Amendment agreed to.

LORD SALTOUN

My Lords, the next Amendment is a consequential Amendment. I beg to move.

Amendment moved— Page 27, line 12, leave out ("so chosen") and insert ("who is to give the attendance.")—(Lord Saltoun.)

On Question, Amendment agreed to.

Clause 43:

Disqualification of persons providing services.

(7) Regulations shall make provision— (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 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—

THE EARL OF SELKIRK moved, in subsection (7) (a), after "section" where that word occurs a second time, to insert: shall be informed, soon as may be, of the substance of any charge or complaint to which the inquiry relates and.

The noble Earl said: My Lords, this is an Amendment to ensure that practitioners who are brought before the tribunal set up by this Bill have a clear statement of any complaints which are made against them at the time when they are being, shall I say, examined by that tribunal. It is a common and accepted doctrine of our criminal law that a man should know exactly what he is charged with. The proceedings before the tribunal are very similar to criminal proceedings in effect, because a man may well lose his profession and cease to be able to follow the line of his avocation. I think this Amendment is fair and proper, and I have great pleasure in moving it.

Amendment moved— Page 39, line 17, after ("section") insert the said words.—(The Earl of Selkirk.)

LORD MORRISON

My Lords, I informed your Lordships' House on the Committee stage that I agreed to the noble Earl's Amendment in principle, but that some alteration in the wording was necessary. That alteration, I understand, is agreeable to the noble Earl, and I have pleasure in accepting this Amendment.

On Question, Amendment agreed to.

VISCOUNT MERSEY

My Lords, I have received from the noble Earl, Lord Elgin and Kincardine, and the noble Earl, Lord Selkirk, a consequential manuscript Amendment to the Second Schedule: Page 63, line 18, leave out "five" and insert "seven."

THE EARL OF ELGIN AND KINCARDINE

My Lords, this Amendment, as the noble Viscount says, is purely a consequential Amendment.

Amendment moved— Page 63, line 18, leave out ("five") and insert ("seven").—(The Earl of Elgin and Kincardine.)

On Question, Amendment agreed to.

Then, Standing Order No. XXXIX having been suspended:

LORD MORRISON

My Lords, in moving the Third Reading of this Bill I should like first of all to thank your Lordships very sincerely for the reception you have given it. I think there is general agreement that the Amendments which have been made, and particularly those that have been inserted in the Bill this afternoon, represent a real improvement to the Bill. There are one or two points which noble Lords raised at earlier stages of the proceedings and to which I have not yet had an opportunity to reply as fully as I would like. Perhaps, therefore, your Lordships will bear with me if I mention briefly some of these matters.

The noble Lord, Lord Saltoun, speaking, I understand, as trustee of a voluntary hospital, sees difficulty in handing over endowment funds unless he has a reasonable assurance that these funds will be used for the purposes for which they were dedicated, or that these services will be otherwise met. In particular, he asked whether the Secretary of State would subscribe to an assurance given in debates on the English Bill that a hospital hitherto maintained in a particular locality by endowments given for that purpose would be continued in operation. The Secretary of State does subscribe to that assurance, that a hospital will not be discontinued unless and until some other provision at least as adequate is made for the benefit of the people served by the existing hospital. The difference in the future will be that the deciding factor in determining where hospitals shall be erected will be the need for a hospital in that particular place, not the chance that an endowment is available for the benefit of that particular locality.

As regards the general question of handing over hospital endowments to be re-allocated by the Hospital Endowments Commission, I can only say that the noble Lord, Lord Saltoun, is freed of all responsibility as trustee when he hands over trust funds in obedience to an Act of Parliament. His feelings as to the future use of these endowments are met by the directions given to the Hospital Endowments Commission in Clause 8 (2) of the Bill which require the Commission, in settling the future application of endowments, to have special regard to two things: the spirit of the intention of the founder, and the extent to which the original purpose of the endowment is now sufficiently met by a public service or otherwise. The whole procedure follows the well-tried method adopted in the education field as long ago as 1872 and more recently in 1928.

The noble Earl, Lord Selkirk, asked me a question on Monday as to why the provision of refresher courses under Clause 48 related only to persons providing services under Part IV of the Bill. The answer is that persons providing services under other parts of this Bill are employed by employing bodies—that is to say Regional Hospital Boards and boards of management, whose general powers are sufficiently wide to allow them to provide refresher courses for their own employees. Persons providing services under Part IV are not employed by any employing body with general powers of this kind. In the absence of the provision in Clause 48 no authority would have any power to provide refresher courses for them.

The noble Earl, Lord Elgin, spoke about the arrangements for co-ordinating the three divisions of the service. As the Bill stands, it will be entirely open to any of the three executive authorities concerned—the local health authority, the Regional Hospital Board and the Executive Council—to take the initiative in proposing arrangements to this end. I may add that the Secretary of State intends, in due course, to draw the attention of all three of these authorities to the desirability of establishing local co-ordinating machinery suitable for their area. There is no need for any specific provision in the Bill, unless the local health authority might wish to contribute to the expenses of a co-ordinating body; and Clause 3o provides that power.

I should like to say something about one or two points that have been mentioned to me privately. The Secretary of State recently received a recommendation from his Medical Advisory Committee that there should be in Scotland a comprehensive laboratory service covering pathology and bio-chemistry as well as bacteriology. I am asked why, if the Secretary of State accepts that recommendation, the power to provide laboratory services in Clause 18 refers only to bacteriology. I am advised that the Secretary of State does accept the recommendation from the Committee, and intends to act upon it. The necessary powers, so far as pathology and biochemistry are concerned, however, are included in the Secretary of State's general power to provide services at or for the purposes of hospitals. Clause 18 provides the necessary supplementary power to provide for bacteriology work not required for hospital purposes, and subsection (2) of that clause enables all the Secretary of State's functions in relation to laboratories to be discharged as a comprehensive service regionally organized in association with the hospital service.

There may be some misunderstanding about the scope of dental treatment which can be provided as part of the general dental service proposed in the Bill. The chief point is that wherever, in the view of the Dental Estimates Board, a particular form of treatment is required on clinical grounds, that treatment will be provided free of cost to the patient, however complicated, unusual or expensive it may be. There is another case where some special form of treatment is proposed by a dentist, but which is not considered necessary on clinical grounds by the Dental Estimates Board. To meet this case Clause 45 (2) of the Bill provides a means whereby some forms of dental treatment may be carried out on payment of part of the cost by the patient. The special forms of treatment covered by this provision are to be determined by regulations which will be made after full discussion with representatives of the dental profession. The intention is that in these circumstances the treatment may be given within the service; the dentist receiving from public funds the fee for the equivalent work considered clinically necessary by the Dental Estimates Board, and the patient paying the extra cost of the special treatment given. This would cover, for example, the provision of gold fillings in cases where ordinary amalgam fillings would, in the opinion of the Dental Estimates Board, be perfectly satisfactory on clinical grounds.

There is also, I think, undue apprehension on the part of some people employed in the present health services whose present jobs will be affected by the reorganization under the Bill. Compensation for loss of office is restricted to persons in whole time direct employment only. That could not be altered without widespread repercussions in many fields. The Secretary of State, however, does not think that any of the people concerned have substantial grounds for fearing that they may find themselves without jobs and without compensation. The inauguration of the new service will be a complicated and difficult task, in which the Secretary of State expects that there will be a great need for the help of those with knowledge and experience of the existing services.

Finally, I should like to mention one other point raised by the noble Earl, Lord Selkirk. He is most anxious that the General Board of Control should continue to be an independent body for the discharge of their functions relating to the liberty of the subject. That is most certainly the aim of the proposals in the Bill. The statutory provisions under which the Board operate in this connexion are unchanged. Members of the Board will, as in the past, hold their appointments from the Crown. The Board will have the same duties as hitherto to publish returns and information bearing on the subject. Not all the members of the Board will be officers also of the Secretary of State. It is the intention that wholly independent persons otherwise unconnected with Government departments should continue to hold part-time appointments as members of the Board. The reason why the Medical Commissioners are to have part-time appointments also under the Secretary of State, is to strengthen their position in the field of mental illness, and not weaken it.

At the moment, mental hospitals are supervized by the Board of Control. In future, mental hospitals, like other hospitals, will be provided by the Secretary of State. The dual appointments given to the Medical Commissioners will enable them to keep in the closest touch with the running of these hospitals, and thus put them in the best possible position to discharge their other responsibilities relating to the liberty of the subject. Members of the Board who do not hold simultaneous appointments under the Secretary of State will also be kept in touch with this side of the administration of the mental service, if less directly, in consequence of the requirement in Clause 49 (2) of the Bill that the Secretary of State, in performing his functions relating to mental illness or mental deficiency, shall consult the Board.

These are, I think, the main outstanding points upon which explanations were due, and I hope the explanations will be found to be satisfactory. May I add that as soon as the Bill becomes law the Secretary of State will, as your Lordships have emphasized, be faced with an administrative task of great magnitude, involving consultations, discussions and negotiations with a large number of organizations interested in the future health service. From time to time many sets of regulations embodying the results of these discussions will come before your Lordships' House. These will, I am sure, be received in the same spirit of constructive criticism as has been the case with the Bill itself. The Secretary of State was much encouraged by the views which some of your Lordships were good enough to express, that this is a better Bill for Scotland than a mere translation of the English Act would have been. He is sure he will have the co-operation and assistance of all noble Lords in Scotland, on whichever side of the House they may sit, in building up, on the basis provided by this Bill, a health service in Scotland which will be second to none. My Lords I beg to move.

Moved that the Bill be now read 3a.—(Lord Morrison.)

3.20 p.m.

THE EARL OF SELKIRK

My Lords, I thank the noble Lord for what he has said and I should like to say that the assurances he has given to-day are of real value and will be greatly appreciated by very many people. What the noble Lord has said to-day will give great satisfaction to those who are concerned with hospital services and insurance committees. There are, in fact, powers in the Bill which will provide for allowances and superannuation in full to insurance committees and others. We shall have to depend upon circumstances as a guide to how the liability will have to be discharged. The noble Lord has told us very frankly that this Bill takes its paternity from the Ministry of Health, and in spite of this pre-natal condition it does seem a pity it was not allowed to emerge from its native heath at an earlier date.

There are two points I would like to mention. There is a danger in this Bill of over-stereotyped services. We found during the war that too much direction had a restrictive effect which does not assist towards progress. I hope this service will in fact be a free and personal service, as the medical service has always been in the past. Secondly, I think it is a pity that this is more of a national sickness service than of a national health service. There is reference to positive health, but I would have liked to see that made a little more clear, because, after all, health depends much more on food, diet, housing and environment and on a real, keen, and lively interest in the job one is doing. These are factors which are of greater value than the most remarkable, extended, and scientific forms of treatment in the world. I am sure the Secretary of State would wish that the hospitals, whether in the boroughs or the counties or the clachans in Scotland should be regarded still as our hospitals. I thank the noble Lord, Lord Morrison, for the kindly and courteous way in which he has conducted this Bill and, very respectfully, I would congratulate him on what is, I think, the first major Bill he has conducted through this House.

3.24 p.m.

THE EARL OF ELGIN AND KINCARDINE

My Lords, I should like to add my thanks to those which have been expressed to the noble Lord, Lord Morrison, and to say a word on the points just made by the noble Earl, Lord Selkirk. It is our hospitals we are thinking of. Local authorities take a real and lasting pride and interest in their hospitals, and it was from the point of view of maintaining that interest and that power of initiative that I sought to bring in the Amendment under Clause 21. I am glad to have had the assurance from the noble Lord in moving the Third Reading of the Bill that it is the intention of the Secretary of State to draw the attention of local authorities and others to these powers of initiating co-ordination, because it is co-ordination which is required. There is a tendency at the present day to put county council and town council authorities more or less in the position of what I may call recording angels of the acts of the fairy godmother at St. Andrew's House, and this rather destroys the initiative of the local authorities. I would like, therefore, to say that I welcome the assurance which the noble Lord has just given, that the Secretary of State intends to pay special attention to the whole of Scotland, to their powers and possibilities, and to urge them to take co-ordinating efforts in making these our hospital services.

LORD SALTOUN

My Lords, I should like to add a word to what has been said by the two noble Earls who have just sat down and to express my appreciation of the way in which the noble Lord, Lord Morrison, has handled this Bill. We are much indebted, also, to the hard spade work that the noble Earl, Lord Selkirk, has devoted to this Bill. He deserves not only your Lordships' thanks but also the thanks of the people of Scotland—which I have no doubt he will receive. I believe the people of Scotland will be grateful to both noble Lords for what they have done in this connexion.

I should like to say one word on the question of trustees. In the case of all trustees who hold funds, I think that steps should be taken to give them a definite idea of the future of their hospitals, and, if possible, of the use of their funds, before they are asked to hand over those funds. These men have been entrusted with a variety of endowments, possibly with a variety of conditions controlling them, and they have accepted that responsibility. They are responsible not only to the people who benefit by these great endowments but also to the dead, It is perfectly true that Parliament can do anything, and may take those funds for any purpose it likes, but a trustee may very well say that although Parliament Can take these funds from him it cannot take them from him as a consenting party until he is assured what is to be done with them. I should like to think over what the noble Lord has said in this connexion.

I understand that the trustees with various endowments in hand will be asked to hand them over to a Regional Board on a blank cheque. They may very well dig in their heels until they are given reasonable grounds, and I therefore beg my noble friend to represent what I have said to the Secretary of State, and to get some definite information for the people who are in charge of these funds. There is one thing Parliament cannot do: it cannot make a man who is determined to do right, do what he thinks to be wrong. I hope the Bill we are now pass- ing will be the beginning of a new development of greater efficiency in medicine and in the health treatment of the people of Scotland.

On Question, Bill read 3a with the Amendments, and passed, and returned to the Commons.