HL Deb 28 January 1959 vol 213 cc876-966

2.45 p.m.

LORD BALFOUR OF BURLEIGH rose to call attention to—

(A) the proposals of the Board of Governors of St. Mary's Hospital, Paddington:

  1. (a) to convert 39 out of 76 beds of Princess Louise (Kensington) Hospital for Children for temporary use as maternity beds, and
  2. (b) ultimately to convert the whole of the children's hospital for adult use;

(B) the decision of the Minister of Health communicated to the Royal Borough of Kensington in his letter of the 16th June 1958 to allow proposal (a) and to defer a decision for proposal (b);

(C) the facts that—

  1. 1. the number of in-patients at Princess Louise Hospital was, in 1950, 1,212; 1951, 1,478; 1952, 1,643; 1953, 1,665; 1954, 1,729; 1955, 1,372; 1956, 1,744; 1957, 1,282; 1958, 1,536; (bed availability reduced by infection in 1955, 1957 and 1958);
  2. 2. the number of out-patient attendances has averaged well over 20,000 during the period of the last ten years: now out-patients numbered over 4,000 in 1957 and approximating 5,000 in 1958;
  3. 3. during the spring of 1958 the Princess Louise Hospital coped successfully with an outbreak of a virulent and rapidly fatal complaint in infants known as bronchiolitis;
and to move to resolve, That Her Majesty's Government foe requested to reconsider the Minister of Health's decision of 16th June 1958 with the specific object of:—
  1. (a) securing such maternity beds as are temporarily required by St. Mary's Hospital, Paddington, by converting to adult use other children's beds in older hospitals, e.g., St. Charles's and Paddington General, or elsewhere;
  2. (b) maintaining unimpaired the vital service being increasingly rendered by this modern children's hospital in a densely populated area.

The noble Lord said: My Lords, the subject of my Motion was debated at some length in your Lordships' House in 1957. I am not apologising to your Lordships for bringing it back to-day, the reason being that a decision in the matter was reached by the Minister a few months ago, and that was a decision which I regard as most unfortunate. This, therefore, is, I feel, the last opportunity, the last effort, to secure reconsideration of the whole matter. There are really four parties to the dispute: the Board of Governors of St. Mary's Hospital, Paddington, the Regional Hospital Board for the area, which is the North West Metropolitan Regional Hospital Board; the Royal Borough of Kensington, which I can assure your Lordships has the whole population to a man, woman and child, behind them, and lastly the Minister of Health.

Let me begin by clearing the ground, because there is a good deal of ground which is common between us. There are two factors: one, the surplus of children's beds, and two, the shortage of beds for adults. The first factor, the surplus of children's beds—which we so rejoice about because it means a reduction of ill children—is, happily, common pretty well throughout the country. The shortage of adult beds happens to be acute at the moment in the North Kensington and Paddington area in the matter of maternity beds. With regard to the first factor, the reduction of the number of sick children, I would only say to your Lordships that that is so marked that it has reached the stage where it requires complete re-thinking of the whole policy of the treatment of children in hospital. The case which I am going to put before your Lordships is that the Minister's decision, which was conveyed to the Kensington Borough Council a few months ago, in favour of the proposals of St. Mary's Hospital is wrong—doubly wrong, because I say it offends both in the particular and in the general.

I shall deal first with the particular case, and I must preface what I have to say about that with the assurance to your Lordships that I speak in no spirit of hostility to St. Mary's Hospital. All I want to do is to set out the facts, not in the least because I want to be censorious, although I am afraid your Lordships may think I shall be, but solely because it so happens that only if we can get the facts of the situation clear shall we find that we have ready to hand a solution of all the troubles which beset us. That in this instance, is literally true. In my submission, what I am going to propose will cure the situation. That is something that seldom happens. One often finds oneself in a difficulty and one says that something must be done about it. How often do we hear that? In this instance I am in the fortunate position of being able to put before your Lordships a definite policy which I believe will make a radical cure.

With that introduction, I turn to the particular case of the Princess Louise Hospital. There the trouble has its roots as far back as 1946. In 1946, St. Mary's Hospital took over two children's hospitals—one at Paddington Green with, say, 50 beds; the other the Princess Louise with 76 to 80 beds. There are four wards which I believe can hold either 19 or 20 beds. That, I believe, is the root of the present trouble, and I do not think it will be denied by noble Lords who speak for St. Mary's, because St. Mary's has continually complained ever since then about their overload of Children's beds, conveniently forgetting that it was entirely their own doing.

For the record I must tell your Lordships that those agreements were made just before the passing of the National Health Service Act, when the terms of that Act were already known. Your Lordships will see that that action by St. Mary's in the early part of 1946 had the effect of depriving the future Regional Board, which of course did not exist then, of both the children's hospitals which are in that Regional Board's area. Moreover, those amalgamations with the children's hospitals were made by St. Mary's with knowledge of the report of the Goodenough Committee—the Interdepartmental Committee on Medical Schools—which made a specific recommendation that, for a teaching hospital, the appropriate percentage of children's beds was 10 per cent. I must add that the agreement made between St. Mary's and the Princess Louise was expressed to be, and was intended to be, for the mutual benefit of both hospitals. But there were two particular conditions which were vital to the Princess Louise. They were, first, that St. Mary's would make the Princess Louise an integral part of its pædiatric unit; and secondly, that the Princess Louise Hospital should continue as a children's hospital.

That story is highly relevant because it is the possession by St. Mary's of the Princess Louise Hospital through all these years that alone has prevented the Regional Board from converting their less efficient children's beds to adult use. That could have been done years ago. It should, and would, have been done but for the fact that St. Mary's were in possession of the Princess Louise Hospital; and the integration as part of the pædiatric unit was never carried out. Now we have before us the present proposals, first to convert half the beds of this children's hospital to adult beds for temporary maternity purposes, and then, later, to convert the whole hospital to adult use. Not only has that situation prevented the regional board from converting their inefficient children's beds in the past but, so far as I can see, it would put an end to any chance of the Regional Board ever giving proper hospital treatment to children.

Just consider for a moment what the position would have been had that agreement never been made between St. Mary's and the Princess Louise Hospital. Inevitably the Princess Louise Hospital would have been under the Regional Board, and that would have made all the difference in the world. The Board would have had at their disposal all these years this delightful children's hospital, expressly built for the treatment of children in an open site—for although it is in a densely overcrowded area it includes a bit of open ground—with light airy wards entirely suitable for children.

It so happened that I became a member of the Kensington Borough Council just thirty-five years ago, at a moment when the Council were closely occupied with the project to build a new children's hospital in North Kensington. As I happened to be particularly interested in the housing question I spent a good deal of time in North Kensington, and I remember well the reasons given to me by the people there for wanting a new children's hospital. Your Lordships will remember that in those, may I call them, "bad old days", the housing conditions in North Kensington were very bad. There was great overcrowding, very bad housing, large numbers of children, and no easily accessible children's hospital. I say that with full knowledge of the fact that two and a half miles away—or two and a quarter miles, according to the point one takes—lies the Paddington Green children's hospital. I shall say a word about the inconvenience for North Kensington of Paddington Green later, when I have to ask the noble Earl the Minister for his idea about alternative facilities.

To continue my story, the money was raised; the Princess Louise Hospital was built, and was opened by King George V and Queen Mary in 1929, exactly where it was most wanted, and, my Lords, still is most wanted. Had the Regional Board had that hospital at their disposal I say with complete confidence that the present difficulties would not have arisen. It would have been quite definitely a question of solvitur ambulando. It is only the possession of the Princess Louise Hospital by St. Mary's through those years that has prevented that from happening.

Regrettable as all that is, what we have to do is to tackle the situation as we find it to-day, under which full use is not being made of all the available hospital beds in the area. There is a plus and a minus in the area—a plus of children's beds and a minus of beds for adults. Why have the two not cancelled out? Quite simply, because there is, and has been, a divided responsibility between the Regional Board and the teaching hospital; and between them they have failed to adjust their differences. Just to remind your Lordships, and to illustrate that point, I will quote briefly from the debate of 1957 The noble Lord, Lord Cottesloe, chairman of the Regional Board, then said [OFFICIAL REPORT, Vol. 204, col. 393]: In those circumstances, when the suggestion was made to my board that we might take over the hospital from St. Mary's Hospital, we came to the conclusion … that if the Princess Louise were offered to my Regional Board we should be prepared to take it over, integrating it with the St. Charles's Hospital as the pædiatric department of that hospital, which is closely adjacent to it, and closing the children's beds at present in St. Charles's Hospital, and perhaps also some of the children's beds in Paddington General Hospital. A little later in the same speech the noble Lord said: There is, I think, no doubt that such an arrangement would be, in general, beneficial. It would relieve St. Mary's Hospital of their pædiatric incubus; it would reduce the total number of children's beds in the area, and it would give the Princess Louise Hospital the benefits of integration with a large hospital. But there is one thing it would not do: and that is to provide St. Mary's Hospital with the additional beds for maternity and obstetrics and for other specialities that they need for teaching their students. My board would be prepared to go further in an attempt to solve this problem. They have expressed their willingness to make available to St. Mary's Hospital for teaching—and it would not be altogether easy to do so—fifty beds at St. Charles's Hospital under arrangements similar to those at Paddington.

That offer was met with a definite and categorical refusal by the noble Lord, Lord Moran, speaking for St. Mary's Hospital. In that same debate he said [col. 414]: 'If that is so, why do you not accept his offer of additional beds?' The reason is that, though it is valuable clinical material, from the point of view of teaching it has serious disadvantages and limitations. These are, that unless you have administrative control you cannot control the cases admitted to the hospital, which is half the secret in getting suitable clinical material. For that reason, if the noble Lord, Lord Cottesloe, now stood up and said, 'You can have administrative control', I would sit down and say. 'I have nothing more to say—I accept it'. It is as simple as that. I do not quote these statements for the purpose of apportioning blame or adjudicating between the two views. I think it is a question for the doctors. It seems to me that power to select is very important, and it might be the critical question for a teaching hospital, and therefore I am not judging who is right. But I have told your Lordships about it because it illustrates my point that it is the dichotomy between these two bodies which has prevented full use of beds and directly produced the current difficulties. One word about the duty of the Minister in these circumstances. The Minister is, I suppose, head of the National Health Service, and it is his duty to see that it works efficiently. I say that the Minister of Health could, and should, have taken action years ago. What his powers are under the Act I do not know, but he obviously has great influence, and if he is powerless to interfere in a case like that then there must be something very wrong with the set-up under the Act. But I do not believe that it is so. I believe that the Minister, had he seen fit, could have taken action which would have made matters right.

There it is, my Lords. If I am right there was a failure on the part of a whole series of Ministers of Health, and because of it we are now faced with the imminent destruction of the Princess Louise Hospital: not merely partial, temporary occupation, as your Lordships might think, for St. Mary's are asking for a complete conversion—though what for, we have never been told; there is something of a mystery about it. They are asking for complete conversion to adult use in the future. On that point the Minister has reserved his decision, but who is going to suppose that if this conversion takes place it will ever go back?

In the last debate the noble Lord the Minister estimated the cost of conversion at £6,000. I believe that to be a complete underestimate. Such experts as I have consulted tell me that the cost might easily be as much as £10,000. But be it £6,000, £8,000 or £10,000, who is going to suppose that after two years the Minister will have enough money at his disposal to allow that money to be spent on reconverting? I simply cannot believe that that is possible. Once converted, that hospital will never go back, more particularly as that is the aim and object of St. Mary's. I was under the impression that one of the great objects of the Minister in administering the National Health Service Act was to retain the good will of the population—an important aspect, because he still requires a good deal of voluntary help. This particular decision has aroused fierce resentment: the whole population who use the hospital are really furious about it and feel that they have been deprived of an asset which really belongs to them.

My Lords, there is a quite minor point—a medical point, on which I will merely touch, in passing. I am told that this division into half maternity and half infants' beds in this small block is highly objectionable from a medical point of view, particularly the pædiatric point of view. I would ask the Minister in his reply to tell the House what authoritative pædiatric advice was sought before this move was given the official approval of the Minister. It is important that it should be pædiatric advice, and not merely general medical advice. I am told that, whatever may be the merits of this scheme, if it were a question of building afresh now, no one would dream of putting up a building of that size for the "half and half" use now suggested.

I now come to the question: is this hospital needed? I put that question because it would not matter what St. Mary's or anyone else had done if it were to be proved that the Princess Louise Hospital is no longer needed. I ask your Lordships to look at the figures on the Order Paper. I had the figures of in- and out-patients put in the form of a fact because I think they are so important. Of course, the hospital was closed to in-patients during the war; the children were evacuated. In 1950 in-patients numbered 1,212, and there has been a steady rise to over 1,700 in recent years, the only exception being where certain beds were closed because of infection, something that must happen from time to time in any children's hospital. As regards out-patients, in the debate in 1957 I said that there were 30,000 out-patient attendances. The recent figure is 20,000, as the Ministry of Health have adopted a new classification. They separate what they call the referential departments—I understand that that means X-ray, physiotherapy, bacteriological and pathological tests, and so on. That those things are now classified differently accounts for the odd 10,000; the total number of out-patient attendances remains at 30,000 annually. It is worth noting that out-patient attendances in 1958, the year just closed, were actually substantially greater in number than in any other year since 1950.

One other point on the need for Princess Louise is that your Lordships will see on the Order Paper that during the spring of 1958 Princess Louise coped successfully with an outbreak of a virulent complaint in infants known as bronchiolitis. I understand that this is an acute respiratory condition; and the particulars are that within a matter of weeks 104 infants were admitted to the hospital. One was dead when brought in; one died after half an hour; but every other single life was saved. So much attention was given them that sixteen of these infants were in oxygen tents simultaneously. Please compare those figures, and that fact with the statement of the noble Lord, Lord Moran, in the last debate, that the blunt and brutal truth is that the … hospital is no longer needed. I think that the figures really disprove that assertion.

The noble Lord also made another remark which I will quote. He said [OFFICIAL REPORT, Vol. 204, col. 413]: … children's diseases are not only falling rapidly, but they are going on falling rapidly. If the Princess Louise Hospital, as a result of this debate, received a respite, it would only be a respite. Taken quite literally, that remark means only one thing: it must mean that, in the noble Lord's opinion, within a very few years there will be no sick children needing hospital treatment. It may be that the noble Lord may wish, on reflection, to modify that opinion. If not, I venture to disagree; and I maintain that this children's hospital is still, and will be, for all the years that we can foresee—at least, which I can foresee—needed in this densely populated area.

I have no official connection with the Princess Louise Hospital. I am not on the board. Therefore your Lordships might think that my information is out of date. But I know how keen the medical committee were about this agreement in the old days; I have taken such steps as I can to ascertain the views of the present medical committee, and I believe it is true to say that they like it as little as their predecessors who made the agreement with St. Mary's would have done.

I turn for a moment to the legal position. I will quote the Minister. The Minister says: On the coming into force of the National Health Service Act the terms and conditions of the amalgamation agreement between St. Mary's and Princess Louise were terminated. That is the view of the Minister's legal adviser and one must accept it. It seems a little odd, if that is literally true, that, while the possession of Princess Louise by St. Mary's was not terminated, only that part was terminated which was vital to Princess Louise. Of course, some legal decisions are odd—I speak in the presence of a good many distinguished lawyers—and this one seems to be very odd indeed. But your Lordships will see that it was highly convenient to St. Mary's. They were enabled to keep their asset without fulfilling the very obligation they had come under in order to acquire it. They had acquired a valuable asset for a definite consideration, and by this queer legal quirk they are relieved from carrying out their bargain. However, legal obligations are not the only thing in this world; there is such a thing as a moral obligation. In fairness to the board of St. Mary's, who are honourable people, I would say that they have not thought so; and I must remind your Lordships of why not.

We had different explanations from two noble Lords who spoke for St. Mary's on the last occasion. The noble and learned Lord, Lord Cohen, said that, in his view, the new board were not bound by the decision of the old. If that is his view, I say, with great respect, that it seems to me to be both legalistic and founded on a technicality. The noble Lord, Lord Moran, took a different line altogether. The noble Lord, Lord Moran, said—and I quote from col. 413: If I am right in saying that many of these beds are now redundant, it would not be sensible blindly to carry out an undertaking before the National Health Service came in, given in totally different circumstances eleven years ago. My Lords, the noble Lord's memory betrayed him. St. Mary's did not wait eleven years. The Dean of St. Mary's Medical School waited only for the coming into force of the National Health Service Act, which happened in 1948, before seeking to change the whole occupation of the hospital from children to adults. The noble Lords who represented St. Mary's on the last occasion were doubtful about an agreement that I quoted then, although they were honourable enough to admit afterwards that I was right. In case they are doubtful about this, let me say that I have in my hand a copy of a resolution of the Public Health Committee of the Kensington Borough Council, and that a copy of it was sent to the Board of Governors of St. Mary's Hospital by the Town Clerk of Kensington in January, 1949. So, my Lords, I do not think that Lord Moran's arguments about a change of circumstances really have much validity.

So much for the particular as concerns the Princess Louise Hospital: now I come to the general question. I believe that, in the new circumstances as regards children, the treatment of children in hospital needs entire rethinking, and I do not see any evidence that that has happened at the Ministry of Health. It would be more surprising if it had happened than that it has not, when one remembers that there have been four Ministers of Health since 1955. There have been four Ministers of Health since these proposals were put up. In 1956, the then Minister, Mr. Turton, said in answer to a deputation from the Borough Council, of which I was a member—and I quote verbatim: … that he was informed by his medical advisers that the modern trend of medical opinion was against having separate institutions solely devoted to children's cases. It was in favour of having children's beds in general hospitals because of the superior availability of highly specialised staff, equipment and resources. On the other hand, the noble Earl, Lord Onslow, answering a Question asked by me recently, said [OFFICIAL REPORT, Vol. 212 (No. 9), col. 499]: My right honourable and learned friend "— that is the Minister of Health— fully recognises the merits of special children's hospitals". So it does not seem to me that the Ministry of Health have quite made up their minds.

Very relevant is the unanimous report of the Pædiatric Committee of the Royal College of Physicians published in 1957; and here I quote the late Lord Webb-Johnson, whose loss we all deplore, who quoted that report during the last debate. It is a unanimous report, and it is signed by the President of the College. Its members were the medical officers of health of London and Birmingham, representing municipal health, the Chief Medical Officer of the Ministry of Health (who, of course, was on it in his own capacity as a Fellow of the College), and also the Ministry's chief pædiatrician. I quote only one paragraph from that report. It is quite short. It says: There is no doubt that special children's hospitals offer the best service for children, because the staff, at all levels and in all departments, is attuned to the special needs of the sick child. Children's hospitals carry with them a tradition of service which cannot lightly be set aside. In a published letter the present Minister of Health says that he accepts the report and lays special emphasis on the feature which it advocates, of the importance of visiting facilities. On the question of facilities for visiting, the Princess Louise Hospital, in addition to being an efficient children's hospital, is absolutely at the top of the class, because it was put right in the middle of these thousands of densely-crowded people, just so they could visit daily.

In passing, there is this very minor point. It seems to me a little peculiar that, when the cause of the trouble is a greater demand for maternity beds, no one should have thought that that position might involve an increase in the number of babies. If there is going to be an increase in the number of babies, what a moment to smash the babies' hospital! Summarising the Royal College of Physicians' report, I would say that it is that the policy should be to close small, inefficient children's wards and use them for adults; transfer the children to larger and more efficient units, and keep those units at full capacity. That is a fair summary of the report. This decision by the Minister does precisely the opposite. It closes an efficient, large unit, and it scatters the children over the face of the earth.

The Minister's approval of this application is based on his assurance that similar facilities exist in suitable, neighbouring hospitals. There are three vital words there. The facilities must be "similar," and the hospitals must be "suitable" and "neighbouring." Will the Minister, in his reply, please say where he thinks the 1,700 in-patients and 30,000 outpatients now annually attending the Princess Louise Hospital will go? I assume he will refer to Paddington Green. If one takes a central point of the catchment area of the Princess Louise Hospital, Paddington Green is two and a quarter miles distant. To get there you have to take a threepenny bus fare and then change on to a threepenny trolley-bus fare—a total fare of a shilling return for each adult. The mere journey takes not less than an hour—inconvenient and possibly harmful to a small child, and very burdensome to the mother. Remember, my Lords, that for in-patients daily visiting is recommended by the College of Physicians; and, surely, for out-patients, who have to go quite often, easy access is important. In this same large area they can get to the Princess Louise Hospital by pram. I am dealing with Paddington Green Hospital at the moment because I anticipate that that will be one of the hospitals recommended by the Minister for the displaced children. But that was why the Princess Louise Hospital was built—because Paddington Green was so inconvenient.

The next choice may, perhaps, be Hammersmith Hospital. That is the favourite of the noble Lord, Lord Moran. Hammersmith is neighbouring and it is efficient, but is it suitable? Can it provide similar facilities? Hammersmith is a post-graduate teaching hospital and is consequently highly selective in its admission—just as selective as Lord Moran wishes to be in his maternity cases. How many of the 1,700 in-patients and 30,000 out-patients could Hammersmith take, to say nothing of sixteen babies at one time in oxygen tents? Picture the consternation of the management committee of Hammersmith if they were told that they had to handle those cases on top of those they have already.

In the last debate all sorts of distant places were mentioned. It was even suggested that Willesden General and Central Middlesex could take the overflow. I need hardly tell your Lordships that those hospitals are neither neighbouring nor suitable. These are not people who take their children to hospital in taxis. They either walk or go by public transport. Finally, the Minister may mention a group of what are fairly described as the old poor law hospitals. There is Paddington General, not neighbouring, St. Charles's (formerly Marylebone Hospital), and St. Mary Abbott's (formerly Kensington), which are both neighbouring but have no other qualifications. The children's beds in these three hospitals are the very beds which ought to have been converted to adult use long ago. It so happens that those three alone contain the number of beds which St. Mary's now seek to get in Princess Louise. It is not only unfair to the Princess Louise children, it is uneconomic, because it is not making the best use of the expensive equipment which has been provided for a specific purpose. When the Minister replies on the question of available facilities, will he please specify, in particular, in which hospitals he thinks epidemics such as bronchiolitis will be treated. It is perfectly clear that lives were saved on that occasion which would have been lost if the facilities had not been available.

To sum up as briefly as I can, it is common ground that the full and efficient use of hospital beds in the North West Regional Area is prevented by the lack of balance—the surplus of children's beds and the shortage of adult beds. I say that that is entirely and completely due to the action of St. Mary's—for two reasons: first, their acquisition of an excessive number of children's beds, and, secondly, the retention of the Princess Louise, which had been acquired solely on an undertaking which they have not seen fit to carry out. That is what all these years has prevented the Regional Board from closing less efficient beds. The difficulty of the Regional Board about children's beds will continue indefinitely if St. Mary's demands are agreed to.

I would ask the noble Lords who speak for St. Mary's whether they do not feel inclined to admit that their attitude has been, and is, a little of the dog-in-the-manger. Princess Louise is not essential to them for teaching and never has been. If it is not a rude thing to say, they do not even seem to know what they want it for—at least, I have never been told. But it is vital to the Regional Board if children are to get the hospital treatment to which they are entitled.

What is the solution? I say that the solution is obvious, when the facts are grasped, and it is essentially a simple one—to transfer Princess Louise to the Regional Board, as was suggested by the deputation from Kensington Borough Council to the Minister four years ago. It happens to be the very solution proposed in a cogent leading article in The Times to-day. There will remain to be made the administrative adjustments which seem to cause St. Mary's and the Regional Board so much difficulty. They can and must be made. I say that it would be intolerable if the efficiency of the National Health Service Act were to be impaired merely by the lack of cooperation between the two bodies responsible for working the Act in this area—and that is what is happening. I claim that I am entitled to the support on this Motion of anyone who takes a personal interest in the work and efficiency of the National Health Service Act. Of course, my Motion does not go anything like so far as to propose that solution. It involves no commitment on anybody. What I ask for is reconsideration, and I submit to your Lordships that I have made a case for reconsideration, both in the particular and in the general, and I hope that the Government will agree to have another look.

What would be lost? I venture to hope that the noble Lords who speak on behalf of St. Mary's and the Regional Board will join in my appeal to accept the Motion. I cannot see why the Regional Board should not, and if St. Mary's does not, I must ask noble Lords to consider, why not. Look at the Motion. What I am asking is that such maternity beds as are temporarily required by St. Mary's should be secured elsewhere than from Princess Louise. If it is temporary, what does it matter to St. Mary's where they have them? Why should they insist on having them at Princess Louise, unless, of course, the hope of St. Mary's is to smash up this children's hospital and get the job finished with. I do not believe that; but if it is not so, then I think that there is no reason why they should not support my plea to the Government for further consideration. This is an opportunity, I venture to say further, for the noble Lords who represent St. Mary's to make a generous gesture which would be in keeping with the traditions of the great hospital they represent. Would the Minister not welcome an opportunity to think again? Surely there is food for thought in the facts that I have put before your Lordships. I hope for your Lordships' support. If I get it, and if the Government will not reconsider, I shall certainly press my Motion to a Division.

Moved to resolve, That Her Majesty's Government be requested to reconsider the Minister of Health's decision of 16th June, 1958, with the specific object of:

  1. (a) securing such maternity beds as are temporarily required by St. Mary's Hospital, Paddington, by converting to adult use other children's beds in older hospitals, e.g., St. Charles and Paddington General, or elsewhere;
  2. (b) maintaining unimpaired the vital service being increasingly rendered by this modern children's hospital in a densely populated area.—(Lord Balfour of Burleigh.)

3.26 p.m.


My Lords, listening to the noble Lord who has just sat down, I could not help wondering whether we could not set this whole question in its proper perspective without making debating points. It must be very unpleasant to all of us to criticise an institution which he has so much at heart, and indeed I should not have been drawn into this controversy at all if it were simply a squabble between two hospitals. There is a basic principle involved, and that principle is the very core of the efficiency of the hospital system—namely, that if hospital beds are no longer necessary for the purpose for which they were originally designed, then they must be set free by the Minister for purposes which the community requires.

There are two reasons why the Minister must set beds free when their function has passed away. The first is the capricious distribution of hospitals before the National Health Service Act was passed. They were dumped anywhere, without any regard to the needs of the community, simply according to the capricious bounty of donors. The result was that one might get two children's hospitals in the same street. When the National Health Service Act came in, it was obvious that the Minister had to provide hospital accommodation for every kind of malady for the whole population, and inevitably he had to review the uses to which hospital beds were put.

The second reason is that diseases which thirty or forty years ago were a menace to the community, have in the passage of time lost their sting and become relatively innocuous. I remember when diphtheria was a dreaded malady; to-day, a medical student never sees it. In 1949, infectious diseases took up 21,848 beds; six years later they occupied 9,607 beds. With tuberculosis there is the same story. In 1955 it was possible, because of antibiotics and the like, to take 1,000 beds from tuberculosis and devote them to other purposes. The following year it was possible to take away 3,700 beds, and in the next year, 1957, it was possible to take away a further 3,900 beds. That is to say, in three years' time between 8,000 and 9,000 beds hitherto devoted to tuberculosis were set free to be used for other diseases. And it is the same happy story, as is generally admitted, with children's diseases.

Clearly, the Minister is faced with the bounden duty of seeing that these beds are properly used, yet whenever he attempts, in a very modest way to perform this co-ordinating function, there is a terrific outcry. When St. George's-in-the-East was closed, the agitation went on for about three years. When a general practitioner's hospital in Kingston was converted into a gynæcological unit the out-cry lasted for even longer than that. Today we are simply running according to form.

I must repeat to your Lordships the warning that I ventured to give in 1957. If local loyalties and local feelings are going to take charge, and if, everywhere, co-ordination is to be forgotten; if beds which are no longer needed for the purpose for which they were designed are still to be used for that original purpose because of local clamour; if this controversy which has been going on for three years is to become a pattern; if the beds taken away from tuberculosis and infectious diseases, to which I have just referred, are to be restored to them, not because they are needed, but again because of local clamour—if, in short, the whole attempt to co-ordinate the hospital system is to be given up, then I shall despair of the future of the hospital system.

It is in the light of all these facts that I think, we should review the undertaking given by St. Mary's in 1946. The noble Lord, Lord Balfour of Burleigh, has called it. "a legalistic change of mind". What are the facts? A new board of governors, after the National Health Service Act transformed things everywhere, were faced with new responsibilities and new duties. Was it the duty of that new board to fulfil those duties or to be bound by an agreement come to by a former board of governors, in totally different circumstances, when they had not these responsibilities and when, moreover, there was only one survivor of that board of governors? Surely the noble Lord, Lord Cohen, was right when he said that the old St. Mary's cannot bind the new St. Mary's.

In spite of that, when this came up in 1957 speaker after speaker rose and expressed his abhorrence that charitable monies given for a special purpose should be diverted to other purposes. Has not that always happened? When a charity has outlived its usefulness, it has been the practice for the trustees to go to the Charity Commissioners and ask if they could use the money for other purposes; and it has been the habit of the Charity Commissioners to go into the matter carefully and, if satisfied, to grant that request. We appealed to the Ministry of Health, who in this case acted as the successor of the Charity Commissioners, for permission to use these beds temporarily for obstetrics and after long consideration that permission was given.

Could the Minister of Health have come to any other decision? On the one hand he was faced with the fact that there was an acknowledged surplus of children's beds; and on the other hand there was the most acute shortage of obstetric beds. For example, a woman now goes to Paddington Hospital seeking admission to have her first child. In the old days she would have got that without a murmur, but she will not now get it unless there are special circumstances in her environment which make it necessary. The Minister may well have said that the very purpose for which these beds are borrowed—that is, for obstetrics—is just what the community needs, because they are being borrowed for two years so that the unit at St. Mary's can be rebuilt and enlarged from thirty beds to fifty beds, which will make a considerable contribution to what in this region is one of the most vital questions at the moment; that is, to provide proper obstetric treatment for the inhabitants of the region.

Not only are these beds needed by the community, but they are needed by the medical staff of Princess Louise. I do not know whether the noble Lord, Lord Balfour of Burleigh, is aware of that fact. If your Lordships have grandchildren, you may be happy in the feeling that they are not likely to be cut off by the old infections, diphtheria, pneumonia and the like. Broadly speaking, the dangers of childhood are two: accidents, such as burns, and the infections which happen in the first month after birth—what are. called neo-natal diseases. These are so important that no complete pædiatric unit can be put up that is not in close conjunction with an obstetric unit. Indeed, I shall make a prophecy that in two years' time the staff of the Princess Louise will come to us and say: "Do not take away these obstetric beds; they are far too valuable" And if we have to do so, they will be very sad.

I sometimes wonder whether the noble Lord, Lord Balfour of Burleigh, keeps in close touch with the medical staff of the Princess Louise. Their attitude has completely changed. They are now—and they said this a few days ago, on January 21—completely willing to co-operate with St. Mary's in carrying through this arrangement for obstetric beds. I think that is a remarkable fact.


I beg the noble Lord's pardon for interrupting, but as he has made that statement I feel bound to read a letter which I received from Dr. Chester, a senior member of the medical staff of the Princess Louise Hospital. She writes: I attended the last Board meeting of St. Mary's Hospital, which was held on Thursday the 22nd January, as an observer. At each of these Board meetings one representative attends from each of the constituent hospitals, by courtesy of the Board of St. Mary's Hospital. In such capacity I could not take part in the proceedings of the Board, and therefore could not comment upon a statement made by Lord Cohen to the Board. This was to the effect that he understood that the Medical Staff of Princess Louise had accepted willingly the proposition that two of the wards of the Hospital should be converted, as soon as possible, from children's wards to maternity wards. He indicated that he intended to make use of this in the House of Lords debate to-morrow. We have not had the opportunity of considering the statement of Lord Cohen formally at a meeting of the Princess Louise Medical Committee, but after consultation with several of my colleagues I can say that the Medical Staff at Princess Louise still feel strongly against the part-conversion of the Hospital, even for a temporary period, accepting neither the necessity nor the desirability of such a conversion. They are also apprehensive about the policy for the future of the pædiatric hospital. Nevertheless, if the Minister does not reverse his decision in respect of the conversion, and we are instructed by the Board of St. Mary's Hospital to proceed with the proposition, my colleagues and I, as loyal members of St. Mary's Group, will co-operate with the medical staff of St Mary's to the best of our ability, and will endeavour to make the combined pædiatric and obstetric unit a working one.


May I say that I agree with part of that statement, but not all of it. However, I think it will probably be convenient if I reserve exactly what I have to say about it until I come to address your Lordships.


I accept entirely that that is the opinion of that member of the staff. I was informed by the officials of the hospital. I am sure that the noble Lord, Lord Cohen, is far more competent to deal with this than I am. I simply quoted what was given to me by the officials and one or two members of the staff.

To continue my remarks, I do not think I need take up any more of your Lordships' time in arguing that beds should be able to change their function, and that the Minister should support it, because the noble Lord, Lord Balfour of Burleigh, said in the previous debate that it was inevitable in this area that children's beds should be converted into adult beds. There is no dispute about that, but he naturally discusses where these beds shall come from. He agrees that children's beds may have to be cut down, but not in the Princess Louise Hospital. That is where we join issue. In support of that he has made great play with a report of the Pædiatric Committee of the Royal College of Physicians. I listen attentively to pronouncements from that body, because I was its President for nine years. Therefore, when he quoted this report I thought I ought to write to the twenty members of that Committee asking them what was in their minds. They had to answer by return—it had only occurred to me at the last moment—and all but two have answered. One was a complete exception to what I am saying, and the rest were practically unanimous in what they said.

The first thing they laid down was that they all felt, after the debate of 1957, that this report had been quoted out of its context and with a meaning never intended by the hospital; and that pædiatricians could stand by it only if it was placed in its proper context. The report said that there was no doubt that special children's hospitals offer the best service for children. Not one of them had in mind all special children's hospitals; they were thinking of the Sheffield Children's Hospital which had 221 beds in it. Further, it was pointed out to me that if the noble Lord who admires this report had turned over the page he would have found it referred, quite explicitly, on page 2 to "a children's hospital or a children's unit of adequate size"—it did not matter which, provided two things were supplied. One was that it was of adequate size, and the other that the ancillary departments, mainly pathology, radiology and the like were first-rate.

Now why is it important that a children's hospital should be large? If it is not, it will not be able to compete in the open market for first-class personnel for the accessory departments. The good radiologists and pathologists want to go to a hospital where there is plenty of material. Therefore we come to this sombre conclusion, which I do not think anybody disputes, that the days of small hospitals in every branch of medicine are numbered. They are not economic and they cannot possibly compete for the personnel necessary to run their ancillary departments effectively. That means to say that to get first-rate accessory departments the pædiatric unit of the future should be big enough to supply them itself. To do that it must either be another Great Ormond Street Hospital or, alternatively, it must be a pædiatric block attached to a general hospital which itself has these departments.

I do not think any of us feel that it is practical for the country to go on building "Great Ormond Streets." At most one will be built. So if you are going to get first-class departments you have to get them in general hospitals. Let us apply this to Princess Louise Hospital. The Regional Board Chairman. Lord Cottesloe, said: Princess Louise Hospital suffers from the disadvantage of being a small specialised hospital detached from the resources that can be made available in a large general hospital. One of the leading pædiatricians in the country wrote to me. He was on this Committee. He said: I have personal experience of small children's hospitals or units from a remote adult parent hospital, and I know how unsatisfactory and frustrating and inefficient they are. The Royal College Hospital itself, in its Report, emphasised the gain of being adjacent to the first-rate departments of a large hospital. Having said that, I think it is only fair that I should add a postscript. In all these letters, which I have tried to analyse fairly, there was one recurring thought. It did not matter a hit whether it was a children's hospital or a pædiatric block; what mattered was this: It is not everything to have a large pædiatric block, either in a teaching hospital or large general hospital; it is necessary to have something in addition, and that something is this: pædiatric nursing, pædiatric pathology, pædiatric radiology, pædiatric psychiatry, and so on, are so different from those branches in the adult that it is necessary that these adult departments should be attuned to children's uses. Now, I think everybody of experience will admit that, if you have a really understanding pædiatrician in charge, will the right sisters, you will get things attuned in that way.

The first thing I would say to the inhabitants of Kensington who may fear for their children is this: that in spite of all the noble Lord has said, I do not think there is any doubt at all that the six pædiatric units which almost surround Princess Louise can supply this service. There is another danger—namely, that if half these beds are closed to children for two years the stream of admissions, often a trickle, may dry up altogether. I would reassure them by telling them that when on June 17, 1944, the West End Hospital for Nervous Diseases was hit by a flying bomb the authorities subsequently borrowed 33 beds from the Princess Louise Hospital and administered them with their own nursing and medical staff. That went on until May, 1946, two years later. Apparently that did not have any effect upon the demands for admission, which I think is a refreshing fact. It is feared that the centres for speech therapy, radiology, cardiology, neurology and the like, would be lost. Speaking personally, I am sure it is unsound that highly developed clinics of this kind should be in a small medical centre. Again, there is the question of the Princess Louise training for nurses. The Board of St. Mary's have already guaranteed that nurses in training will not suffer. But what happens to subsequent nurses? All I can say is that recent developments have made it possible to go ahead and to see what can be done with 37 pædiatric beds at Kensington. Add the 52 at Paddington Green, and we shall see whether that meets with the requirements of the Nursing Council. If it does not, I understand that another children's hospital is willing to help.

The noble Lord who opened the debate quoted my remark about the Princess Louise hospital not being needed. I believe that, for the reasons I have given, it will eventually suffer the fate of all small hospitals.

The noble Lord spoke of Poor Law infirmaries, and I rubbed my eyes. This is going back twenty years. I was on the staff of what was called a Poor Law infirmary at Paddington and it was gradually converted into a first-class hospital. Though I have been off the staff for a long time, when I left it was a first-class hospital. There are no such things now as Poor Law infirmaries! The noble Lord is completely out of date.


May I interrupt? I did riot say they existed now. I described them as the old Poor Law hospitals.


I thought the innuendo was there: that that was their weakness. But, in any case, it is not a weakness; they are going concerns.

With regard to administrative control, the noble Lord suggested a solution. I have nothing against that solution except that I do not think you are going to find that the administrative body, the Regional Board, will agree. They are preoccupied with the need for obstetric beds. Whereas they might have countenanced taking it over at one time, I am sure they are not going to do it now. I do not think the Regional Board will feel themselves in a position to play. That is the answer. As to administrative control, when I said beds must be under administrative control I was not stating a fad. The London University, which provides the funds for all medical schools, have said definitely they do not think St. Mary's could fulfil their obligations if they had any further beds of this order of which they had not got administrative control. Finally, my Lords, I feel that I ought to crave your Lordships' indulgence for the length of my arguments, particularly as some of them must bear a great family resemblance to those I used in June, 1957.

3.53 p.m.


My Lords, I am quite sure we shall agree, first of all, that this is not in any sense a Party question. It is a local case; and it is of great human interest. We have listened to two speeches from opposite angles which have both reached a very high standard of debate. The position that I take up on this matter is a purely personal one. My noble colleagues on these Benches will, if this Motion should go to a Division (I hope it will not) vote as they please, according to their own individual views about this human and health problem. I myself feel that I have been long committed to maintaining as far as possible the voluntary interest of the nation, and especially of the individuals who make up the nation, in health treatment, and we have in the working-class movement in consequence a national hospital of our own. One may easily, whilst pursuing what one calls the best basis of hospital and medical organisation, at times cut across and wound feelings which ought not to be wounded, in trying to harness the whole sympathy of the nation for the best possible treatment of medical cases, whether adults or children.

The facts which were placed before the House on the previous occasion by the noble Lord, Lord Balfour of Burleigh, seemed to show that there was certainly strong ground for a local Kensington grievance. The agreement that was entered into in 1946 between the board of St. Mary's and the board of the Princess Louise Hospital seemed to me to have been made with full knowledge of the provisions of the Bill (which afterwards became the Act) which was passing through the House at that time and was under consideration. It is certainly true that the appointed day of the consequent Act did not occur until 1948, but in fact all the likely happenings under the Act which was put into operation in 1948 were known to both sides in the negotiations between St. Mary's and the board of the Princess Louise Hospital. It seems to me that that agreement has not at any time been carried out or attempted to be carried out. It was to keep the Princess Louise Hospital out of the general health scheme of hospital treatment; it was to secure for St. Mary's a teaching hospital for pædiatric purposes; and an undertaking was given, so far as I remember from the papers I have read, that if the Princess Louise Hospital carried out their side of the agreement then that would secure that the Princess Louise Hospital would be retained for that particular purpose.

It is perfectly true that there are bound to be (as was pointed out in the very forensic speech made to the House by the noble Lord, Lord Moran), large and wide-spreading questions with regard to diseases which have to be considered. There are not only medical science, research and medical skill and the improvement of nursing skill, but there are social factors which have been changing in the last thirty-five to forty years especially, which all contribute to the desired end, and we are all very glad about it. But I am bound to say that there are also some objections made by some medical officers, even though they may not always be in a majority, against the principle that has been enunciated by the noble Lord, Lord Moran, so ably to-day. Some still consider that if you get a unit which is large enough for the particular circumstances required and have all the proper ancillary services in there, the proper treatment of children can be secured that way. I am quite content to sit down and listen to the medical experts battle that out from one side to the other, but certain it is to my mind that the failure of the Board of St. Mary's Hospital to carry out their agreement or to attempt to carry it out puts them in rather a bad position in the present controversy.


My Lords, may I interrupt the noble Viscount? I agree that there is no Party point in this at all. But one thing is puzzling me and I think it is puzzling a great many of your Lordships. We have not been told what are the precise terms of the agreement which St. Mary's entered into with the Princess Louise Hospital for maintaining it. Could not somebody tell us what is the term in the contract?


My Lords, perhaps I may answer that. It was a perfectly legal document setting out that the Princess Louise Hospital was to be maintained for ever as a children's hospital, that its name was not to be changed and that the care of children was to continue. The other arrangement which was part of the bargain, and the reason why the medical staff of the Princess Louise Hospital agreed, was that the hospital was to be made part of the pædiatric teaching unit of St. Mary's. That part has never been carried out, and St. Mary's are now seeking to break the main condition, which was that it should continue to be a children's hospital.


My Lords, may I ask whether it was for a children's hospital only, or for a children's hospital so far as it was needed for a children's hospital?


I am afraid that I should have to refer to the original. I do not think there was anything of that sort at that time. That consideration did not arise.


May I remind the noble Lord of what appeared in the course of the debate? I think it was I who read out the agreement. It was dated February 28, 1946, and is recorded in column 396 of the OFFICIAL REPORT for June 26, 1957. So far as it is relevant it contains two provisions. The first was that The Children's Hospital is to remain in existence and shall retain its name, its properties, investments and other assets. The other provision which I read was: The name 'Princess Louise Hospital for Children' is to be retained and shall appear both in the Annual Report of St. Mary's Hospital and of the Children's Hospital if a separate Report is issued. I think those are the two relevant provisions. I hope that has answered the question of the noble Earl, Lord Swinton.


My Lords, it seems to me that that answers the question up to a point, but it refers only to the title, and to nothing else. I always like to admit it if there is a point to be made on the other side. That extract from the agreement refers only to the title; but certainly the understanding has been, as I am assured, that it was to be a teaching hospital for pædiatric purposes, and attempts have never been made to carry out that understanding. I am assured by Lord Balfour of Burleigh and his friends that they would never have made that agreement if that promise had not been made. That is my information. I thought the one weakness in the speech which was so ably put before us for our study by Lord Moran was that he did not touch upon the fact of where the children are to go. Lord Balfour of Burleigh made some reference to that—he pointed out the facts and the difficulties that would arise; but Lord Moran made no reference to that at all.

It seems to me that, if there is such a shortage of maternity beds, there ought to be some real programme to provide an adequate number of beds in the proper sort of obstetric unit. Apparently, that has not been going on. What is proposed is the temporary use of Princess Louise beds for maternity cases while they are waiting for places in other hospitals under the National Health Service. I mention that point because this is not the only case where this sort of thing is happening. Anybody who reads the Sussex papers will know of the great controversy which is going on in Brighton about the proposal to close the Sussex Maternity Hospital, which has been in existence there since 1831, and to transfer the beds to the Brighton General Hospital, another of the old infirmaries which has been brought up to date as a general hospital. This scheme will provide, in relation to an expanding population, fewer beds for maternity than are now available as between the National Health Service hospital and the Sussex Maternity Hospital.

I quite agree with Lord Moran that changes are matters to take into consideration in great schemes like this, but surely it is vastly important that one should not alienate the sympathies and the support of any sections of the population by riding roughshod over opinions very firmly held and justified by strong local needs as well. On that point, I would say that I have received a personal letter from Mr. George Rogers, the Member of Parliament for North Kensington, in which he says—I will not read all his letter, but just a short extract: This Hospital was created by the people of Kensington, paid for out of their own pockets. There is widespread resentment in all Parties at the move to take it over as an adult hospital. At the moment the Minister's decision is to take part of the hospital for maternity purposes, but it is clear that this will be the thin end of the wedge. I am not completely reassured on that point by the statement that Lord Moran made, although I realise that he was probably going as far as he could go, in his individual capacity, upon a matter that has to be decided by a main board.

There are two other things that I should like to say. First of all, in all the circumstances I regret the decision of the Minister in refusing the request, long since made by the Kensington Borough Council, for a proper inquiry. I think that the people were entitled to have an inquiry. It is a great pity that that has not been done. In the circumstances as they have been presented to-day, I think there is a case for reconsideration of this matter: not for giving the board of St. Mary's all that they would ask, and running the risk of having empty beds, but for making the best possible use of Princess Louise Hospital on the basis mentioned by the noble Lord, Lord Balfour of Burleigh, that it will be handed over to the North West Metropolitan Regional Board, so that they, unhandicapped by the promise, or the failure to fulfill a promise, by the Board of St. Mary's, can make proper provision in all the circumstances.

It might well be that there would be no danger of there being only a trickle of children going into the Kensington Hospital. In that case, many of the maternity needs in general, apart from special teaching in obstetrics, would not have to wait so long as happens to-day before they can be met by other hospitals. I understand that there is a real shortage of beds in that connection, and that in those circumstances St. Mary's want to make temporary use of these beds in the Princess Louise Hospital. The real solution could be arrived at to-day. I would ask the Government to promise just a reconsideration, and, if possible, out of that reconsideration to make an arrangement for the Princess Louise Hospital to be handed over to the North-West Metropolitan Regional Board, to be used, so far as possible, for the Borough of Kensington but to be absorbed into the general needs of hospital treatment in the region. If that is done, my Lords, I shall be very pleased indeed.

4.8 p.m.


My Lords, it might perhaps be of some use to the House if at this stage of the debate I were to give a few facts as to why the Minister considered it best to make the decision which has given grounds for this most interesting debate. After most careful consideration, he decided that he was justified in approving the temporary use of two wards in the Princess Louise Hospital for Children for maternity patients. He made it quite clear that he was not at present prepared to approve the long-term use of that hospital for adults only, but would review the future of the hospital again towards the end of the period for which it had been temporarily part used, as to these two wards, for maternity purposes.

The noble Lord, Lord Balfour of Burleigh, said that he understood that it was not particularly sound medical practice for these two classes to be mixed. He also quoted from the report of the Royal College of Physicians Pædiatric Committee. If the noble Lord would look at paragraph 11, entitled "Infants in Maternity Units", he will find these words: The Committee has already stated that all maternity hospitals and departments should have pædiatricians on the staff and they should undertake full responsibility for the care of the new-born. In the larger units the services of a pædiatric registrar are advisable, and the obstetric house surgeons should be directly responsible for the infants to the pædiatric registrar and consultants. Every maternity hospital should be linked with a children's hospital or children's department of a general hospital and thus be able to call upon the special facilities in the pædiatric unit. I do not think that that shows that the Minister has failed to pay due regard to that particular section of the report.


My Lords, does that cancel out paragraph 3 of the report?


No, my Lords. Perhaps I might also refresh your Lordships' memory as to the exact history of the hospital itself, as there has been a certain amount of discussion on it. As some, at any rate, of your Lordships will be aware, the hospital consists of 76 children's beds. It was built in 1928, as has already been said, very largely out of local subscriptions. The committee of management voluntarily joined the St. Mary's Hospital Group in 1946, in anticipation of the coming into effect of the National Health Service in 1948, as the noble Viscount, Lord Alexander of Hillsborough, has mentioned.

In February, 1955, the St. Mary's board of governors notified the Minister of their proposal to change the use of the hospital, and the two proposals put forward were, first, that two wards should be converted temporarily to accommodate maternity patients whilst the maternity department of St. Mary's Hospital was being turned into a professorial wing for obstetrics and gynæcology in connection with the appointment of a professor by the University. Those wards are being used temporarily because this other section of the group's available beds will be out of use for (I believe) about a couple of years while the alterations are being made. The second proposal is to make the hospital entirely an adult hospital. The Minister has agreed to the temporary use of two wards for two years, but has said definitely that he will defer his decision on the second proposal so that he may be better able to give his view in the light of experience. I believe your Lordships will agree that that was a wise decision.

The reasons why these proposals have been put forward by the board have already been stated, but it will not hurt if I reiterate them. There is a disproportionately high number of children's beds in the group—in fact, 18 per cent. of all the beds in the group—and there is also a fall in demand for children's beds, both nationally and locally. At the same time, the board have a statutory duty to provide the associated medical school with facilities for medical teaching and therefore they must (1) find other accommodation for the St. Mary's maternity patients while the new professional wing is under construction, and (2) reduce the number of children's beds in order to increase the number of adult beds in the group, so that the proper balance may be maintained.

Before reaching his decision the Minister gave very careful consideration to the many views that had been expressed on the matter, including those expressed in the debate in your Lordships' House in June, 1957, and those of the deputation which he received from the Royal Borough of Kensington; and these are some of the factors he took into account. In 1949 the board proposed to convert the 52 children's beds at Paddington Green Children's Hospital to an adult hospital. This proposal, however, was not formally submitted to him and was resisted as strongly as the present one has been; and the conversion—which would still have left the board with an excess of children's beds in the group—was not pursued. Since the board's original proposal to convert Paddington Green the children's outpatients clinics at St. Mary's Hospital have been transferred to Paddington Green Hospital and developed there; and the pædiatric teaching of the group is now mainly concentrated at Paddington Green and the Lewis Carroll Ward at St. Mary's. For geographical reasons alone it would be impracticable to use the Princess Louise Hospital for these purposes.

The figures supplied to the Ministry of Health by hospital authorities in the National Health Service indicate a falling demand for pædiatric beds together with a shorter duration of stay. Perhaps some of these figures may be of interest to the House: 1954, occupied beds, daily average 5,108, average duration of stay, 18.4 days. 1955, daily average 4,527, duration of stay, 17.7 days. 1956, daily average 4,383 beds; average stay 16.7 days. 1957, 4,361 beds; average stay 15.9 days. I believe that these figures bear out the argument that there is a decline.


My Lords, would the noble Earl allow me to interrupt? The figure of the average stay of a patient in the Princess Louise Hospital last year was less than ten days.


My Lords, I am coming to that. The board of governors say that there is a similar position at the St. Mary's group and they supply the following details of the waiting list for children's beds. In 1953, the figure was 539. That total is broken down and consists of 435 E.N.T., and 104 others. In 1955, it was 320 (256 E.N.T., 64 others). In 1957, it was 222 (184 E.N.T., 38 others) In December, 1957, it was 131 (92 E.N.T., 39 others).


My Lords, would the noble Earl excuse my ignorance—would he explain what "E.N.T." means?


E.N.T. means "ear, nose and throat". The figures supplied to the Minister indicate that the waiting list for the Princess Louise Hospital itself fell from 180 at December 31, 1955, to 39 on December 31, 1957; and I understand that all of those 39 cases could have been admitted in less than one month and that of the 39, 23 were tonsils cases. These figures show that almost all the applicants for the Princess Louise Hospital could, I submit, still be admitted. The board also said that in contrast the adult waiting list was never less than 1,600; in other words, there were three waiting patients for each bed throughout the three years preceding these proposals.

The board also claim that the outpatient demand at the Princess Louise Hospital has declined, and the figures supplied annually confirm this decline in the consultant clinics. These figures, again, relate to the Princess Louise Hospital: 1953, new patients, 2,650; total attendances, 10,291. 1954, new patients, 2,253; total attendances, 9,697. 1955, new patients, 2,269; total attendances, 8,623. 1956, 2,634, and 9,121 total attendances; and 1957 (the last available total figures), 2,260, and 8,434 total attendances. I am sorry to bore your Lordships with these figures but I think they are very relevant to the dispute.


My Lords, I must apologise to the noble Earl for interrupting him, but if I heard him aright these figures are entirely different from the figures on the paper.


These are the figures that are sent by the Hospital direct to the Ministry and the Minister.


My Lords, I will reserve my remarks on them until my reply. I must not further interrupt the noble Earl.


My Lords, as I say, these figures were the ones sent to the Minister from the Hospital in the returns which they have to make, and I feel we must consider that they are reliable figures, otherwise we cannot consider that any of these things are workable. The Minister saw no reason why the needs of the area could not be served by St. Charles's Hospital, W.10, Hammersmith Hospital, W.12, West London Hospital, W.6, St. Mary Abbott's Hospital, W.8, Paddington General Hospital, W.2, as well as Paddington Green Hospital, also W.2, and St. Mary's Hospital, W.2, which together have 205 children's beds. Public transport facilities between the various districts appeared to him to be adequate and distances not unreasonable.

A fairly recent investigation into the districts from which patients for Princess Louise Hospital came showed the percentages to be: from W.10—that is, North Kensington—22.1 per cent.; W.11, Notting Hill, 19.8 per cent.; W.12, Shepherds Bush, 24.2 per cent.; W.14, West Kensington, 6.7 per cent.; W.6, Hammersmith, 5.8 per cent.; W.3, Acton, 2.5 per cent.; W.2, Paddington, 2.8 per cent.; W.4, Chiswick, 1.2 per cent.; and further afield, 14.9 per cent, making 100 per cent.

An examination of the occupancy of the children's beds during 1956 in the hospitals to which I have just referred, other than Paddington General Hospital, showed that the occupancy varied from 66 per cent. to 34 per cent.

I should like to stress that my right honourable friend recognises the advantages of special children's hospitals, as I believe was said in reply to an earlier Question which the noble Lord raised a few weeks ago; but he does not think that these necessarily outweigh all other considerations. It is a matter, he feels, of assessing the advantages in relation to the circumstances of every case. To be effective and economic a separate hospital needs to be of a fairly considerable size, and such a hospital must serve a big enough population to justify it. If one planned to meet all children's needs in separate children's hospitals a large number of patients would have to travel long distances from their homes; and the modern idea of treatment is to do everything possible while the child is in hospital to preserve the link with his or her home by frequent visiting by parents and others. I believe that that is also quoted in this report. The report of the Pædiatric Committee of the Royal College of Physicians, to which I have referred, as others have done also, contemplates that children will often be nursed elsewhere than separate children's hospitals, and, provided they are not put into adult wards, there is no overriding objection to this proposal.

London is, of course, certainly big enough to support a number of children's hospitals; but I would suggest that the siting of these in relation to each other and to the general hospitals needs careful thought. I said earlier that the Minister has not yet decided on the long-term use of the Princess Louise Hospital. What he has decided, having regard to the falling off in the demand for children's beds arid to the sufficiency of such beds in neighbouring hospitals, is that there is no justification for not approving the board of governors' proposals to utilise temporarily two wards in this hospital for maternity patients.

In reaching this decision my right honourable friend had regard to his obligations under Section 6 (4) of the National Health Service Act, 1946, and he came to the conclusion on the evidence that it would be practicable for those entitled to the benefit of the objects of the Princess Louise Hospital to avail themselves of those objects in nearby hospitals during the temporary use of the two wards for maternity cases. In informing the board of governors on June 16, 1958, of his decision, my right honourable friend sought an assurance from them that suitable arrangements would be made in consultation with the North West and South West Metropolitan Regional Hospital Boards to ensure that, if necessary, local children, especially those from the postal areas W.6, W.10, W.11 and W.12, who are unable to gain admission to the Princess Louise Hospital because of the change in use of the two wards, will, subject to medical needs, be admitted to another hospital as near to their homes as possible.

The Resolution moved by the noble Lord, Lord Balfour of Burleigh, appears to be designed to precipitate the Minis- ter's decision on the long-term use of the Princess Louise Hospital, a decision which he intends to defer until towards the end of the period of the temporary use of the two wards, and then, as I have said, to make it in the light of the existing circumstances and the experience gained. My right honourable friend has authorised me to say that he is not prepared to direct the North West Metropolitan Regional Hospital Board to convert children's beds in other hospitals to meet the needs of the board of governors of St. Mary's Hospital, but if, at this eleventh hour, the Regional Board and the board of governors of St. Mary's Hospital in consultation with each other can agree on a satisfactory alternative proposition to meet the board of governors' requirements for obstetric beds while the new professorial wing is constructed, he would willingly consider such a proposal on its merits, provided it would not further delay the construction of the professorial wing. It would, of course, involve immediate consideration of the long-term future of the Princess Louise Hospital in the light of the board of governors' need to redress the balance of beds for children and adults; and as I have already said, the Minister would prefer to delay his consideration a little longer so that the experience gained by this temporary arrangement can be of assistance in making a final long-term decision.

4.28 p.m.


My Lords, I think we must all sympathise with my noble friend Lord Balfour of Burleigh's feelings at the prospect of the Princess Louise Hospital for Children, for which he was in the first instance so largely responsible and in whose affairs he has ever since taken so active a part, being used for purposes other than those for which he brought it into existence. We can all sympathise, even though, if I understand the position correctly, it is intended that half the hospital shall continue to have children's beds in any case, notwithstanding the purpose to which it is proposed temporarily—and I was glad that the noble Earl, Lord Onslow, laid so much stress on the temporary character of the Minister's decision—to divert the use of the other half of the beds. The production rather than the treatment of children is, in a sense, perhaps not so remote from the original purpose.

I cannot speak with the long and deep professional knowledge of the noble Lord, Lord Moran, who has spoken on these matters. I speak as a layman; but I think it may help your Lordships, if I, as Chairman of the Regional Hospital Board within whose area the Princess Louise Hospital and St. Mary's Hospital lie, tell your Lordships how the Minister's decision that Lord Balfour of Burleigh's Motion calls in question appears to those on whom is laid the responsibility for the service of the public in the area. The Regional Board are entrusted with that responsibility, and although they have no jurisdiction over the Princess Louise Hospital or St. Mary's Hospital, or any other teaching hospital whatever, it is the fact that they have to depend, to a very large degree, on the teaching hospitals to provide in the London area the necessary service to the public.

My Lords, the hospital services are not static. The hospital service is a living and growing organism which has to adapt itself, like other organisms, to the changing world around it; and the requirements from the service are constantly changing. As the need for beds for tuberculosis cases, as Lord Moran said, grows mercifully less, so, in an ageing population, the need for beds for geriatric patients grows ever greater. In the same way as the need for children's beds has in recent years greatly diminished all over the country, owing to remarkable improvements in ante-natal and post-natal care, and in immunisation and treatment, so the need for maternity beds grows greater in a growing population and in some places has been much increased locally by an immigration from overseas which adds both to the local population and to the local birthrate.

The area of North Kensington and Paddington, in which the Princess Louise Hospital and St. Mary's lie, is such a locality. Although I am told that the population in Paddington may recently have fallen a little, the increase in the birthrate has by far outweighed that. While many of the children's beds in the area lie empty (for instance, half the small number of children's beds, 22 in all, at Paddington General Hospital are empty at this moment: and, in passing, let me say that I do not in the least accept Lord Balfour of Burleigh's suggestion that the children's beds at Paddington General Hospital are inefficient, or less efficient, beds) at the same time the requirement for maternity beds has rapidly outgrown the number available.

The normal practice, of course, is for the doctor or clinic to book a maternity bed in a hospital beforehand, when the family circumstances or the family accommodation make that course desirable. Unfortunately, there are no figures available from the Emergency Bed Service for the period before the first quarter of 1956, but until that time the supply of maternity beds in the area in question was adequate, and the Emergency Bed Service had no calls, or only a small number of calls, to find last-minute maternity beds: but later in that year such calls began to come in, and the number of mothers who have been found beds by the Emergency Bed Service at the last moment has grown, and is still growing. Those numbers have been (I am speaking only of the general area of North Kensington and Paddington): in 1956, 60; in 1957, 109; and in 1958, 158; and the figures are still growing.

I am told that mothers expecting their first baby are now being advised in the clinics that a bed cannot be booked for them in advance, and that the mother should ring up her doctor when she feels her first pains and that he will then get her an emergency bed if it is impossible for her to have her baby at home. I need not tell your Lordships that that is a quite shocking state of affairs—a state of affairs that must be remedied at the earliest possible moment. I need hardly say that my board have made, and are making, strenuous efforts to ease this grave situation by whatever stopgaps they can devise. But, my Lords, our own resources in the area are limited, and in this matter we have to depend very largely on the teaching hospitals. St. Mary's have for a long time planned the rebuilding and the enlargement of their maternity department, with the intention of increasing their number of maternity beds from 29 to 60, if I am correctly informed; and if, by some magic process, that rebuilding and enlargement stood completed to-morrow, there would be no further need for concern. That increase of 31 beds would provide for some 600 births in the year, and there would be no need for calls for such purposes on the Emergency Bed Service, either now or in the foreseeable future.

When Lord Balfour of Burleigh raised this matter of the Princess Louise Hospital in the debate in your Lordships' House in June, 1957, this maternity problem was only developing, although even then it was a matter that was beginning to cause some concern. In that debate I said that I hoped the Minister would find the means of enabling St. Mary's to build the additional beds that they needed. It was urgent then; it is far more urgent now, and the Minister's decision of six months ago. enabling St. Mary's Board of Governors to convert half the beds at the Princess Louise Hospital for temporary use as maternity beds, is designed to effect just that purpose by providing for the decanting of St. Mary's maternity department so that they may rebuild and enlarge it at St. Mary's.

Now, my Lords, it is no good saying, as Lord Balfour of Burleigh's Motion would have us say, that the decanting should be carried out by using empty children's beds in Paddington General Hospital or in St. Charles's Hospital—the only two hospitals the Regional Board has in the area. It is true that of the small number of children's beds in these hospitals a considerable proportion are empty, but in any substantial general hospital serving an area there must be some children's beds available for casualties and emergencies. Despite the dictum of the Royal College of Physicians, on which Lord Balfour of Burleigh has laid so much stress, there is a sharp division of professional opinion on whether children are better looked after in special children's hospitals or in special children's wards in general hospitals. But the one thing on which there is no division of opinion is that children should not in any circumstances be taken into adult wards in general hospitals.

It is therefore essential to have some children's beds in a large general hospital, and it is simply not practicable to suggest that the ten or a dozen children's beds that happen to be empty in the children's ward at Paddington General Hospital at this moment, and the six or eight which happen to be empty in the children's ward at St. Charles's at this moment, should be converted to use as maternity beds. Efficient maternity treatment cannot be provided in that piecemeal sort of way, let alone proper facilities for teach- ing obstetrics to medical students from St. Mary's.

Some reference has been made to an article that has appeared in The Times this morning, and I think that perhaps I should say one word about that. What I should like to say about that is that it is easy to pontificate if you do not really understand the problem; and The Times leader is behind the times—eighteen months behind the times. It is true that eighteen months ago the Minister of Health asked my board whether we would accept the Princess Louise Hospital for Children as a children's hospital if we were offered it. With some reluctance, but in a desire to be helpful, we said that we should be prepared to do so. We went further and said that we should be prepared to make 50 beds at St. Charles's Hospital available to St. Mary's for teaching on the same basis as we make 200 beds at Paddington General Hospital available to St. Mary's for teaching at this moment. That offer, for reasons that I can well understand, did not meet the requirements of St. Mary's, who need not only beds under their own hand but beds for particular purposes at one time and for other particular purposes at another time, as they are carrying through a scheme of rebuilding and reconstruction. So that suggestion fell to the ground.

There is some suggestion that something of the sort might be revived now. But the fact is that events have moved on; the situation has changed. And I think that if the same question were put to my board now, against the background I have outlined to your Lordships, they would not be prepared at this moment to renew the offer they made earlier. The process of decanting that is envisaged in the Minister's decision will mean, as I am informed, some temporary small reduction in the number of maternity beds during the period of rebuilding, and that in itself will aggravate the already serious maternity position; but that difficulty must be faced sooner or later and the longer it is put off, the more difficult it will become. The service of the population dictates that this rebuilding should be carried through as a matter of the utmost urgency, and I must hope that St. Mary's will press forward with it, as I know they are anxious to do, at the earliest possible moment. It is long overdue and the effect of adopting this Motion would be to delay it still further. If the noble Lord divides the House, as I have told him, I shall feel myself impelled to vote against the Motion.

4.44 p.m.


My Lords, I want to confine myself to one or two of the more general medical aspects of this controversy which has been going on for so long. I should like to say first that among the medical profession there will be a good deal of support for the Motion put down by my noble friend Lord Balfour of Burleigh. I am not going to say that it will command universal support—that would be saying far too much; but it has a good deal of support. Only last night I was talking on the telephone to my noble friend Lord Evans, who greatly regrets that he cannot be in his place this afternoon. He told me that if he were here, he would certainly speak in favour of the Motion.

The first point I should like to mention is agreed, I think, by all noble Lords who have spoken: that there are too many children's beds in London at the present time, and particularly, I think I am right in saying, in the part of London where this controversy is raging. Therefore it is quite right to shut a number of these beds to children and turn them to other purposes. But there is a growing opinion on this matter, and I would venture to prophesy about what is going to happen in the not too far foreseeable future to children's hospitals and children's beds. In this matter I have the support of a number of pædiatricians, although I know that quite a number do not support it. I think that the future lies largely in specialised hospitals for children, although, as my noble friend Lord Cottesloe mentioned, there must be a few children's beds in general hospitals for emergencies and accidents. Such cases, however, could be moved as soon as practicable to these specialised hospitals.

There are a number of sound reasons for this view. One of them is that the training of nurses for children is much better if, after they have done their general training, they can train and work in the wards of children's hospitals. I think that that is accepted by a great many people. The second point is that a good deal of the work, particularly technical and medical work, is different and is far better done from laboratories attached to children's hospitals than from a general hospital. I will give an example of this which may sound rather foolish but which I think is quite sound. A pathological technician who has to draw blood from a child for various tests finds it a very different matter to draw blood from a one-year-old from drawing blood from, say, a Member of your Lordships' House. The apparatus used is similar but the technique is different. That is certainly the opinion at the big teaching hospitals for children in London, such as the Hospital for Sick Children at Great Ormond Street.

Another important point is the difficulty of dealing with sick children if they get infections. I admit that these are not nearly so common as they were, but it is essential to have proper isolation for children when such cases do occur. That is something which is easy to get in a children's hospital but difficult to get in a general hospital. I am not going to say that it is impossible, because nothing is impossible in that way: but it is a far simpler matter in a children's hospital than in a general hospital. And that applies particularly to children suffering from gastro-enteritis, which is becoming a relatively uncommon disease but which, when it does occur, is very lethal in its effects, particularly among very young children.

The fourth reason is that the nursing and teaching staffs get greater experience of children in children's hospitals. Although the Princess Louise Hospital, for example, is not a big hospital, there are more children's beds there than in the children's wards in general hospitals. This, I think, is one of the important things about medicine now. Much of the work is specialised and it is no longer the case that a man who has one or two cases a year is as good as the man who sees fifty or 100 cases. That is not true. A further point, which is important from the economic point of view, is that children's hospitals of a certain size are a more economic way of treating children than in the wards of general hospitals.

I know that there will be two big objections raised against my views. One is the trouble about undergraduate teaching. I agree that that is a difficult point, but I do not think that it is one which is insoluble. I sometimes think that the care of the people has to come first, even though teaching is a little more difficult. The other objection is the vexed one of children being visited by their parents. Here I can see grave difficulty, but I think that it could be overcome if it were felt to be in the interest of the children to keep them in specialised hospitals.

I believe that there is some support for what I have said in the tendency towards specialised hospitals for children which is to be seen in provincial cities and in foreign countries, particularly the United States of America. The feeling in America is more and more in that direction. At present, the feeling has not reached London very much, and I do not know whether it will. Probably there may be a change of opinion before the belief in specialised hospitals does get here, but certainly this is the tendency at the present time. I think that these are the factors which we must take into consideration.

There is another point about the Princess Louise Hospital which I think is important. It is, I think I am right in saying, the newest and most modern place for the treatment of children in that part of the town. It therefore seems a pity to shut it down unless there is some very good reason to do so, and I have not heard of one up to the present time.

The noble Lord, Lord Balfour of Burleigh, has quoted a lot of figures which I do not propose to repeat, because I think we have heard quite enough of them. What I want to ask, however (I know it has been asked before, and I exert asked it myself in the debate in 1957), is why it is necessary to close Princess Louise Hospital when you are going to keep children's beds in Paddington and St. Charles's. I know that there has been a great improvement in those two hospitals. When the National Health Service first came into operation I was a member of the management committee of those two hospitals, and I well remember what rather sad cases they were in 1948. I have not been there much since 1951, but a great improvement was made in that time and much more has been done since. They are not as melancholy and gloomy as they were, although I agree that the appearance of the building is somewhat forbidding. Why riot make these wards into the maternity wards that are required? I have never had an answer to that question, but I hope the noble Earl will be able to give one when he comes to reply. That would certainly solve the problem from the point of view of the maternity patients, about whom the noble Lord, Lord Cottesloe, is quite rightly so worried.

Another question that has been raised is the advantage of having maternity wards in a children's hospital. That may be an advantage, but it is something that I have never come across and I cannot believe that it will ever come to stay. It may have certain rather minor advantages, but even now the number of newly born children who need to go into a children's hospital must he extremely small: if I might venture a figure, I should think that .5 or .05 of 1 per cent. of total births would cover it. While I think we should all agree that it is most important to have a good link between the maternity hospital and the pædiatric hospital, I do not think it is a good idea to put maternity cases in the same building as children. There is a certain amount of evidence, which I do not think is universally accepted, that it may lead to increased infection. However, I do not know whether that is true and I do not want to press it at the moment.

I feel that the answer might be (and I am sorry at what was said by the noble Lord, Lord Cottesloe), if it were possible, for the Princess Louise to be given to the Board for a first-class pædiatric hospital. Here I should like to make a somewhat strange suggestion. As a return, it might be possible to give more than the use of beds, the actual administrative control of the beds in one of the hospitals, preferably Paddington, where teaching is done now, to St. Mary's. I sympathise with St. Mary's; they are short of beds and they have a great work to do. There would be a precedent for this. In the case of my own hospital, we got into it rather more quickly than St. Mary's, and on the appointed day we took over the infirmary of the old St. Pancras Institution, which has been of great value to us. I was not on the staff at the time this happened, but I understand that there was a good deal of argument. I think that that would be a good solution to the difficulty because even if St. Mary's do get the Princess Louise changed, they will, in time, be confronted with a shortage of beds. The only way to overcome that is to build a new hospital or to carry out some kind of exchange. I should like to recommend that suggestion to the Minister, to the noble Lord, Lord Cottesloe, and to the board of governors of St. Mary's.


My Lords, before the noble Lord sits down, may I say that he has suggested that the making of beds available by the Regional Board to St. Mary's for teaching, and the possibility that they might come under the full administrative control of St. Mary's, is something that might ease the situation, if it could be arranged. This is a technical matter and I do not want to worry the House too much with it, but I might tell your Lordships that the 200 beds at Paddington available to St. Mary's under the present arrangement are in no way under the administrative control of St. Mary's. When I came into the House to-day I received a copy of a note from the Medical Director of Paddington General Hospital, which says: As you know, at Paddington General we have a teaching arrangement with St. Mary's which has worked very successfully for the past eight years. We feel here that its success has depended on the fact that administrative control has remained with the hospital management committee and the Regional Board. He sent me a memorandum on the subject which he tells me has been favourably received by St. Mary's also.


I am most interested in what the noble Lord has said. It seems as if there is a possibility of some kind of solution, maybe not on the drastic lines that I mentioned but on similar lines, which might be agreeable to the parties.

4.56 p.m.


My Lords, I do not always agree with everything that my noble friend Lord Moran says, but this afternoon I find myself agreeing with every single item in his speech. I cannot find any point where I could usefully disagree or differ from him on any medical issue. I think he summarised the position admirably, clearly and objectively. Nevertheless, I have a certain sympathy with the noble Lord, Lord Balfour of Burleigh, because I once found myself in a very similar situation. It concerned a small but even more famous London voluntary hospital, the London Lock Hospital.

The London Lock Hospital was a great charity; it stood in Soho Square, and it looked after sufferers from venereal diseases. Soon after the start of the National Health Service the North West Metropolitan Regional Hospital Board decided to convert the function of the London Lock Hospital from its previous duties to being a neuro-surgical unit. I was approached by various members of the staff of the London Lock Hospital with their sad story, and the result was that I made an impassioned speech at the Regional Hospital Board pleading for its continuation as a venereal diseases hospital. I remember the occasion well, because I was subsequently completely defeated and "shot down in flames", as indeed I think I ought to have been. It was pointed out that, thanks to the advances of chemo-therapy, venereal beds were no longer needed, and thanks to the advances in neuro-surgery many conditions which had previously been fatal could now be treated in hospital, provided that there was somewhere to treat them. So I gave way, and it was absolutely right that I should have done so.

One of the important medical reasons for introducing the National Health Service was to enable us to deploy our resources at the point of greatest need. The fight against ill-health is not like a battle; it is much more like a continuing war on many different fronts. When we achieve success on one front we have speedily to redeploy our forces. This means that hospitals must be flexible and adaptable. Indeed, in this sphere the National Health Service has already had a great deal of success. The case of the Princess Louise Hospital is not an isolated example; literally hundreds of hospitals all over the country have already changed their functions. I personally have been associated with five such changes, apart from the London Lock Hospital, where I mistakenly tried to resist change.

I remember that the Victoria Cottage Hospital at Barnet was a case in point. It had to be converted into a maternity block. There was great resistance, not from the people of Barnet as a whole, but from the former members of the committee of the hospital who, rightly and reasonably, having worked hard over the years to build it up, felt that their work was going for nothing. Yet if one looked impartially at the needs of the community, there was no question that the hospital had to become a maternity hospital to meet the needs of this area. Equally, I remember the case of the maternity wing at St. Pancras, where the noble Lord, Lord Amulree, works, where exactly the reverse had to happen. There it was proposed to convert the maternity wing into a tropical diseases hospital. The medical staff of St. Pancras Hospital rigorously resisted this course; they said that they needed more teaching beds for obstetrics. But it was a question of the doctrine of priority. It was a greater priority that in the capital city of the Commonwealth we should have a tropical diseases hospital. There was nowhere else, and this place was eminently suitable. The conversion was carried out, and I think it is probably now part of the pride of University College that it has in its midst this very fine hospital for tropical diseases.

One has seen the conversion of little convalescent homes into mental health institutions, the fever hospitals into the geriatric units—and so one could go on. There have been hundreds of these changes: in the last ten years. Often these changes have involved the smaller voluntary hospitals. Let me say, quite frankly, that in the old days these hospitals were often not very efficient. That was nobody's fault. They were built up by local effort. They were staffed, as it were, by local medical labour, and they could not appoint the great consultants. As the noble Lord, Lord Moran, has said, there is an optimum size. That is why I disagree with the noble Lord, Lord Amulree, when he suggests there should be a whole series of specialist children's hospitals, because they have to be small, even as the Princess Louise Hospital is small. That is not the optimum size. The noble Lord, Lord Moran, has explained why it is essential that there should be in one group a large number of beds—perhaps 300, 400 or 500—so that there may be the radiological and pathological services available to the children which will not be available in these small children's units.

Nevertheless, these local voluntary hospitals were objects of great local pride, exactly as the Princess Louise Hospital is. It was natural that everybody who helped to build them up should want to keep them as they were, even though an overall view of the needs of the people in the area showed that a change was essential. But, with tact and good sense, the changes have been made, and they have brought great benefits to the people in the areas. Not one in one hundred of these changes has reached your Lordships' notice. You have not noticed that they were taking place.

The last ten years have been a period of unparalleled medical advance. The result has been a complete change in the pattern of disease which hospitals are called upon to fight. "V. D." beds have vanished, and tuberculosis beds are going down rapidly. The great problem now will be what to use these sanatoria for, because they are not ideally situated for geriatric units. The long-stay beds for rheumatic heart disease are rapidly becoming unnecessary and all over the country the need for children's beds is going clown. Inevitably, there are more and more old people in general medical and surgical beds—more and more old people have to be treated. It is not a very romantic, exciting thing to have to work and think of the geriatric service, and yet it is no less noble than looking after sick children.

In the next ten years, my Lords, medical advance will be still more rapid. We must therefore expect many more changes in the use of hospitals with which we are familiar and which, indeed, we love. We can be certain this is going to occur; and it is a good thing that it should occur. It would be quite unrealistic to suppose that merely because we have strong emotional attachments to individual hospitals they ought to continue doing the same thing. They must be used for the job in hand. We must accept that, in exactly the same way that the Army has had to accept the abolition of well-loved regiments. It must be remembered that the hospitals are the response to the failure of first-line defences against ill-health. The first lines of defence are the general practitioner services, the home nursing services and housing. As these improve, so will the need for hospital beds ultimately begin to decline.

Primarily as a result of improved nutrition, and secondly because of the coming of the antibiotics and effective inoculation, fever hospitals have already been emptied. Everywhere our children's hospitals are about 50 per cent. occupied, and the Princess Louise Hospital is no exception to this general rule. Within a reasonable distance there are something like 200 children's beds. But in North Kensington, as elsewhere, there is a great shortage of maternity beds. I am pleased that this hospital is going to be used for maternity purposes. I do not feel that in this purpose there is anything contrary to the intentions of the original founders, because, as the noble Lord, Lord Moran, has said, easily the most dangerous time in the life of us all is our first four weeks of childhood, especially the actual hours of birth and the few days afterwards. It is here that there is the greatest scope for preventing, for example, the development of the cerebral palsies—a matter in which the Princess Louise Hospital has played a great part.

I was taught pædiatrics by the late Dr. Jewesbury, of St. Thomas's. He was a follower of Truby King who perhaps is a little old-fashioned nowadays. But Dr. Jewesbury used to teach us that the work of the pædiatrician started at the moment of birth—at the moment a child is born. If the Princess Louise Hospital becomes a maternity unit it will still, in the best sense of the word, be a hospital for children—a hospital dedicated to producing children who can grow up fit and strong, and who will not need to use hospital beds later on, because they have been started on the right road when their need was greatest.

5.8 p.m.


My Lords, it is always with great trepidation that I venture into the consulting room of any doctor, and it is with almost as great trepidation that I venture to intervene, however briefly, into what is almost entirely a medical debate. Let me say that I know nothing of the medical rights and wrongs of this matter. I do not feel myself qualified to say anything about that at all. There appear to be differences of opinion about this subject, as usual in the medical world, and if I do intervene it is because there is one feature of this question which causes me, as an ordinary citizen, a certain amount of misgiving, and that is the question of the undertakings given by St. Mary's to the Princess Louise Hospital, and the manner in which they have been disposed of. There appears to be little doubt, and I do not think it has been seriously contraverted this afternoon, that there were two undertakings given by St. Mary's Hospital to Princess Louise Hospital. Whether they were both incorporated in the form of a legal document, I do not know—I gather not.

The noble Earl, Lord Swinton, asked your Lordships whether somebody could explain exactly what this agreement was, and I gather that part of it was incorporated into a legal agreement, and the other part was more or less understood between the parties concerned. If I may refresh your Lordships' memory, I should like to read to you an extract from the speech of my noble friend, Lord Balfour of Burleigh, which he made last June [OFFICIAL REPORT, Vol. 204, col. 372]. This was at any rate the version of the agreement as understood by Dr. Janet Aitken, who was the chairman of the medical committee who negotiated the agreement with St. Mary's. I hope your Lordships will forgive me for reading this briefly: At the time of nationalisation and regrouping of hospitals, the Medical Committee and House Committee of Princess Louise Hospital sought an association with St. Mary's Hospital for the purpose of forming an integral part of the pædiatric unit of the St. Mary's Group with mutual benefit to St. Mary's and Princess Louise Hospital, and all the consultations and deliberations with St. Mary's as a whole and with its pædiatric personnel were undertaken on this basis and understanding. No one on the Princess Louise Hospital side would have entered into such deliberations if it had been contemplated that there was any risk whatsoever of the care of the children of the North Kensington area not being continued at Princess Louise Hospital as heretofore, and as far as we are aware this was not in the mind of any member of the Board of St. Mary's Hospital at that time. Certainly it appears never to have been referred to in any of these deliberations. Any contemplated change, therefore, in the use of the Hospital for adults, as distinct from children, would appear to be a breach of this understanding upon which the whole association was based. That seems to be fairly explicit, and I have not heard it seriously controverted by anybody this afternoon that there was this understanding that the Hospital, if it went under St. Mary's, should continue as a children's hospital, and secondly, that St. Mary's would establish a pædiatric teaching unit in the Princess Louise Hospital.

As I understood the noble Lord, Lord Moran—I am paraphrasing what he said and if he thinks I am being unfair or misquoting him perhaps he will interrupt me—he said that circumstances change; that just after this we had the coming into force of the National Health Act and that altered everything, whereupon all the solemn undertakings which were entered into beforehand were completely upset and they had every right not to carry them out. I must remind your Lordships that the agreement referred to here took place within the twelve months before that Act came into force. I would ask your Lordships whether you consider that St. Mary's Hospital at that time, knowing the Act was coming into force, knowing, roughly speaking, the sort of consequences which must inevitably flow from it, really entered into this agreement with no idea whatever of changed circumstances. I find that very hard to believe.

It seems to me that here is something which must cause concern to the ordinary citizen in this country. It happens over and over again. It seems to be the doctrine of the end justifying the means. Solemn agreements are entered into. The breach of this agreement, so far as I can see, has been rubber-stamped by the Government, who are saying that it is perfectly all right. An agreement is entered into; circumstances change; you say you could not foresee the change; the agreement is torn up, and everybody says that the end justifies the means—the end being the public good. That is, after all, the old doctrine by which every dictatorship has lived—the public good. Circumstances change; and everything we have agreed to is torn up. That, to me, is profoundly disturbing in this case. I do not know whether the noble Lord, Lord Moran, is right medically; I do not know medically what the public good is. I leave that to more expert and better heads than mine to determine. But I do know that this sort of thing in our public life is wrong. I do not think that this House ought to approve of it, and, for that reason, I feel profoundly disturbed at what has happened.


My Lords, before the next sneaker begins, may I just say this? The noble Lord has mentioned my name. He puts aside all the practice of the Charity Commissioners which has gone on for years. Not only that, but the reductio ad absurdum of his argument is that because of this undertaking these beds will be used in perpetuity for children, even when children's diseases have disappeared. That is completely absurd.


My Lords, if I may reply, I would say, first of all, that I think that the analogy with the Charity Commissioners is a little far-fetched. In most cases the Charity Commissioners are dealing with trusts and deeds drawn up very often many centuries ago, which are completely out of date. Here we are dealing with an agreement made less than twelve months before the Act of Parliament came in, and the justification of the noble Lord was that the Act of Parliament changed everything. I entirely agree with the noble Lord that possibly you should not keep these things in perpetuity, but may I ask why St. Mary's entered into the agreement and persuaded the Princess Louise Hospital that they would be able to honour it, if they could not?


The noble Lord is completely misrepresenting the position. We did not approach Princess Louise; they approached us. I think one noble Lord said in the previous debate that he blamed them for what he called their intellectual snobbery in wanting to belong to a teaching hospital. I think it is possible to argue on either side, but what I do resent is the suggestion that this is a question of what honourable men do not do. It is quite absurd to put it like that. About a hundred hospitals would have been held up and not able to transfer their beds; the whole thing would not be workable. You cannot work your hospital system if you cannot use the beds for the purposes for which they are needed at that particular moment. This is not just one case; there are cases all over the country. You would have absolute chaos. That is why I think we can ask men of good will to support the Minister when he has to do what is essentially right from a medical point of view, though it must be very unpopular.

5.18 p.m.


My Lords, may another ordinary citizen enter into this discussion? My attention was first drawn to the subject during the year 1955, when I was engaged in a battle with the Minister of Health in relation to the ban which he proposed to put upon heroin. It was for that reason that, when the noble Lord, Lord Balfour of Burleigh, approached me on this subject, I took some interest in it. The noble Lord, Lord Lloyd, has questioned the propriety of certain actions which have taken place in this respect. May I read exactly what has happened so that the House can get it quite clear: St. Mary's entered into an agreement with Princess Louise by which Princess Louise became part of St. Mary's. A condition of the agreement was that Princess Louise should remain a children's hospital and that the name should not be changed. About the same time St. Mary's entered into a similar agreement with Paddington Green Children's Hospital. In the case of Princess Louise a fundamental condition was that St. Mary's would establish their pædiatric teaching unit at Princess Louise. Without that undertaking St. Mary's would not have obtained possession of Princess Louise, which would inevitably have been one of the hospitals falling under the North-West Metropolitan Regional Hospital Board in the administrative arrangements set up under the National Health Service Acts. Has that agreement been honoured, or has it not? Is it proposed to honour it or not to do so? That is the point which the noble Lord, Lord Lloyd, put, and which I repeat. If an agreement of that nature, entered into in such circumstances, were not honoured, it would introduce a profoundly disturbing element into our public life.

I propose to detain the House for only a few minutes in regard to the general question. I am impressed by paragraph 3 of the report of the Royal College of Physicians, a paragraph which the noble Lord, Lord Moran and the noble Earl, Lord Onslow, tried to "play down". May I read that paragraph to the House? It says: There is no doubt that special children's hospitals offer the best service for children, because the staff at all levels and in all departments is attuned to the special needs of the sick child. Children's hospitals carry with them a tradition of service which cannot lightly be set aside. The noble Lord, Lord Cottesloe, has suggested to-day that there was medical opinion contrary to that view. That may be so. Lord Moran and others may have done the same thing. But I stand by paragraph 3 of the report of the Royal College of Physicians. Can the noble Earl tell me whether the Royal College of Physicians has publicly dissociated itself from that paragraph? If not, then I think that the ordinary citizen is entitled to take that paragraph as representing the considered views of the Royal College of Physicians.

The noble Lord, Lord Amulree, has rightly pointed out that medical science and medical activities will more and more become specialised. In regard to the action proposed—the gradual abolition of the Princess Louise Hospital—I should suggest that, if the House sanctions a policy of that nature, it will be dealing a deathblow to the care of children throughout this country. It will begin with the Princess Louise and it will go on throughout the country. I would do everything I could to prevent that from taking place. I hope that the representative of the Ministry of Health on the Front Bench will be able to say that he will be able to reconsider the decision that has been reached. It is a very small thing for which the noble Lord, Lord Balfour of Burleigh, is asking. Why should the Minister not give some reconsideration to the matter? I remember that in regard to heroin the Minister of Health did reconsider the matter, with the result that the ban on heroin was not introduced and patients and doctors throughout the country were happy. I urge the Government to pay heed to the request of the noble Lord, Lord Balfour of Burleigh, in this case, and to give the further consideration for which he asks in his Motion.

5.24 p.m.


My Lords, I entirely agree with one statement made by the noble Lord, Lord Balfour of Burleigh—namely, that this is mainly a medical matter. For that reason I shall not endeavour to pursue in great detail the arguments from the medical point of view in support of the Government's proposal which have been advanced by Lord Moran and Lord Taylor. I, like Lord Cottesloe, speak as a layman. Lord Cottesloe, in the course of his observations to-day, has covered most of the ground that I wanted to cover, so I hope that I shall be able to confine my observations within reasonable limits.

First of all, I must deal with the observations made by the last two speakers, the noble Lord, Lord Lloyd, and the noble Viscount, Lord Elibank, because I think they present an entirely misconceived picture of the position created by the agreements and by the Act. The material clauses of the agreement are set out in column 396 of the OFFICIAL REPORT of the last debate, on June 26, 1957. I have read them once to your Lordships this afternoon and I will not repeat myself. I am quite content to accept as the proper basis in which to approach that agreement the basis suggested by the noble Viscount, Lord Alexander of Hillsborough—namely, that both sides, not only St. Mary's, entered into the agreement with knowledge that the National Health Service Bill was before, or about to come before, the House and with knowledge of its contents. If they did so, they must have known that whether or not St. Mary's would be able fully to implement the undertakings depended on matters largely beyond their control.

If I may refer to just two sections of the Act, I should like to remind your Lordships of Section 6 (4) to which the noble Earl, Lord Onslow has already referred. That provided that All property transferred to the Minister under this section"— that, of course, included both the Princess Louise and St. Mary's— shall vest in him free of any trust existing immediately before the appointed day, and the Minister may use any such property for the purpose of any of his functions under this Act, but shall so far as practicable secure that the objects for which any such property was used immediately before the appointed day are not prejudiced by the provisions of this section. That meant that after the Act came into force, whether the new St. Mary's could implement the undertaking depended on the Minister in whom the property was vested: he would have full discretion as to its use, but having regard, so far as practicable, to the provisions affecting the property before the coming into force of the Act.

On the second misconception, I want to speak first as to what St. Mary's was. Before the passing of the Act St. Mary's was a voluntary hospital under its own board, governed by its own constitution, with members largely, if I may put it so, self-appointed, or appointed by contributors over whom the Minister had no control. Under Section 11 of the Act an entirely different state of affairs came into being. Section 11 (8) says: The Minister may, after consultation with the university concerned "— that is, in the case of teaching hospitals— by order designate as a teaching hospital any hospital or group of hospitals which appears to him to provide for any university facilities for under-graduate or post-graduate clinical teaching, and the Minister shall, in the case of any hospital or group so designated, by order constitute, in accordance with Part III of the Third Schedule to this Act, a Board of Governors for the purpose of exercising functions with respect to the administration of that hospital or group. Now look at Part III of the Third Schedule, and see how the Board was to be constituted. There it is laid down that The Board of Governors of a teaching hospital shall consist of a chairman appointed by the Minister and such number of other members so appointed as the Minister thinks fit, and of those members—

  1. (a) not more than one-fifth shall be nominated by the university with which the hospital is associated;
  2. (b) not more than one-fifth shall be nominated by the Regional Hospital Board for the area in which the hospital is situated;
  3. (c) not more than one-fifth shall be nominated by the medical and dental teaching staff of the hospital; and
  4. (d) other persons shall be appointed after consultation with such local health authorities and other organisations as appear to the Minister to be concerned."
So that, after the coming into force of the Act, it is right, I think, to say that the matter was fully under the control of the Minister who appointed the board, with certain limitations as to the type of person whom he could appoint. That board had to carry out the functions prescribed for it by the Act.

Among those functions, and perhaps most important of them, was the duty to see that the best use was made of the wards in the various hospitals placed under their control, both from the point of view of a teaching hospital and from the point of view of a hospital designed to procure the best service for the public in need of treatment. But while the board were supposed to have regard to what their predecessors had done, they were not, as the noble Earl, Lord De La Warr, suggested the last time this matter was discussed, merely a newly elected board of a company, bound to carry out any agreement which their predecessors had made. They were a new body, a body with new and definite functions prescribed by the Act; and they had to carry out that Act. So I hope that the noble Lords, Lord Elibank and Lord Lloyd, will realise that it is not a question of a gross breach of faith with the hospitals but a case of a body of men endeavouring to carry out, to the best of their ability and having regard to all the circumstances, the duties which have been entrusted to them by the Act.

Now I must remind your Lordships that the question before you is not the same as it was in June, 1957. On that occasion the position was that the board of governors of St. Mary's Hospital had put forward to the Minister proposals which, in their ultimate result, would have involved the permanent change of Princess Louise (Kensington) Hospital from a children's hospital to an adult hospital. The board decided, before implementing their decision, to consult the Minister and seek his guidance, and I do not think any one would question the propriety of their action in so doing. When your Lordships last discussed this matter no decision had been given on the proposal, and the noble Lord, Lord Strathclyde, gave his assurance on that occasion that the matter would receive the earnest and sympathetic consideration of the Minister in the light of the debate which had taken place. I believe we may assume that this was done, not only from the fact that nearly a year elapsed before a decision was communicated but also from the figures and arguments which were presented earlier in this debate to-day by the noble Earl, Lord Onslow, as reasons for the Minister's decision.

The noble Lord, Lord Balfour of Burleigh, I am sure unintentionally, somewhat misrepresented part of the facts of the proposition which is before your Lordships' House to-day. If I have made a correct note of his observations, the noble Lord talked of "the question at issue being the imminent destruction and complete conversion of the hospital." That, as I understand it, is not the issue before the House to-day. The issue here is whether the Minister's decision, which involves, for the moment, only the conversion of two wards for temporary use for maternity cases, should be carried out. Certainly, speaking here only for myself, I shall be delighted if, when that temporary use comes to an end, circumstances have so changed that the Minister is able to restore Princess Louise Hospital to its original use as a children's hospital—although I hasten to add that I do not include in those changed circumstances an increase in sickness among children.

What I have in mind particularly (and I hope that in this I am not going beyond the proper ambit of this debate) is that from our point of view the most important change of circumstances would be a decision to proceed at once with the much-needed rebuilding of the hospital. As the noble Lord, Lord Balfour of Burleigh, very properly pointed out, there is a good deal on which we are agreed. I believe it is agreed—and certainly it is clear from what was said by the noble Lord, Lord Cottesloe—that, looking at the country as a whole, or, indeed, looking only at the area of the North-West Metropolitan Regional Board, the number of children's beds is in excess of the needs of the public. A second point is that, quite apart from the needs of the teaching hospitals, there is in the area of that Regional Board a woeful shortage of available maternity beds. If this be so, there can be no doubt—and I think paragraph 2 of the Motion of the noble Lord, Lord Balfour of Burleigh recognises it—that the issue is limited to the question of whether improvement should be effected by changing the use of two wards in the Princess Louise (Kensington) Hospital or by changing the use of other children's beds in that area.

The possibility of the second alternative has been discussed by the noble Lords, Lord Moran and Lord Cottesloe. The noble Lord, Lord Moran, referred to the reasons why administrative control is necessary. It is not purely a question of administration but of the necessity for procuring the proper clinical material; and the noble Lord, Lord Cottesloe, referred to the necessity of any big general hospital, such as Paddington General Hospital, having a children's ward into which urgent casualty cases could be taken.

I understand (although on this point the noble Lord, Lord Cottesloe, if he were here, would be better able to advise your Lordships than I am) that there is another reason for retaining children's wards in general hospitals; that is, the necessity for providing pædiatric experience for nurses in general training. It is difficult to see how this need would be met if the suggestion put forward by the noble Lord, Lord Balfour of Burleigh, were adopted.

On the last occasion the noble Lord, Lord Balfour of Burleigh, put to me the question whether we at St. Mary's Hospital gave priority to the requirements of teaching or the care of the sick, and I then said that I had not had to consider the question because I thought that on both grounds the change of use was justified. I am still of the same opinion, although I would add that the business of a teaching hospital is to provide for the medical school with which it is linked the facilities that that school requires; and therefore, in allocating beds to particular faculties and specialities, the hospital must have regard to the require-mews of that medical school. Subject to meeting that demand, we should have regard, I think, to meeting demands from practitioners and the Emergency Beds Service. I need hardly add that with every case admitted the main consideration is cure of the patient.

The Minister's decision was given in June, and your Lordships may ask what steps have been taken by the board of St. Mary's Hospital to implement that decision. They have appointed committees jointly with representatives of the house committee and medical committee of the Princess Louise (Kensington) Hospital to discuss the best method of implementing the decision, so as to cause the minimum interference with the work of the Princess Louise Hospital as a hospital for children. Those committees will meet shortly. As a result of another meeting held last week between representatives of the board of St. Mary's Hospital and all the members of the medical and house committees of the Princess Louise Hospital it was agreed that the staff and house committees of that hospital will co-operate in the arrangements to be made for the temporary accommodation of maternity patients in the Princess Louise Hospital.

At this point, my Lords, I will deal with the matter raised by the noble Lord, Lord Balfour of Burleigh, in his interjection, when he read a letter from one of the staff of the hospital which purported to state what I was supposed to have said at the last meeting of the board. I do not think I said anything of the kind, and if I did I probably misstated, speaking extempore, what I understood to be the attitude of the committee of the Princess Louise Hospital. I hope your Lordships will forgive me if I read what I understood to be the attitude of the Princess Louise Hospital committee. I want to be accurate. Naturally they do not welcome the Minister's decision, and they hope that when the lime comes to determine the future use of the hospital the conclusion will be that the Princess Louise Hospital can once again become a hospital for children, and nothing else. In the meantime, however, we are assured of their co-operation in trying to make the arrangements necessitated by the decision work smoothly and without inconvenience to the patients. I believe that that statement of the committee agrees with the end portion of the letter read by the noble Lord, Lord Balfour of Burleigh, and certainly it was my recollection of what I understood I told the meeting, although I am not myself on any of the committees to which I have referred.

I hope that if the noble Lord, Lord Balfour of Burleigh, carries his Motion to a Division your Lordships, by your vote, will indicate that you wish to give the Minister's proposal a chance of being carried out with the co-operation of all concerned, although you may hope, as I do, that ultimately circumstances may change and the Princess Louise Hospital may once again become, if circumstances demand it, a hospital devoted to the service of children. I will conclude by saying that, like one of the other speakers (I believe the noble Lord, Lord Cottesloe), I very much hope that nothing further will happen to delay the time at which we are able to proceed with the conversion of these beds into maternity beds and the creation of an obstetric unit.

5.40 p.m.


My Lords, I have listened, as no doubt all your Lordships did who either heard or took part in the debate on June 26, 1957, to the debate this afternoon with considerable surprise. Nothing whatever has been said in my hearing (and I have been present all the time) which was in any way adding to or taking away from what was said eighteen months ago. Therefore it: is not really necessary for me to detain your Lordships for very long.

We have, first of all, a statement by the noble Earl, Lord Onslow, that the Minister has given serious consideration to that debate. The debate, apart from the two noble Lords who spoke from St. Mary's, was all on one side. Therefore, the consideration has not been of that weighty nature that I think we were entitled to expect. Then the noble Lord who has just spoken said that this was a medical matter. I am afraid I must differ from him there, as I differ from him on a good many points. It is not wholly a medical matter, in my opinion, because though the medical aspect comes into it greatly there are much bigger considerations than the purely medical consideration raised by this point.

Nor is this question at all a parochial matter. It is true that all the people in the area affected are unitedly of one mind in favour of the retention of Princess Louise Hospital as a children's hospital, and I think that that deserves some fairly serious consideration; but all who support the noble Lord, Lord Balfour of Burleigh, on this question take their stand on three major principles. None of us, I think, attempts to dispute the integrity of the object of the St. Mary's Hospital governors in this matter. I feel that they are doing what they believe to be the best in the interests of the public. But there are three matters which I think need more consideration.

First of all, there is the question of the third section of paragraph 1 of this report on the care of children in hospital of the Pædiatric Committee of the Royal College of Physicians of London. The noble Viscount, Lord Elibank, read out the words and I do not think I need repeat them. The noble Lord, Lord Moran, poured scorn upon them. He not only did not follow those words but he attempted to suggest that the writers of them not only did not mean what they said but meant exactly the opposite of what they said. I think nothing is more clear than that medical opinion is gravely divided on this matter. There are some eminent physicians who take the view of that report; there are others who differ from it. If that is so, it is obviously a case where we are entitled to ask the Minister again to consider very seriously this matter, not to uphold a decision made six months ago and then let us get on with it as if the report had not been written.

Secondly, there is the matter of the agreement on which the noble Lord, Lord Lloyd, dwelt very forcibly; and the noble Viscount, Lord Elibank, followed him up. Two things are not in dispute. First, it was obvious that the National Health Service Bill was coming through; everybody knew what the facts were and the agreement was therefore reached in the light of the knowledge of what was about to come. Secondly, the Governors of Princess Louise Hospital would never have entered into this agreement unless they had been assured it would remain a children's hospital and that the name would not be changed. No one has denied that; it has been stated and not contradicted at all.

I think there is a great deal of force in our feeling that the agreement has not been kept. The noble Lord, Lord Moran, argued that because the Health Bill was coming (and the noble Lord, Lord Cohen, said the same thing), therefore all was to be swept away. But I think that both of them respectively went further than that. They said that because of the change of personnel the new board were not bound by the agreement entered into by the old. That is a very cynical reading of public affairs. I do not think that anybody in business or in any form of negotiations could possibly support such a doctrine as that. One may not be bound for ever; of course not; changes come about. But nobody has made out that such a change has come about in the time since that agreement was entered into to make it worthless, so that it should be torn up.

Thirdly, a point which I raised eighteen months ago and which has not been raised at all to-night is that money was subscribed by the inhabitants of North Kensington not so long ago for specific purposes. Those purposes are being thrown away. It is perfectly true that money subscribed in the past cannot be maintained for ever. No one suggests that those purposes should always be maintained, but I think that before they are changed two things must be done. First, the institution raised by that public money must have outlived its usefulness. No one has attempted to assert that at all; and the figures, though they are diminishing, are not in any way negligible. Secondly, it must be shown that the work is being carried out inefficiently. Again, no one has attempted to support that contention. So I feel, and I am sure many of us who are outside the actual medical proposition feel, that there is really a double breach of faith here—and we are very much disturbed about it—not only on the part of the Governors of St. Mary's, whatever the nature and integrity of their object, but also against those who subscribed only twenty years ago for this hospital. In fact the whole of the argument really is based upon the cynical line. "Let him take who has the power." The Minister has, very much to our concern, given authority for the take-over.

There is one other matter on which I think I might briefly touch. The noble Lord, Lord Balfour of Burleigh, in his very powerful opening speech, asked where these children are to go. No one has answered that question. We are told that the Minister sees no reason why they should not go here, there and everywhere. I am sure that the parents of the children see every reason why they should not. The other half of the Government's case seems to rest on the word "temporary". Many of us have been in public affairs for a long time and we know how utterly illusory that word is. When once a thing is established—I could give many instances which have occurred in my own life—there is always a very good reason for not going back on it. Does any noble Lord really feel that when once this decision has been implemented the use of the hospital as a children's hospital will be reinstituted? I know that the noble Lord, Lord Cohen, ended by hoping that it would, but does anyone really think that there is the least chance of it? This is our opportunity to ask the Minister to think again; and I hope that noble Lords will follow the noble Lord, Lord Balfour of Burleigh, into the Division Lobby if he decides to divide the House.

5.48 p.m.


My Lords, the noble Lord who has just resumed his seat, and other noble Lords who have taken part in the debate, appeared to think that there was something almost immoral in the action which St. Mary's Hospital hope to take, and something less than legal in the decision of the Minister. I firmly gathered the impression, until I had listened to the speech of the noble Lord, Lord Moran, that St. Mary's Hospital were being accused of something like sharp practice, in that they came to this agreement in 1946, and a very few months after the take-over, at the time of the National Health Service's inception in 1948, they made a new proposal. It was therefore a revelation to me to learn that it was in fact the Princess Louise Hospital which made the first suggestion that they should join with St. Mary's. In fact, in the words of the noble Lord, Lord Cottesloe, in the previous debate in 1957, Princess Louise Hospital were of the opinion [OFFICIAL REPORT, Vol. 204, col. 391]: … that if the hospital was to preserve its self-esteem, it was necessary it should be grouped with a teaching hospital, with the crême de la crême. Those concerned with the Hospital therefore pressed strongly, and pressed successfully for the Hospital to be administered by the board of governors of St. Mary's Hospital. So, in fact, the initiative came from the Princess Louise Hospital in the first place.

Now, undoubtedly and unquestionably there was an undertaking as to the preservation of the purpose of the hospital and the title by which the hospital was to be called—and there is a suggestion that if that is not continued indefinitely there is something immoral and illegal in the position. But, as I understand the Act which has guided the Minister, Section 6 (4)—the section of the Act quoted by the noble Earl, Lord Onslow—says: All property transferred to the Minister under this section shall vest in him free of any trust existing immediately before the appointed day, and the Minister may use any such property for the purpose of any of his functions under this Act, but"— and I think these are the operative words— shall so far as practicable secure that the objects for which any such property was used immediately before the appointed day are not prejudiced by the provisions of this section.


Might I interrupt the noble Lord? He would not wish to misrepresent the attitude of the Princess Louise Hospital in this matter. I do not think he laid enough stress upon this fact. It is quite true to say that the initiative came from the Princess Louise Hospital, but let me read this: At the time of nationalisation and regrouping of hospitals, the Medical Committee and House Committee of Princess Louise Hospital sought an association".— as the noble Lord has said— with St. Mary's Hospital for the purpose of forming an integral part of the pædiatric unit of the St. Mary's Group with mutual benefit to St. Mary's and Princess Louise Hospital. It was for that specific purpose, and that has been departed from.


Yes. I am glad the noble Viscount realises that I did not want to misrepresent him in any way, and I hope I have not done so. In fact, I specifically say that it was part of the contract that this should be continued as a children's hospital and that this obstetric unit should be established there, and that that part of the bargain made by St. Mary's has not been kept. I fully admit that. But I would submit that the important issue here is not the specific legal issue, which I think is covered in any case, and it is not even that there was a kind of covenant made. The important interest, and the one that we are here to try to safeguard is that of the people who are going to use the hospital beds. That is the issue—the only one, I would submit, of importance.

Everyone, of course, must sympathise with the noble Lord, Lord Balfour of Burleigh, in his efforts to preserve intact the purpose for which the Princess Louise Hospital was built and towards which he has made such an outstanding and continuous contribution. But that purpose no longer exists to anything like the extent that it did thirty years ago, when the hospital was built. The noble Lord himself said that in London, and, indeed, throughout the country, for reasons for which we all rejoice, something like 50 per cent. of children's beds in hospitals stand empty. The diseases arising directly or indirectly from malnutrition are no more, and advances in medical knowledge and improvements in hygiene, immunisation, and the like, have reduced many of the former scourges to the level of things forgotten. It is almost true to say that the only reason for the retention of a children's ward in a hospital to-day is so that we can ensure that child casualties do not have to be dealt with in a general ward with adults.

Some empty beds of course there must be, but the Minister of Health and the hospital authorities would utterly fail in their duty to the public if they allowed expensively-maintained hospital beds to remain empty when they could be properly put to other use—and everywhere there is overwhelming need to put these beds at the service of other types of patients who are in desperate need. We all know of many cases of mothers who, for medical or other reasons, such as housing, need these beds. How many hundreds of desperate cases did I know about, as a Member of another place for Shoreditch and Finsbury!There was the case of the mother with three children already, living in one room, having another baby, who was told that there was not room in the hospital for her to have her fourth child.

It is still going on. Only last week I heard of the wife of one of my employees, a young married couple, having her first baby. The hospital was three miles away. The husband telephoned me and said: "They say they cannot take her, and she has started her labour". I said: "Take her to the hospital". It was three miles in a taxi, and the hospital said: "The labour pains are not frequent enough yet. Come back when they are every half an hour." Now, a hospital does not do that kind of thing because they wish to be cruel or callous they do it because they have to—because there are just not the beds there. Indeed, we all know, too, that beds are desperately needed for geriatrics, and for the long list of urgent surgical cases that have to be met in any case. That is the general position, as we all know, and it is surely unanswerable that children's beds can, without detriment to children's health and safety, be put to these other uses. If they can, then they must be.

The noble Lord, Lord Balfour of Burleigh, while admitting, at least by implication, the general case, argues that the Princess Louise Hospital is a special case to which the general does not apply. In the memorandum which he was kind enough to cause to be circulated, of which I received a copy, he says—and I would ask noble Lords to note this: The case for retention of the Princess Louise as a children's hospital rests on the acute need in this densely populated area. His case rests on that. In the memorandum he also points to the constantly increasing use of the hospital since the war, and very properly he draws attention to the fact that in the three years when it might be thought that the usage was less, there was infection in the hospital. We know that in 1957 they had acute trouble with salmonella infection. But one of the years he mentions as having been concerned with infection was 1958, when the noble Lord suggests that bed availability was reduced by infection.

But according to my information, out of 76 beds in the hospital the average bed availability in 1958 was over 70, easily the highest for the last four years, and a very high figure indeed for a children's hospital in any year. There must always he some children's beds which have to be out of use for cleaning and so on, and the suitability of the new patient coming in with regard to the child who has occupied the bed previously has to be borne in mind. So in that year 1958—last year—which I do not think it would be unfair to take as a fairly normal year, out of 76 beds in the hospital the average number of beds occupied was 42, which means, of course, that the average number unoccupied was 34. That scarcely supports the noble Lord's claim of acute need on which he bases his whole case. It might, indeed, on this evidence alone, be claimed that 39 of the Princess Louise beds could be used for maternity cases without discommoding a single potential child patient. But if there is any doubt I would submit that it is speedily removed by the knowledge that in other hospitals in the fairly near neighbourhood there are available no fewer than 217 beds for children.

The noble Earl, Lord Onslow, gave the hospitals and the figures of the beds in each, so I will not repeat them; but they total 217. He mentioned that the bed occupancy was between 36 and 65 per cent., so it is not unfair to say that at any given time among those children's beds 4 out of every 10 were empty, which means at least 80 out of the 200. Eighty empty beds would be far more than enough, if the need arose, to accommodate all the children at the present time being treated at the Princess Louise Hospital. I would submit on this evidence that if the St. Mary's Hospital proposal is approved, not a single child in the area will suffer, either through delay in admission to hospital or through deficiencies in treatment. If this is accepted, as I think it must be, then the noble Lord's case based, as he admits, on acute need, fails completely.

Even so, I think that it is necessary for St. Mary's to prove the need for the proposed change. I would say that the need is proved immediately one looks at the figures of the waiting lists. On January 9, just a few days ago, the waiting list of adult cases for St. Mary's was 1,520. The waiting list at the Princess Louise Hospital, excluding ear, nose and throat cases, was 24, of whom I have no doubt some are out again, having regard to the fact that the average stay is only ten days. In the light of this knowledge of the acute need of St. Mary's patients, I submit that we cannot support the view that the empty beds at Princess Louise Hospital should stay empty. If those 39 beds could be used for maternity cases, then in the course of a year it seems likely that at least 9,000 mothers, who might otherwise endure squalor and even danger, would be able to bear their babies under ideal conditions. As my noble friend Lord Taylor has said, that in itself would be a service for children.

The noble Lord, Lord Balfour of Burleigh, has suggested that St. Mary's might use the 24 children's beds at St. Charles's Hospital and the 21 at the Paddington General Hospital as maternity beds. But this would mean a unit split in two parts and not under the management of St. Mary's. St. Charles's has no maternity beds at present, so that if this proposal were followed it would mean the provision of other facilities, such as a labour ward, so that the empty accommodation would reduce the number of beds available from 21 to about 12, and it would mean also that any children who had to go to Paddington General or St. Charles's could not go there unless they went into adult wards, which is most undesirable. Above all, it would mean that the St. Mary's obstetric and midwifery staffs would have to work under a different regional administration, and I submit that that would be a wholly impracticable and, indeed, absurd arrangement.

I submit that the facts are plain and the issue simple but important. If your Lordships support the Motion, a fine small children's hospital will continue in being nearly half-empty and at a totally unwarranted cost per patient. If your Lordships oppose the Motion and support the St. Mary's proposal, the empty beds will help to satisfy an acute need, and not a single child will suffer. Hospital authorities (and I have been a member of a Regional Board) are fully aware that changes of this kind often encounter, quite properly, strong objection from local interests and from people who have a real love for and pride in a hospital they have helped to build. That is quite understandable. Consequently, hospital authorities do not make these proposals unless they feel that in their public duty there is no other course open to them. Their basic duty, however, is to the patients who need hospital treatment, and with that in mind it is our plain duty to oppose this Motion.

6.5 p.m.


My Lords, we have already had twelve speeches this afternoon, and as there are still two other noble Lords who desire to speak I will be as brief as possible. I have listened with great interest to all who have taken part in this debate. I speak now not, like some noble Lords, as a former chairman of a Regional Board, but rather as a hospital worker, having lived and worked in Windsor for a comparatively short time since the war, five years, serving on the committee of the King Edward II Hospital, a good school because it has geriatric and maternity branches, as well as a large general hospital. Although I cannot in any way claim the experience and knowledge of noble Lords like Lord Moran and Lord Balfour of Burleigh, I have listened with great interest and understanding to the arguments put forward, as I listened to the previous debate in 1957, and I would say with my noble friend Lord Gorell that I support the Motion.

My noble friend Lord Balfour of Burleigh gave in his speech all the facts and figures relative to the arguments, and there is no doubt, as has been pointed out twice already, that hospitals such as the Princess Louise Hospital offer the best service for children because the staff, at all levels and in all departments, are attuned to the special needs of the sick child. Children's hospitals carry with them a tradition of service which cannot be lightly set aside, as the late Lord Webb-Johnson said eighteen months ago. That is what I felt when I began to examine the problem of the Princess Louise Hospital nearly two years ago. I felt that there was an overwhelming case for keeping it open as a children's hospital, and after listening to all the arguments this afternoon, I am still of that opinion. In conclusion, I should like to say that Truby King is a great man, a New Zealander whose teaching at Kiritani has always been a high model of this kind of work. I never thought that I should have to defend him. I beg to support the Motion.

6.8 p.m.


My Lords, I speak with considerable reluctance in this debate, because it involves opposition to so many noble Lords with whom I am normally in agreement and with many of whose observations I agree to-day. My reason for speaking is that I wish to raise a perfectly simple legal point which has not hitherto been raised in the course of this debate. It has been generally assumed by noble Lords who have spoken, on both sides, that whatever was the most convenient course to take on medical grounds was necessarily one that should be taken and that the Minister would have power to take it. In my respectful submission that is not the case.

Only three noble Lords have mentioned what I agree with the noble Lord, Lord Stonham, is the important section of the National Health Service Act, 1946—namely, Section 6 (4). As the whole of my argument is based on that section I wish to remind your Lordships with precision of its terms. The noble Lord started to read it, but I think he was put off by an intervention from reading the most vital part of it.


I think I had already read what I wanted to read before the noble Viscount interrupted me.


I was on a different point.


Anyhow, I wish to be absolutely certain that this matter is before the House. The subsection says: All property transferred to the Minister under this section shall vest in him free of any trust existing immediately before the appointed day, and the Minister may use any such property for the purpose of any of his functions under this Act"— and now come the vital words— but shall so far as practicable secure that the objects for which any such property was used immediately before the appointed day are not prejudiced by the provisions of this section. I ventured on the last occasion to conclude my observations by expressing the strongest possible doubt of the legality of the action which it was then feared that the Minister was going to take. I asked my noble friend who was to conclude the debate on that occasion whether he agreed with me that the Minister would be bound by those express words, and that that was one of the most important considerations he would have to bear in mind. I concluded with these words [OFFICIAL REPORT, Vol. 204, col. 410]: I do not know whether that question is a question of fact or a question of mixed law and fact, but in either event I must express the strongest possible doubt, if it is agreed that the obligation imposed by the subsection applies, whether it could possibly be held, in the circumstances of the case, either that the purposes for which the Princess Louise Hospital was used would not be prejudiced by these proposals which the Governors have accepted or that it was not practicable to avoid such prejudice by continuing to use it as a children's hospital. This subsection of the Act is most important. If I may remind the House of the great controversy when the Bill which is now the National Health Service Act was going through Parliament, that Act treated very roughly ancient trusts or recent trusts, and diverted charitable funds to uses for which they had never been intended. I remember the tussle well, because at that time, as representative of the combined English Universities, I numbered among my constituents more doctors than any other Member of the House of Commons, with the sole exception of the Member for the University of London. The provisions were strongly contested, but on one thing I think both sides ultimately agreed—namely, that if ancient trusts and charitable intentions were to be roughly treated, at least we should have the security of those words which I have quoted. That is all that was left to secure that the charitable intentions of donors were not completely ignored; and although the two sides of the House differed on the merits of a great deal of the Statute, I believe that my Socialist opponents held just as sincerely as those of us who took the other view that those words which I have quoted represented a statutory provision to which there was every intention that the Minister should strictly adhere.

Now, my Lords, three things have happened since I ventured to express those doubts in the debate of June 26, 1957. The first is that my noble friend Lord Strathclyde, in concluding the debate on that occasion, gave me the assurance that he agreed, and the Minister agreed, that those were the considerations by which the Minister would be bound. The second relevant thing that has happened is that the Minister has given the decision of which my noble friend Lord Balfour of Burleigh complains. But there is a third thing that has happened, which is perhaps more important but which has not hitherto been mentioned in the course of this debate; that is, that the subsection I have quoted has been the subject of judicial decision in the Scottish Courts. It was a decision on the corresponding section of the Scottish Act, but perhaps the House will accept from me that it was a section in identical terms. Anybody who is interested will find the case reported in 1958 Scots Law Times, at page 258.

The judgment in that case greatly strengthens the doubts which I then put forward, and incidentally it negatives a brief remark of my noble and learned friend Lord Cohen, who said that the parties negotiated with knowledge that the Act was to come into force and that there was this section in it, but went on, I think, to say that this section gave a discretion—implying almost an unlimited discretion—to the Minister. But that is exactly what the Scottish Court has said it does not do. The Minister assumed in that case, as he has assumed throughout in these proceedings, that he had power to accede to a request made to him, if he regarded that course as in the public interest. But the Scottish Court, in case which I have cited, said that there was not that discretion, and in fact reversed the decision to which the Secretary of State for Scotland (who has the same position in that country as the Minister has under the Statute in this country) had come.


I am grateful to the noble Lord for allowing me to interrupt. Is it not a fact that in the Scottish case to which he has referred it was a covenant or undertaking that a woman doctor should be employed? In my humble opinion, the Minister was wrong in that case to rule that it was not practicable to employ a woman doctor, because there are many women doctors. But I submit that the case which the noble Lord is now making is not parallel, because it is impossible to carry on a children's hospital full of children if there are not enough child patients.


I am sorry if I gave the impression that I had finished with this case; I have not. I was quoting this case at this stage as negativing the discretion of the Minister which my noble and learned friend Lord Cohen (it was only in a single sentence, which would, I think, have been framed differently had he had this case in mind) thought the Minister possessed.


Is it the Adams case?


I have given the reference.


As my noble friend has referred to me, perhaps he will forgive me for interrupting to say that I deliberately did not deal with the legal aspect, if only for this reason: that this matter might come before this House, and I think it would be improper for me (although I did not sit on the case) to express an opinion on that kind of matter when it might come before me or my colleagues in a judicial capacity.


I thought that that was the perfectly proper and admirable reason why the noble and learned Lord did not do so. But I think he will agree with me that, if the point is a sound one and may ultimately come before the House, I am right in bringing it to the attention of the House before they proceed to a vote on this issue. I should mention one more point that was decided in this case in answer to the honourable Member who just interrupted me.


Order, order!


The noble Lord and I were so long associated in another place that sheer force of habit made me make that absurd blunder. I apologise to him. Sometimes one forgets that one is no longer in another place.

I was about to deal with a matter of some importance. It will be remembered that in the subsection I quoted there occurs the word, "objects". It refers to the objects for which any such property was used immediately before the appointed day … The Court said in that case, in construing the word "objects": It follows that the word 'objects' cannot be limited to trust objects. It must, I think, include objects for which the transferred property was in fact used at the relevant time whether or not that property had been held under trust or under a formal deed specifying objects. My Lords, there is no doubt at all that at the relevant time this hospital was used as an efficient children's hospital. In my submission to the House, that use can be changed only if the Minister can say one of two things: either that the objects are not prejudiced, or that it is not practicable to avoid such prejudice. He must say one or other of those things if he is to establish the legality of what he is contemplating. I think that the noble Lord, Lord Stonham, thought that the objects would not be prejudiced at all. I find it quite impossible to hold that view. The object here was not merely to provide an efficient children's hospital, but to provide it in a particular and convenient place for the beneficiaries for whose benefit the money had been originally subscribed.

I noticed that my noble friend Lord Onslow, to whom I gave notice, as I did to the noble Earl who is to wind up for the Government, that I was raising this point, dealt briefly with this subsection, but in my respectful submission he stated the relevant consideration wrongly. He did not say whether or not the objects would be prejudiced: what he said was that it was practicable to send the children elsewhere. But that, with respect, is not the point. The point is that if there is this prejudice to the objects of the hospital—and I cannot think it could be seriously denied that there is such prejudice—then the burden is the other way. The Minister has to show that it is not practicable to avoid that prejudice.

I have given my opinion after the best study I could make, both of the terms of the Act and of the relevant legal decision upon it. I hope that I am as conscious as any other Member that I may be wrong, and I will add that there are two things which would divert me from my present intention—forced intention—of supporting my noble friend Lord Balfour of Burleigh if this matter is carried to a Division. The first would be if my noble friend Lord Dundee were able to show that there were facts that I had completely overlooked, or conclusive reasons why I was wrong. The alternative method by which he could demolish me would be by saying that the serious point of law—which I am raising not for the first time, because I raised it in debate in 1957—had been submitted to the Law Officers of the Crown in considering this specific case and had been submitted to them since the Scottish Court gave the decision which I have cited. If he could say that, I should yield at once to the superior legal acumen of the Law Officers of the Crown. But if he is not in a position to do either of those things, then I can only say that the vital subsection—for which some of us fought strenuously when this matter was going through Parliament—must be rigidly enforced. It is the one security against a diversion of charitable intentions, and, I think, against legal impropriety, that exists under that Act. For the reasons I have given, I feel bound, as at present advised, to support my noble friend in the Motion.

6.28 p.m.


My Lords, perhaps you will permit me at the outset to explain, in view of the fact that my namesake, the noble Lord, Lord Cohen, has taken so important a part in this debate, and that I propose to support the view which he expresses, that this is not a family conspiracy. Indeed, if further evidence of the fallibility of The Times were required than this morning's leading article on the topic that we are debating to-day I will tell your Lordships that even The Times has mistaken our identities and confused our physical features. I took no part in that earlier debate which The Times this morning described as "a protracted and undignified squabble". Perhaps The Times was justified, because at that time there was no specific ministerial decision which was being debated. Motives of one kind and another were being imputed and thrown across the House at some of your Lordships individually.

I would remind your Lordships, however, that to-day we are debating (and this fact seems to have been lost sight of by those who have said that the Minister's decision is designed to put the Princess Louise Hospital out of commission and, as my noble friend Lord Amulree said. to "close down" the Princess Louise Hospital) the Minister's decision, which is to retain 38 beds (a significant figure, to which I shall return later) for the use of children in the Princess Louise Hospital, and to provide what many hospitals would be privileged to house, a university unit giving the highest possible maternity service and attracting students to the hospital for obstetrical training. It is encouraging that those of your Lordships who have spoken to-day have been clearly aware that we are not dealing solely with a parochial problem.

The problem which we are, in effect, debating is whether the available resources of the National Health Service are to be used to the best advantage. It may well be that your Lordships will take the view that many of those who have spoken hitherto are interested protagonists in this issue. I speak as one who owes allegiance to none of the hospitals, nor indeed to the hospital region concerned in this debate. But I do owe allegiance to the hospital service of this country. I have served for over thirty-five years as a consultant in a teaching hospital, and I have since the inception of the National Health Service served continuously on a Regional Hospital Board, on a board of governors of a teaching hospital, on ministerial advisory committees and the like.

It is with that background that I want to discuss the issue from the medical point of view—and let me say at once that I have no qualifications to discuss or debate the legal questions which have been raised at this last moment by the noble Lord, Lord Conesford, although he spoke of them in an earlier debate. For me, when there are legal issues in question, there would appear to be an appropriate remedy, and I suggest that the remedy is to be sought when this House has given its decision as to whether it will, on grounds of national interest, support the Minister's view or not. On the moral issue I would say but this: that I am immensely conscious of the need for retaining voluntary service within the hospital system. Indeed, the whole of the administrative structure of our present hospital system depends upon voluntary service. Our Regional Hospital Boards, our boards of governors, our hospital management committees, are all statutory instruments of voluntary service for our hospitals; but local good will, which is not a statutory requirement, to provide service within individual hospitals, to provide the human touch and to provide amenities which cannot be given under the Service, must be retained. For that reason, nothing which disturbs the good will of the public in our hospitals and hospital system should in any way be permitted.

But, my Lords, there are three overriding factors. The first is one which has been stressed this afternoon, and which I do not propose to enlarge upon, because it has been conceded by all those who have taken part in this debate; and it is that within the last decade or so the need for children's beds has declined dramatically. Secondly, and again of great importance, there has been within that period a quite different orientation of service towards children. I do not propose, as I say, to discuss that aspect further; for it is common ground. And it is agreed that although that is valid in general it is true of the North-West Metropolitan Regional Hospital Board's territory in particular.

But there is a second overriding factor, and that is the need to secure within any regional hospital system a balanced service. After all, the crucial purpose of the regionalisation of hospitals, to which Parliament gave its assent in 1946, was to ensure that there was a balanced service, and that any group of the population should not be without vital services whilst another group had too many facilities provided for it. Before 1948 there was no plan in the hospital service. There had been, as my noble friend Lord Moran has said, a haphazard distribution of hospitals, due to desirable private and charitable motives on the part of individuals or groups of individuals. But the result was that we had no hospital system. What we had, indeed, was a lack of a hospital system, and I suggest that, in effect, what the Motion of the noble Lord, Lord Balfour of Burleigh, seeks to do is to perpetuate that laisser-faire policy of the past, allowing everyone to try to hold on to his own without considering the needs of the community as a whole.

There is a third overriding factor, and it is that there is a need of adequate facilities for clinical teaching and research. I need not elaborate upon this point. We cannot run our hospitals without doctors. The need for clinical facilities for the training of doctors is paramount. We cannot advance medicine, and so diminish the need for beds in hospitals, unless research unmasks some of nature's mysteries and thus enables us to control the causes of disease. There is just one point, however, which I should like to stress: it arises from the statement, which has already been referred to by my noble and learned friend, Lord Cohen, suggesting that the needs of teaching and of service are different and, by implication, suggesting that the service of teaching hospitals is not necessarily as Rood as the service in other hospitals. There is no conflicting dichotomy of standards of treatment in teaching hospitals and in regional hospitals. The best regional hospitals—and I could name many—have risen, because of the National Health Service, to standards which are as high as those in any teaching hospital. But the teaching hospitals do help to maintain standards by diffusing their influence over the whole of a region.

The Regional Hospital Board's duty is to ensure that in a given area there shall be a service for all those who need it. It has to take into account in so doing the resources of the board of governors. I suggest that what has happened in this instance is that there has been a clear excess of children's beds, and that the way in which it has been dealt with by the Minister—a point to which I shall return in a moment—is the right one. No one, I think, would deny that it is absolutely necessary to find accommodation for a university professorial teaching unit. The suggestion is that the Princess Louise Hospital should house this unit for two years, at the end of which time the Minister will reconsider the long-term use of the hospital. I do hope, my Lords, that there will be no implications of skilfully hidden motive, that this is, as it were, a delaying action for what is already in the Minister's mind. The Minister is explicit: he will determine in two years' time, in the light of further experience and of the needs of the region, which will then be better known, and which may be somewhat different from the present needs, what is the best use to which the Princess Louise (Kensington) Hospital can be put. The noble Lord, Lord Balfour of Burleigh, has quoted absolute figures of in-patients and has shown that there has been a fluctuating number of in-patients during the last ten or so years. On the whole, however, the number has remained pretty steady—perhaps in some years there has been a slight increase—except when there has been some infectious disease which has in part emptied the hospital.

Absolute figures, however, as I am sure has become evident in this debate, are not the significant statistic. The significant statistic is what use is being made of these beds? I can give your Lordships (I am now quoting the official figures supplied by the board of governors) the kind of use, and whilst I am so doing I should like you to bear in mind the fact that 38 beds will, during the next two years, remain in the Princess Louise Hospital as pædiatric beds. Let us consider the bed occupancy of the beds at present at the Princess Louise Hospital, and let us suppose that an 82 or 83 per cent. bed occupancy is desirable. Then the number of beds which would be required for the number of in-patients in Princess Louise during its best years—and I take 1954 and 1956 as two of its best years—would have been 46; in other words, there is a surplus of 30 beds in the Princess Louise Hospital during an average year. I will deal in a moment with the question of emergencies which arise, because if we take Lord Balfour of Burleigh's own statement of 16 cots being needed during an epidemic of acute bronchiolitis in which oxygen had to be administered, we have then used only 16 of the 30 surplus beds, and if children had acute bronchiolitis and if there were an epidemic, there is alternative accommodation available.

It is interesting to compare the figure which I have given with that for the Paddington Green Hospital, a much smaller hospital. If we take the same rate of bed occupany to be a desirable rate, then out of 52 beds at Paddington Green there was a surplus of three in 1954 and a surplus of seven in 1955. I wonder whether that is due to the fact of a teaching influence within the atmosphere of the Paddington Green Hospital. In the last debate Lord Balfour of Burleigh said that in this matter geography is all important. I have taken some trouble. because I feel myself in a position to make an objective judgment of this situation, to visit the neighbourhood of the Princess Louise Hospital and the hos- pitals within two miles of Princess Louise. There are six hospitals, which have already been mentioned by the noble Earl, Lord Onslow, and those six hospitals—


If the noble Lord will forgive me for interrupting, is he saying that there are six hospitals within two miles?


I am so saying, and one is 2½ miles away. That is Fulham. That is an additional hospital to the six I have mentioned. If the noble Lord doubts my statement, he can, of course, correct it. But these are six hospitals within two miles of the Princess Louise Hospital. They provide over 200 children's beds independent of the 38 beds which will remain with Princess Louise Hospital.

I have looked with great care at the accounts given by the British Pædiatric Association of the need far children's beds in any area; and if we take the population which is served by the Princess Louise Hospital as, let us say, between 400,000 and half a million, then the Princess Louise Hospital has within two miles more beds for children than most areas in this country. It also, of course, has the hospital at Hammersmith. I know that the noble Lord has spoken, I am sure not deliberately, about Hammersmith as if it were perhaps a little distant, and therefore not a very good substitute for the Princess Louise Hospital. But Hammersmith is a magnificent hospital, with a university pædiatric unit capable of giving all the services which may be required. And, after all, Great Ormond Street, the paragon of all pædiatric virtues, is not so far away. Indeed, if we take that distance, I believe that it is less than practically three-quarters of the population of this country would have to travel if they needed hospital service. Moreover, the St. Mary's Hospital home nursing scheme for children has already dealt with 500 children and prevented them from going into hospital. This surely is the new orientation for which Lord Balfour of Burleigh asks.

Thus, whilst no one questions the quality of the service which is now being given at the Princess Louise Hospital, no one can maintain, on the figures which have been quoted by all noble Lords who have spoken in this debate and have not misused statistics, that the beds at the Princess Louise are being fully used. I would say also that there is no obstacle to the continuance of the present outpatient clinic facilities and also of the special clinics, at an appropriate site, some of them possibly within the hospital itself, if the Minister's decision is implemented.

A certain amount of stress has been laid on the Royal College of Physicians' report of April, 1957. Although I do not think it is wholly germane to this issue, some noble Lords may have been impressed by what has been said in this connection and I think it only fair to quote it in full. Your Lordships will know of whom Shakespeare wrote when he spoke of those who "cite scripture to their own purposes". The Royal College of Physicians' report of April, 1957, said: There is no doubt that special children's hospitals offer the best service for children because the staff at all levels and in all departments is attuned to the special needs of children. Children's hospitals carry with them a tradition of service which cannot lightly be set aside. Then it immediately went on to say: In large general hospitals a separate self-contained children's block in close association with the obstetric department of the general hospital is desirable. That might appear to be a little inconsistent. I suspect that it is. I suspect that it may well have been an attempt to mollify a recalcitrant member of the committee (perhaps one to whom my noble friend Lord Moran referred as being the one of the twenty-one members of the committee who still retain this view) and obtain a unanimous report. It is a device not unknown on committees.


My Lords, has the Royal College of Physicians publicly repudiated paragraph 3 of the report?


My Lords, I will deal, now, if I may, with the observation of the noble Viscount, Lord Eloquent—I beg his pardon, Lord Elibank. The Royal College of Physicians—for which, I may say, I have no direct personal responsibility—did in fact issue an earlier report in 1946 when considering a pædiatric service for the nation, in which it made no mention whatsoever of the desirability of separate children's hospitals as against separate children's wards and units in general hospitals but if the noble Viscount will do me the honour of listening to me will quote from the report of the executive committee of the British Pædiatric Association, and I would remind the noble Viscount that that Association is the official body of pædiatricians in this country.

The executive committee of the Association issued a report in July, 1957, which made no differentiation between children's hospitals and separate departments in general hospitals. Indeed I suspect that the question which is being posed is the wrong question. It should not be, "Are separate children's hospitals better than children's units in general hospitals?", but. "Are children's hospitals, whatever their size, however effective or ineffective they may be, or however economically wasteful they may be, better than a self-contained, good, large unit for children within a general hospital at which all services will be available at the appropriate time?" That is the question, and to discuss this as if it were a discourse on semantics as to special children's hospitals or children's units is, I suggest, to get hold of the wrong end of the stick.

There is, however, one significant point of which the noble Viscount, Lord Elibank, might well take note. One of the contentions of the noble Lord, Lord Balfour of Burleigh, who is moving this Motion is that the juxtaposition of maternity and children's cases in the same hospital is undesirable for both medical and administrative reasons. As my noble friend Lord Moran has already pointed out, the report—which the noble Viscount, Lord Elibank, accepts with such alacrity in regard to a special children's hospital—does, in fact, advocate an association of maternity and pædiatric units. Indeed, the report of the executive committee of the British Pædiatric Association on hospital accommodation for children says this: In the joint work of the obstetrician and pædiatrician lies the greatest hope of a further reduction not only in foetal and neo-natal loss but also of morbidity and its consequent social problems. I do not propose to detain your Lordships with any further detailed analysis of the pros and cons of this issue, but I would add this: the Minister's responsibilities in trying to resolve conflicting interests in these disputes—and this, as your Lordships have heard, is no isolated example—is both difficult and unenviable. If he decides to continue unchanged the uses of the Princess Louise (Kensington) Hospital he will be accused of being indifferent to the pressing needs of the medical school with an outstanding record of training doctors and of advancing knowledge. He will be accused of sacrificing the interests of the teaching hospitals and of economy to the clamour of those who are impelled by a narrow parochialism. If he decides that the board of governors have made out their case for temporarily housing the university unit in the Princess Louise Hospital and that the pædiatric needs of the district will continue to be met adequately, he will be accused of overriding the wishes of many who have played a noble role in establishing and maintaining a fine local children's hospital.

I would yield to none in my admiration for the work which the voluntary hospitals did in the pre-1948 days when on more than one occasion I tried to defend them against incursions from other authorities. The Minister has weighed the question judicially and without prejudice, a year after there took place in this House a debate in which all the arguments which have been used to-day, almost without exception, were then put forward. He has come to an interim decision which meets the immediate needs of teaching and which would appear to meet the local pædiatric needs. He defers a final decision on the long-term future of the hospital so that in the light of further experience and conditions the problem may be considered again in two years' time.

The noble Lord, Lord Taylor, in referring to disease as inexorable and relentless, used the analogy of war—a common analogy—the war which is waged against disease. Now in war all our resources must, as he said, be deployed to the best advantage; and in the war against disease all our resources of men, of our therapeutic armamentarium, all our hospital resources and all the resources of preventive medicine must be brought into full play. But also our strategy in the battle must be fluid and flexible, because day by day we are meeting novel and altering situations. It would be true to say that before 1948 that war was conducted by a series of local campaigns and local skirmishes without any co-ordinating plan and without adequate resources or adequate manpower. To-day both the resources and the manpower, though they are still inadequate, are immeasurably superior to those of ten years ago; and we now have commanding officers and also a plan. I hope that this House will not disturb a plan which, after due consideration, is regarded by those who can bring to bear upon it an unbiased judgment as one which gives, in their view, the greatest benefit to the greatest number.

6.59 p.m.


My Lords, you have had the great pleasure of listening to a large number of noble Lords who can speak with unrivalled authority on medicine, hospital administration and local government. Indeed, I do not think I can remember any debate in your Lordships' House in which the list of speakers was more stiff with experts. And, as often happens, the opinions of all these experts are not quite unanimous; they do not all quite say the same thing. But their advice is none the less valuable for that, and it will be closely and carefully considered by my right. honourable friend the Minister of Health. In thanking noble Lords who have taken part in this debate, including those one or two who modestly described themselves as ordinary citizens and not experts, I think it will be most useful that I should refrain from entering into any of the scientific and administrative controversies which have been aired, except in so far as is absolutely necessary in explaining the decisions which have actually been taken by the Minister of Health, and which so far are very limited.

What the Minister of Health wants to do is to develop the National Health Service in the best interests of the people of this country, having regard to the specially valuable contributions which can be made by small institutions with traditions and individuality of their own. Just as in education a school with its own character and individual traditions can give special service to the cause of education, so in health a medical institution or a hospital which has its own loyalties, its own ideas and its own special traditions, can claim to have imponderable assets which are a contribution to the general needs of the nation, and they must not be neglected.

This Motion clearly falls into two parts, one concerning the temporary purpose to which it is proposed to divert two wards in the Princess Louise Hospital, and the other, the permanent question, of whether later on the hospital shall be converted into a permanent hospital for adults, or whether it shall be partly for children, or whether it shall revert to a hospital used wholly for the purpose of children. These two questions are quite separate. On the first question, my right honourable friend has taken a decision; on the second question he has not done so. The noble Lord, Lord Gorell, and others, have argued that once a temporary thing is done it is almost bound to become permanent; and I agree that it very often does. But I would remind noble Lords, as the noble Lord, Lord Cohen of Birkenhead, pointed out in his very comprehensive and excellent speech just now, that the first decision, the temporary decision, is not to divert the Princess Louise Hospital even temporarily away from the purpose of dealing with children. Only half of it is to be used for maternity wards, and during this temporary period the other half will continue to be used for children's cots.

The reasons for this temporary decision are, I think, well known to your Lordships. The acute shortage of maternity beds, which we have in any case, will be greatly intensified in this North-West Metropolitan Regional area for the next two years owing to the decision to reconstruct the maternity department of St. Mary's Hospital and to convert it into a professorial unit for obstetrics and gynæcology following on the appointment of a University professor. The work which has to be done is fairly extensive; a great deal of structural work will be involved. It will cost about £86,000 and it will take two years to do. After that there will be 54 maternity beds at St. Mary's Hospital instead of 29 as there are at present. But during the next two years—the work is, I believe, due to begin this summer and it is estimated to take two years—we shall temporarily lose these 29 maternity beds at St. Mary's Hospital. What are we to do about that? How are we to replace them during that period?

The noble Lord, Lord Balfour of Burleigh, has given a number of figures showing what magnificent work Princess Louise Hospital has been doing for children in recent years and, indeed, over the whole period of its existence; and he was quite right to do so. I am not going to enter into discussion on any of his figures, but I think the simple figures which impress me most in relation to this particular subject are, first, that the waiting list at Princess Louise Hospital since the end of 1955 has been reduced from 180 to 39—it is really negligible. Of course, these 39 waiting children are not waiting because of lack of beds; they are waiting only because they have got probably some ear, nose or throat trouble like tonsillitis, which cannot be attended to for a week or two. They are certainly not waiting because of lack of beds.

The other figure which impresses me is—and I have verified this; it is the information which we have obtained straight from the hospital itself—that during the year 1957, which is the latest date for which figures have so far been compiled and sent to the Minister, only between 35 and 36 beds, on average, were occupied throughout the year. That is less than half the total number of beds—35 or 36 beds out a total of 76. So that over the year as a whole about half the beds, indeed rather more than half the beds, were unoccupied. In these circumstances, having regard to the terribly acute problem of finding services to deal with maternity cases, which has been so well described by the noble Lord, Lord Cottesloe, and other noble Lords who have spoken, and the urgent need of the mothers to get attention which cannot be met at the present time, I do not see what other course the Minister of Health could have taken than to approve the recommendation of the Board of Governors of St. Mary's Group.

It has been suggested that these maternity services might have been found elsewhere, at St. Charles's Hospital or Paddington Green, I believe—at any rate within the North-West Metropolitan region; and in view of the debate on this subject in your Lordships' House in the middle of 1957 I listened with particular attention to the speech of the noble Lord, Lord Cottesloe, who is Chairman of the North-West Metropolitan Regional Board, in order to find out whether even at the last moment the attitude of the Government might be modified on this point, because the Minister of Health has always been prepared to consider it if there were agreement between the North-West Metropolitan Regional Board and the Governors of the St. Mary's Group. In view of the leading article in The Times this morning I listened with particular interest to what the noble Lord, Lord Cottesloe, said, to see whether there was any possibility of an agreement on those lines; but I was not greatly surprised to hear the opinion of the noble Lord, Lord Cottesloe, which was I think in effect that tempora mutantur, nos et mutamur in illis. At any rate, he did not apply that to The Times newspaper. His view on that rather seemed to be that The Times was out of joint. I do not think that, in view of the urgent need which is so universally recognised, and the impossibility of having any satisfactory alternative agreement, the Minister of Health could have done anything else than give approval to this recommendation—and that is the only decision which the Minister has so far made.

My noble friend Lord Conesford particularly wanted a reply to be given to a legal point which he raised. He said he was very reluctant to raise it. I think my noble friend knows, as I have often told him, that. I am always a little sceptical of his reluctance to talk on any subject at any time: but I am certain we are never reluctant to hear what my noble friend says. I am always delighted to listen to him. But what I am reluctant to do is what he has asked me to do, which is to give him conclusive reasons why he is wrong. He seemed to have an almost pathetic desire to be proved wrong. In fact, he asked me if I would demolish him in order to give him an excuse for not voting in favour of this Motion. I am afraid, my Lords, that I cannot do that, and I am not going to enter into the Scottish case which he brought up.

All I can tell him is that the Minister has taken legal advice on Section 6 (4), which my noble friend referred to. He has taken legal advice on that point and the advice is to this effect: that under this subsection he is required to secure that the objects of the hospitals which existed before July, 1948, are, so far as practicable, not prejudiced; and in consider- ing what is practicable the Minister must have regard to the interests of the National Health Service as a whole and to the duties imposed upon him by Sections 1 and 3 (1) of the Act of 1946. There appears to be no reason to doubt that the original objects of the hospital could be preserved in premises other than those where the objects were originally carried on, provided the Minister was satisfied that it was practicable for those entitled to the benefits of the objects in question to avail themselves of such objects in other premises. I am quite sure my noble friend will not consider that this conclusively proves him wrong, but it is the best advice that the Minister of Health has been able to get.

With regard to the long-term question of what shall happen to Princess Louise Hospital after the estimated two-year period has expired, not only am I unwilling to make any forecast but I think it would be very undesirable that a Government spokesman should do so. The noble Lord, Lord Moran, the noble Lord, Lord Cohen of Birkenhead, and the noble Lord, Lord Cohen, have all given possible forecasts. Lord Moran thought that after two years Princess Louise Hospital would eagerly clamour for the maternity wards to be maintained. I do not know whether that is true or not. Other noble Lords have suggested that it may be possible for the hospital to return 100 per cent. to children's wards—subject, of course, to the hope that children's diseases will not increase, which I rather think the noble Lord felt was the only reason which was likely to make that probable.

But, my Lords, we cannot foresee what the circumstances are going to be, what the needs of the community are going to be, and what the feeling of the staff of the Princess Louise Hospital is likely to be, in two years' time. Therefore, I think that the Minister is right to refrain, not only from making any decision at this time but also from giving any forecast as to what his position is likely to be. His object is to make the best use of this hospital, and I am sure we would all join him in hoping that its services to the country, and in particular to the Borough of Kensington, and most especially to the children, will satisfactorily continue in the future on the same scale as they have done during the very honourable thirty years of its existence.

7.15 p.m.


My Lords, at this late hour I shall do my best not to detain your Lordships longer than necessary, but there are one or two points that I feel bound to touch upon. May I say, first, that I find it rather depressing that speaker after speaker has referred to the fact that there are too many children's beds and too few maternity beds, as though that was an argument against my Motion. Over and over again I have been told of the need to close children's beds. My Lords, that is what I began with, and it really is rather depressing. Perhaps some noble Lords did not take the trouble to listen to what I said. At any rate, that is what I began with, and it is no argument whatever against me.

Secondly, your Lordships are probably tired of hearing about these broken agreements. I am not going to go back on that too much, except to say that I still maintain that there was a bargain between St. Mary's and Princess Louise Hospital. Who spoke first has been actually produced as an argument against the Princess Louise Hospital. Somebody said: "It is a great shock to me that the Princess Louise Hospital first approached St. Mary's, and that puts the Princess Louise in the wrong". I have never heard such rubbish in my life. There were two agreements, and they were both broken. There have been speakers who have defended the breaking of one—that is, the proposed change of user. That is as may be. I do not agree with it, but it is arguable. The breaking of the other agreement, about giving pædiatric teaching at the Princess Louise, has not been defended by anybody: nor has it been denied that the occupation by St. Mary's of children's beds has been the cause of all the difficulties about the maternity beds. Had the Region had the hospital from the beginning, the maternity bed question would not be troubling your Lordships today.

One very small point that I feel I must touch on is the question of the medical staff, on which I interrupted the noble Lord, Lord Moran. I understood the noble Lord to say that the attitude of the Princess Louise medical staff had entirely changed, and that was why I interrupted to read the letter. I think the noble Lord, Lord Moran, was clearly wrong. What the noble and learned Lord, Lord Cohen, said corresponds with what the medical lady wrote to me; but the fact remains that the medical staff at Princess Louise have not changed their attitude, and they still dislike these proposals.

The next point upon which I wish to touch briefly is the rather depressing one of how so many arguments have been used both ways. We have been told to deploy our resources at the point of greatest need and to use the facilities to best advantage. Of course, we all think that that is what we are trying to do. It is no use people arguing like that. They must try to prove where the greatest need is. The noble Lord, Lord Cottesloe, explained that when, in his hospitals, his beds were empty, they were empty for casualties and emergencies; but when we come to the poor Princess Louise—


My Lords, I do not wish to interrupt the noble Lord, but I would point out that I said nothing of the sort, as he will see when he reads Hansard to-morrow.


I apologise to the noble Lord; it must have been somebody else. However, one noble Lord did say that you must have empty beds for emergencies and casualties; but when my poor Princess Louise has empty beds it is said that there is proof of the lack of need.

I would say one word about the remarks of the noble Lord, Lord Cohen of Birkenhead. The geographical answer he gave has absolutely staggered me. He has discovered six hospitals within two miles of the Princess Louise Hospital. I can assure your Lordships that I have some considerable local knowledge, and I do not know how he makes that out—possibly he means two miles as the crow flies. It is true that if you take a straight line across the map, you get shorter routes, but that is not how the people go to hospital. They do not fly there; they do not even take a taxi; they have to walk. And I explained to your Lordships at some length the convenience they find in getting to the Princess Louise Hospital. That point remains unanswered. If this hospital is closed people will be put to very great inconvenience. Although the noble Lord, Lord Cohen of Birkenhead, dealt with my argument about bronchiolitis, I maintain that the Minister has not made the smallest attempt to answer how an epidemic of bronchiolitis of 104 cases would have been dealt with.

In conclusion, I would call attention to one further small point. The noble Lord, Lord Cohen, said that I described this as merely a medical matter. What I said was a medical matter was the selection of patients to go into hospitals. The main point is not a medical matter. I maintain that it is a matter of common sense. The medical Lords have contradicted one another up to the hilt, and therefore we laymen have to rely on our own common sense. The issue before the House will settle the fate of the Princess Louise Hospital. I say that the division of the hospital is wrong and that its complete conversion would be still more wrong. The right policy is to transfer the hospital

Resolved in the negative, and Resolution disagreed to accordingly.

House adjourned at twenty-seven minutes before eight o'clock.

to the Region. Why should noble Lords speaking for the Government be so tender about these two bodies: whether the teaching hospital and the Regional Board would agree? They have got to administer the Act with the greatest efficiency, and if they do not, it is for the Minister to knock their heads together and make them do it. I think that the Government are dead wrong on this matter, but it seems that we shall not get them to alter their view unless we can do something to make them see that they are wrong. I have no alternative but to go to a Division.

On Question, Whether the said Motion shall be agreed to?

Their Lordships divided: Contents, 14; Not-Contents, 47.

Amulree, L. Elibank, V. Piercy, L.
Balfour of Burleigh, L. [Teller.] Gorell, L. Rathcavan, L.
Cholmondeley, M. [Teller.] Harrowby, E. Saltoun, L.
Conesford, L. Kinnaird, L. Stair, E.
De L'Isle, V. Lindsey and Abingdon, E.
Auckland, L. Granville-West, L. Onslow, E. [Teller.]
Bathurst, E. Grenfell, L. Perth, E.
Brentford, V. Hailsham, V. (L. President.) Radnor, E.
Buckinghamshire, E. Hawke, L. St. Aldwyn, E. [Teller.]
Chesham, L. Howard of Glossop, L. St. Just, L.
Cilcennin, V. Kilmuir, V. (L. Chancellor.) Selkirk, E.
Cohen, L. Lansdowne, M. Silkin, L.
Cohen of Birkenhead, L. Latham, L. Stonham, L.
Colville of Culross, V. Leconfield, L. Strathclyde, L.
Cottesloe, L. Lucan, E. Swanborough, Baroness.
Derwent, L. Macpherson of Drumochter, L. Swinton, E.
Dundee, E. Melchett, L. Taylor, L.
Ebury, L. Merrivale, L. Waldegrave, E.
Elliot of Harwood, Baroness. Merthyr, L. Waleran, L.
Fortescue, E. Milner of Leeds, L. Wolverton, L.
Gosford, E. Moran, L.