Lords Sitting of 7 March 1963

Preamble
The House met at three of the clock, The LORD CHANCELLOR on the Woolsack.
Prayers—Read by the Lord Bishop of Birmingham

PETITION FROM DARTMOOR PRISONER
LORD STONHAM: My Lords, I beg leave to present a Petition from Kenneth Edward Holmes, at present detained in Her Majesty's Prison at Dartmoor.
Petition presented, and ordered to lie on the Table.

WATER RESOURCES BILL [H.L.]
3.5 p.m.
Order of the Day for the Third Reading read.
EARL ST. ALDWYN: My Lords, I have it in Command from Her Majesty the Queen to signify to the House that Her Majesty, having been informed of the purport of the Water Resources Bill, has consented to place Her Majesty's interest so far as it is concerned on behalf of the Crown, the Duchy of Lancaster and the Duchy of Cornwall at the disposal of Parliament for the purposes of the Bill.
THE MINISTER OF STATE, HOME OFFICE (EARL JELLICOE): My Lords, I rise formally to move the Third Reading. I think that any debate which your Lordships may think necessary on the merits of the Bill might more appropriately take place on the later Motion, That the Bill do now pass, and that the Third Reading might deal solely with the Amendments on the Marshalled List. I beg to move that the Bill be read a third time.
Moved, That the Bill be read 3ª.—(Earl Jellicoe.)
On Question, Bill read 3ª.
Clause 17 [Gauges and records kept by other persons]:
THE JOINT PARLIAMENTARY SECRETARY, MINISTRY OF HOUSING AND LOCAL GOVERNMENT (LORD HASTINGS): My Lords, this Amendment continues an undertaking given orginally to the noble Lord, Lord Cawley, and as a result of further consideration of the matter it has been decided that gauges installed for temporary purposes are unlikely to produce information of value to the river authority and that there is no reason why prior notice of their installation and notice of the place where records, if any, are to be kept should be given to them. I beg to move.
Amendment moved—
Page 17, line 25, at end insert—
("Provided that this subsection shall not apply to any gauge which is removed at or before the end of the period of twenty-eight days beginning with the date on which it is installed.")—(Lord Hastings.)
On Question, Amendment agreed to.
Clause 24 [Exceptions from general restrictions]:
LORD HASTINGS: My Lords, this Amendment and the next go together. The general purpose of them is to extend the exemptions from licensing afforded by Clause 24 in order to cover effectively abstractions made as part of or in consequence of land drainage, mining, engineering, building and similar operations and transfers of water in the course of or resulting from operations by navigation, conservancy and harbour authorities. The need for the Amendment arises because the provisions of subsections (3) and (4) of Clause 24 are in parts too restrictive as they stand. I beg to move.
Amendment moved—
Page 23, line 10, leave out from ("household") to first ("the") in line 16 and insert—
("(4) The restriction imposed by subsection (1) of the last preceding section does not apply to any abstraction of water from a source of supply—

(a) in the course of, or resulting from, any operations for purposes of land drainage, or

(b) in so far as the abstraction (where it does not fall within the preceding paragraph) is necessary to prevent interference with any mining, quarrying, engineering, building or other operations (whether under-ground or on the surface) or to prevent damage to works resulting from any such operations.

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(5) In the case of any abstraction of water from underground strata which falls within subsection (3) or subsection (4) of this section").—(Lord Hastings.)
On Question, Amendment agreed to.
LORD HASTINGS: My Lords, I beg to move.
Amendment moved—
Page 23, line 22, leave out from ("to") to end of line 31 and insert ("any transfer of water from one inland water to another in the course of, or resulting from, any operations carried out by a navigation authority, harbour authority or conservancy authority in the performance of their functions as such an authority").—(Lord Hastings.)
On Question, Amendment agreed to.
LORD HASTINGS: My Lords, this Amendment, which has been suggested by the Federation of British Industries, extends the exemption to work done for the purpose of testing fire fighting apparatus and anything done in the course of training and practice in the use of such apparatus. I beg to move.
Amendment moved—
Page 23, line 33, leave out from ("for") to end of line 34 and insert ("fire-fighting purposes (within the meaning of the Fire Services Act 1947) or for the purpose of testing apparatus used for those purposes or of training or practice in the use of such apparatus.").—(Lord Hastings.)
On Question, Amendment agreed to.
Clause 26 [Protected rights to abstract water]:
LORD HASTINGS: My Lords, this is a drafting Amendment. I beg to move.
Amendment moved—
Page 25, line 6, leave out ("24 (3) (a) or 24 (3) (b)"') and insert ("or section 24 (3)").—(Lord Hastings.)
On Question, Amendment agreed to.
Clause 33 [Entitlement to licence of right]:
LORD HASTINGS: My Lords, at the Report stage the noble Lord, Lord Lindgren, put down a rather similar Amendment, which he did not in fact move because it was part of a group of five and we had the discussion on the first one. It appears that there is a case for making some provision to secure that an abstraction made in complete disregard of the licensing provisions of Clause 14 shall not entitle the person making such abstraction to a licence of right under
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Clause 33. I therefore beg to move this Amendment.
Amendment moved—
Page 31, line 44, at end insert—
("(3) For the purposes of this section, and of sections 34 and 35 of this Act, no account shall be taken of any water abstracted in contravention of section 14(5) of the Water Act 1945 (which restricts the abstraction of underground water in areas to which that section is applied).").—(Lord Hastings.)
On Question, Amendment agreed to.
Clause 42 [Proposal by river authority to revoke or vary licence]:
LORD HASTINGS: My Lords, this is a drafting Amendment, I beg to move.
Amendment moved—
Page 38, line 29, leave out ("authorises abstraction from") and insert ("relates to").—(Lord Hastings.)
On Question, Amendment agreed to.
EARL JELLICOE EARL JELLICOE moved, after Clause 60 to insert the following new clause:
Special charges in respect of spray irrigation
".—(1) Where a person (in this section referred to as 'the applicant') is for the time being the holder of a licence under this Act to abstract water, and in accordance with the provisions of the licence (in this section referred to as 'the relevant licence')—

(a) the water is to be used on land of which the applicant is the occupier, and

(b) the purposes for which water abstracted in pursuance of the licence is to be used consist of or include spray irrigation,

the applicant, either before or after the coming into operation of a charging scheme prepared by the river authority, may apply to the river authority to make an agreement with him under this section, and, subject to the following provisions of this section, the river authority may make such an agreement accordingly.
(2) During any period for which an agreement under this section is in force, charges shall be payable by the applicant to the river authority in respect of the relevant licence, in so far as it relates to water authorised to be abstracted and used on the relevant land, as follows, that is to say—

(a) basic charges calculated in accordance with the agreement by reference to the quantity of water authorised to be so abstracted and used from time to time in pursuance of the licence, and

(b) supplementary charges calculated in accordance with the agreement by reference to the quantity of water which is measured or assessed as being abstracted from time to time by or on behalf of the applicant from the source of supply to which the relevant licence relates for use on the relevant land.

(3) In determining whether to make an agreement with the applicant under this section, and

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in determining the charges to be leviable under such an agreement, the river authority shall have regard to the extent to which, in any year within the period proposed to be specified in the agreement as the period for which it is made, the quantity of water referred to in paragraph (a) of the last preceding subsection is likely to exceed the quantity referred to in paragraph (b) of that subsection.
(4) The period specified in an agreement under this section as the period for which it is made shall mot be less than five years.
(5) An agreement under this section shall remain in force until the occurrence of whichever of the following events first occurs, that is to say—

(a) the period specified in the agreement, as mentioned in the last preceding subsection, comes to an end;

(b) the relevant licence expires or is revoked;

(c) the applicant ceases to be the occupier of the relevant land, or, if he has previously ceased to be the occupier of a part or parts of that land, ceases to be the occupier of the remainder of it;

(d) the agreement is terminated under the next following subsection.

(6) At any time while an agreement under this section is in force, the applicant may apply to the river authority to terminate the agreement; and if on any such application the river authority are satisfied that, by reason of any change of circumstances since the agreement was made, it ought to be terminated, the river authority may terminate the agreement, either unconditionally or subject to such conditions (whether as to any payment to be made by the applicant or otherwise) as the river authority and the applicant may agree.
(7) The provisions of subsections (3) to (5) of section 58 of this Act shall have effect in relation to applications and to the exercise of powers under this section as they have effect in relation to applications and to the exercise of powers under that section, as if in those provisions any reference to the making of an agreement or to the terms of an agreement included a reference to the termination of an agreement or to the conditions subject to which an agreement is to be terminated, as the case may be.
(8) Where the relevant licence authorises water abstracted in pursuance of the licence to be used on the relevant land for purposes which include spray irrigation and other purposes,—

(a) any agreement made under this section shall provide for apportioning, as between those purposes respectively, the quantity referred to in paragraph (a) and the quantity referred to in paragraph (b) of subsection (2) of this section;

(b) subsection (2) of this section shall have effect as if in each of those paragraphs the reference to the quantity of water therein mentioned were a reference to so much of that quantity as in accordance with the agreement is opportioned to the purpose of spray irrigation;

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(c) in subsection (3) of this section any reference to either of those paragraphs shall be construed as a reference to that paragraph as modified by paragraph (b) of this subsection; and

(d) subject to the provisions of this Part of this Act other than this section, charges shall be leviable in accordance with any charging scheme for the time being in force in respect of so much of the quantity referred to in paragraph (a) of subsection (2) of this section as in accordance with the agreement is apportioned to purposes other than spray irrigation.

(9) Subject to the last preceding subsection, where an agreement under this section is in force, then in so far as the relevant licence relates to water authorised to be abstracted and. used on the relevant land, the provisions of this section shall have effect notwithstanding anything contained in any other provision of this Part of this Act or in any charging scheme; but—

(a) nothing in this section or in any agreement made thereunder shall affect the operation of any other provision of this Part of this Act or of any charging scheme in relation to a licence in so far as it authorises water abstracted in pursuance of the licence to be used on any land other than the relevant land, and

(b) nothing in this section or in any such agreement shall affect the operation of section 55 of this Act.

(10) An application under subsection (1) of this section may be made by a person who has applied for, but is not yet the holder of, a licence under this Act to abstract water; and, in relation to an application so made or to an agreement made on such an application,—

(a) the reference in that subsection to the provisions of the relevant licence shall be construed as a reference to the proposals contained in the application for a licence, and

(b) any other reference in this section to the relevant licence shall be construed as a reference to any licence granted to the applicant in pursuance of the last-mentioned application or in pursuance of an appeal consequential upon the last-mentioned application.

(11) In this section 'the relevant land' means the land on which the relevant licence, as for the time being in force, authorises water abstracted in pursuance of the licence to be used for purposes which consist of or include spray irrigation, and 'year' means a period of twelve months beginning with the date on which an agreement under this section comes or is proposed to come into force or beginning with an anniversary of that date."
The noble Earl said: My Lords, during the Report stage I said that we hoped to devise a scheme for an alternative charging system for the spray irrigator which would strike a reasonable balance between the requirements of that spray irrigator, the revenue of the river authority and the vagaries of our

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charming climate. It is our belief that the scheme embodied in the new clause which I am now moving does strike that reasonable balance.
This is an important Amendment, and even at this late stage of the Bill I think your Lordships would expect me to say a few words on it. The essence of the new clause is that it enables a river authority to make an agreement with a spray irrigator providing that for a period specified in the agreement (which period is to be not less than five years) the charges payable in respect of the abstraction authorised by his licence shall be in two parts. The first would be a basic charge calculated by reference to the quantity authorised to be abstracted. The second part would be a supplementary charge calculated by reference to the quantity of water actually abstracted.
The spray irrigator, like the statutory undertaker, has become a familiar figure to your Lordships as a result of our discussions on this Bill. Consequently, the reasons for this Amendment will be apparent to you. The basic reason, of course, is due to the possibility—I think I would correct that and say the probability—that in many years a spray irrigator will in practice require very much less water than the maximum amount which he has obtained a licence to abstract and which will represent his need in a dry year. At an earlier stage of our discussion the noble Lord, Lord De Ramsey, who throughout has made such notable contributions to our consideration of this Bill, quoted figures to show that the average demand of the spray irrigator in the East Midlands over a period of five years might not exceed a half of the total peak demand for which he had sought a licence.
Moreover the fluctuations in demand are entirely outside the abstracter's control. They stem from the vagaries of what until this winter we thought was the temperate British climate. Spray irrigation needs are in fact inextricably linked with rainfall or the absence of it. That is why we considered that these new provisions should be quite clearly restricted to abstractions for that purpose—namely, spray irrigation. I would grant that there may well be other abstractions which vary with the weather. In hot weather we need more water to water our gardens, or to slake our thirsts with beer or
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bitter lemon, and to make ice-cream or coca-cola. But in no case is the fluctuation of demand so extreme—from zero up to maximum peak—or so unpredictable as it is in the case of spray irrigation. Hence this new clause.
I do not propose to take your Lordships through the maze of its various subsections, but I should like to refer to one—namely, subsection (4). That subsection provides, subject to subsections (5) and (6), that any agreement must last at least five years. On Report the noble Lord, Lord Williams of Barn-burgh, suggested that we might settle for a three, rather than a five, year period. With, I suspect, his tongue in his cheek and with an old adage in his mind, he was kind enough to credit me with good intentions. As always, he was, of course, quite right; and perhaps I should just explain, given those good intentions, why we have opted for five years. This period has been chosen as the minimum period for an agreement in the belief that it will be fair to both licence-holder and river authority. A shorter period is likely to be much too short to produce anything approaching a reasonably representative experience of the English climate. Five years is also, I might mention, the period during which a charging scheme under this Bill ought to remain without amendment.
My Lords, the technique of spray irrigation is likely to become increasingly important in the future, at least in the drier parts of these Islands. It is our belief that the new clause should assist those who wish to increase agricultural productivity in this way. It is also our belief that it does no undue violence to the main structure of the charging system which we are writing into this Bill. I beg to move.
Amendment moved—
After Clause 60 insert the said new clause.—(Earl Jellicoe.)
3.17 p.m.
LORD LINDGREN: My Lords, the noble Earl quite rightly called the attention of the House to the fact that this Amendment fulfils an undertaking which was given during Committee. Although the Amendment is long and complicated, I think it not unfair to paraphrase it, and to say that the real essence of the clause is in subsections (1) and (2). Subsection

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(2) provides the new principle for charging. I think the House ought to face the fact that a basic charge is to be levied with reference to the amount of water authorised to be abstracted, and a supplementary charge on the actual amount of water abstracted. We had considerable discussion during the Committee stage on the charging scheme, and I submit that the fact that the Government feel that it is necessary to introduce the Amendment strengthens the case that I put to the Committee on a number of occasions, that there ought to be a new look at the charging scheme as a whole.
It is not unusual for Members who are in Opposition to twit the Government with changing their mind and breaking the principles which they have set down. I do not think it is unfair to paraphrase the general assumption which the Government have adopted during the whole of our Committee stage: first of all, that all abstracters must pay both in respect of past abstractions and future abstractions because all will benefit, and that there are no special dispensations. The second point on which they hung their policy was that the charge must be based upon the quantity authorised to be abstracted, since the river authority must plan on the basis of the maximum demand that can be made on the river, and the cost of any works that must be operated according to the maximum amount that any abstracter is entitled to take.
On the Report stage I again twitted the noble Earl with the fact that he had broken that principle in respect to canals, concerning which special arrangements were made. The new clause for spray irrigators breaks down not only the first principle on which the Government have hung their charges scheme, but also the second principle, that charges are to be based upon the amount of water abstracted.
There appears to be no good reason why the principle of charging according to the abstraction authorised should not be broken down. If there is sound reason, then surely there is no necessity for this alternative method of charging to be restricted to spray irrigators. I do not object to their having this special facility, but I suggest that there is no basic reason why it should be restricted to them. For
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example, there are water undertakers who make peak demands at certain times of the year who will be bound to obtain licences on the basis of their maximum abstraction. It is difficult to understand why spray irrigators should be treated differently from other abstracters.
The new clause tabled by the Government again raises the question whether the whole charging scheme should not be revised. The suggested clause rather goes against the principle of the Report of the Central Advisory Water Sub-Committee on water charges which for a considerable period was chaired by the present Minister and, after he became a Minister, Mr. John Cochran took over from him. I would draw the attention of the noble Earl to Chapter IX of that Report under the heading "Water used for other purposes", paragraphs 55 and 56. The whole basis of that chapter is the fact that, when resources are low, these special abstracters are generally required, in order that demand should be able to be met, to undertake considerable work in the way of conservation. If the abstraction is going to take place when resources are low and if they have to provide the works in order to get the necessary reserves to meet that period, it is fair and reasonable, I think, that those who demand the creation of a reserve should pay for that reserve to be created. The fact that they do not want it when resources are plentiful applies to many other people. The Water Resources Advisory Committee Report refers to boarding-house keepers at the seaside, to canning factories and others. The same principle could apply all the way through. The real point is that this is giving a special feature to agriculture and to spray irrigation.
3.22 p.m.
LORD MERRIVALE: My Lords, one can understand that the inflexibility of Clause 56 (2) has led Her Majesty's Government to propose this new clause, involving a new principle with a two-part charging scheme. But why, as the noble Lord, Lord Lindgren asked, should it be available only to one class of abstracter? I recognise that the needs of spray irrigation are great, but so are the needs of certain users in industry—I have in mind the amount of cooling water that is used. Although this statement may not accord with what my

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noble friend Lord Jellicoe said, I think it was said in the course of a symposium which took place in London last year that the needs of spray irrigation in, say, 20 years would equal those of industry and the water undertakers. It therefore seems that there will be extensive demand, and that in the years to come the needs of spray irrigation on the question of quantity will be in keeping with those of industry.
I would therefore ask my noble friend when he comes to reply—because I should like to have this on record—whether Her Majesty's Government would be prepared to have another look at this, as was suggested by the noble Lord, Lord Lindgren, so that these provisions could be extended to other users of water in order to provide an equitable measure of relief in appropriate circumstances where the actual quantity is less than the authorised quantity, thus avoiding hardship to other abstracters. One can appreciate that spray irrigators may have had cause to complain of hardship before this clause was introduced, but other users might well be in a similar position.
3.24 p.m.
LORD WILLIAMS OF BARNBURGH: My Lords, there is just one point to which neither the noble Earl nor my noble friend referred, and which, I think, must have prompted the noble Earl to produce this new clause. I, personally, welcome it for at least one reason, and that is that the Bill, as now drafted, gives the supplier of water the right, on appropriate occasions, to reduce the quantity of water already decided upon and bargained for, when there is a long period of dry weather. It would not be convenient for the water supplier to continue to allow the maximum to be taken by a number of sprays in large fields during that sort of period. I think everybody would agree that the supplier must have the right to limit quantities taken by those large sprays; it is right that the supplier should have the power upon such occasions to limit the quantity of water taken.
It is equally fair that if the man is denied the right to take the quantity of water originally bargained for, he ought not to have to pay the maximum amount of charge. This new clause at all events takes care of that. Although, there may
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be genuine substance in my noble friend's case that this is changing the principle, it would be grossly unfair to leave these suppliers in a position where they could enter into a bargain with a sprayer for him to take so much water for five years and then, on occasions when it suits the supplier, could cut off the supplies because the season is a dry one. In all, therefore, I think the clause is well-merited, and I congratulate the noble Earl upon having produced it.
EARL JELLICOE: My Lords, I argued at some length during our Committee stage why we felt the principle should be maintained that the charging system as a whole should be based on the principle that the charge should be levied on the quantity of water authorised to be abstracted rather than on quantities actually abstracted or on some two-tier system as embodied in the present Amendment. I personally still feel convinced that in general that principle is right and should be maintained, because if we go over to a system of charging on quantities actually abstracted, or to a two-tier system over the whole field, we shall, in my view, be making the position of the new river authorities almost impossible. They will have no firm basis upon which to plan, because they will be quite uncertain of what their revenue in general is going to be.
I must say that I am a little surprised that the noble Lord, Lord Lindgren, and the noble Lord, Lord Merrivale, have taken exception to the Amendment which I have just moved. I am surprised because I did foreshadow at Report stage what is now in this Amendment, and, so far as I can remember, there was no protest during our Report stage along the lines we have just heard. I do not wish to make too much of that point, but I did give due notice of the main lines of the Amendment which I have just moved.
That Amendment, of course, is the result of our attention to the arguments which I think were very powerfully deployed by the noble Lord, Lord De Ramsey, on behalf of the very special position of the spray irrigator. I tried to show, in introducing this Amendment, why we thought the spray irrigator did in fact stand in a very special position in this respect, in that with no other

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abstracter is the variation between what he is authorised to abstract and what he may abstract so extreme or so unpredictable as it is in the case of the spray irrigator. I claimed that there were good reasons, which I still think remain, why an exception to this general principle should be made on behalf of the spray irrigator. I would also point out, if I may, in amplification of what the noble Lord, Lord Williams of Barnburgh, has said, that so far as I know no other abstracter is in the specially unfavourable position of the spray irrigator, as shown in subsection (2) of Clause 44, in that he may have the quantity which he is authorised to draw cut off in times of drought. That does not apply to other types of abstracters.
All that said, my Lords, I would merely add, without in any way wishing to tie the hands of my colleagues in another place, and without holding out any promise whatsoever that we shall depart from the principle of charging embodied in the Bill as it now stands, that I hope your Lordships will agree to this Amendment with my assurance that, subject to those two conditions, we shall of course examine the points which have been made by the noble Lord, Lord Lindgren, and my noble friend Lord Merrivale.
On Question, Amendment agreed to.
Clause 78 [Reserve funds of river authorities]:
LORD HASTINGS: My Lords, the next Amendment is drafting. I beg to move.
Amendment moved—
Page 70. line 33, leave out ("(d)") and insert ("(e)").—(Lord Hastings.)
On Question, Amendment agreed to.
Clause 97 [Protection of duty of statutory water undertakers to supply water for domestic purposes]:
LORD HASTINGS: My Lords, the next three Amendments go together, and your Lordships will notice that Nos. 11 and 12 are consequential upon No. 10. The purpose of that Amendment is to give effect to my acceptance in principle of an Amendment put down at the Report stage by the noble Lord,
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Lord Lindgren, and my noble friend Lord Sinclair of Cleeve. I beg to move.
Amendments moved—
Page 86, line 41, leave out from ("provide") to end of line 42 and insert ("supplies of water to which this section applies.
(2) This section applies to the following supplies of water, that is to say—

(a) a supply of water for domestic purposes, and

(b) a supply of water for any such purpose as is mentioned in section 32 or section 37 of Schedule 3 to the Water Act 1945 (which relate respectively to supplies for extinguishing fires and to supplies for cleansing sewers, drains and highways and for similar purposes).")

Page 86, line 43, leave out ("the preceding subsection") and insert ("subsection (1) of this section")
Page 87, line 13, leave out from ("provide") to end of line 14 and insert ("supplies of water to which this section applies").—(Lord Hastings.)
On Question, Amendments agreed to.
Clause 111 [Validity of decisions of Minister and proceedings relating thereto]:
EARL JELLICOE: My Lords, this Amendment is consequential upon Amendment No. 8, which your Lordships approved a moment or two ago. I beg to move.
Amendment moved—
Page 98, line 17, at end insert—
("(5) Any reference in this section to section 58 (4) of this Act shall be construed as including a reference to the said section 58 (4) as applied by any other provision of this Act.")—(Earl Jellicoe.)
On Question, Amendment agreed to.
Clause 120 [Provisions as to Rivers Esk and Tweed]:
EARL JELLICOE: My Lords, this Amendment and the following Amendment are linked, and I suggest that they might conveniently be taken together. Clause 120 deals with the application of the Bill to the two major Border rivers, the Esk and the Tweed. Subsection (3) (b) of Clause 120 says that the provisions of the Bill relating to the new functions of the river authorities are not to apply to so much of any inland water as
"is part of the River Esk at a point where either of the banks of that river is in Scotland."
There are other tributaries of that river which also need to be dealt with, and

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there is also the River Sark, part of which is bisected along its length by the boundary between England and Scotland. These Amendments extend Clause 120 (3) (b) to cover these other rivers. I beg to move.
Amendments moved—
Page 104, line 16, after ("Esk") insert ("or of the River Sark or of any tributary stream of the River Esk or the River Sark")
Page 104, line 17, leave out ("that river") and insert ("either of those rivers or of any such tributary stream").—(Earl Jellicoe)
On Question, Amendments agreed to.
Clause 126 [Interpretation]:
LORD HASTINGS: My Lords, Amendments Nos. 16, 17 and 18 are simply a question of inserting in the Interpretation Clause the necessary definitions of conservancy, harbour and navigational authorities, these terms having been inserted in many places during the Report stage. I beg to move.
Amendments moved—
Page 109, line 41, at end insert—
("'conservancy authority' means a person or body of persons (whether corporate or unincorporate) having a duty or power imposed or conferred by or under an enactment to conserve, maintain or improve the navigation of a tidal water, and not being a navigation authority or a harbour authority.")
Page 110, line 8, at end insert—
("'harbour authority' means a person or body of persons (whether corporate or unincorporate) who, not being a navigation authority, is or are a harbour authority as defined by section 3 (5) of the Oil in Navigable Waters Act 1955.")
Page 110, line 47, at end insert—
("'navigation authority' means a person or body of persons (whether corporate or unincorporate) having a duty or power imposed or conferred by or under an enactment to manage or maintain a canal, whether navigable or not, or to manage or maintain an inland navigation other than a canal, whether natural or artificial and whether tidal or not.")—(Lord Hastings.)
On Question, Amendments agreed to.
An Amendment (privilege) made.
3.38 p.m.
LORD HASTINGS: My Lords, I beg to move that the Bill do now pass. I do not intend to delay your Lordships very long, for I believe that most noble Lords will feel that after the twelve days which we have spent in examining and amending the Water Resources Bill it is hardly necessary to indulge in a lengthy discourse. There are, however,
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two matters which I should like to mention. First, I would refer to a few of the changes which have been made in the Bill as a result of your Lordships' efforts. Secondly, I want to say a further word about the charging schemes under the Bill which have caused a certain amount of anxiety in some quarters, as we have heard again this afternoon. Your Lordships will remember that a promise was given during the Report stage that something more specific would be said at Third Reading about the sort of charges that were likely to be made by river authorities in the performance of their new functions.
During our discussions great attention was very properly paid to the role of the Water Resources Board. Although the House accepted the Government's advice that the duties of the Board should not be extended to cover the transferred functions of a river authority, the Government have acceded to demands that the Board should be concerned with securing the proper use of water resources, with economy in the use of water, with questions of quality as well as quantity and, where appropriate, with the de-salting of water as a means of augmenting resources. The Government are confident that the Water Resources Board can, under the Bill as amended, become the forward-looking, energetic and effective central authority on which so much stress has been laid.
Noble Lords who have taken a particular interest in the problem of amenity—that is, a very large proportion of your Lordships' House—have, I believe, been very largely satisfied by the Amendments which have been made to the Bill in order to safeguard the natural beauty of the countryside. A number of Amendments have been made to meet the legitimate requirements of the farming community and of those concerned with land drainage. Only a few moments ago an Amendment was inserted into the Bill to help solve the special problems, in relation to charges, of those farmers who need to abstract water for spray irrigation.
Several points raised by those noble Lords interested in statutory water undertakers have been met, with consequent improvements in the Bill, and in particular the Government have done their best to allay the anxieties of water undertakers

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in so far as their statutory obligations for the public supply are concerned. We also claim that the interests of industry are well protected in the structure of the Bill, but certain points bearing upon its operation have been raised here and in consultation outside. To some of these—for example, the manner of settling the terms of licences of right—industry attaches very great importance, and they merit, and are receiving, the closest consideration. It is recognised that the whole enterprise of an industrial abstracter may depend upon the same continuance of present supplies. Further consideration of this particular problem is likely to be given in another place, as well as of other matters outstanding which have not finally been resolved in your Lordships' House.
Now, my Lords, I will turn to this question of charges, and will give some figures which I hope may be useful. It may be helpful if I preface what I have to say on this by reminding your Lordships that four main classes of expenditure are likely to be incurred by river authorities on their new functions. First will be expenditure on day-to-day management—the hydrometric work, the running of the licensing system and, of course, the establishment costs. Next will come small-scale conservation works—small improvements and maintenance works, installation of gauges, observation boreholes and the like. The third class of expenditure will be in respect of major conservation works, reservoirs, aqueducts and the working of schemes for artificial recharge of underground aquifers. Finally, something must be allowed for building up the reserve and replacement funds for which this Bill provides.
Now the river authorities will not be undertaking major works without some clear evidence of need and a clear indication of who is to benefit. The cost of them will, so far as possible, be apportioned among those who so benefit. It is, I am sure, generally accepted by the major users of water, whether it be industry or the public water supply undertakers, that such an apportionment is the right way of proceeding. They would not object to carrying their proper share of the cost of necessary works of this sort, as they would have to do, directly or
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indirectly, if there were no river authority in the picture.
The capital cost of these large-scale works can be very high; but it should be understood that the works most likely to be built by river authorities—river regulating reservoirs—make water available at an extremely low cost per thousand gallons. Thus, the Tryweryn dam will cost about £2½ million—with another £500,000 to be added on account of associated and ancillary works. For an expenditure of something over £3 million, Liverpool Corporation will be able to abstract 65 million gallons a day from the River Dee just above Chester at a cost of something like 1½d. per thousand gallons. This is not, of course, the cost to consumers, for the water must be pumped 25 miles from the point of abstraction to Liverpool and treated, before being put into public supply. But it shows the low cost of making the water available by river regulating works.
Take another case: the reservoir to be constructed under the Clywedog Reservoir Joint Authority Bill, which was being discussed in your Lordships' House a few days ago. If approved, this proposed reservoir will cost about £4½ million. It will regulate the flow of the River Severn, and will enable an additional 100 million gallons per day to be taken from the Severn at various points along its course by the participating authorities. Costs at the point of abstraction will range from less than a ½d. to 1¼d. per thousand gallons. By any standards this is cheap water, and the price should be no deterrent to anyone whose needs are to be met by a river regulating scheme. Of course, the figures that I quote relate to steady abstraction throughout the year. Spasmodic reliance on the reservoir in dry times only would mean a greater cost per thousand gallons taken. So much for major works.
That leaves three other sorts of expenditure—day-to-day running costs, minor works, and contributions to reserve and replacement funds—to be carried by the general charging schemes under the Bill. The level of charges likely to be necessary under such schemes is a matter of keen interest to noble Lords and to those who will be affected by the operation of the Bill. If this statement is somewhat lengthy, I hope that noble

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Lords will excuse it, because I think the House is very interested in this particular matter. It is not possible at this stage to be precise about the amount of expenditure for purposes other than major works, as requirements will vary from one river authority to another, for each has different problems to meet. But, making allowance for these widely different circumstances, annual expenditure of river authorities other than that on major works may well rise after a time, when a water conservation effort has developed on a pretty substantial scale, to something in the range of £65,000 to £150,000 a year. That is the best estimate we can make at the moment.
In the same way, it is not possible at this stage—six years before charging schemes come into force—to be categoric about charges for any particular abstraction in any particular area, but some broad conclusions can be drawn from the available material. Such material as there is to give a lead has all been carefully examined by the Ministry of Housing and Local Government. It consists primarily of the Hydrological Surveys conducted by the Ministry, but also includes information about industrial water use collected under the ægis of the Central Advisory Water Committee, and in other contexts of the Ministry's work. Let us assume expenditure of the order I have just mentioned as having to be carried by the general charges: then, for surface water, charges ranging from a fraction of a penny per thousand gallons for water taken and returned virtually undiminished in quantity and quality, to a few pence for water entirely consumed, would suffice. For water from natural reserves underground, an appropriate charge would be of the order of a farthing to a halfpenny per thousand gallons. It will cost more, of course, where steps have to be taken to boost the underground reserves by artificial means.
I think it will be helpful if I illustrate what these charges mean in total sums paid by individual abstracters. Two million gallons per day at a halfpenny per 1,000 gallons would amount to £1,500 per year. At one-tenth of a penny, it would be £300 per year. A brewery taking, say, 400,000 gallons per day from underground, none of which is returned to the source, would pay, at a farthing per thousand gallons, about £150 a year. A water undertaking taking 7 million
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gallons per day for consumption within the area of the river authority would pay, at a penny per thousand gallons, about £10,500 annually. These figures are illustrative only. But if applied to the Severn area or the Essex Rivers area, for each of which there already exists a Hydrological Survey, charges of this order would produce an income adequate to carry an annual expenditure to be incurred by a river authority of well over £100,000.
This charge of one penny per thousand gallons for river water can be set in perspective by referring to an actual example of charges for the taking of such water—from the Thames. Payments are made to the Thames Conservancy by the Metropolitan Water Board and by other statutory water undertakings amounting altogether to £300,000 per year. This represents a charge of between six-tenths of a penny and one and three-tenths pence for every thousand gallons, according to the abstraction in question.
My Lords, I do not claim great precision for any of the estimates of future expenditure which I have given, nor do I say that the levels of charges which I have foreshadowed as providing adequate income for the river authorities' new functions are more than an illustration of what the position may be. Nevertheless, I hope that they will be reassuring to those who have regarded the future in this respect with a good deal of pessimism. I do not think it can justifiably be said that charges of this sort will be so burdensome as to price water conservation, or the abstracter's products, out of the market. Equally there is no doubt that expenditure of this order must be met if the management of our water resources is to function on a sound basis. That is all I have to say about the charging scheme.
All in all, my Lords, I believe that this Bill is a good Bill and a fair Bill, and moreover, I also believe that it will prove to be an effective Bill. If your Lordships agree that this is so, then, for my part, I have no hesitation in sharing the credit, which I believe may be claimed by Her Majesty's Government, with your Lordships' House and in particular with those noble Lords in all quarters of the House who have worked so hard, so constructively, and with such good will in order to make an already good Bill an even

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better one. And, if I may, I should like, before sitting down, to thank the two noble Lords who with myself formed the Government team; my noble friend, Lord St. Oswald, for his valuable support in matters agricultural; and my noble friend, Lord Jellicoe, without whose inspiring leadership, I freely confess, I should have at times felt very lost. I beg to move.
Moved, That the Bill do now pass.—(Lord Hastings.)
3.51 p.m.
LORD LINDGREN: My Lords, the Bill emerges at the Third Reading in principle, fundamentally, as it reached this House. One does not complain too much about that because, after all, the Government are the Government and it is their right to make decisions, but we have had considerable discussion and a large number of Amendments have been placed on the Order Paper. It would therefore be churlish not to appreciate the fact that many of those Amendments have been accepted in principle by the Government and given effect to in Amendments which they have subsequently placed on the Order Paper. From this side of the House I would express our appreciation to the Ministers who have been in charge of the Bill, not only for their courtesy, which, of course, we have come to expect from them, but for the manner in which they have dealt with Amendments.
Fundamentally we are legislators. We consider legislation. We are not practical people who are giving effect to that legislation in the field. Sometimes it has been pointed out to me by those who have the responsibility in the outside world that they have some difficulty in understanding what Ministers and Parliament meant when they brought legislation before the House. The detailed discussions in Parliament, and sometimes the detailed opposition that has been made by Ministers against Amendments, have meant that those who have the responsibility for administering this Bill will be far clearer about the Government's intentions than they otherwise would have been. This leads to a far more effective administration of this Bill.
There is, however, one point on which I am still fundamentally in opposition to the Government, and that is the reference
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made by the noble Lord, Lord Hastings, to the Water Resources Board. I am still uncertain (as are many of my colleagues on this side of the House and as are, I think, most of those associated with water—the statutory water undertakers or those in industry) as to whether or not the Water Resources Board will have sufficient power to do the job that they really ought to do. The river authorities have been given some very real and extended powers and I take the view that many of those powers ought to have been centralised in the Water Resources Board.
Perhaps I may give one example. At the moment the control of underground water supplies lies with the Minister of Housing and Local Government under Section 14 of the 1945 Water Act. Under this Bill, of course, it goes to the river boards in the area and the central authority no longer exists. The control of water resources strictly within the river authority area is doubtless adequate for local problems. But the vital question to my mind is how water is to be moved from one river basin to another. This is clearly one of the major problems which face a country such as ours in which we have a very heavy concentration of population and where, in fact, we have a wet side and a dry side. Unfortunately it is true (though perhaps I should not have said "unfortunately") that in many of the drier areas we have great concentrations of population such as we have in South-East England. Therefore, this complete freedom of movement from one river authority to another is essential if we are to get fluidity of supplies and the maximum supplies available in the area in which the water is required. I think it is a major policy matter, or should be one, in dealing with national water resources.
In any event, I take the view that we shall have to have a grid for water supply in exactly the same way as we have a grid for electricity supply. To my mind, that is the only way in which we are likely to get the heavy flow of water from where it is to where it is required. It is my view that it is not easy to see how that is to come about under this Bill. It may well be, in practice, that the Water Resources Board will be able to plan for the conveyance of water, but it is doubtful under the Bill, as I see it, whether they will

541
have the power to ensure that their plan is given effect. Having said that, I must, at least, admit that the establishment of the Water Resources Board is a very big step forward. It is a welcome step forward, although it does not go as far as I and my colleagues should like. Much will depend on the chairman and members of the Board itself. If they are strong, then they are perhaps likely to give themselves the "teeth" which the Bill does not have.
For a while I was associated with the Ministry of Housing and Local Government and I know, of course, that as a centralised Ministry they had control of water resources and supply in this country for very many years. It seems to me that there will be a tendency on the part of the Minister not to give up that long-held authority which they have had over water resources and not to hand it over to the statutory water undertakings.
There is another practical problem, I believe, so far as this Bill is concerned: while it deals with supply and distribution, we have not under this Bill dealt with the problem of economy in the use of water. Perhaps the weather of the last few weeks has brought to many people in this country the realisation of how valuable water is, because of the effect of the weather on the availability of their water supplies. But I think much more could be done, not only in water conservation, but in getting ready for the problems of a dry summer and the availability of supplies in areas of concentrated population and problems of the reduction in the waste of water. The noble Lord, Lord Hastings, referred to the cost of water. It is so cheap that I have a strong suspicion that industry considers that it is not necessary for it to be as economical in its use as it could and should be. It is not a question of cheapness but of the availability of supply, and it behoves all sections of the community to be economical in the use of water.
Industry could do much by the re-use of water, and I am certain that the statutory water undertakings would be only too pleased for industry to consult with their experts in order to obtain an improvement here. This is equally true of agriculture and of domestic consumption. Would is be daring of me to suggest that our plumbing system is antiquated? We have only to think of the past few weeks to be reminded of this. There
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ought to be a review not only of the plumbing system but also of its protection: because many hundreds of thousands of gallons of water have been lost over the past few weeks as a result of inadequate plumbing protection. We should also look at the bye-laws governing public health, which were established under that wonderful Act—wonderful for the period—the Public Health Act, 1875. We have gone a long way since then, but in many areas the general regulations have not been amended since they were first put into force. I think that we ought to look at these in order to see whether we can reduce the use of water, without affecting public health in any way, by the elimination of tanks in roofs and unnecessary flushing tanks in lavatories, which we have in some parts of the country.
In accepting this Bill on Third Reading, I think that it has been improved. I should have liked to see it a much stronger Bill, but because of the general problems confronting the Government, they have been a little afraid of their shadows and they have not had the courage to do the things they ought to have done. But I conclude by expressing our deep appreciation of the manner in which the Bill has been handled by the Ministers in charge, and of the concessions they have made to us, which I hope will improve the Bill and lessen the work which will be necessary for the House of Commons to do.
4.4 p.m.
LORD SINCLAIR OF CLEEVE: My Lords, while I endorse wholeheartedly most of what the noble Lord, Lord Lindgren, has said, there are one or two other aspects of the two cardinal points in his remarks—namely, organisation and charging—to which I should like to refer briefly. At the outset, however, I must refer to the Water Resources Board. I listened carefully to the statement made by the noble Lord, Lord Hastings. Anything I say, I am afraid, must be conditioned by my study of it, but I hope that I do not sound churlish when I say that I was not altogether reassured by what he said in that regard. If I heard him aright, he stressed the fact that the Water Resources Board would be an effective, forward-looking instrument. I am afraid that one of the criticisms some of us have had is that I there is too much emphasis on the forward-looking

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and too little on the power to act.
I feel that the Water Resources Board should be able to ensure that the broad plan, as approved by the Minister, is efficiently and economically carried out. When it comes to the problem of the transfer of water from one river authority area to another, for the Board merely to have power, under Clause 12 (3)
"… to encourage and assist river authorities in the formulation of such plans"
is not sufficient. It would seem that, without waiting for fresh legislation, it would be a great help if there could be written into this Bill, without in any way derogating from the authority of the Minister, power for the Board, acting under the Minister, to co-ordinate the action of the river authorities in regard to their new functions. In that connection, I must confess that I am still convinced that the fewer river authorities, within reason, there are, the better will be the organisation and the more efficient its working.
The noble Earl, Lord Jellicoe, in the discussion in Committee of Schedule 1, gave a full explanation of the reasons why the Government, at this point of time, did not wish to go further in the direction of amalgamating river board areas than is proposed in the Bill as it stands. This very important question will no doubt he further debated in another place, but let me take this opportunity, for the record, of adding my support to the arguments adduced in the first instance by the Proudman Committee and supplemented by several noble Lords in speaking on this Bill, that the number of river authorities should be substantially reduced below that specified in the Bill as it stands. I may be wrong in this, but I believe that a good deal of the opposition raised to the merging of the areas of two or more river boards into one river authority rests on a belief that in such cases the boards themselves will be merged. I cannot see that happening in any little sense, because the important work the river boards do will still have to be done and it can be done on a river board basis and, one would have thought, desirably only by people who have been doing it and have the local knowledge and experience. They may
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be co-ordinated by the river authority and surely they can in some way be represented on that authority.
As has been said before, the authority could well have three committees—a water conservation committee, a river boards committee and a finance committee. It would seem to be a good thing if such matters were determined so far as possible in the light of experience. That was one of the reasons —there may be others, but with time so short I will not develop them now—why I have always felt that it would make sense if the Government could be persuaded not to institute all the river authorities on the same day but for there to be an interval of one year, or perhaps two, between the instituting of the first batch and the instituting of the last. I do not think there would be any great difficulty, because in the meantime the preparation of the hydrometric scheme, the assessment of minimum flow, and so on, could well be done by the river boards in areas where river authorities had not been established.
As regards charging schemes, here again I look forward to an opportunity to study what the noble Lord, Lord Hastings, said, but, by and large, he seemed to indicate that the Government subscribed to the principle, which many of us feel to be vital, that the cost of new works should be predominantly, and if possible wholly, borne by those who directly benefit. I hope I am right in saying that. It is most important, and we were glad to hear it. On that basis, as I think the noble Lord indicated, the standing charges of the river authority should not be a very significant sum per 1,000 gallons.
There are two aspects of this to which I might refer. Many of the key works we are talking about, which arise particularly in these charging schemes for implementing a direct abstraction, will be a duplication or extension of works that have previously been executed by the abstracter, whether it be a statutory water undertaking or an industrial firm. The work has to be approved by the river authority, whether it arises from the authority's initiation or at the request of the abstracter. But the abstracter is vitally interested in the cost of the resultant supply. The river authority is obviously interested in having the work done as economically and

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efficiently as possible. Therefore, I submit that the authority should not, merely as a matter of principle, undertake work that can be done better by the abstracter himself. There may be a danger (I do not suggest that this will happen) that river authorities will build up unnecessarily large staffs to do the planning and supervising work that could be carried out by the abstracter.
My last point relates to simplification and, therefore, economy arising on the inclusion in the charging schemes (as they will have to be included) of the costs of transferring from one river authority's area to another. That transfer can be arranged only with the approval of the Water Resources Board and the river authorities concerned. But assuming the necessary approvals have been given, in so far as the transfer is related to the particular need, then the charge should be agreed between the abstracter in question and the river authority in the area from which the water comes.
In many cases the arrangements for defraying the cost could well be made on the basis of a bulk supply contract directly negotiated, on the one hand, by the supply authorities in the receiving area, and, on the other, by the river authority in the area from which the water comes. In that way the cost of the necessary works in both areas would be covered and would be borne by those receiving the water. Neither in the receiving area nor in the area from which the water comes would the river authorities have to spread the cost of those new works over all users, whether or not they benefited directly from the work. That may seem to be a point of detail, but I think it illustrates a procedure that is not covered in the Bill, as it stands, and might well prove both simple and economic. In conclusion, may I add my tribute to the courtesy with which the noble Earl, Lord Jellicoe, and the noble Lords, Lord Hastings and Lord St. Oswald, have listened to and, so far as possible, dealt with the many points of detail raised on the Committee stage?
4.14 p.m.
LORD MERRIVALE: My Lords, in view of the Motion on the Order Paper to be moved by the noble Lord, Lord Amulree, I propose to be brief, and first of all I would convey the regrets of my noble friend Lord Colville of Culross
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that he cannot be here to-day. He has asked me to thank the Government on his behalf for so kindly meeting his points with regard to amenity questions. I should like to take up one point made by the noble Lord, Lord Lindgren, regarding the need for economy in the use of water by industry. I agree with that. But I think I am right in saying that industry is very conscious of this necessity and, so far as certain applications are concerned, water is re-used or re-circulated as much as forty times. I think one can say, therefore, that there is economy in industry.
Before this Bill leaves for another place, I should like to stress that, so far as industry is concerned, there have been practically no changes in regard to minimum acceptable flows, licensing, charging schemes and consultations. This makes me feel that industry in this context definitely has not a parent Minister. I was sorry to see the noble Lord, Lord Derwent, leave his place a short time ago, because I was hoping he would pass this view on to his right honourable friend the President of the Board of Trade. On February 12 [OFFICIAL REPORT, Vol. 246 (No. 38), col. 900] my noble friend Lord Hastings said, in reply to an Amendment put down by my noble friend Lord Albemarle—and I believe he reiterated the assurance to-day—that the noble Earl could be assured that the Minister of Housing and Local Government would make adequate provision to look after the interests of industrial water users.
My noble friend Lord Hastings also said on that occasion that his right honourable friend the Minister of Housing and Local Government had consulted with the President of the Board of Trade regarding the appointment of an appropriate representative, and the result of their discussion was that it was felt that somebody not familiar with industry in general, but more concerned with the use of industrial water, would be the more suitable nominee. It is my humble contention that the Board of Trade should be brought into these further discussions. If I understood my noble friend aright when he spoke this afternoon, he said that there were to be further discussions on the question of industrial water, but I did not hear him say that they would be with the Board of Trade. I think it has become increasingly clear that industry in this context requires a parent Minister

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to fight for its rights and also with a view to obtaining concessions similar to those made to statutory water undertakers and to agriculture.
THE EARL OF ALBEMARLE: Hear, hear!
LORD MERRIVALE: There seems to be every indication that industry will pay the piper but will have little to say about the tune. For instance, appeals on minimum acceptable flows, should there be any objection on the part of statutory agricultural bodies are now to go jointly to the Minister of Housing and Local Government and to the Minister of Agriculture, Fisheries and Food. I think this shows to what extent parent Ministers can influence a Government decision.
Industry's biggest immediate problem is still in connection with licences of right and the safeguarding of the abstraction of water to the same extent as in the past. Therefore I am grateful to my noble friend Lord Hastings for having elucidated a little this question of charges to industry. I feel, however, like my noble friend Lord Sinclair of Cleeve, that it is something which industry will have to study carefully on reading Hansard. There is a feeling within industry that in effect the Minister of Housing and Local Government still does not have the necessary information on this question of the industrial use of water, having regard to the complexity of the problems involved. That is why it is felt that the President of the Board of Trade would be a highly satisfactory person to bring into this question.
For the Record, I should like to rectify a statement I made on February 14 last [OFFICIAL REPORT, Vol. 246 (No. 40), col. 1069] regarding the amount of water used by industry in America per ton of finished steel. I said that the figure was 600,000 gallons, when it should have been 60,000 gallons. I apologise for that, but it was due to a typographical error in the information supplied me and not to any fault of mine. However, I think one should remember that Belgian industry uses over double that amount. I am saying that because I feel it stresses the fact that the relationship between water consumption and weight of similar products is not simple and affects costs. Also on that day I quoted the figure of
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one penny per thousand gallons. That would seem to be the average figure mentioned to-day by my noble friend Lord Hastings. If one takes into account present consumption by industry at that cost, it would represent approximately a figure of £3 million per annum to industry, which is not insignificant. My Lords, those are the few remarks I wish to make on this Motion, and I should like to thank my noble friends for the kindness they have shown and also for the way in which they have tried to meet, so far as they could, the points put to them by Back-Benchers on this side of the House.
4.23 p.m.
LORD MORRISON OF LAMBETH: My Lords, on the Question, That the Bill do now pass, I wish to draw attention to the legislative process in which this House, together with another place, plays an important part. It is not widely realised, I suspect, that the process of amendment of Parliamentary Bills is never ending. Before ever a Bill sees the light of day it may be that, within the Department, it goes through ten, twenty or even more editions before being presented to Parliament. The Civil Service, the Ministers concerned, and particularly that little-known public servant, the Parliamentary draftsman, to whom our country and Parliament, in particular, are enormously indebted for the work they do behind the scenes without public knowledge, do work of very great value. The Bill comes to one of the Houses of Parliament, where it has a Second Reading, a Committee stage, which may be heavy or light, a Report stage and a Third Reading. In your Lordships' House Amendments are eligible (as we have seen to-day), even sometimes of substance, on the Third Reading of the Bill. Therefore, it is a long process.
The point to which I wish to draw attention is that some people object to there being two Houses of Parliament. They believe their views are progressive, and I quite understand their feelings. But if there were not two Houses of Parliament, the output of legislation would inevitably be much less than it is. From some points of view that would be a good thing. I have some views about this Session. I could easily eliminate at any rate one great measure. When I was Leader of the House of Commons.

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one of things which impressed me was that if there were no Second Chamber—which we call the House of Lords—then that great programme of legislative output could never have been achieved. While we have been considering the Water Resources Bill here, another place has been considering other Bills, one of them, unhappily, drawn from the same curious Government Department as this Bill. So two Bills from the same Department are before Parliament at the same time. Work is being done down the corridor, and work is being done here. That is a great economy tin the use of time.
May I pay my respects and compliments to my noble friend Lord Lindgren for the considerable amount of work he has put into the Bill, on Committee and Report stages in particular, assisted as he has been by my noble friends Lord Williams of Barnburgh and Lord Champion? The Ministers themselves, of course, have had a hard time wrestling with their briefs and arguments that have been advanced. It has meant an enormous amount of work. I should like to point out that if there were no Second Chamber the legislative process would be more difficult. If this House, with all its perfections—and, let me add, its imperfections—did not exist (it is not perfect, and I should like to see some composition changes: I do not want changes in its powers, because it has its virtues) the capacity to handle Bills and tidy them up would be greatly curtailed. This Bill will go to the House of Commons in a relatively tidy shape, so far as we know. It will not prevent further Amendments being made, but an enormous amount of the work has already been done.
If we had not this Second Chamber we should have to invent another stage, if not two more stages, in the House of Commons, in order to get the necessary detailed examination of Bills; because it is very important that Bills should be word perfect before they become Acts of Parliament, otherwise there could be all sorts of trouble in the courts; as we have seen, an enormous amount of examination has to be made. I would say, therefore, that this institution is time-saving. It is a good Chamber at revision, and it does the work in a businesslike way.
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I have never forgotten a Road Traffic Bill which I, as Minister of Transport, introduced in another place in 1930. They took four months on Committee stage and there were columns of argument on the same Amendment, principally with the aim of obstructing not that Bill but a Bill which was coming after it. When that Bill came here, what impressed me was that the late Lord Russell, who was my Parliamentary Secretary, would get up and resist an Amendment moved in about half a column of Hansard. In answer to the Amendment he would get up and say. "My Lords, this Amendment really will not do," and in about a quarter of column of Hansard would tell the House why. Almost certainly the noble Lord who moved the Amendment would get up and say, "My Lords, I beg leave to withdraw." It did me good to see that going on at this speed. They nearly killed me in another place on that Bill, whereas here it went with expedition. As I say the House of Lords is a timesaving institution. It contributes to the perfect drafting and wording of Bills; and so, to quote the words of Sir Alan Herbert, in his play Big Ben:
"There's a lot to be said for the Lords!"
4.30 p.m.
LORD CHORLEY: My Lords, I hope your Lordships will forgive me if I intervene for a short time this afternoon. Those of us who were particularly concerned with the Amendments in connection with the preservation of natural beauty felt that we had received more concessions on this Bill than we have ever previously had, and the noble Viscount, Lord Colville of Culross, agreed to express our appreciation. It is true that the noble Lord, Lord Merrivale, has apologised for his inability to be here, but as I have been very much concerned with this problem I felt that I should like to mention the matter specifically on behalf particularly of those noble Lords who have been concerned with it. I did not think earlier that I should be able to get here in time.
The noble Lord, Lord Hastings, referred to the Amendments which the Government had put down in answer to the pressure on them, and indicated that they regarded the Amendments as a very important part of the improvements

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which have been effected in the Bill. Certainly we feel strongly that that is so. It is not long since these Bills used to come up with no provision for amenity clauses or anything of the kind. I am very glad to see here to-day the noble Viscount, Lord Mills, who helped us on the first occasion, not many years ago, with the Electricity Act. When the Transport Bill came up it was singularly deficient, and this Bill also was far from being as good as it might have been.
Noble Lords in all parts of the House are now very sensitive to these matters, and we have been gratified at the amount of support we have been getting, and also to find the growing sensitivity of the Government in regard to these matters. We can only hope that this sensitivity will increase as time goes on, because these matters are now very much more in the eyes of the public than they were a short time ago, and it is essential that Parliament should take them in hand. My noble friend and leader in past times has just referred to the valuable work which can be done in many ways in this House in connection with these Bills, and this is one particular side which can perhaps be particularly well undertaken here. I hope your Lordships will forgive me for making these few observations at this stage of the Bill and for again expressing our sincere gratitude, particularly to the noble Earl, Lord Jellicoe, who we know has these matters very much at heart, and who we feel deserves perhaps a particular pat on the back for the interest which he has taken and the help he has given to us.
4.33 p.m.
EARL JELLICOE: My Lords, I am sure you will now wish to cast this Bill off down the river on its voyage to another place without further ado, and I therefore propose to duck the closing salvoes of noble Lords regarding such various matters as the strength of the Water Resources Board, a national water grid, water economy, the number of river authorities, the staggering of their birthdays, the future charging system, the effect of this Bill on industry, the bicameral system of Government, flushing tanks and toilets and so on. However, I am sure that my colleagues in another place will wish to give due attention to those remarks.
However, before we take final leave
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of this stage of the Bill, I wish just to endorse what my noble friend Lord Hastings has said. This is not a dramatic measure. Nevertheless, it is a necessary and important one, and I would claim that its importance has been fully reflected in the very thorough attention which it has received during its passage through your Lordships' House. I am personally very grateful to my noble colleagues, to my noble friend Lord St. Oswald and to my noble friend Lord Hastings, for all they have done to keep the Bill, with its virtues, and me, without mine, unblemished and on the rails. I am also most grateful to those noble Lords—Lords Labour, Lords Liberal, Lords Tory, Lords neuter, Lords industrial, Lords bucolic, and, last but not least, the Lordly undertakers in this House—who have contributed so much to our discussions on this often technical but never dry subject.
I should also like to thank the noble Lord, Lord Chorley, and other noble Lords for their very generous remarks to-day. In concluding I would say two things: first, how particularly grateful I and my colleagues are to the noble Lord, Lord Lindgren, who has led for the Labour Opposition on this Bill, for the constructive, informed and sometimes valid criticisms which he has brought to bear throughout; and secondly, that I would endorse very warmly the wise words which have just fallen from the lips of the noble Lord, Lord Morrison of Lambeth.
On Question, Bill passed, and sent to the Commons.

THE PORRITT REPORT ON MEDICAL SERVICES
4.38 p.m.
LORD AMULREE LORD AMULREE rose to call the attention of Her Majesty's Government to the Review of Medical Services in Great Britain (Porritt Committee); and to move for Papers. The noble Lord said: My Lords, I have been thinking for a long time of putting down a Motion on the National Health Service for debate in your Lordships' House, but there appeared to be no particular reason for putting such a Motion down until the Report of the Porritt Review Committee was published, which was not so very long ago. That seemed to me to be an occasion upon which I could hang, as it were, a debate in which I could make some references to

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my feelings about the National Health Service.
The first thing I should like to say is that the Porritt Committee is, I think, the first body of entirely medical opinion which has considered the National Health Service and has published a Report. The Committee was quite a large one. It consisted of 44 doctors and was representative of the various Royal Colleges both in England and in Scotland and of bodies like the British Medical Association. Most of these bodies, if not all, were represented upon the Committee by their President for the time being, so one can fairly say that it represents what a good deal of the informed medical opinion feels about the National Health Service at the present time. What they have issued in the form of this document is a general review of circumstances as they are now. They have come to some conclusions from their review and they have made recommendations for certain changes which might be made in the future. They have made a number of recommendations, with some of which I agree entirely and with some I do not agree; therefore it is not my purpose to try to support the complete Report but, as I said before, rather to take the Report as a basis for a general discussion about some matters concerning the Service.
The Porritt Review Committee say that the basic concept of a National Health Service is fundamentally sound and is acceptable to the vast majority of the medical profession. With that I would entirely agree, and I think I should be right in saying that such a concept is acceptable to the vast majority of your Lordships' House. When the National Health Service was first founded, however, it appeared that it was a Service superimposed upon others which already existed rather than an attempt to absorb all the services dealing with health into one big Service which would deal with every branch of medicine in the country.
For example, there are at the present time nine Government Departments who supply a health service of some sort. I refer to the Ministry of Education, the Ministry of Labour, the Ministry of Housing and Local Government, the Home Office, the Ministry of Pensions, the Ministry of Agriculture, Fisheries and Food and one or two more—I will not bother your Lordships with all the
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details. There are various branches of health service which do not come under the National Health Service. I refer to the occupational health services, the industrial health services. The first is possibly a matter on which the noble Lord, Lord Taylor, may have something to say, because he has far more experience of occupational health than I have myself. But it seems to me that it might be an advantage if these services could in some way be combined. I am not going to say they should be carried out by the same people. I am not going to say they should all be run in exactly the same kind of way. But it seems to me that if you are going to have the Ministry of Health running the National Health Service, that should be the focal point for all the health services in the country. In that way one would probably economise in the use of manpower—and I mean both men and women doctors; one would probably economise financially, which is quite an important point; and one would certainly save a good deal of overlapping of work, which again is something well worth considering.
The National Health Service was really based upon two existing props and a third one which was made especially for it. The two existing props were the preventive and social medicine side, which were the province of the local authorities, and the general practitioner or family doctor side, based on the old National Health Insurance Scheme. The side which had no prop was the hospital service. That, I think, is what has led to the formation of the tripartite system, as it is called, with one body doing the preventive and social side, one body looking after general practitioners and one looking after the hospital service. That has led once again to a certain amount of disagreement and suspicion—I will not go so far as to say a certain amount of hostility, but a certain amount of difficulty between the various branches of the Service.
The Porritt Report recommends that these branches of the Service should all be brought together under a series of Area Hospital Boards which would be based upon the general hospital for certain areas. That sounds, on the face of it, a rather attractive, agreeable idea: but when one comes to think of it I am not sure it is really a practical idea,

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certainly not from the point of view of the debate I am initiating now, because it would mean to a great extent a redrafting or re-writing of our present system of local government, which is more than I want to suggest should occur at the present time. That is one of the many difficulties. I do not want to pursue that line any further, but I do not think that at the present time it is a practical idea.
But there is one way in which I think a start might be made towards adopting a more rational method for dealing with the local authority side of the Service, and that is by combining the departments of health and welfare into one, which might, for the want of some better name, be called the social department. I merely suggest that as a name which occurs to me at the moment, but there might well be some better one. Porritt suggests that there should be a department of social health based upon the general hospital where these Area Boards are to be themselves based. But if it were to be combined with the hospital side, that, it seems to me, would be making too much of a hospital matter of the whole thing; whereas the idea is to try to make people think of the Health Service as based not entirely on people going to hospital but on their not going to hospital—on treating them before they get to the hospital stage. Therefore, I do not recommend making the hospital the central prop of the complete Service.
That advantage would be gained from combining the health and welfare departments can, I think, be drawn from the fact that under the Local Government Act, 1958, local authorities with more than 60,000 people were allowed to combine their two departments, in the sense that they could make the medical officer of health the chairman of both departments, of welfare and of health. That system has been adopted by most, if not all, local authorities of that size, and at the same time by quite a number of county boroughs and county councils. Many of the burghs in Scotland have done the same thing, although as they work under a different Act of Parliament, things are not quite comparable. I am sure that if that could be done, if the two departments could be joined together,
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it would be more successful than at the present time; because it is practically impossible to make a real distinction between health and welfare. You probably have people on the far extremes of both services in regard to whom you can say that their work is either health or welfare; but you have an enormous number of people in the middle where it is very difficult to decide on which side of the fence they should come.
I think it was a pity that in both the National Health Service Act and the National Assistance Act that particular question was not recognised, and that those two very important Acts of Parliament tended to run in parallel rather than to come together from time to time; because, as we were all taught at school, the essence of parallel lines is that they never meet but go on to infinity. That, I think, has been a great mistake. Indeed, I once upon a time tried to get this matter elucidated in your Lordships' House. In 1959 I put down an Unstarred Question with this end in view. Unfortunately, we got nowhere in that discussion, which confirmed, I believe, that you really cannot separate health from welfare.
One of the points that the Porritt Committee make—they go a little further than I have gone now—is the great importance now of integrating social medicine, family doctoring and hospital practice. There, of course, nobody would agree more than I myself, and I am sure that the noble Lord who is to reply for the Government would agree too. I do not want to pursue that point any further, but I would say a word or two about the general practitioner side of the Service. What we are told when we are talking about the Health Service is that the general practitioner is far and away the most important person; that if it were not for him it would break down; that he is the kingpin, and such phrases as that. But when one comes to see what has been done for the poor fellow, one wonders whether that is merely a form of words and whether it has been put into force as strongly as it might be; because in many parts of the country general practitioners still feel cut off from the hospital and suspicious of the local authority. Both of these feelings go back a long way in history.
I do not want to go into some of the unfortunate causes that have led to this feeling, but it is one which has certainly been in existence for a long time. The point about a good general practitioner is that he does not want to be merely a signpost to the hospital: you come to your doctor, you go to the hospital. That is not what the practice should be, and few really good general practitioners want that to be so. Unfortunately, more and more people are being transferred direct to hospital, with the effect that the hospitals are fuller than they have been before and are becoming rather overburdened with work.
One wonders what is the reason for all this. There are a number of reasons, some of which I think could be prevented, though some of them probably could not: because the science or art of medicine has greatly improved and expanded over the last ten, fifteen or twenty years, and there are to-day greater facilities than hitherto for diagnosis and for treatment, all of which puts a greater demand on the work of the hospital. At the same time, the number of doctors has become smaller and they are being given a good deal of work to do which is not necessarily strictly medical.
To move on from that point, do we really know what number of doctors we need, first, at the present time, and, secondly, in, say, 25 years' time? A Committee which was set up under the chairmanship of a former Minister of Health, Sir Henry Willink reported some years ago that the number of doctors needed might decrease rather than increase. As a result of that, a certain number of medical schools cut down the number of students they took in. I think that most of them have now realised that that was a mistake, that that Committee was mistaken in its views, and that the number of doctors we have now is too small. The shortage was not really apparent until about four or five years ago, but I think I am right in saying that as time goes along it is becoming more and more apparent. Therefore one wonders whether it would not be a sensible move to have a general practitioner advisory sub-committee of the Central Health Service Council, which would be able to report on the work and practice of the general practitioner and upon what should be the ideal size of such a practice.
We have a certain idea about what should be the size of a practice, but I think that, of necessity, the right size will vary in different parts of the country. Probably in most parts of the country the practitioners' lists are still too large, although one must say straight away that the cutting down of lists to a more workable size does not necessarily mean in every case a better clinical practice—although in quite a number of cases that will be the result. One of the difficulties, of course, is that under the present capitation system if we reduce the particular number of patients on a doctor's list it means he will suffer a fairly substantial reduction in income. That, I think, is something to be deplored, not only because I am a doctor myself but because I think it is a bad thing that people's incomes should be reduced: they should be given a reasonable income for the work that they do. It has been suggested that there might be some other method of remuneration over the capitation fee. There has been a good deal of discussion about that proposal but, so far as I know, no system, apart from the capitation fee, has been worked out which it is thought would prove more successful than the capitation fee. So I think that the capitation fee has probably got to stay.
In the event of our needing more doctors where are they to come from? The present medical schools are, for the most part, working to capacity. They might be able to take a few more students, but not a great number, because there is a definite limit to the number of young men and women who can be taught in a class, especially on, the pre-clinical side. One wonders why none of the proposed new universities has a proposed medical faculty. One would have thought that some of the universities which are situated in fairly thickly populated parts of the country could well take a part and include among their faculties a small medical school. Possibly this is a matter for the University Grants Committee—and we know that at the present time that Committee is not feeling too kindly disposed towards distributing money. But I firmly suggest that one or two more medical schools are urgently required.
Another question also has arisen. It has not been talked about much lately,

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but about two years ago there was a good deal of talk about the number of young doctors who emigrated. Finding that they could not get work in England, or because they did not like the work in England, they left the country. I believe that somebody once said that between one-quarter and one-fifth of the doctors emigrated. I know that it is a difficult figure to estimate, but I wonder whether the Minister has figures which would reveal the real number. Certainly from the experience of my own school, so far as we can work it out, the proportion is nowhere near as large as that; it is about 6 or 7 per cent. of those who qualified, not, as was said in other cases, 15 to 20 per cent.
We should also bear in mind that, in a number of cases, those who emigrated did so, perhaps, for only a year or two, and then came back again. I am sure that is a practice to be encouraged. It is one way we have of spreading British medical knowledge and skill among the under-developed countries. I personally should be extremely sorry if the number of doctors who emigrated for a short time were to drop, because I believe they are doing fine work in spreading their knowledge in other countries. At the same time, one hears people say that if it were not for the people who come here from the Commonwealth countries, the National Health Service could not run. That comment does not worry me at all, either, because it seems to me that we are doing our duty properly by these young people from other countries, in allowing or encouraging them to come here, so that they can work and be trained here, and then go back to their own countries and spread the good learning and knowledge which they have got from people over here.
There is another point about the practitioner to which I should like briefly to refer. Quite a number of general practitioners prefer to work in groups of four or five, rather than to be entirely single-handed. They find that if they work in groups they can afford to run a much more satisfactory practice; they can have reasonable premises to see patients; they can keep a certain number of secretarial assistants and receptionists, and others—like nurses, health visitors and midwives—to assist them in their
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work. But I think that requires a practice of about 10,000 patients, which certainly means having four doctors.
I gather that one of the troubles in this connection is that it is extremely difficult for doctors to find suitable premises in which to practise. In the old days people practised from their own houses, with the dining room or the drawing room being used as a consulting room, and that sort of thing; but if one is going to have four doctors in a practice this is not practicable. Not only is it difficult to find suitable premises, but I am told that at the same time it is difficult to borrow money from the building societies for such premises. The premises are no good for any other purpose, and building societies prefer to lend money for ordinary houses rather than those which have been changed into consulting rooms and rooms for doctors to practise in.
Another point is this. If doctors are going to be encouraged to have working for them secretaries, receptionists, health visitors, nurses, and so forth, they will probably have to pay more for the staff they employ themselves as the salaries outside increase. A number of them find that they cannot afford to employ these people. Would it be possible to make some kind of extra-financial provision for the expenses of doctors in view of the increasing amounts of money needed to run a practice of this type? I am sure that if one could get more group practices one would cut down the referring of patients to hospital, with a consequent saving in the number of hospital beds needed. I am sure this would be a great advantage to the National Health Service in general. The hospitals could be of great assistance to the general practitioners in giving them more facilities than they do now in the way of X-ray photographs and pathological investigation, without the patients necessarily having to be referred to one of the consultants at the hospital. This would also have the advantage of not adding to the long queue of out-patients in the hospital.
There are several ways in which practitioners can be assisted. I will quote one or two examples which I have come across quite near London. There is a big centre in Peckham—it was the old Pioneer Health Centre before the war—which has now become the general

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practitioner centre for South-East London, to which general practitioners can send patients for X-rays and pathological investigation. They can perform a certain amount of minor surgery there; they can send their patients to have their injuries dressed, and can get a certain amount of simple physiotherapy carried out. This takes a big burden off the hospital service. These are patients who do not really need to go to hospital, and this system encourages the general practitioner, with the aid of this centre, to treat his patients himself. There is a further service, though not on such a big scale, in the Borough of Ealing, where much good work is being done by the local authority in providing a centre to which doctors can send patients for physiotherapy and other forms of treatment. This, again, is a great advantage to the doctors themselves.
Before I move from the general practitioners, I should like to put in a good word for trying to retain some of the general practitioner hospitals which it is intended to get rid of under the ten or fifteen year Plan. The reasons for retaining these hospitals have been given on numerous occasions; I do not want to elaborate them too much now. There are really two important reasons. One is that it is very good indeed for general practitioners to have a hospital of their own, where they can take care of their patients, and where they can meet their colleagues so that they do not feel they are working in complete isolation from the other practitioners in their part of the world. At the same time it would make more use of part-time nursing staff than if the hospitals were merely to be concentrated in one big district hospital. Furthermore, it would be appreciated by the patients and their relatives, who would not need to travel such long distances to reach hospital. Supposing there were some real objection to retaining these hospitals under the Regional Hospital system, would it not be possible for them to be transferred to the Executive Council so that they could be general practitioner hospitals in the true sense of the word and not part of the whole Regional Board system? I feel this is a point which is really well worth considering. I should like to ask the Minister to what extent the various branches of the profession were consulted
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on the ten-year Hospital Plan, apart from the Central Health Services Advisory Council, which was obviously consulted.
Then a question in parenthesis. Would it not be possible for hospitals to be given some sort of transport of their own? At the moment the ambulance service is run entirely by local authorities. The local authorities, broadly speaking, do their job very well, but I work in the London County Council area and we experience great trouble in dealing with elderly patients who come up, say, for physiotherapy once or twice a week in the afternoon, most of whom have got to be brought by ambulance. This work usually finishes at 4 or 5 o'clock, but frequently patients have to wait until 7.30, 8 o'clock, in some cases even 9 o'clock before the ambulance can pick them up and take them home again. This means that the staff of the department must also stay there, and it means that the patients are kept waiting there, which is discouraging for them. Could not some change be made in the rule that transport must be entirely under local authorities? Could not the hospitals in future be allowed a limited amount of their own transport?
I should like to see the general practitioners as directors, as it were, of what one might call the public health services, with the local authorities—or whatever would be the appropriate body—seconding to, or deploying in, their service a large number of the nurses, health visitors, and social workers who at present work entirely for the local authority. I know that this has been done in a number of areas, and where it has been done well it has worked with great success. If that were done it might be possible to reduce the number of workers who go round visiting people in their homes. One problem in the past has been that there have been large numbers of people, some employed by the local authority and some by other bodies, who have visited people in their homes, and this has been rather confusing to some of the homes. The more unscrupulous families have played one visitor against another.
I wonder whether something could not be done about combining some of these services into one. I put forward

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these ideas rather tentatively, but, for example, could not the health visitors and the social workers be combined? I know we have just passed a Bill dealing with the training of more social workers, but perhaps we should think again, and make some other arrangement of that service. Would it be possible to co-ordinate more with the nursing service? Should the social workers be given some nursing training, not to the extent of being State registered nurses, but rather more than the ordinary Red Cross training for nurses, or something like that? If that were done, they could become of great assistance to the general practitioners, to whom they could be attached. That, I think, would be one way whereby the local authority side and the general practitioner side could be brought very much closer together, and work could be done for the mutual benefit of the two. At the same time, I think that a certain amount of staff could be saved, with a saving in money, too.
My Lords, before I sit down (I am afraid that I am keeping your Lordships a very long time) I should like to refer to my own particular subject; that is, the care of the elderly people. I agree that the crying need for these people is to keep them at home as long as one possibly can, with as many services to assist them as is humanly possible. But I wonder whether the time is coming when we shall be able to get many more people to assist them in their homes. The other day I was looking at the Report of the London County Council and I was rather shocked at the figures which I saw for home-helps—and these people are really fundamental in keeping a single, old, frail person in his or her home.
What I found, rather to my surprise, was that between 1957 and 1961 the number of home-helps had gone up by only about 500. It occurred to me that maybe the supply is tending to dry up, and that we shall not get enough suitable women to take on that job. It may, therefore, be necessary—much as I deplore the idea—to think more of arranging suitable accommodation in communal homes for some elderly people, or of some other means of preventing them from becoming sick and becoming a charge (I do not mean
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a financial charge, but a moral charge) upon members of the community. That leads me to another question that I should like to ask the Minister: whether he has any idea of the total number of beds required for old people in the country. I do not mean the total number of hospital beds, but the total number of beds required for those in need of some kind of care, whether it is mental care, physical care or medical care. I wonder whether there are figures for that, too.
Then I think that something might be done to provide some sort of clinics for old people, rather on the lines of the old maternity and child welfare clinics, possibly staffed by a general practitioner, where old people, or not so old people—young-old people, if you like to put it in that way—who would not want to call in their general practitioner, could go and consult about various problems. I merely put that forward as an idea, but I think it might be worth looking into.
I would also ask the Minister whether it would be possible to transfer back to the hospital service the accommodation which is available for infirm and elderly people under Part III of the National Assistance Act, because at present it is very difficult, to get a normal though frail old person transferred from hospital to accommodation under Part III. I wonder whether it would be an improvement if that could be encouraged and brought about. I know that the subject has not been thought about very much until now, but it seems to me that that might be one way of solving the difficulty.
Another thing which might help would be to make the housing lists of local authorities a trifle more flexible. On several occasions I have heard about people who live by themselves on the top floor of a two or three-storey building and who could cope with life quite well if they lived on the ground floor. But because of the housing list and their place on that list it is almost impossible to get them moved quickly up the list. I do not want for a moment to suggest that people should be "jumping the queue", right, left and centre. But it seems to me that an exception might well be made in the case of a fairly frail person living on the top floor, who cannot manage but

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who could live an independent life on the ground floor. It does seem to me rather silly if that person cannot move to the ground floor, because she is No. 452 on the housing list instead of being No. 2. Perhaps the attention of local authorities could be drawn to that point, so that some change might be made there.
My Lords, I have been speaking far too long, but there are just two other points to which I should like to refer before I sit down. There is the body which was rather well described in the Lancet as the "greater medical profession," which consists of all those people who are of such enormous assistance to the doctors at the present time—physiotherapists, occupational therapists, almoners, and many others. Their numbers are nowhere near enough to go round, and their pay is not all that it should be. I know that we have discussed this matter in your Lordships' House on many occasions, but I should like to mention it once more, because I think it is something of great importance with which we shall have to come to grips fairly soon, or the supply will just dry up.
Before I sit down I would make two suggestions to Her Majesty's Government. One is that the Health Service should be far more decentralised than it is at the present time. At the present time, we have the hierarchy, on the hospital side, of the hospital management committee, Regional Hospital Board and Ministry of Health. That journey up there and back again takes quite a long time, wastes a great deal of energy, and frays a good many tempers. When the Health Service was being debated we were told, if I remember aright, that though centralisation was essential at the start, the time would come when a cerain amount of decentralisation would occur. I wonder whether that time has now come, and whether, if decentralisation cannot yet occur, we really need this further tripartite system of the management committee, Regional Hospital Board and Ministry of Health.
The other point I wish to suggest, which may seem a minor one after what I have said, concerns the composition of the Central Health Services Council. I wonder whether that could not be a body elected by the profession, or containing
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a number of elected members, rather than a body nominated by the Minister. If such a change were made, I think it might give great encouragement to the profession; and it would not, I think, lead to any diminution in the quality of the work the Council did. My Lords, I have taken up far more of your Lordships' time than I usually do when I address you. I beg to move for Papers.
5.20 p.m.
BARONESS SUMMERSKILL: My Lords, I am quite sure that we should all like to thank the noble Lord, Lord Amulree, for putting this Motion on the Paper and so enabling us to debate a very interesting Report. I agree with him that one cannot approve of all its proposals, or disapprove of them all; but this review—and it is a very long review—nevertheless stimulates thought among those of us who are very anxious about this subject, and who have only one objective, which is to improve the National Health Service. I must confess that, by the time I had read this document (as I say, it is a very long one), I was very sorry for the chairman, because he apparently sought and received so much advice from so many quarters that, in endeavouring to please everybody, he arrived at some conclusions which tend to cancel each other out.
I always believe that, in a Report of this kind, one should never try to compromise on matters of principle. That is absolutely fatal, because by the time people who are interested in it and who read it arrive at the end they are not quite sure precisely what kind of service the authors intend to establish. I must confess that, to me, the Report seemed finally to be speaking with two voices—the voice of Jekyll and the voice of Hyde. Dr. Jekyll pronounces with wisdom, experience, humanity and knowledge; and then, suddenly, Mr. Hyde pops in his little ugly head with some mean little suggestion. For instance, Dr. Jekyll announces that the Gallop Poll reveals that people believe that the concept of the National Health Service is sound. Mr. Hyde—a hireling, I suspect, of the Fellowship for Freedom in Medicine, which is a very small, reactionary body (I am glad the noble Lord smiles) representative of only a small number of doctors—in this guise, whispers,

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"The doctors should, when possible, be in direct financial relationship with the patient rather than with the State, thus strenghening the bond beween doctor and patient while weakening the power of the Government over the medical profession." Can it be in the interests of the patient—let us say, one suffering from some mental disability—to feel that the strong bond between himself and the doctor is a financial one?
Then, again, it is suggested that the drug bill of nearly £100 million should be increased by providing drugs for private patients on the same terms as those for National Health Service patients. Of course, if this were done it would inevitably undermine the whole structure of the National Health Service, because it would thereby establish two categories of patients within the service. I do hope that noble Lords realise that this is entirely different from approving of private patients who go to the doctor as a private patient, take their prescriptions and go to the chemist. The suggestion here is that the prescription, E.C.10, which is provided under the National Health Service, should be given to one patient free, but that a charge should be made by the doctor if he gives it to somebody else. Now this would introduce such discrimination that it would, I believe—I do not think this is an overstatement—undermine the whole principle of the National Health Service.
Now these various suggestions to increase the financial interest of the doctor hardly accord with the evidence before us that both the doctor and the patient are, under the National Health Service, faring well. The Committee tell us in the Report that the doctor has retained his clinical freedom and that the very small number of formal complaints by the public against the doctors is one indication of the public's general satisfaction with the service. I have said that this Committee is speaking with two voices. On the one hand they say that, and then, in paragraph 116, it is suggested
"that the possible advantages of a direct contribution by the patient should be the subject of continuing study."
It is to be regretted that the 44 people responsible for this Report, mostly doctors—if the noble Lord looks through the 44 names I think he will find that
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they are not all qualified doctors of medicine, but that most of them are doctors—seem to have forgotten that one reason, as I recall it, almost the primary reason, for the introduction of the National Health Service was to include the mothers, the children and the aged. If a financial contribution is now demanded from these particular categories, they would inevitably tend to avoid obtaining medical advice in the early stages. That is what happened in the poorest parts when we had children dying from bronchial pneumonia following measles. It was because the mothers could not afford, out of the housekeeping allowance, even a small contribution to the doctor. They said, "This is only measles", and they waited for the rash to go, but the cough continued and the child developed bronchial pneumonia. Look at the statistics to-day. These women can now obtain medical treatment for their children at an early stage of their illness, and the result is that the change in our morbidity statistics in this field is absolutely spectacular. I do ask the noble Lord, when he comes to reply, to give us the assurance that we shall not go back to the stage when these particular categories were asked to make a financial contribution.
I welcome the suggestion that the family doctor's maximum list of patients should be reduced from 3,500 to 2,500. Although the noble Lord said that, if this were done, he did not think it would mean that the patient would necessarily have more attention and that the doctor would perhaps take more trouble in the clinical field, I confess that I welcome this proposal, particularly in the interests of the doctor. For the same reason, I am pleased that it is quoted again that the "properly organised emergency deputising services" in large cities are not frowned upon.
There are so few family doctors to-day. There are not enough family doctors for the whole nation. Their occupation hazard is coronory thrombosis, and their expectation of life is one of the shortest in the community. I believe that the longest is for a minister in the Church of England, and I believe the shortest is to be found for some people in the breweries. The doctor of medicine, one would think, with his knowledge, would have a long expectation of life. But not

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at all, my Lords. The pressure upon him—physical, mental and intellectual—is such that his expectation of life is not very long. I would ask the House to consider whether the time has not come when the doctor should cease to be the only worker in the country expected to do day and night shifts. That is why I welcome the paragraph on the emergency deputising services. I think that certainly his conditions of service must be reviewed more carefully if we are to receive good recruits for medicine. That is why I should give more consideration to the establishment of health centres.
The noble Lord spoke just now about the corner house, with its drawing room and dining room—the kind of place in which I was brought up—which was converted into the home and the surgery and the waiting room. These big, old Victorian houses were absolutely ideal in which to conduct a general practice for the neighbourhood, but they are no more. He was of course quite right in what he said about the building associations and the banks, which are not prepared to make big advances for colossal museums, as they think they are, which are converted by the doctor and afterwards, of course, are of no use for family residence. I think the answer to this is health centres, and I am very sorry that health centres have been dismissed as they have. Again, the noble Lord spoke about the payment of the general practitioner. He thought that the capitation method was not the right one. Again, I really think that perhaps the whole question of a salaried service should be reviewed. It functions very well in many other countries which have a health service equal to ours.
Now we come to the shortage of doctors and medical students. This has been emphasised, but in view of the demand by able girls for places in medical schools the statement in this document that
"Few of any walks of life have so much to offer the able young man as medicine"
will astonish many of us. I suppose that this Freudian lapse should not surprise many of us who will already have observed that this survey was conducted by a Committee of 44 individuals, of whom only one was a woman, to examine a service in which about 75 per cent. of
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those employed are women. The noble Lord reminded us just now of the "greater medical profession", of these wonderful women, the psychiatric social service workers, the workers in what we have called "the professions supplementary to medicine" (this is a clumsy term and I should have preferred "the larger medical service"), and we find that all are women. Yet this document has been compiled about a great women's service by 43 men and one woman. No doubt this attitude accounts for the failure to direct attention to the diehard attitude of the London medical schools, which still attach more importance to sex than to ability.
I would remind noble Lords that we are discussing the shortage of doctors. In the North of England, North of the Wash, the hospitals cannot be conducted without immigrants to this country. In many wards the men and women, not necessarily doctors but helpers, find it difficult to speak English. Yet of the London medical schools to-day only one admits more than 15 per cent. of women. We are told that there is a shortage. We all know this. There is a deplorable shortage. The Willink Committee was entirely wrong. I hope that now the medical schools, when able young women go to them, will recognise that they can be first-class doctors irrespective of their sex. No noble Lord who looked at television last night would have minded having an anæsthetic given him by the women anæsthetists who were then shown. But the diehard medical schools say 15 per cent. and no more.
I was very glad that the noble Lord spoke about preventive medicine. Of course the Porritt Committee are quite right, and there should be a reorientation of service from curative to preventive medicine. Nobody would dissent from that. But I find it difficult to reconcile this proposition with the establishment of Area Health Boards. I agree entirely with the noble Lord, Lord Amulree, who reminded us of the variety of Government Departments concerned with preventive medicine, with housing, welfare and the children's service. As I read it, if these Area Health Boards were set up they would be entirely divorced from these welfare departments which it is so necessary to amalgamate with the strictly health service.

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I also agree with the noble Lord, Lord Amulree, when he was talking about social workers and the health workers—he did not call it a team—who are sometimes attached to certain general practitioners. It is the well-organised team of domiciliary health workers which should be in the van of preventive medicine. They know what is happening in the family; they know who is sick; they know who needs help, and they know where to send some individual for that help. If successive Ministers of Health had taken more action in this field, we should not be told in this review that the facilities for the chronic sick and elderly are inadequate in every respect. I thought the noble Lord, Lord Amulree (as we all know, he devotes his life to the geriatric service), was very kind in not emphasising those parts of this review which related to his particular field of work, though he reminded noble Lords that the service for the chronic sick and elderly is inadequate in every respect.
Might I remind noble Lords who were at the unemployment debate only a fortnight ago that I said then that in the North-East of England where the noble Viscount, Lord Hailsham, spent some of his time, are large numbers of able young men who have the aptitude to serve in our welfare service if only we could recruit them. They could be given work immediately. The need is great and, as the noble Lord has said, we could bring them into some of these teams to care for elderly men neglected in their homes. In the North-East in a short time we could establish a first-class geriatric service. This was my suggestion in the unemployment debate a fortnight ago. The noble Earl, Lord Dundee, who answered regarded it as so stupid that he did not devote one sentence or one word to it.
A fortnight later we come to this House to debate another Report which reveals the desperate need for able young men and women—not necessarily with high educational ability, but able in other respects, willing, kindly, cheerful, and prepared to help in a team where there is a desperate need for them. Yet the Government Departments work on the subject in such a watertight manner that while unemployment is rife in one area and is dealt with in one Department, yet another Department introduces a Report
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—or at least gave its blessing to its being debated—which shows there is a great demand for labour.
Now I come to another aspect of the work. The Report states that
"the closer association between general medicine and psychiatry will we confidently expect, lead to a raising of psychiatric standards."
Well, my Lords, we all agree with that. We welcome it. Nevertheless, out of 44 members of the Committee—mostly doctors—there were very few psychiatrists.
A NOBLE LORD: My Lords, I think there were three.
BARONESS SUMMERSKILL: There were only three psychiatrists out of 44 doctors. Does this omission indicate, strikingly, the fundamental attitude of general medicine towards sickness of the mind? I believe that while we permit the people of this country to become pill addicts in the interests of the pharmaceutical industry we tend to ignore the crucial problems of psychogenic disorders. Therefore much more attention must be paid to the teaching of psychotherapy in our medical schools.
Now I come to the tripartite administration of the Health Service. I agree with the noble Lord, Lord Amulree, entirely on that aspect. Of course, one cannot really complain, and I do not complain, in so far as it is our attitude—the British way—to deal with matters in a piecemeal fashion. We are completely pragmatic in our approach to many of our services. We find out if something works and if it works we set up a committee to administer it. After a time we find it has been a little haphazard, but nevertheless the rest of the world admires us for this pragmatic approach and for being not so doctrinaire as some other countries. But the time has come when the whole thing must be revised.
The criticism of the tripartite administration is well justified, particularly with regard to the maternity services; and the Porritt Committee mention the maternity services as illustrating their point. We are reminded that some maternity hospitals are so overcrowded and understaffed that they are compelled to discharge mothers within a few days of delivery. I read somewhere a little while ago that in some hospitals mothers were

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being discharged after 48 hours. We must remember that when a poor mother is discharged, she does not go to a home where there is somebody to wait on her, but often it is necessary for her to sit in bed and conduct the housekeeping from there. Although, from a medical point of view, a stay in hospital may not be necessary, a mother may not be ready mentally to grapple with household problems, and she deserves and needs a rest mentally, if not physically.
In support of the Porritt Committee's adverse comments on the maternity service, I would remind your Lordships of the findings of the perinatal mortality survey conducted under the auspices of the National Birthday Trust. Every year there are 25,000 babies born in Britain who are either stillborn or die in the first week of their lives. It is significant that the death rate of babies in the professional classes is half that of the rate in the class of unskilled labour. When the noble Lord comes to reply I hope he will deal with perinatal mortality and not with the infantile death rate, which is a different thing. I am glad to learn that a conference is being held in Friends' House on this subject, in which eminent obstetricians, of whom Professor Nixon is one, will speak.
The Cranbrook Report on Maternity Services recommended that all women having their first babies should be delivered in hospital. Yet one-third of the women having their first babies are booked for their confinements outside hospital. In the year ended March, 1962, over 4,000 women were admitted to London hospitals as obstetrical emergencies—that is, after labour had started—an increase of 20 per cent. over the previous year. This reveals that in London more and more women have to go into labour before proper arrangements are made for their delivery.
I say deliberately that to-day the women of this country have only a second-class maternity service. The figures I have given and the conditions I have described are evidence of this. The pressure on the available accommodation in hospitals is so great that the limited number of overworked and underpaid midwives are subjected to an intolerable pressure. It has been said over and over again—by the Porritt Committee, by the Cranbrook
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Committee, in this House and in another place in one debate after another (though perhaps in years past your Lordships did not talk so much about maternity as we do now)—that midwives are overworked and underpaid. At the moment, the question is sub judice, I understand, because the midwives are before the industrial court. It is grossly unfair for people who have no pressure groups to be called upon to do this invaluable work and still be exploited by the community.
While I am speaking on the maternity service, I would remind the House that while other countries have taken action since the thalidomide tragedy to protect their mothers and children against the consumption of inadequately tested drugs, the Minister of Health has done nothing but set up a Committee. Last week in another place, he was again asked what was being done to protect people against these inadequately tested drugs and he said that he was still waiting for a report from a Committee. The United States took action, the Scandinavian countries took action and the German Government took action, but in this country tranquil-lising drugs are still sold and advertised as the proper thing to give women in the early months of pregnancy. Yet eminent physicians have said that women would be safer without any drugs in the early months of their pregnancy.
I can in this debate deal with only a few aspects of this Report which must be limited. I welcome the unequivocal statement in paragraph 607 that
"… basically the concept of a comprehensive health service is sound"
and that in general it
"… has proved of great benefit to the community".
On the other hand, it is a little naïve for the authors to plead that the Service should be kept out of politics, having regard to the fact that when the Labour Government introduced the National Health Service it was voted against on Second and Third Readings. In the course of the last eleven years, it has been necessary again and again for the Opposition to draw the attention of both Houses to the condition of hospitals, the shortage of staff of all kinds, the long waiting lists, and the low pay of nurses and midwives and in the larger profession of medicine. This review highlights these

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things and calls for improvement. I can only say to the authors that while we thank all 44 of them—43 men and one woman—who have given their time and energy to produce this survey, the improvements they would like to see introduced can be expedited only by an active and ever-vigilant Opposition.
5.48 p.m.
LORD BRAIN: My Lords, the Report of the Porritt Committee covers such a wide field that it is impossible to deal with more than a small part of it, and I propose to concentrate on the question of medical research. But, first, I should like to make one general comment. I echo what the noble Lord, Lord Amulree, said about how striking and satisfactory it is that this Committee—I was going to call it broadly representative, but perhaps, after what the noble Lady said, I should not—has reached the conclusion that basically the conception of a comprehensive National Health Service is sound.
The Committee did not have a great deal to say about research, because, as it pointed out, its remit did not extend to the scientific aspect of medicine. Nevertheless, it emphasised, and rightly, that
"… research is so vital to the development of the nation's medical services, …"
and added this:
"From our study of the existing arrangements for the co-ordination of research, we have concluded that basically they are now working well within the financial limits imposed. However, it is impossible to judge how much research potential has been lost through lack of adequate funds."
These are the points which I wish to discuss.
There is a good deal of dissatisfaction with the state of medical research in this country, and it is those with the greatest authority and experience in this field who are the most vocal. Our organisation of medical research illustrates in the highest degree our national genius for interdepartmental complexity and divided responsibility. To discover how it works is a work of research in itself, and it is this which makes a diagnosis of the cause difficult and makes it possible for those who are responsible to point to individual parts of the system, which admittedly are working very well, without paying due regard to the picture
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as a whole. Everyone, I think, will agree that we may well be proud of the Medical Research Council. It can point with satisfaction to its expanding budget, to the excellent work done in its units, and, as the noble Viscount the Minister for Science said in this House last Wednesday, to the Nobel Prizewinners, fostered by the Council. This is a justifiable pride. But, as every gardener's wife knows, it is possible to win prizes for lilies and yet to be short of potatoes. It is the shortage to which I want to draw attention.
The present organisation of medical research as a whole is such that an élite is fostered, but there is too little encouragement for promising young doctors to go into it; and if they do go in, so many obstacles are put in their way that many give up, and those who persevere have to battle with unnecessary frustrations. It has always been the policy of the Medical Research Council to use the greater part of its resources to pay for the management of its own units and to be highly selective in its award of grants to other applicants. I do not criticise this policy which, it may be claimed, continues to yield excellent results. But I want to look at its consequences. In the year 1960–61 the current expenditure of the Medical Research Council amounted to £4,600,000. Out of this sum, the amount which it spent on temporary grants and training awards—that is, to workers outside its own units—was £424,000, or 9·2 per cent. of its total budget. There are two kinds of research workers who may receive temporary grants from the Medical Research Council: there are groups working in a university department, to whom the grant is made in the first instance for five years, and there are individual workers, whose grant is usually made for three years. So the £424,000 which was spent on temporary grants in that year was not all available for new research projects, because some of it went in continuance of existing grants. Hence, if we leave out of account what the Medical Research Council spends on its own units, the amount it spends on groups or individuals wishing to start new research in a single year is about £100,000, out of an annual budget which is now over £5 million.

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But, having been selected, what has this type of research worker to look forward to? If he is an individual with a three-year grant he has no security beyond the three years, and at the end of that time he must show that what he has done justifies the continuance of his grant. With groups working in the university the position is somewhat different. At the end of five years, by an arrangement made between the University Grants Committee and the Medical Research Council, the university concerned will be asked whether it is prepared to take over the responsibility for the group and to assess the priority of the takeover in terms of its other commitments. Here, then, two elements of uncertainty enter into the picture: the research group has to prove its worth to the university, and the university has to have enough money to take it over. The Clinical Research Board can point to a gratifying increase in the amount of money which it is devoting to clinical research, but here again, outside its own units, the policy with regard to the individual research worker is the same as that of the Medical Research Council. He has no security for more than a few years ahead.
There are many young doctors who start their medical careers imbued with a sense of scientific inquiry. While holding junior posts they have opportunities for research, but they do not want to devote their whole career to nothing but research. They may perhaps want to become consultants, but to go on doing research at the same time. Very often the quality of the research they have already done is an important factor in securing for them a consultant post. But what encouragement or opportunity does the young consultant receive to go on doing the research of which he has shown himself capable? There are a small number of medical schools which have adopted the far-seeing policy of providing additional sessions for research as an integral part of their new consultant appointments. But these are still a minority, and this policy, if generally implemented, would mean more money from the universities. Elsewhere, all the young consultant can do is to apply for a grant from the Medical Research Council or the Clinical Research Board, which neither will guarantee for more than a few years.
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And even if he could get such a grant, only too often the hospital has not the laboratory accommodation or the technical assistance which he would need. What happens? Instead of doing research, he can get another consultant appointment at another hospital, and he will then have a contract which will last until he is 65, and will not only give him security but, like his original appointment, render him eligible for a distinction award. Is it surprising that in such circumstances research gets left behind?
I know that there is held to be a good reason for the cautious policy which requires grants to be frequently reviewed and which makes hospital boards reluctant to give sessions for research as well as for clinical work. Superficially this caution looks prudent. Who can tell, it is said, that a man who is doing good research at 30 will still be doing it at 40, or even 50? Is there not a danger that we shall waste a lot of money if we encourage peple to take up research who may not continue to deliver the goods? The noble Viscount the Minister for Science, in the debate in this House last Wednesday said [OFFICIAL REPORT, Vol. 247 (No. 46) col. 95]:
"It is easier to waste public money on science than on almost any other subject."
But in scientific research, as every scientist knows, you cannot always predict results, and you must be prepared to risk wasting money, if that is what you call it. For only by encouraging and supporting considerable numbers of scientific workers, by an act of faith if you like, will you create the conditions in which, not only by scientific judgment, but sometimes also by good fortune, great discoveries are made.
On December 4 the Parliamentary Secretary to the Minister for Science, in reply to a Question in another place made this statement [OFFICIAL REPORT, Commons, Vol. 668 (No. 26) col. 1121]:
"It is untrue to suggest that greater progress in finding the causes of cancer would necessarily be made by the mere expenditure of money. If money in research is not to be wasted, there must be first-class men with first-class ideas"—
BARONESS SUMMERSKILL: And women.
LORD BRAIN: I am still quoting—
"who must then be supported. I do not believe that there are any such projects in this field which are not being supported either by the Medical Research Council or by the voluntary bodies."
My Lords, I believe this to be a dangerous fallacy, and I would ask: how does the Parliamentary Secretary know? By choosing first-class men with first-class ideas you may run a department with the maximum economy. But in research, as elsewhere, the spirit bloweth where it listeth, and it sometimes happens that a man turns out to be first-class only ex post facto. Fleming discovered penicillin as a result of a happy accident. He could not have put down on paper in advance any ground for thinking that he was going to discover it. Besides, much valuable work is done by research workers who would not claim to be individually distinguished. It is not wasteful to support them. And if a clinician wants to continue to do research work part-time, it should not be impossible to arrange for him at a later date, if he finds that he can do no more, to give it up in exchange for a further clinical appointment.
I now come to the part played by the universities in medical research. I began by drawing attention to the complexity of our arrangements for the promotion of research in this country, and I should like to say at this point that, in spite of its drawbacks, I think it is a very good thing that medical research is not the responsibility of any single body. The universities may have the opportunity of doing things which the Medical Research Council, by its nature and organisation, cannot do; and the independent private research organisations also play a vital part. Incidentally, may I at this point put in a good word for the pharmaceutical firms? In some ways they are not very popular just now, but they do make a most important contribution to medical research, particularly in a field and of a kind which no other body would be likely to undertake.
Of course, it is only to a limited extent that one can generalise about the part played by the universities in medical research at the present time. But I think it is a safe generalisation to say that for a long time they have had far too little money to devote to it. Forty years ago, after the First World War, when the
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medical professorial units were first founded, there was a considerable amount of accommodation, and the problem was to find and train up the right people. Now, with all the growth of the technological side of medicine, and the enormous development of medical research, the problem of accommodation is an important limiting factor. One university department, for example, with an international reputation, which started 40 years ago with ten research workers and about the same number of technicians, now has 60 research workers and over 100 technicians in the same space. There can be few, if any, medical schools which are not seriously hampered by the lack of space for research facilities, and particularly space for clinical research which needs to be done in the immediate neighbourhood of the wards. If some schools are not even asking for the space they need, I suspect that it is because they have become completely disheartened by the financial stringency adopted in respect of university expansion in recent years; and the recent rejection by the Treasury of the University Grants Committee's recommendations in this respect was a blow from which the universities have not yet recovered.
I could quote many instances of our research deficiencies in the university field, but I will mention only one. As Professor McMichael pointed out in The Times the other day, we have only one professorial Chair in Virology in this country. Virology is concerned with the vast range of diseases caused by viruses, including poliomyelitis, influenza and the common cold. But, more than that, the study of viruses is throwing light on heredity, cancer and the nature of life itself. I know that good work is being done in this field elsewhere, including M.R.C. units, but it is not being adequately fertilised at the university level. We ought to be leading the world in virology; instead, as Professor McMichael pointed out, we depend on the United States of America for our Salk and Sabin vaccine for poliomyelitis, products of their inadequate high school education.
There is another reason why it is important that the universities should be encouraged to play a much larger part in promoting medical research. Medical research has a vital part to play in medical education. If universities ever came to

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be regarded merely as teaching institutions they would lose half their educational value. It is essential to the education of both the undergraduate and the post-graduate student that they should be brought up in an atmosphere in which positive contributions are being made to knowledge and there is a spirit of critical inquiry alive. This can happen only if active research is going on in the medical schools. There will be some research workers who devote their whole time to research, and others who will combine with teaching. What matters is that the student should have the opportunity of seeing research at first hand, and that research workers and teachers should meet over lunch or a cup of coffee.
As the Porritt Committee Report says:
"We cannot escape the conclusion that the medical faculties of British universities are now lagging considerably behind those of many comparable countries in respect of research facilities, accommodation and available teachers … Unless the Government provides the funds to facilitate research and expand accommodation in our medical schools, universities will be unable to recruit all the staff they need, and in a time of world shortage we must expect to see many of our most able doctors absorbed into other countries"—
which, of course, is happening. Not only that, but we shall cease to attract to our shores the cream of the post-graduate students from all over the world who in the past have come not only because of our reputation as teachers, but also because of our outstanding contributions to research. Only the universities can implement the educational value of research. Apart from its units which happen to be housed in universities, the Medical Research Council can make no contribution to this. Indeed, its influence operates in the opposite direction because, by isolating leading research workers in its own institutions, it withdraws them from the teaching life of the universities.
My Lords, it is inescapable that we cannot develop medical research properly, especially in the universities, without more money. I have said how much we owe to the big charitable funds and generous individual donors, but it cannot be right that heads of departments should have to spend so much of their time begging for money from private sources in order that research may be begun, or even continued. One London post-graduate hospital, in addition to recurrent grants from the
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U.G.C. and the M.R.C., receives money from no fewer than 30 private charities and individuals. What I have said about medicine is true of dental surgery, too. Excellent work is being done in the field of research, but while we spend £50 million a year on dental surgery, in the form of treatment, we spend a comparatively meagre amount on research. Dental colleagues need better facilities and more encouragement to take up research as a career.
So far I have said nothing about the Ministers. The Minister of Health at present has little direct responsibility for research but, just as he must provide facilities for medical teaching, he is concerned, with the U.G.C, with questions of accommodation for research in teaching hospitals. I suspect that his negotiations are directed mainly to making sure that the U.G.C. pay for it. In the Regional Hospital Board hospitals a little research goes on, and it is said that there is little application for the funds which the Board can allot for this purpose. That is not surprising, because, on the whole, effective research does not spring up sporadically: it grows in an atmosphere where it is cultivated; and that atmosphere does not exist in most Regional Hospital Board hospitals; nor have they the accommodation for it; nor have most Regional Hospital Board consultants the time.
I hope that special attention will be paid to the need for both education and research in Regional Hospital Board hospitals and especially in the new district hospitals. I know the Minister is very sympathetic to developments in post-graduate education in this field, but I would emphasise that research is as important for education there as elsewhere. At present, Regional Hospital Board hospitals in general have no link with the universities, though Birmingham's new plans are setting an excellent example of this. The material for research in Regional Hospital Board hospitals is very large, and I hope that future plans will provide for space, equipment and salaries. To sum up, I know that, given the opportunities, the accommodation and the equipment, we can hold our own in the field of medical research, and education, with any other country in the world. But we are not now getting the opportunities we deserve. We all know the reasons for this, but I hope that we may be honest about it and not pretend that we do not really need more money for

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medical research because we have not the workers to spend it on.
The Times Review of Industry and Technology, published this month, contains a survey by Mr. Brian Abel Smith of the health expenditure in seven countries, including England and Wales and the United States. I will not go into details, but a comparison which comes out of it is that, according to his estimate, we in this country spend on education and research £33 million a year, and the United States £207 million a year. Taking into account the difference in the population, this means that the United States is spending about twice as much per head of the population on medical research and teaching as we are. As the noble Lord, Lord Todd, said in this House in the debate last Wednesday [OFFICIAL REPORT, Vol. 247 (No. 46) col. 129]:
"… if we want to spend money on anything like the American scale the first thing we have to do is to increase our gross national product."
I do not question the desirability of that, but it does not exclude another possibility. We might have a different sense of priorities and spend more on medical and scientific research and, indeed, on our universities in general, even if we have to spend less on some other things.
6.10 p.m.
The LORD BISHOP OF LICHFIELD: My Lords, I should like to begin by expressing my gratitude to the noble Lord, Lord Amulree, for bringing this subject to our attention to-day, because it seems to me that at this particular juncture of the National Health Service it was an excellent thing that this distinguished body of people should have taken this long, critical look at the medical services of Great Britain; and I am very thankful that it is being debated in this House. I feel, as one who is not an expert in these matters, that I ought in a sense to apologise for taking part in this debate, but it is a fact that, apart from the trained workers in this field, I suppose there is no one who is more closely in touch with the sick people of the land than a minister of religion. One of his primary pastoral duties is to visit the sick and, therefore, we do get a pretty good idea of the sort of opinion that people have about the way in which they are treated.
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I therefore ask myself what it is that the ordinary person wants and needs in regard to possible illness. He needs, first, to feel that if he or any member of his family is overtaken by illness he will be able to get skilled attention. Second, he needs to feel that he can get this without being ruined financially; and, thirdly, in a free country such as ours he desires to go to a doctor of his own choice. Under the National Health Service these needs are basically met. As has already been pointed out by the noble Baroness, Lady Summer-skill, no one to-day need fear that they cannot get medical treatment on the ground of expense; everyone can get it. All of us have our own doctor, on whose list we are; and the Executive Council has a duty to see that everybody is fixed up with a doctor. So, when the Porritt Committee state that in its view the National Health Service is approved by the people of this land, there is no doubt in my mind whatever that they are 100 per cent. right. I think it has conferred great benefits on our people. I know that there are certain aspects of the National Health Service which can be misused, but, after all, that is part of the moral issue which faces the nation and I think it has to be viewed on that ground.
What is also needed in the National Health Service is that the people who work in it should be content. They must be able to do their job in reasonable freedom and decent conditions and must feel that they have been given a fair deal in regard to both their status and remuneration. The noble Lord, Lord Amulree, made some amusing remarks in regard to the lip service that may be paid to the phrase that the general practitioner is the lynch-pin of the whole Service; but, as he himself pointed out, in actual fact that remains true, because it is the general practitioner more than anybody else who is in touch with the general public at the first moment of the development of illness, and it is he who has to decide what illness is serious and what is not. I therefore welcome this opportunity of saying that, in my view, having talked it over as I have done with many people, the vast majority of these people in this land are very grateful to their general practitioner for what he does for them.

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I notice that in conclusion No. 50 the Committee find little ground for the allegation that the G.P. is conscious of a loss of status. I have often discussed this with a number of my medical friends and I would, with all respect, beg leave to ask if there is not possibly a sense in which the general practitioner is feeling that he has lost a certain status. I think there is some evidence that not all the general practitioners are particularly happy at the present time, and it may be that some are feeling that their position vis-à-vis the consultant is not quite what they wish it to be. If so, are there not means by which real partnership in every sense of the word between the consultant and the general practitioner can still be further strengthened?
May I say how much I welcome the stress in the Report that the general practitioners should have full opportunities of playing a part in hospital work? This is already done to a much greater extent than is sometimes realised. In the Birmingham region, the one with which I am personally most acquainted, one-third of our general practitioners have some kind of hospital post, which is a very large number. But, again, in talking with some of my medical friends, I have heard it suggested that it would be desirable and helpful if there could be more traffic the other way. Just as it is encouraged that general practitioners should go into hospitals and work there, can consultants come out more and discuss with the general practitioners their problems, and work with them? Here I speak as a layman. I cannot venture an opinion on a professional matter such as this. But for the Service to work absolutely satisfactorily obviously the fullest fellowship between consultants; and general practitioners is vital.
It seemed to me, therefore, that presumably this was one of the reasons which led the Porritt Committee to suggest the idea of the area health board. As the noble Lord, Lord Amulree, said, at first sight this must be a very attractive idea. In the whole National Health Service the fewer watertight compartments there are the better, but I hope I may be permitted to make one or two observations on the proposal and, in so doing, I want to turn to the question of hospitals. In conjunction with the Ministry of Health one of the chief
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duties of the Regional Hospital Board is to plan the set-up of the future hospitals. I would suggest that to do this adequately it must be in charge of an extensive area if it is really to get a broad sweep into its planning.
But if the area health board is to be responsible, as it is, for practically all the aspects of the Health Service, if it is to be in charge of such a wide area, what would follow? Just think of the enormous amount of detailed running of services that would come its way. From the point of view of detailed administration, surely the area health board should not cover too big an area; but if its area is reduced for that reason, what of the planning of the hospitals? I would further suggest that to scrap almost the entire present administrative set-up would be a very drastic step to take. The present bodies—the hospital services, executive councils, and the health authorities of the local authorities—might be prepared to give up some of their functions or even to die if there was a great benefit thereby caused. But will the benefits conferred by centralised control really justify the upheaval? Only comparatively recently have the existing bodies been able to plan ahead. Until then they had been adjusting themselves to carry their heavy loads. Forward plans are now being made which are broad in scope and these will improve and rationalise the services which are being given. I would suggest that a major administrative upheaval now might well delay those plans.
Further, I think we ought to consider the relationship of the teaching hospital with the rest. The Committee propose that if area health boards are set up the teaching hospitals should be left outside them. What would be the effect of that? One of the greatest benefits, I think, conferred by the National Health Service has been the upgrading of many of our hospitals. I know that we have a long way to go, but there is no longer now the two-tier system of the voluntary hospital and the rest; and in saying that I am not criticising the old voluntary hospital at all, but I am saying that one of the most encouraging things is to go into some of these hospitals which in the past were rather shocking, and see the way in which they have been improved and the way in which their morale has gone up as a result. This has had an agreeable effect

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on the recruitment of staff in these hospitals.
I would agree that the teaching hospitals must occupy a special position. Their functions demand this, and that is why, very properly, they have their own boards of governors. But I would suggest that if you are not to get an unpleasant kind of dichotomy in the hospital system of the land, while the teaching hospitals must have their special position they should not have an extra special position; and I cannot help feeling that if you have this proposal of an area health board with everything else there and the teaching hospitals outside it, you might get that rather unfortunate division.
I would also suggest to your Lordships that this proposal for the setting up of area health boards might lead to such an upheaval that it would cause a great deal of uncertainty in the working of these services at the present time. It is my privilege to see a good deal of the way in which our official administrators, the salaried men in our staffs, carry out their duties, and I must say how impressed I am with the sense of devotion and vocation with which they do it. I would ask, therefore, is this the moment when they should be disturbed? Further, we ought to consider the effect of this sweeping proposal on those who work voluntarily in this system. I do not think it is generally realised that there are more people who are working voluntarily to-day in our hospital system than ever before. That, I think, gives the lie to the nonsense that is occasionally talked about the whole system being one of bureaucracy.
At this moment I am thinking of the people who are serving on Regional Hospital Boards, hospital management committees, and the like. The composition of these bodies changes gradually from year to year as one-third go out of office each March, and they may return or they may not. But I would feel that normally gradual change in the composition of these bodies is all that is required, for sweeping change can lead to a breakdown in the sense of continuity of the work. Occasionally I would not deny there must be sweeping change. That took place in 1948 on the Appointed Day, when the new committees and
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Boards took over from the old ones. But I would beg leave to doubt whether a similar sweeping change is needed at the present time, and I think that there are many who would agree with me when I say that the relations between the various branches of the National Health Service at the present time are good and they are improving.
Finally, I would just mention one or two things about which I am extremely grateful to this Report for what it has said, because undoubtedly there are certain aspects of the National Health Service which could be improved and which should be improved. The noble Baroness, Lady Summerskill, spoke in a very moving fashion about the maternity services of the land and the need there is for improvement in this direction. May I suggest that one of our chief difficulties is the shortage of practising midwives—not trained midwives, there are a number of those, but practising midwives? I therefore think that if there could be greater co-ordination whereby the local authorities and the hospitals could pool their resources of practising midwives that might considerably help. I think that possibly—here the noble Lord. Lord Amulree, is an authority—that pooling of resources between hospital and local authorities might also help in the matter of geriatrics.
I would also say how grateful I was to the Porritt Committee for what it said in kindly fashion about the value of small hospitals. We know the great district hospital of the future has to come and I suggest it will do great things. It will be the parent hospital for the area and set the tone for the rest and encourage them in their work. But as one who has recently emerged from being a patient in a small hospital, mainly manned by general practitioners but with consultants coming in, I cannot forbear this opportunity to say how grateful I was for the treatment I received and the kindly, friendly atmosphere in such places. I know these small hospitals cannot exist everywhere and they obviously have their limitations, but I believe that they have definite assets and I hope we shall not lose them.
I have had the privilege over the years since the Appointed Day of working very closely with various aspects of the National Health Service. I think the

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Service is something of which our country can be justly proud. I believe it confers social benefits which are of immense value to our people. I am therefore grateful to this distinguished Committee for this careful look they have taken at it, and for the debate to which it has given rise in this House to-day, and I feel that many of us will go back to the work we try in all humility to do, with renewed enthusiasm.
6.25 p.m.
LORD TAYLOR: My Lords, it is always a pleasure to listen to the right reverend Prelate giving us his personal experience of the working of the Health Services in his area: one gets a breath of fresh air and a feeling straight away that he knows exactly what he is talking about from personal experience. He did it as usual to-day, and I agreed with almost everything he said. I am not quite sure that I always enjoy being in a small hospital. If I were due to have my gall-bladder out, I think I should rather go to a bigger one and pick my surgeon rather carefully. But if one is to have something less serious, there is immense advantage in the pleasures and comforts of the small hospital. The practical difficulties which arise are those which come from having so many doctors coming into the small hospital, particularly if it serves a large area and a large number of general practitioners. The nurses have great difficulty in keeping track of the differing instructions which different doctors give; and not all small hospitals are of the standard we should wish them to be.
The other point where I take leave to depart a little from the right reverend Prelate is with regard to what he said about teaching hospitals. Not that I do not agree with his criticism of the possible effects of the area health boards, but I think his criticism is equally valid now: the separation of the teaching hospitals from the Regional Board hospitals is a very real thing, even to-day. It might be a little worse with area health boards, but it is certainly something which already causes some difficulty.
It seems to me that the noble Lord, Lord Newton, is going to have a difficult job, when he comes to reply to this debate, because it has already ranged so widely. We cannot blame the noble Lord,
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Lord Amulree, for that, for the Porritt Report ranges so very widely. I felt that the noble Lord, Lord Amulree, rather cheated a little, because he took the Report as his text and preached a series of sermons which did not bear any great relation to the text. He made us read the Report, but then, so far as he was concerned, all our work was in vain. The Report is an interesting document, but it is rather odd and peculiar. It was born in the anger and discontent of the Annual Meetings of the British Medical Association in 1956 and 1957. That is what started it off, when there was talk of strikes among doctors. They were all so fed up and furious—mainly on money matters, let it be said—that they decided they would do something about it. Their attitude was that anybody could think up a better National Health Service than the one we had at that time. So they took some steps, and it was a very sensible thing to do.
First of all, they decided to select a distinguished Chairman, and get the Secretary of the B.M.A. to be the Secretary. Then they invited all the professional bodies to nominate possible members, which these bodies did; and then the Chairman and Secretary themselves selected from these nominees the people they would like to serve on the Committee. That is how this Committee came to be appointed. It was a most odd proceeding, and although the Report says at the beginning that it is sponsored by the Royal College of Physicians, the Royal College of Surgeons and so on, it is not really sponsored by them, and I do not think it would claim now to be sponsored by them.
In fact, my Lords, the Report is produced by this group, as my noble friend Baroness Summerskill said, of 43 men and one woman, of whom half are under the age of 50, as a sort of intellectual exercise. That is really what it is, and I am told by my friends who know a lot about this Committee that at first there was a terrific amount of scrapping; they were all at each other's throats; they thought the National Health Service was Terrible and all the rest of it. But as they started to study it, they began to get more and more sensible—which was a healthy thing; they performed a job of self-education. They set out a number of the recommendations in

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the Report—perfectly sensible and reasonable recommendations, though some of them are not properly thought out.
The great majority of these people were practising clinicians. They were weak on administrative experience; they did not know anything about it. They knew little about public health. They had, I think, one representative of industrial medicine, yet they have a most important section on industrial medicine. There was nobody who had run a Regional Hospital Board. There was certainly nobody except doctors—it was a wholly medical Committee. As my noble friend Lady Summerskill said, they were a little weak on psychiatrics. I think they were a little cheeky about psychiatrists; they said that if only psychiatrists were as good as general physicians, how much better everything would be! My experience is rather the reverse: if only practising physicians were as good as some psychiatrists, how much better things would be! But that depends on the kind of people you have on the Committee.
They started off in a state of criticism and they ended up in a state of praise of the National Health Service. My noble friend Lady Summerskill quoted their view, and I do not want to repeat it, but I draw your Lordships' attention to the Gallup Poll survey at the end. It is not a bad piece of work. It contains some most interesting statistical work, including some interesting questions about whether women would prefer to have their babies at home or in hospital. Table 24 shows this interesting fact: that about 30 per cent. of women would prefer to have their baby at home, and about 54 per cent. would prefer it in hospital. This depends on all sorts of factors, as your Lordships know from other sources, but it is worth remembering that a great many women want to have home midwifery for good reasons—perhaps because there is nobody else to look after the home if they are not there, and they can at least keep an eye on things upstairs, where they are, if they have younger children; and perhaps for other reasons.
The Committee started this inquiry in criticism and ended up in praise. But there were two themes running through it. They were concerned, if they possibly could, to concentrate all the health
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services under the Ministry of Health, although they were not absolutely consistent about this. They suggested pulling out the services in industry at present run by the Ministry of Labour and putting them under the Ministry of Health; and they also wanted to pull away all services run by the local authorities, put them under the area health boards and then place them under the Ministry of Health. So really they wanted to get a monopoly of services under the Ministry of Health.
The second theme was the creation of the area health boards. I think they had the germ of a good idea here, and that was that it would be a good thing to bring the general practitioners, the local health authority services, the hospital services and the consultants all together, so that they were all of equal parity and esteem and were all working as one group. But they have not thought it out at all. They have not told us how big an area health board should be; they do not give a clue about this, whether it is to cover 100,000 or 1 million, or 2 million or 3 million population. There is no clue in it as to whether it is to have one major hospital in it, two or four major hospitals—there is nothing here about it. The composition of the boards they never thought out. They did not say whether they are to be appointed by the Minister of Health or elected by various bodies. They have not thought the thing out at all. They have not proposed the size, or the number of people who should comprise the board, and they have not looked at the question of the position of the general practitioner.
Whatever the defects, out tripartite system has the nice advantage that, so far as the general practitioner is concerned, he is a self-governing person. The general practitioners run their own service through their local executive councils, along with the chemists and the dentists and the opticians. Those in the general practitioner service are more self-governing than in any other part of the Service. But, so far as I can see, under these area health boards the general practioner would quickly be subordinated to the medical officers of health and the consultants and hospital services. The Committee have not examined that at all. They have not examined the statutory results of converting the

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medical officer of health into a sort of social medicine physician working for the area health board. If they had done, they would have found that they were faced with a mountainous task in trying to straighten things out.
The difficulty about the work of the medical officer of health is that a lot of it is often dull, but most of it is important. Preventive work is often not exciting because you do not see much happening; it is only when things go wrong that you get a dramatic picture. Yet a lot of the work of the M.O.H. is of that kind. I am not at all sure, just as the noble Lord, Lord Amulree, said, whether it really is right to put him in with the Hospital Service. But I suspect that one of the attractions was that in the Hospital Service he would be graded as a consultant and would get a better salary. So I think this is ill-thought out and not really practical.
The noble Lord, Lord Brain, spoke about research, and I must say that his was a most interesting speech. I only wish it had been delivered a week ago, when we were debating scientific research, because I tried to say almost exactly the same thing as he did, except that I was speaking about psychiatric research. Every problem I spoke of, every difficulty we had, was reflected in what he said about general medical research. The position is exactly the same vis-à-vis the Medical Research Council. There is the difficulty over getting the universities to create research posts; for junior and more advanced people—they are identical. The time that is wasted over getting money from private charities in order to keep the good work going is deplorable and sad. I agreed with everything he said, and I only hope that his having repeated the argument will have driven it home. The only thing is that, unfortunately, it is not the job of the noble Lord, Lord Newton, to answer on research, unless he is holding a watching brief for the Medical Research Council as well as everything else.
I am going to say only one word more, and that about the proposals in connection with industrial health services made in this Porritt Report. They suggest that the industrial health services have been neglected in the past; and they are quite right. They suggest that that might well be one of the functions of
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the area health boards. They want to see the appointed factory doctors and the medical factory inspectorate transferred to the Ministry of Health. They have not thought at all about the nursing side of industrial medical services which are, from the cost point of view, far the most important. They have not thought about how they should be paid for at all. They make some vague reference to money coming from the area health boards to pay for them, and that the area health boards should play some part in their administration. That is really not good enough because, in my experience, these services are extremely difficult to run. But they are well run where paid for by industry, and I think there is a great deal to be said about making industry pay for them, though it might be nice in some ways if we could have contributions from the Health Service. Nevertheless, there is a lot to be said for them because they are an integral part of industry, and ought to be. Again, the Committee have not thought it through.
Therefore, the impression which this Report has left on me is one of satisfaction that the medical profession should have come so far in its own personal growth and development, but I also have the feeling that perhaps there is not a great deal that is very novel or very important in the Report. It is encouraging that they should have found things far better than they expected to find them, but in so far as they have made constructive suggestions they have not, as I say, thought through their full implications.
6.40 p.m.
VISCOUNT WAVERLEY: My Lords, I should like to thank my noble friend Lord Amulree for giving us this opportunity of debating the Report. I do not propose to take up much of your Lordships' time to-night. There is, however, one aspect of the Report which I should like briefly to mention. I refer to Chapter 16 and the comments on medical education. Here the Report records the members' conviction that the standard of medical care in any country can be fairly directly equated with the standard and the efficiency of medical education. It expresses anxiety—an anxiety echoed by my noble friend Lord Brain—that this country's medical schools in teaching

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hospitals and universities may be lagging behind those in other comparable countries. The Report urges the Government to provide the necessary money to overcome shortcomings in respect of research, accommodation, and teacher availability. That Her Majesty's Government should indeed strive to undertake greater responsibility in these fields is, I think, right.
There is an aspect of the problem which has not received emphasis, indeed it has not really been mentioned; and it will, I am sure, in the years to come assume an ever-increasing importance. Traditionally in this country a considerable part of medical education has taken place around the bedside. Here are learnt the art of interrogation, the techniques of full and efficient physical examination, and the correct evaluation of such abnormal signs as may be found. All these, despite the enormous expansion of scientific methods of investigation, are still an indispensable part of the full evaluation of the patient.
One of the products of the National Health Act, as I am sure your Lordships will agree, has been the progressive upgrading of the standard of service provided by the Regional Board hospitals. A consequence of this has been that increasing numbers of patients, who in former times would have been referred by their family doctors to teaching centres for investigation and treatment, are admitted to their local district hospitals for this purpose. As one who has the honour to be on the staff of such a hospital, I have over the past decade become increasingly disturbed that so much excellent, indeed one might say indispensable and essential, teaching material is being denied to our medical undergraduates.
I think it likely that, as I am on the staff of a non-teaching hospital, diffidence would have prevented my presuming to mention the question of medical education at all, were it not that one of the most experienced of medical educationists, my noble friend Lord Cohen of Birkenhead, raised just this point when your Lordships debated the Hospital Plan approximately a year ago. My noble friend said on that occasion [OFFICIAL REPORT, Vol. 237, col. 531]:
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"… teaching hospitals are now feeling the draught. They no longer have a sufficiency, either in number or variety, of patients for clinical teaching."
He described how shortly before a board of clinical students of a university hospital had written to him, saying:
"it is generally agreed that there is an increasing insufficiency of teaching material in teaching hospitals because first-class hospitals now supply the needs of patients in their own neighbourhood …"
It was my noble friend's belief, as he put it, that teaching and district general hospitals should walk the path of progress together, and that into district general hospitals students should be admitted, believing, as he did, that district hospitals had a major and indispensable part to play in medical teaching, education and research.
With the views of so distinguished a colleague I most emphatically agree. If patients are no longer arriving at the teaching schools in sufficient variety and number, then inevitably undergraduates must go to the patients. This implies periods of secondment to selected district I general hospitals. The present staff of these hospitals are already too hard-pressed to undertake the additional responsibility and burden of fully supervising their studies and teaching. It would be necessary for clinical tutors, probably of senior registrar grade, to rotate from the teaching centre. They, too, would benefit from the added experience. It would also be necessary, in the planning of the new district hospitals, to provide library, lecture room, laboratory facilities, and so on, for these many young men and women, and, of course, residential accommodation. I hope Her Majesty's Government will give due consideration to the perspective of the whole question of medical education.
6.48 p.m.
LORD AUCKLAND: My Lords, I would first apologise to the House for not being present, due to a private engagement, when the noble Lord, Lord Amulree, opened this debate. From these Benches I would welcome this debate on a most complex but highly interesting Report—a Report which can hardly be debated in full in one sitting. I hope that when the time comes for the next debate on hospital services or the ten-year

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Hospital Plan the contents of this Report will be carefully studied and the relevant parts incorporated in the Government's proposals. This seems to me to be the best way of implementing the more desirable aspects of this distinguished Report.
Most noble Lords who have taken part in this debate are themselves distinguished persons in the field of medicine, but I take part as a layman whose only claim to do so is serving on a house committee of a children's hospital. May I at this juncture make one criticism of the Report? There seems to me to be no mention of children's hospitals, which play a vital part in the hospital life of this country. I think it is a pity that nothing has been said about the care of children other than the care of subnormal children—though I recognise that that is a very important aspect of our hospital routine. But bearing in mind the recent Ministry of Health recommendation to allow unrestricted visiting in children's wards and in children's hospitals, I am rather surprised that the Report did not have something to say on this score.
The noble Baroness, Lady Summerskill, and others, have dwelt on the maternity services. I should like to say just a word about them, because I have toured quite extensively the maternity department of my own local hospital at Epsom. I would bear out much of what the noble Baroness says, because no mother is fit to leave hospital and run a home after only 48 hours' confinement after the birth of a child. I think that at least ten days are needed. Being a father of three young children myself, I have naturally been given views on this, and I think it is fair comment.
This argument is reinforced by the fact that there is an acute shortage of home-helps—certainty in the Surrey area. This means in many cases that a mother who has no relations or close friends living near has to go home and cope not only with the new-born baby and the cooking and other household duties, but probably with other young children as well. This frequently means that the mother develops further complications, leading to a return to hospital and imposing an added burden on the already overworked hospital staffs. So I feel that the Government should pay particular attention to improving maternity services. This is especially true, I believe, in the
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New Towns. I have mentioned this point before, but there are two or three New Towns planned to commence construction shortly, and in these New Towns there will be a preponderance of young people, many of whom will, in time, marry and have families. So it is essential that there should be proper facilities for hospitals, especially new hospitals to be built under the ten-year plan, for this improvement to take place.
May I now say a word about the problem of the smaller hospitals, which is mentioned in paragraph 398 of the Report? I agree that old, small and uneconomic hospitals should be scrapped, but there are many small hospitals, cottage hospitals, especially in rural areas, which do an exceptionally good job. There are also small general hospitals—and may I instance just one, that at Teignmouth in Devon? This is a new hospital, built in 1954; indeed, it is the first completely new National Health hospital to be constructed, because the old building was completely destroyed during the last war by a direct hit from a bomb. So far as I know, this hospital is not scheduled for closure, but I would paint out that it has equipment and amenities of which many London teaching hospitals might well be jealous. If one is going to be ill, or even have a major operation, this is an ideal hospital to enter. It has lovely views of Teignmouth harbour, the most modern operating and X-ray theatres, and it serves a large area. It also precludes the need for many elderly people to travel fifteen miles to Exeter, where there is already, I believe, quite a large waiting list in the city's two rather old, although very well-run, hospitals.
May I now say a word about accident services? It is very necessary, with the increased amount of traffic on the roads, and the ever-increasing number of accidents in the home, to have properly equipped casualty services in our hospitals. Many of the modern ones have these, but a number do not. In one of the daily newspapers recently there was a disturbing story of how in the Grimsby General Hospital a number of drunken people, some of a violent nature, had been admitted for casualty treatment during the evenings, and young girl nurses were frequently asked to look after them. It seems essential that there should be a component of male

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nurses for such work. That case also shows how the casualty departments of these hospitals, particularly at night, are often understaffed. I would ask the Minister to bear this point in mind, and, if necessary, bring it to the attention of the Regional Hospital Boards.
Another small section of this Report deals with the ancillary services—radiographers and physiotherapists. As I understand it, a recent pay award has been granted and is in the process of being implemented. But, even so, salaries are still not adequate. I would say particularly of physiotherapy that recent advances in medicine have made it even more necessary to have fully qualified and sufficient numbers of physiotherapists and especially, I would say, of male physiotherapists, who often have families to support, and frequently very inadequate salaries on which to do it. My Lords, I would conclude as I started, by commending this Report. It is not perfect. To be quite frank, I have not had a chance of reading every single section of it, and I do not suppose many others of your Lordships have, either. But I hope that the Government will study it very seriously, and that when their own ten-year hospital plan comes up for further discussion this Report will be largely taken in conjunction with it.
7.0 p.m.
BARONESS HORSBRUGH: My Lords, I have listened with great interest to this debate. I, like others, am most grateful to the noble Lord, Lord Amulree, for putting down this Motion to-day. Many noble Lords have spoken about the amount of reading, and certainly, with a Report of this size, our homework has been quite considerable; but I made a list of the various points, and I thought that, as the debate went on, I should know how many I need not refer to because they had already been referred to by other noble Lords. Some noble Lords, I know, realise the particular interest to me of this Report, because in the days when I was Parliamentary Secretary at the Ministry of Health we were doing all the basic work for the Health Service; and I think that never enough praise was given to the late Mr. Ernest Brown for the difficult years he went through then. We began before the Beveridge Committee had reported in
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1942, and we worked on until we produced the White Paper of 1944.
My interest in coming back to the White Paper again was because this idea of an area board is very much in line with some of the proposals in that White Paper of 1944. At that time, as noble Lords know, there was a Coalition Government, and the debate on the White Paper in February, 1944—there was no Division—was an extremely interesting debate. I took the precaution of looking up and re-reading the speech I made then, when I was in another place but geographically in this place, and the points that were brought up then on the subject of a National Health Service. We all agreed from the start, I think, on a National Health Service (inside here it is called a "comprehensive service for all") but the question was: how was it to be organised?
When I read this Report, and particularly that part about the area boards, I came to the conclusion that this Report is a very disappointing one, and it is disappointing for two reasons. The first reason is that, on going through the whole thing, one feels it shows a certain dissatisfaction of the scheme by the authors, but very little suggestion as to how to improve it. In fact, they take one bit after another, put up a suggestion and then say that they do not agree with it. I was interested because I think we have really had something pretty genuine from these people. So often a Report comes out and it is thought that everybody on the Committee believed in every mortal thing, and people do not realise that the members of the Committee had any difficulty in their minds at all. As I say, there was no difference between us, and there is none between them, on a comprehensive Health Service: it is on what sort of a Service that is going to be. That was my first disappointment with this Report.
My second was this. I had always hoped that we might get a less complex method of administration. We have an organisation from the Minister down to the hospitals; we have the general practitioners; we have this council, we have the other; we have committees; we have all the rest of it. It is tremendously complex; what I would call very bulky. I hoped that on this occasion we were going to find that a Committee of people had

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been able to find a simpler method of organisation, a simpler framework for the administration. But as I went on, I jotted down on a piece of paper the various committes and the various boards recommended. You have the area board, and you also have the Regional Board. On we went, through the divisional councils, the department of social health, and so on. I came to the conclusion that, if possible, this was worse, and it was worse for another reason—and I hope that this will not be misunderstood in any way whatever. It seemed to me that more and more of the doctors' time was going to be taken up sitting on committees, councils and boards, when after all, they ought to be using their skill to heal the sick.
It is a very difficult problem, I know. The Committee say that the internal administration of any hospital should be tripartite—medical, nursing and lay—to concentrate on making it harmonious. We all know these things; I knew them very well in the Emergency Hospital Service during the war. Then we find that the chairman is to be the honorary secretary of the medical committee, or one of the consultants. In each case more and more skilled doctors are being taken and used on more and more committees. I am not satisfied that our present set-up is completely right: I was not satisfied, as we said in the debate in 1944, that the White Paper was completely right. That put forward a scheme for a wider, joint board; and a scheme, too, suggesting that the hospitals should not be separated from the other services. It set out that the new joint authority should be charged with preparing an area plan for the Health Service as a whole, not only the hospital service.
Then it set out that it was to be the duty of the joint authorities themselves to secure a complete hospital and consultant service for that area, including sanataria, isolation, mental health services, ambulance and ancillary services. We also kept the maternity hospitals inside the plan of this joint board. I do not believe the idea of different personnel would have been entirely satisfactory, but I do not think we have necessarily found the most satisfactory way yet. This is not surprising: we are dealing with an enormous problem. We are dealing with something which is costing an enormous
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amount of money. It is spread over the entire country, and yet its success depends on the individual doctor looking after the individual patient. There is the big problem we have to face.
Now, my Lords, if we are to deal with this Report, and not, perhaps. with our ideas on a new Health Service (though it would be interesting if every noble Lord would make his suggestions), I must cut out a good many things with which other noble Lords have dealt and with the majority of which I agree, but I should like to say something about rehabilitation, because nobody has yet mentioned that. It is dealt with in paragraph 510. As to rehabilitation or convalescence—call it what you will—I believe that at present there is a big gap. The Report says:
"Rehabilitation is concerned with the recovery phase of illness."
Further down, it says,
"… yet in this phase of illness the patient is left to fend for himself more than in any other".
I am myself absolutely convinced that there is a great deal of truth in that. People naturally come out of hospital very soon these days. Beds are required, and not only in maternity cases. Often it is very difficult for people coming out of hospital; they get depressed and worried. The trouble is psychological as well as physical. Only last week I was inquiring of somebody about a friend of hers, an elderly person who had come out of hospital about six months ago. I asked her how she was, and my friend said, "The operation was entirely successful, but she has never really recovered her health". There is too much of leaving the thing at that stage, to see what help can be given afterwards. That help might be given by the family doctor, in which case there might be more room for the smaller hospitals, so that the family doctor could help the patient when the acute stage was over.
So far as I remember, no noble Lord has yet referred to two parts in the Report, one dealing with private practice and one dealing with private beds in hospitals. I have been trying to get some figures (but I do not think it is really possible to get them) to show how many people are using private practice only, how many are on a doctor's list

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but mostly go to private practice, and how many go between the two. I have figures, but the figures I have are for 1952, and I believe there has been an increase in the number who are going to private practice. As the noble Lord, Lord Amulree, has already said, there is a great deal of praise for the work of the general practitioner; and this is right. There is also the feeling that perhaps the standard will not stay as high as it ought to stay. I am sure that in any profession there are the good, the very good and the not so good. I hope that the standard is being sufficiently kept up so that we do not have many of the not so good. Some patients are not finding it so, and are therefore going to private practitioners. They do not take their names off their doctors' lists; they simply go somewhere else.
But I would say that I have nothing but praise for the medical attention I have had under the National Health scheme. Nothing could have been better; there was kindness, skill, attention, and patience, endless patience—and I am one of those people who ask a lot of questions. The standard could not have been better. I have been treated both under the National Health scheme and as a private patient, and I have been struck by the care, attention and patience both of the general practitioner and of the consultants. I believe that they could not have given me better attention. I would say that that happened in Edinburgh, where we find one of the highest standards of medical attention in the world. But perhaps I had better be careful because I might be thought to have some prejudice in favour of the surgeons in Edinburgh. As I had the great honour of being made a Fellow of the Royal College of Surgeons, Edinburgh. I wish that the noble Baroness, Lady Summerskill, were here. I could tell her that I was the first woman to receive that honour.
LORD TAYLOR: My Lords, is the noble Lady aware that in Edinburgh and in Scotland there are only two ladies who are practising surgeons? In that way Scotland is very far behind us. They are a Miss Kate Branson and one other.
BARONESS HORSBRUGH: My Lords, if I had been asked the number, I would have said that it was higher; but probably
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the noble Lord knows best. Perhaps they thought it better to help out in England and to bring their extra skill here. But the number of patients who are using private doctors is going up. I cannot get the exact figures.
I should now like to say something on the subject of private beds in hospitals. There is nothing against having them. We find this Report says that the rise in the price of private beds is astronomical. There is a great demand for medium-price beds, but I would ask: what about amenity beds? Are they being fully used? We know there are now various provident associations and that people are insuring so that if they have to have an operation or go into hospital they have their expenses paid. I believe the number in these schemes is over one million. It is moving in that direction. More and more people are wanting that cover. Reading the debate of 1948 on the Second Reading of the National Health Bill, as it then was, I noticed that the late Mr. Aneurin Bevan pointed out that there was no reason at all why people who wanted to pay for extra amenities, such as privacy, should not be allowed to do so. He went on to say that if we had a State theatre one would not charge the same price for all the seats.
I do think that we ought now to do something further for people who want privacy but have not a great deal of money. I would say that this applies particularly now that we have—and I am not against the plan—so many times more visitors coming into the hospitals. It is very tiring for some patients, who perhaps are in pain, if you have this crowd of people in the wards. There are many who, if they could get amenity beds—and I was told that they ought to cost about eight guineas a week—would be glad to pay for that privacy. I should like to ask the Minister: is it the case that there are amenity beds at that price? Is it the case that the amenity beds are not being used? And is it the case that patients are told in the hospitals that if they wish to have amenity beds, or to be in private rooms for the sake of privacy, then they have a chance of obtaining them? I do not believe they are told. I should like to know whether I am right in thinking that.
There are one or two other things I should like to mention but it is too late.

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It has been an extremely interesting debate. We have agreed on a comprehensive Health Service. The first time we had the proposal actually in print was in 1944. We had the Act in 1948. None of us would say it was perfect, but I would say that if people will get together and study the position—even if, as noble Lords have said, this study is not very realistic—then we shall get some improvements, although they may be minor ones. Although I would not say it was perfect, I do not think the time has come, as the right reverend Prelate said, to reorganise the whole Service.
7.18 p.m.
THE PARLIAMENTARY SECRETARY, MINISTRY OF HEALTH (LORD NEWTON): My Lords, like everyone else taking part in this debate, I am grateful to the noble Lord, Lord Amulree, for giving us the opportunity of a "free-for-all" on the Health Services of this country—an opportunity afforded, as he must recognise, by the all-embracing comprehension of the Porritt Report. We have had a "free-for-all", but I will not say that the various bits of advice which your Lordships have given me cancel each other out, to use Lady Summerskill's description of some parts of the Porritt Report. I was a little daunted when it became borne in on me that no subject would be out of order in this debate, and I am glad to hear I have the sympathy of the noble Lord, Lord Taylor. I am obliged to those of your Lordships who were good enough to warn me of matters that might be raised. But, even so, I fear I shall not be able to deal with all the points if I am not to speak at quite inordinate length, so I may have to reply to some of your Lordships by letter. We have roamed at will over the whole field and I hope the House will not think it unreasonable if I, in my turn, make some observations on my own account.
The Report has been referred by Sir Arthur Porritt to the nine bodies which sponsored the Committee for their views. It would obviously be right to wait for those views, and the House will understand that this limits the extent to which I can comment on the Report's recommendations. However, I can say that we welcome the results of the Gallup Poll organised for the Committee by the Daily Telegraph, which shows that 89
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per cent. of those approached were satisfied with the services they received under the National Health Service. This is something in which we can all take pride, particularly the doctors and nurses and other professions in direct contact with the patient. We welcome, as did the noble Lord, Lord Amulree, the noble Lord, Lord Brain, the right reverend Prelate and all who have spoken, the Committee's concept that a comprehensive National Health Service is sound, and that they have no evidence that patients receive better service under different systems. We welcome the emphasis throughout the Report on a doctor's obligations to his patient and on the importance of clinical freedom. We welcome the emphasis on the importance of adequate services for old people, based on the belief that, wherever possible, they should continue their lives in good health in their own homes.
A number of the Committee's recommendations are already accepted policy—for instance, the encouragement of group practice, which the noble Lord, Lord Amulree, supported, the attachment of health visitors to particular group practices, the conception of the domiciliary team, with the family doctor as its clinical leader, and the emphasis throughout the Report on the importance of expanding community care.
The central recommendation is the, creation of area health boards responsible for planning and development. This recommendation was discussed particularly by the noble Lord, Lord Amulree, by the right reverend Prelate and by the noble Lord, Lord Taylor. This proposal is not worked out in detail, but certain questions will have to be answered. For instance, will co-ordination between the separate branches of the Service be improved by a system under which the day-to-day administration, as seen by the patient, will be split between four separate subsidiary councils, as well as the local health and welfare authority? Is it an advantage to split the local health service, which it is proposed to put under the area health board, from the welfare services, which would remain under the local welfare authority? Will the consultants in the proposed departments of social health, who are to be recruited from existing medical officers of health, happily

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serve two masters—the local health authority and the area health board? Is it in the national interest to deprive county councils and county borough councils of so large a part of the functions which they now exercise? I feel that the noble Lord, Lord Amulree, would probably answer, "No", to that question. I have taken note of those observations of your Lordships which have a bearing on these questions and the Government will await with interest the views upon them of the sponsors of the Committee.
The proposal of area health boards follows from the Porritt Committee's conclusion on what they call the "artificial tripartite division of the present National Health Service organisation." This was discussed by the noble Lord, Lord Amulree, and the noble Baroness, Lady Summerskill. I must say that I was a little surprised that the noble Lady thought it an unsatisfactory arrangement. I think she must have forgotten who was responsible for the National Health Service Act. Unless my recollection is wrong, she herself was a Minister in the Government at the time.
BARONESS SUMMERSKILL: My Lords, the noble Lord has forgotten that that was 1948, and the noble Lord's Party has been in power for eleven years. Times change.
LORD NEWTON: Certainly, my Lords, but we are talking about something very fundamental—the organisation of the National Health Service. Again, I think that I ought to refrain from comment on what is said in the Report about this in advance of the views of the sponsoring bodies, but I should like to assure your Lordships that we believe that there should be the fullest co-operation between the three branches of the Service.
A recent circular on admission to hospital shows in a practical way how we seek to promote such co-operation. The principles which the circular sets out are generally accepted as good practice, but they need to be known and widely applied. Many patients, especially the elderly and those with some kind of chronic illness or mental disorder, do not need to be admitted to hospital if the domiciliary services of the local authority are effectively mobilised. I am referring
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to the services of the home nurse, the health visitor, the social worker or welfare officer, or the home help. This is why the general practitioner, before he approaches a hospital for the admission of a patient, considers whether the patient, with the help of these services, could be properly cared for outside the hospital, and, if so, he informs the local authority officer concerned.
Again, if the patient is put on the waiting list for admission, the hospital authority will give the general practitioner some indication of the probable date of admission and the general practitioner will often approach the local authority to see what supporting services they can provide meanwhile, if necessary, by an intensive mobilisation of help for a short time. A similarly close interaction between general practitioner, hospital and local authority is called for at the time of a patient's discharge, and a complementary circular on discharge procedures will be going out shortly.
Association between general practice and the local health authority services is quite rapidly becoming closer in a number of ways. For instance, current experiments, which are extending to more and more areas, are basing health visitors on the practices of general practitioners instead of on geographical areas, and we regard this as an important future development. At the same time, there is a growing use by general practitioners of the services of social workers, especially mental welfare officers, to collaborate with them in looking after the patients in their practices. The development of a local health authority service of trained social workers is at present in its earliest stages, as your Lordships will realise, and it would be premature to decide now the most effective way of organising this service, but close collaboration with general practitioners will certainly be a feature.
The home nursing service is, of course, closely linked with general practice and it is always available where treatment requiring nursing skill is prescribed by the general practitioner. I am not at all sure that there is a real need for the formal attachment of a local authority home nurse to an individual or group practice, since close collaboration of the home nurse and the general practitioner

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in respect of individual patients has always existed.
Moreover, I could not agree with any suggestion that, because there may be dangers in having too many people advising a patient, the home nursing service should be expanded at the expense of health visiting. The functions of home nurse and health visitor are quite distinct. The health visitor advises on the health problems of people of all ages in the family setting. She is called in when such advice is needed. Much of her work is in the field of maternity and child welfare, and lies not with sick people but with mothers who need guidance in mothercraft, nutrition, behaviour difficulties and things like that.
The home nurse's work is not advisory but clinical. When treatment requiring nursing skill is prescribed by a doctor, the home nurse, under the doctor's supervision, provides the nursing. At times the health visitor and the home nurse will both be concerned with the same family. But even here their work does not really overlap. Each is essential in her particular sphere, and there is no difficulty in establishing a satisfactory partnership.
The noble Lord, Lord Amulree, called for the combination of the health and welfare departments of local authorities into what he thought might be called a social department. In recent years, the trend of much development has been to bring local authority health and welfare services so closely together that they can be administered as one for the benefit of the patient. I agree with the noble Lord that there are innumerable cases, particularly among the old, where it is difficult to say where health ends and welfare begins. Our policy is to emphasise in the strongest terms the need for close cooperation between local health and welfare services but to leave it to local authorities themselves to decide how this can best be achieved. Some have chosen to refer their welfare work to the health committee, but the majority still prefer to administer the services under separate health and welfare committees, each with its own chief officer. Whatever machinery they choose to adopt, however, it remains the responsibility of committees, and particularly of officers, to ensure that the health and welfare services work as one. I do not think I can do better than quote
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some remarks of my right honourable friend at the Welfare Conference of Local Authority Associations in March, 1961. He said:
"There is in fact no intelligible boundary line between the services provided under the National Health Service Act and under the National Assistance Act: indeed, the division between the two is probably partly of historical, and partly of accidental, origin; it has little or no contemporary or logical significance. Whatever the illogicalities of the statutory framework, the plain fact is that the health-and-welfare services ought to be in a single entity from the point of view of those whom they serve. What matters is not the Act under which the powers are exercised (so long as the powers are sufficient), nor even the way in which the exercise of the powers is organised by the local authority (so long as The organisation is efficient), but the way in which the powers are applied to the individual or the family in need of help. They should be unaware of any distinctions created by Acts of Parliament or forms of organisation: the whole combination of services should come smoothly into play according to their needs".
Those are the views of my right honourable friend in his own words, and the local authorities are constantly being reminded of them.
The noble Lord, Lord Amulree, asked me whether hospitals could not have some ambulances of their own. Since the National Health Service Act came into operation in 1948 the ambulance service, as he knows, has been a local health authority's responsibility. The Guillebaud Committee, which reported in 1956, reviewed the organisation of the service in England and Wales and considered the suggestion that administrative responsibility for its provision should be transferred from the local health authorities to the hospital authorities, and they concluded that the arguments against the transfer of the whole of the ambulance service were decisive. This, too, is our current view.
I now come to the care of the elderly. The services for the elderly fall into four main groups: provision of suitable housing—that is to say, single bedroom dwellings and special flatlets with resident wardens; help in the home; residential care; and hospital care. The aim is to provide and keep all these services in balance so that the needs of the elderly are met in the right way at the right time—and I take this opportunity of reminding the House that the gracious Speech from the Throne forecast the publication

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this Session of the long-term plans of local authorities for the further development of their health and welfare services. I cannot this evening offer any anticipatory comment either in general terms or on the plans of individual authorities. I have, however, noted what the noble Lord, Lord Amulree, said about the desirability of making statistical studies.
As for progress up to date, the House, and particularly my noble friend Lord Auckland, might like to know that between December 31, 1959, and December 31, 1961, the number of home helps (in whole-time equivalents) employed by local authorities in England and Wales rose by 2,000, and the number of households assisted annually by home helps rose from 290,000 to 328,000. As regards residential care, the number of elderly people provided for has been rising steadily in recent years. The total reached 76,000 at the end of 1961. In 1962 some 4,000 new places were provided, which works out at between 75 and 80 every week. The ratio of purpose-built to adapted homes has increased continuously for many years, and it has accelerated quite rapidly in recent years. In 1951, 250 homes were opened, but only 5 were purpose-built; in 1957, 68 homes were opened, of which 26 were purpose-built; in 1961 no fewer than 55 of the 75 homes opened were purpose-built. This, my Lords, is an indication of the increased amount of capital made available for welfare services in the last few years. The current rate of opening of new purpose-built homes is about three a fortnight.
The result of all this development in terms of quality has been impressive. In 1948 almost all the available residential accommodation—some 42,000 places—was in ex-Public Assistance institutions. By the end of 1961 the number of such places had fallen to 34,000, even though the number of elderly people accommodated under Part III of the Act had risen to 76,000. The ratio of new to old will improve with every month that passes, and, indeed, my right honourable friend declared last September:
"We shall not be content unles we can see the end of all the workhouses in a decade, reprieving only such as can be made to give service fully on a level with modern standards and ideas. The rest are a blot and an in-adequacy. They must go."
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While on the subject of local authority provision generally, I should like to tell your Lordships that during recent years training centres for the mentally subnormal have been opened at the rate of about one a week, roughly half of these being additional provision and the other half being replacements of unsatisfactory premises. The number of places in training centres for the mentally subnormal has been increased by some 2,000 or more a year, roughly 1,000 each for children and adults.
Local authorities generally take a sympathetic attitude towards applications for housing made to them by elderly people. They are advised to take into account ill-health as a factor of housing need when it is caused or aggravated by conditions which might be improved by a transfer to other housing. Inability to manage stairs is obviously a material factor. Nobody would claim that elderly people can always obtain a council flat or bungalow as soon as they ask for one. However, public authorities have completed about 250,000 one-bedroom flats and bungalows since the war, and the priority that is being given to the needs of the elderly can be recognised from the fact that one-bedroom dwellings account for about three out of every ten dwellings currently being completed by public authorities in England and Wales.
If any local authority tenant, of whatever age, lives high up in a block of flats he is more likely than not to have the use of a lift. But dwellings provided specifically for elderly people are generally built low. There have been one or two high blocks of old people's flats—which have proved popular—but the general arrangement is that old people's housing is provided as bungalows or in blocks of flats of not more than two storeys, or on the ground and first floors of higher blocks. This is not to say that elderly people can never be found living in the higher flats in local authority blocks. Some may have moved into such flats when they were younger, and may still be there, because they like it. A year or two ago, the Building Research Station undertook a sample survey of old people's dwellings, and, according to a report made last May, four-fifths of the old people they found living on or above the sixth floor preferred to do so. But

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local authorities, practically without exception, are prepared to allow their tenants to transfer from one dwelling to another when the need is proved. Indeed, it is often in the local authority's interest to allow such a transfer, since the flat released may be suitable for a family.
I now move on to medical manpower, about which a number of your Lordships have expressed opinions. The Porritt Report alleges shortage of medical manpower in various fields. Its conclusions are, however, tentative, and it simply makes the point, with which we agree, that the various factors which might lead to shortage should be investigated and analysed. The Report continues with a note of warning, that
"any unjustified increase in the number of doctors could … lead to serious consequences."
Its main recommendation is for the establishment of a mechanism to record the facts of medical manpower to which future studies of need could be related. We have already started on arrangements, in co-operation with the British Medical Association, for improving the collection and recording of factual information. The full benefit of the improved system will not, of course, be seen at once, but the information derived will be of cumulative value as time goes on.
My noble friend Lady Horsbrugh asked me about emigration. An inquiry last year of deans of medical schools indicated that, in the case, of those who have kept in touch with former students, some 4 to 12 per cent. (varying according to the school) of their British graduates in the preceding ten years or so are now established abroad. A study on emigration and other aspects of losses from the pool of medical manpower is being undertaken under the auspices of the Nuffield Trust. More reliable information derived from this study, coupled with the improved method of keeping long-term records, should be available in the fairly new future. It has, of course, always been part of the tradition of this country that a proportion of our doctors should go overseas. I was glad to hear the noble Lord, Lord Amulree, endorse this point also.
He referred to the need for more medical students and more medical schools. In 1961, the Government, made a check of the calculations of the Willink Committee
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for student intake, using information which became available subsequent to the Committee's Report. We did not think that the revised figures were based firmly enough to justify precise new estimates, but we felt satisfied that the prospective demand for medical services would justify a rise in the university intake of pre-clinical students to 10 per cent. above the level recommended by the Willink Committee. We invited the University Grants Committee to consider, with the universities, the effect of such an increase. The universities indicated that this increase could be absorbed in existing schools without loss of standard. In the event, the intake increased in the autumn of 1962 by more than 16 per cent. over the Willink figure, and by more than 14 per cent. over the intake for the year ending July, 1961. Hospital boards have recently been asked to undertake a review of their medical staffing to cover the next five years, and the results of this will be available later this year.
LORD TAYLOR: My Lords, the noble Lord is of course aware that the Willink Committee figure was a cut of 10 per cent. on the previously existing figure, so that the 10 per cent. was merely a restoration of the cut which had been made by the Willink Committee. Apparently there has been some extra 4 or 6 per cent. over and above that.
LORD NEWTON: The noble Lord, Lord Taylor, can put what interpretation he likes on what I have said. I am sorry he is not pleased by the explanation I have been able to give your Lordships.
LORD TAYLOR: I wanted to make sure what the information was.
LORD NEWTON: If the noble Lord will be good enough to read in Hansard what I have said he will find it clear enough.
In view of the observations of the noble Baroness, Lady Summerskill, and of the right reverend Prelate, about the maternity services, I should like to mention that in September of last year the figures of nursing and midwifery staff in National Health Service hospitals in England and Wales showed a continued increase over the previous year in all types of staff, whole-time or part-time. Whole-time staff increased by 5,282, or

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3·2 per cent. This rate of increase was larger than in the two previous years and well above the average for the last six. Part-time staff increased by 7,955, or 16 per cent., which was the highest rate of increase ever recorded.
As regards figures for midwives alone, in the same period September, 1961, to September, 1962, the increases were: whole-time 127; part-time 245, and pupil midwives 185. In view of what the noble Baroness, Lady Summerskill, said about maternity services I think I ought to say that the number of births has increased and is continuing to increase very rapidly. Hospital authorities are reviewing their building plans in the light of the latest statistics and forecasts and some maternity units will have to be brought forward and given priority over other projects in the building programme. In London, where the pressure is especially heavy, special steps have been taken to make available upwards of 100 extra maternity beds. I was glad that the noble Lord, Lord Taylor, drew attention to the findings of the Gallup Poll about the number of women who preferred to have their confinements at home, because it has saved me the necessity of drawing attention to them myself.
Now a word about general practitioners. The average list of general practitioners in England and Wales has fewer than 2,300 patients. The total number of general practitioners has increased every year since the Health Service began. Apart from 1959–60, when a number of doctors retired on qualifying for a National Health Service pension, this increase has always been greater than the corresponding increase in the population. The real problem exists in "designated" areas—that is, places where there is a sufficient excess of patients over an average of 2,500 per doctor to make it likely that another doctor could develop a practice in that area. The percentage of the population living in such areas has steadily fallen. It was over 50 per cent. in 1952, and in October, 1961, the latest date for which figures are available, it was 17·1 per cent. It has been calculated that the number of extra doctors required to remove the designation in these areas is less than 250; that is, not much over 1 per cent. of the present number of general practitioners.
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The Porritt Report suggests that if doctors could be sure that later in life they would be successful in applying for another practice in an attractive area, they would be more willing to start their careers in an unattractive one. In fact, if a practitioner who had managed successfully a large practice in an industrial town were to apply, say, in his late forties for a rural practice in the South, his experience would make him a very strong candidate, and he might well be successful. But I am not convinced that such considerations as these really deter doctors from starting work in industrial areas. Mobility among general practitioners has probably never been very great, and I think that most doctors would view a practice as being their work throughout their career.
Both noble Baronesses who have addressed your Lordships to-day spoke about private practice, and my noble friend Lady Horsbrugh said she thought the private practice had been growing. I am afraid that we have no information on which to form conclusions about recent changes, if any, in the extent of private practice. On the other hand, there is no evidence to suggest that it is diminishing. The Government certainly attach importance to its continuance. In this connection, I was interested to see that the Gallup Poll showed that, although 41 per cent. of those approached knew that their doctor had private patients, only 9 per cent. thought that his arrangements for his private patients were different from those for his National Health Service patients.
My noble friend Lady Horsbrugh asked me three questions about amenity beds. One of them was: "Are they fully used"? The answer to that is, "No". The second question was: "Are patients told whether amenity beds are available"? The answer to that is, "Yes". Hospital authorities have been advised that if a patient's primary desire is for privacy and quiet beyond what is medically necessary, he should be told of the existence, nature and availability of any amenity beds. The third question was about charges. The charges are prescribed by regulation. They are 24s. a day for accommodation with a single room, and 12s. a day for accommodation in a small ward. If the average daily cost per inpatient is less than 48s. a day then the

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charges are half the daily cost for a single room and a quarter for accomodation in small wards.
The noble Lord, Lord Amulree, discussed the future of general practitioner hospitals. I am aware that fears have been expressed that the transfer of work from some of the smaller hospitals to the new district general hospitals might mean a lessening of the contribution that general practitioners can give, and wish to give, to the hospital service, but this is not so. As the Hospital Plan says:
"Decisions on the number and location of beds set out in the Plan do not prejudice the question which of these beds or of the hospitals comprising them should be general practitioner beds or general practitioner hospitals."
The Plan, however, specifically envisages general practitioner beds in new maternity units; and, indeed, the new maternity hospital at Birmingham, for which my right honourable friend announced last week an earlier starting date, is planned to include 25 general practitioner beds. Over the next few years developments arising out of the recommendations of the Platt Report on the Medical Staffing Structure in the Hospital Service will deeply affect, and should greatly strengthen, the relationship between general practice and the hospital service. Decisions on the future control of beds, both in the new hospitals which are planned and in the existing hospitals which remain, can best he taken in the light both of these developments and of the outcome of the study being made by the Standing Medical Advisory Committee on the future field of work of general practitioners. Perhaps I should just add here that it has long been our policy that general practitioners should have access to X-ray and pathological departments in hospitals, and, in fact, there are few areas where this is not the case.
The noble Lord, Lord Amulree, asked me whether small general practitioner hospitals could be placed under the executive councils. I am very doubtful whether such a transfer—which, incidentally, would require legislation—would be beneficial. Indeed, separation from the main hospital service might be damaging because it would lead to isolation from the main and constantly developing stream of medicine. The point is that the principles governing
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hospital development derive from the staffing, accommodation and equipment needs of hospitals, and not from the nature of the authority administering them.
The noble Lord, Lord Taylor, gave us the benefit of his great knowledge and experience on industrial medicine—or "occupational medicine", as I think the Porritt Report calls it. He expressed views on the Committee's ideas on the subject, and quite apart from anything else, that lets me out of doing the same thing. I had thought of telling the noble Lord what the Government's policy on this matter is, but I am quite certain he knows it; and, as the hour is getting on, perhaps he would prefer me not to tell him again or at any rate, not to tell him what he knows already.
Although the noble Lord, Lord Taylor, told me—and this was very strong—that he did not think it was my busiess to talk about medical research, I feel that I ought to say something about it, because the noble Lord, Lord Brain, gave us the benefit of his views, and the noble Viscount, Lord Waverley, talked about education. Like the noble Lord, Lord Taylor, I think it is a pity, from Lord Brain's point of view, that he did not make his authoritative contribution in last Wednesday's debate, for he would then have had the benefit of a reply from my noble friend the Minister for Science, instead of from me. Like the noble Lord, Lord Taylor, Lord Brain recognised that my right honourable friend the Minister of Health has but little responsibility.
The Porritt Report, in paragraph 156, criticises the Clinical Research Board for failing to make a sufficient impact or to fulfil its high expectations. The facts are that in the nine years since the Board became responsible for advising the Council the number of clinical research units has risen from 22 to 43, and the total annual expenditure by the Council on clinical research from £400,000 to an estimated figure of over £1,800,000. The noble Lord, Lord Brain, called that a gratifying increase, and I was glad that he did. In addition, the Clinical Research Board has played an important part in the evolution and planning of the Clinical Research Centre, which is a very forward-looking project. This will comprise a comprehensive

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concentration of relevant clinical and para-clinical disciplines and thus facilitate the type of planned collaborative work which is becoming increasingly required to-day. The Centre will be linked with the new district hospital to be built by the North-West Metropolitan Regional Hospital Board at Northwick Park, Harrow.
With regard to Lord Brain's observations about the Medical Research Council, I feel that I must point out that the Council's budget has increased steadily over the past ten years, rising from £2 million to nearly £6 million a year. The Council operate with a high degree of independence and allocate their funds in accordance with their own expert scientific judgment. Their standards for the award of research grants are high, but on the average about 85 per cent. of the applicants have been given an award. In addition to support from the Medical Research Council, medical research is financed through the normal university funds available through the University Grants Committee. There is also an increasing allocation within the National Health Service to Hospital Boards for clinical research closely bound up with the treatment of patients.
Financial support comes not only from the State but also from outside sources, from the benefactions of individuals and from foundations like the Nuffield Trust, as well as from organisations in the United States. There are sometimes complaints that the diversity of these sources causes confusion and waste of time among the scientists seeking support, but I believe that no single body is a repository of all wisdom in these matters, and the diversity of support is an assurance against any worthwhile project being overlooked and provides, I believe, the best hope for the outsider, if I may so describe the potential researcher whose qualities have not yet been recognised or developed.
The noble Lord, Lord Brain, also made reference to post-graduate medical education. I think he knows that the various bodies interested were in agreement that there is a need for the development of schemes of post-graduate medical education of a non-academic kind in the non-teaching hospitals. A sum of £250,000 has been made available by the Nuffield
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Provincial Hospitals Trust to promote developments of this kind, and Regional Hospital Boards have been encouraged to seek support for experimental schemes in their areas so that the most fruitful and economic lines of future advance can be determined. A number of Boards are developing schemes, and reports in the autumn of 1962 indicated that good progress was being made. Eight Boards had been granted, or offered, assistance by the Nuffield Trust for specific projects. They include organising lectures, demonstrations and clinical conferences, library facilities and so on. The arrangements being worked out provide for post-graduate education of general practitioners, as well as hospital doctors, and for fellowships for overseas graduates. We are fully in sympathy with the view that the arrangements should include suitable training for young doctors from overseas who are occupying junior posts in the hospital service, and we hope that many such doctors will continue to come here for this kind of training and experience. Further progress reports by Boards are now being called for, and we shall study them with great pleasure.
Both the noble Lord, Lord Brain, and the noble Viscount, Lord Waverley, talked about accommodation for research in hospitals. We fully accept the need for improved research facilities and we recognise it in the guidance given to hospital authorities on the design of new and redeveloped hospital buildings. In the district general hospitals of the future, clinical research on patients actually under treatment or investigation may well not call for a great deal of accommodation, since much of the research will be undertaken on patients in the wards. But some extra facilities will be required—for example, in the pathology laboratories; and the necessary provision is being made in current building projects. The Ministry's hospital building note on the pathology department of a district general hospital recommends minimum standards which are very considerably higher than those of the past. Not only does each main section of the department—that is to say, morbid anatomy, hæmatology, chemical pathology and microbiology—have its own laboratories, but provision is also made, where local circumstances demand it, for laboratories required specifically for research. In teaching hospitals, of course, fundamental research is

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undertaken as well as clinical research on patients under treatment or examination. The needs of both types of research have been given full weight in the designs of the new hospitals at Cardiff and Sheffield, and at the Royal Free Hospital, Charing Cross Hospital and St. Thomas's, Bristol.
The last thing I want to do is very briefly to answer the question which the noble Lord, Lord Amulree, put to me about what consultation there was with the medical profession about the Hospital Plan. In discussing the Hospital Plan the Porritt Committee say in paragraph 364:
"We understand that there was no consultation with the profession before these plans were announced."
This statement arises from a misunderstanding. The Hospital Plan is in a very real sense the plan of the hospital service as a whole. The plans and proposals of the hospital authorities which it embodied incorporated the thought, the work and the aims of the medical staffs who at every level are integrated into the administration and planning of the Service. Thus the medical view was built into the plan at every stage.
Although I have a great deal more I could say, I think the time has come when your Lordships would wish that I should not do so. I should like again to say haw grateful I am to the noble Lord, Lord Amulree, for giving us all the opportunity to discuss pretty well anything we liked. I certainly have enjoyed the debate. I hope your Lordships have, and I hope that, like me, you have found it valuable.
8.4 p.m.
LORD AMULREE: My Lords, before asking your Lordships' leave to withdraw my Motion, I should like to thank the
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noble Lord, Lord Newton, for his full reply. I am afraid we must, between us, have given him a great deal of trouble in preparing this reply, because the debate has ranged over an extremely wide field. I am more than grateful for the remarks he has made to me. Some, at the moment, have not been very satisfactory, or have not given me the satisfaction I thought they might, but there are one or two things at which I am very pleased.
I was very interested in what the noble Lord said about the Ministry's views about the health and welfare departments of the local authorities. I was impressed with the figures he gave about accommodation for old people. My only comment on that is that although the increase is large, it is nowhere near large enough. I was pleased at what he said about the consultation that took place before the ten-year plan. I shall certainly bear in mind what he said about re-housing elderly people when the question comes up again in my experience. I shall possibly be able to quote from his speech, which may have some effect on the local authorities with whom I am dealing. Finally, I would thank noble Lords, from all parts of the House, for the help they have given me in this debate, for the contributions they have made to it and for the fact that none of us have said the same thing twice, which shows. I think, what a satisfactory debate it has been. I beg leave to withdraw the Motion.
Motion for Papers, by leave, withdrawn.
House adjourned at six minutes past eight o'clock.