§ 6.51 p.m.
§ LORD TAYLOR rose to move, That it be an Instruction to the Committee on the Bill that they should not pass Clause 69 without special attention, and, in particular, should have regard to whether it is in the public interest that non-infectious diseases should be made notifiable. The noble Lord said: My Lords, I beg to move the first of the Instructions standing in my name on the Order Paper. I had intended to initiate a small debate on both Instructions together, but it so happens that838
§ On Question, Whether the said new clause shall be there inserted?
§ Their Lordships divided: Contents, 18; Not-Contents, 44.837
|Alexander of Hillsborough, E.||Gardiner, L.||Shepherd, L.|
|Attlee, E.||Hobson, L.||Strabolgi, L.|
|Burden, L. [Teller.]||Iddesleigh, E.||Summerskill, B.|
|Champion, L. [Teller.]||Latham, L.||Taylor, L.|
|Crook, L.||Lawson, L.||Williamson, L.|
|Gaitskell, B.||Shackleton, L.||Willis, L.|
|Ailwyn, L.||Craigton, L.||Hanworth, V.|
|Albemarle, E.||Crathorne, L.||Hastings, L.|
|Amherst of Hackney, L.||Daventry, V.||Hawke, L.|
|Ampthill, L.||Denham, L. [Teller.]||Hereford, V.|
|Atholl, D.||Derwent, L.||Horsbrugh, B.|
|Audley, B.||Dilhorne, L. (L. Chancellor.)||Lothian, M.|
|Bessborough, E.||Drumalbyn, L.||Massereene and Ferrard, V.|
|Blakenham, V.||Falkland, V.||Molson, L.|
|Boston, L.||Ferrers, E.||Newton, L.|
|Bridgeman, V.||Forster of Harraby, L.||Remnant, L.|
|Carrington, L.||Fortescue, E.||Suffield, L.|
|Chesham, L.||Goschen, V. [Teller.]||Swansea, L.|
|Cholmondeley, M.||Gosford, E.||Teynham, L.|
|Conesford, L.||Greenway, L.||Tweedsmuir, L.|
|Cowley, E.||Grenfell, L.|
Resolved in the negative, and Amendment disagreed to accordingly.
§ the first relates to an opposed Bill and therefore will go to an appropriate Committee for examination in a different way from the second, which is not opposed. Therefore, I propose to move the first one and to discuss it, and then later the second Instruction, so that we can deal with them separately.
§ I should like to draw your Lordships' attention to the terms of the Instruction and to the method by which it has been drawn. I have tried to avoid giving a categorical instruction to the Committee, in the sense of asking them to take any action without first examining the Bill. I am asking them in fact only to examine a clause very carefully to see that it is right and proper and appropriate to the particular Bill in which it is inserted. I shall do the same with the second one. I hope the Committee will examine the clause very carefully, and I hope that they will examine the Promoters of the Bill to see why they have drafted the clause as it is now drafted. As it stands, I must confess that I think the clause is a mistake. I also think that, as it stands, it raises a matter of some national importance.
§ The clause is designed to make certain non-infectious diseases notifiable in the county of Cumberland. The effect 839 on registered medical practitioners will be that when they see these diseases they will be required to notify the medical officer of health that they have encountered such cases and where the diseases have happened. As your Lordships are aware, certain diseases are already notifiable, and have been for many years. These are the ordinary infectious diseases and the diseases due to industry. They are notifiable for obvious public health reasons. In the first case, they are liable to spread to other people; in the second case, they are notifiable because their causes are associated with work, and because other people may suffer in a similar way unless the matter is corrected. From time to time new diseases have been added to the schedule of infectious diseases which are notifiable, but before this was done there has always been strong positive evidence that it was desirable.
§ Clause 69 of the Cumberland Bill seeks to do three things. First, it seeks to make leukæmia a notifiable disease. Secondly, it seeks to make coronary thrombosis a notifiable disease. Thirdly, it seeks to allow the Cumberland County Council to proclaim any other disease notifiable after approval by the Ministry of Health. This, so far as I know, is something that no other local authority in the country has sought to do. I ask the House to ask the Committee to find out why Cumberland wishes to have these very special provisions, and, unless there are very strong reasons in favour of them, I hope the Committee will reject the clause and strike it out.
§ First of all in regard to leukaemia—and your Lordships are all too familiar with this disease, which has recently been much in the Press—I can think of only one conceivable reason why Cumberland is seeking to make leukæmia notifiable. There is in Cumberland the atomic energy station at Windscale, and it may have been thought that there was some connection between this and an increased risk of leukæmia. But what a strang thing to do! In fact, all cases of leukemia that occur are very quickly known to the authorities. They are, I think without exception, admitted straight away by doctors to hospital, for the purpose of treatment, and they at once get on to the cancer register. The cancer register is a nationally maintained list of 840 all cancer cases, which, of course, includes all leukemia cases, so that these cases are in fact already effectively notified—not merely for Cumberland but for the country as a whole. Even if this were not the case, they would still be notified, since they are all fatal, and on death are automatically notified on the death certificate; and the results of the analyses of death certificates appear in the annual reports of every medical officer of health throughout the country.
§ As a statistical exercise—and this is the only reason I can conceive for Cumberland wanting to have leukæmia made notifiable—it is meaningless to suggest that this should be done. Cumberland is a very large county with a relatively small population of 220,000, so that the total number of cases of lcukæmia occurring is very small indeed. In consequence, a single extra case of leukemia in the course of the year will produce a surprisingly large percentage fluctuation in the picture. Therefore, no trends will be visible from a statistical study of such a group. I am at a complete loss to understand why Cumberland wishes to make leukemia notifiable. Moreover, there are certain technical difficulties about this, though they are so technical that I do not propose to go into them. They involve the accurate definition of leukæmia—which does not appear to have troubled the Cumberland County Council when they invite doctors to make these notifications.
§ On the question of social reasons, is it conceivable that there are some special social reasons why doctors should notify leukemia in Cumberland? I cannot think that there are, and I can only imagine, if this were so, that every kind of fatal disease should be notified to the Medical Officer of Health, because leukemia differs in no very great respect, socially, from other noninfectious fatal diseases. Therefore, I can see no justification for this from the point of view of social considerations. So I think that it is up to the Cumberland County Council to present a very strong case indeed for making leukæmia a notifiable disease, before the nation should depart from its well-established practice of not making noninfectious diseases notifiable.
§ The second disease that they seek to make notifiable is coronary thrombosis. 841 I am again at a loss to know why they should have picked on coronary thrombosis in Cumberland, except for one possible conceivable reason, and that is that it has been suggested by some medical statisticians that where the water is very soft there is an increased incidence of coronary thrombosis. If this be so, I can only again suggest that this is a very poor way of trying to study it. The notification of coronary thrombosis presents incredible difficulties. With an ordinary infectious disease it is pretty easy, as a general rule, to decide if the patient has got it and the doctor can take the necessary steps. The diagnosis of mild attacks of coronary thrombosis presents very great difficulty indeed, and sometimes fatal attacks are wrongly diagnosed before death and only after death on autopsy is the correct diagnosis made. Moreover, many people have recurrent attacks. They have an attack of coronary thrombosis one year, then go for a few years, have another attack and then a further attack; and the Bill does not say whether each attack is to be notified or whether when a person has had it once, subsequent attacks should not be notified. So I venture to suggest it is a pretty meaningless piece of work.
§ The third thing for which Cumberland asks is power to extend this notification to other diseases. If, in fact, Parliament grants this power to Cumberland we may be quite sure that other local authorities will ask for similar powers in respect of other diseases. So we shall have the extraordinary picture of many different diseases being notifiable by doctors in each of the counties which has brought in a Private Bill and has had some special reason, or thought it had some special reason—because if there is a good special reason then it is a very different matter. We should have a chaotic situation if this practice were to spread.
§ Notification is a very valuable public health tool. It is one of the ways by which we have prevented the spread of infectious disease, and it must not be blunted by being used foolishly, for purposes whose value is in doubt, or just for pure medical curiosity. Its effectiveness depends entirely on the co-operation of the general practitioners, because unless they can see a good, common-sense reason 842 why they should notify a particular disease they will not do it. It is true that there is a 40s. penalty if they do not notify, and a 2s. 6d. fee if they do notify, but so far as I know no doctor in the history of Britain has ever been charged with failing to notify a case of infectious disease and been punished under this section. Incidentally, the Cumberland clause repeats this 40s. penalty and 2s. 6d. fee in the case of leukaemia and coronary thrombosis, and, indeed, for any other diseases that are added to the list.
§ That is the case, my Lords. My attention was drawn to this clause almost by chance. I was very surprised, indeed, when I saw it and I felt it was my duty to bring it to your Lordships' attention. I could have raised the matter on the Second Reading of this Bill but, as your Lordships know, Second Readings of Private Bills are taken before Public Business and it seemed much better to move an Instruction to the Committee asking them to pay special attention to the clause. I hope they will pay special attention to the clause and that your Lordships will agree to my Instruction, bearing in mind that we are not telling the Committee what to do; we are merely asking the Committee to examine the clause very carefully. If we did not do this, of course, it would not be examined at all because this particular clause is not opposed. We are asking, therefore, that it shall be very carefully studied and that the proposers of the Private Bill will have to make a very strong case indeed for adding this burden to the general practitioners of Cumberland when the information is already available in some cases, or will have no meaning in others. My Lords, I beg to move.
§ Moved, That it be an Instruction to the Committee on the Bill that they should not pass Clause 69 without special attention, and, in particular, should have regard to whether it is in the public interest that non-infectious diseases should be made notifiable.—(Lord Taylor.)
§ 7.7 p.m.
THE CHAIRMAN OF COMMITTEES (LORD MERTHYR)
My Lords, the Cumberland County Council Bill is what is known as a general powers Bill—that is, it deals with a number of different subjects—and this Bill is an opposed Bill, in the sense that there are Petitions 843 against it. There are actually four Petitions against this Bill, but none of those Petitions deals with this Clause 69. Therefore one can say that Clause 69 is an unopposed clause, and for the purposes of this evening's debate let us treat it as such. But, my Lords, that does not mean that this clause will necessarily be allowed in any event, as I shall explain in a moment. That does not follow because—and I should like to make this perfectly clear to the House, especially in view of what the noble Lord, Lord Taylor, said a moment ago—every clause in every Private Bill is scrutinised, whether or not it is opposed. It is scrutinised by somebody, and if it is not scrutinised by a Committee at least it is scrutinised by learned counsel who advises me on these matters.
§ LORD TAYLOR
I am so sorry, my Lords. I should like at once to withdraw the misleading remark I made. I did not intend to mislead the House.
I am much obliged to the noble Lord, who I am quite certain did not intend to mislead the House. But I was going to say this in any event, and I should like the House to appreciate, that although clauses of Private Bills may not be heard of very much by your Lordships, they are in fact, behind the scenes, always looked at, and are always read very carefully by at least one individual acting in an official capacity, and if need be they are scrutinised by a Committee. It is therefore true to say that every clause comes before some Committee of your Lordships' House—which Committee is another matter.
I should just like to say very briefly, because I want to help the House if I can, what would happen, first, if this Motion were not passed and, secondly, what will happen if it is passed. If I can do that, I hope that I have done my duty on this Motion.
My Lords, if this Instruction were not to be passed to-night, Clause 69, since it is unopposed, would not go to any Committee upstairs, as we say, but would be dealt with downstairs by me in what is called an interview. An interview takes place on every opposed Bill. No matter how many clauses are opposed, there is always an interview unless, of course, the whole Bill is opposed upstairs. But where there are 844 some unopposed clauses there is always an interview, and that takes place after the Select Committee have dealt with the opposed clauses. At the interview, there are the Parliamentary agents for the Promoters of the Bill and, where necessary and where appropriate, representatives of the Government Departments concerned with the Bill. There are also available written reports on the Bill by the Government Departments concerned—that is, those Departments which are interested; and in a general purposes Bill such as this which has 132 clauses, a number of Government Departments would no doubt be present and would make reports, and might oppose some of the clauses.
§ LORD SHEPHERD
My Lords, may I ask the noble Lord—because this is extremely interesting—if he can indicate whether, at this interview, when the agents of the Promoters are present and when there may be a dispute (say, in this case, on this particular clause), the Promoters, through their agents, can produce witnesses to substantiate the reasons why the clause has been included?
Yes, my Lords, they can. The Promoters can ask to call witnesses for their side at the interview. For example, in this case the county medical officer of health would probably he there, and would be called and heard, if appropriate and if necessary. Undoubtedly, yes.
Now, my Lords, there is no precedent for this clause, as the noble Lord, Lord Taylor, rightly said, and in all cases where clauses are unprecedented then, at the interview, I am particularly careful to inquire into the clause concerned. There is machinery in your Lordships' House, with which I will not trouble you to-night, by which we know exactly how many precedents there are for every clause in every Private Bill. I could produce whole tables of figures if I wanted to; but for this clause there is no precedent, and the mere fact that it is unprecedented switches on the red light, if I may use that expression, and I would in any event—and I would emphasise "in any event"—ask the Promoters to justify (that is the magic word) this clause, and would then see whether they could justify it. Argument would then follow, 845 and most likely the Promoters would show cause why this clause should be passed into law.
There would then be further argument, probably, and if the representative of the appropriate Government Department (in this case, I think it would be the Ministry of Health) had reported against the Bill—I do not know what the Department are going to say in this case; I have no idea; I have not seen any report yet; it is too early—then he also would be heard, and, of course, the written report on the clause would be available at the interview. So the noble Lord need have no fear, and the House need have none, either, but that even if this Motion were not passed to-night, this clause would certainly be examined.
Now, if the Instruction is passed, what difference will there be? Clause 69 would then go upstairs merely because this Bill is opposed; and therefore there would be a Select Committee—unless, of course, the other Petitions were withdrawn. The mere fact that there would be a Select Committee indicates that the appropriate Committee to deal with this clause would be that Committee. So there is a change in the procedure which would be effected by the passing of this Motion; but that is, I think, the only change that it would effect. The Committee upstairs, having dealt with the clauses which were opposed by the four Petitioners, would then proceed to look at this clause.
One difficulty is that they would be obliged to do so ex parte, by which I mean that there would be counsel for one side but no counsel for the other. In that respect, the procedure would be different from what it is on the opposed clauses, where there are counsel for the Promoters and counsel for the Petitioners. Here, there would be counsel for the Promoters but no counsel for the Petitioners, because there are not any. Incidentally, may I just remind the House that this clause could have been opposed, but has not been? I suppose there are bodies or persons in the country who could have opposed this clause had they wished to, because all the proper notices are sent to every possible interested party. So the Committee upstairs would examine this 846 clause, but would have to do so ex parte.
§ LORD TAYLOR
My Lords, may I ask the noble Lord one question on this? In doing so, would the Committee have regard to the remarks which are made here in the Chamber? Because that is the vital question so far as we are concerned: that the Promoters should be examined on the points which we have raised, or are raising, this evening.
My Lords, I do not think there is anything to compel the Committee to read the Hansard report of to-night's debate, but I apprehend that they probably would do so. One must bear in mind, however, as I have said already, that one side are represented by counsel and the other are not. But I should think that very likely—of course, we do not even know who the Committee are going to be yet—they would bear in mind what has been said. Possibly, some of them are here listening at this very moment.
I might be asked: what about the Government Departments concerned? How would they fare upstairs? A Government Department cannot petition against a Bill, but they can report either for it or against it, or in a neutral way: they can "report upon it" is the correct expression, I think. A representative of a Government Department can be heard by the Select Committee if the Select Committee so require it. It is a much more formal procedure upstairs than it is downstairs; but I can tell your Lordships that if the Select Committee wanted to hear the representative of a Department they could do so, but they cannot hear any other evidence. There is no power in a Select Committee to call witnesses. Upstairs, witnesses can be called only by a party to the proceedings, either the Promoters or the Petitioners, as the case may be. But there is a Standing Order which allows a Select Committee to hear the representative of a Department.
My Lords, there it is. There is nothing else that I can usefully say, but I am at your Lordships' disposal if there are any other questions you wish to ask. I would end by saying that no great difference will be made whether this Motion is passed or not passed. I 847 would add that I have no objection to it in form, and that, with the exception which I have already mentioned, it will make very little difference. The only difference will be that the argument will be upstairs in the one case and downstairs in another.
§ 7.20 p.m.
§ LORD BRAIN
My Lords, I am very glad that the noble Lord, Lord Taylor, has drawn attention to this clause, and I can entirely support what he has said. He dealt with the matter so adequately that there is little I need add. But I should like to deal briefly with two points, the first a scientific one and the other more general.
The noble Lord has pointed out the difficulty arising from attempting to notify coronary thrombosis. Coronary thrombosis is a state in which there is a clot of blood in one of the coronary arteries supplying the heart; and it leads to symptoms because it damages the heart muscle by cutting off the blood supply from part of it. Exactly the same effect can be produced by disease of the coronary arteries without any clot forming at all; the cardiologists say that they often find it impossible to determine in any particular case whether or not in fact there is a clot; and they regard it as of no practical importance in dealing with the patient. So to ask that coronary thrombosis should be notified is really to select arbitrarily a pathological diagnosis which covers only a part of the field of coronary heart disease; and, as the noble Lord, Lord Taylor, said, it may be impossible to establish it with any certainty. It would lead to the greatest practical difficulties for doctors to have imposed on them the obligation to notify coronary thrombosis.
The next point, the more general one, is that this clause does, of course, infringe the principle to which the medical profession attach a great deal of importance: that the doctor shall not divulge without the patient's consent anything he learns about his patient. As the noble Lord, Lord Taylor, has said, the public interest may have to over-ride that consideration—for example, in the case of infectious diseases or industrial intoxication. But I can think of no reason of public interest why it should be necessary to notify coronary thrombosis. The same applies, as the noble Lord has said, 848 to leukæmia. I feel sure that the medical profession would be extremely disturbed by the suggestion that they should infringe this fundamental principle of the medical profession without there being any clear public reason why this should be done. I hope that these points will be given careful consideration by the Committee. Unless some other reasons are brought forward in support of this provision, I hope that the Committee will reject the clause.
§ LORD SHEPHERD
My Lords, may I ask a question of the noble Lord, the Chairman of Committees, in this matter in the light of the speech that has just been made? As I understand it, this Bill will go to his office, and it will be part of his duty to examine it. In reply to an earlier question, he said that the Promoters of the Bill would have the right to produce witnesses and call evidence. The difficulty that I see here is that there may be two disputes: first, whether a doctor should divulge the information; and, secondly, whether the particular diseases would be known to the doctor, at least in the case of thrombosis.
When the noble Lord considers this clause, obviously he will have to consider whether there is a precedent to it. If there is a precedent, it will be easier to judge; if there is no precedent he must obviously make up his mind whether, for the national or local good, this clause should be allowed to go through. Would the noble Lord the Chairman of Committees be able, as Chairman of Committees, to call in expert advice to see whether the evidence of the case that has been made this evening in regard to the practical difficulties of thrombosis diagnosis is valid? I am not disputing the evidence of the two previous speakers; but in fairness to the local authority who are promoting this it would be interesting to know to what extent the noble Lord, as Chairman of Committees, could go to examine the practicability of their proposal. On what grounds would he make his decision?
My Lords, if I may say so, that is a very difficult question to answer. So far as I am aware, I have no power to call in outside expert evidence. I have already said that the Promoters would no doubt have with 849 them at the hearing their own witnesses, in the shape of the medical officer of health and so on. But I would mention that I have the power to refer any Private Bill to a Select Committee, and it might be possible in that way—possibly even if it be a roundabout route—somehow to procure expert evidence; although I think there is a Standing Order which says that a Select Committee cannot call evidence on their own account. As your Lordships know, a judge in a court of law can summon witnesses without either side calling them; but that cannot be done by a Select Committee. I am afraid that I have not answered the noble Lord fully; but I take the point. I should like to look it up and perhaps answer him later, if I can.
§ LORD AIREDALE
My Lords, would it be open to the noble Lord the Chairman of Committees to invite noble Lords who are eminent members of the medical profession to sit with him and assist him, in the case of the unopposed Bill, to determine this matter?
My Lords, it is not the practice to do that. Whether there is a power to do it, I cannot say, offhand. I will look it up. It is not the practice; in fact I have never known a case of that happening.
§ 7.26 p.m.
§ THE JOINT PARLIAMENTARY SECRETARY, MINISTRY OF HEALTH (LORD NEWTON)
My Lords, I do not think it will be necessary for me this evening to express any opinion on the merits of Clause 69. I agree with the noble Lord, Lord Taylor, that it ought to be given special attention. I do not mind, from the point of view of my Department, whether that special attention is given in Committee upstairs or at the interview as described by the noble Lord the Chairman of Committees. I am certainly not opposing Lord Taylor's Motion for this Instruction. No doubt he will make up his mind, having listened to what has been said here, whether he wishes to continue with his Motion. We have noted and are considering this clause; and we are considering whether or not to submit a report on it. If the noble Lord's Motion is carried and if the clause then is considered in Committee upstairs, we shall 850 of course be very glad to produce evidence to the Committee if that proves to be the wish of the Committee.
§ LORD TAYLOR
My Lords, I am fairly sure in my mind that I should like the clause to go to a Committee upstairs. It is not that I think for one moment that the noble Lord, Lord Merthyr, would not arrive at the right conclusion; but I should like to feel that three or four heads had a look at this rather difficult problem, and not just one head, wise though that head be—particularly because we may feel that we do not want to return to this matter and we should like to leave it. Therefore I hope very much that my Motion will be acceptable to your Lordships and that the Bill will go to a Committee.
There is one other point that I should like to make to the noble Lord the Chairman of Committees, who has been very helpful in explaining this rather difficult matter. Is there a verbatim report of the evidence given to a Committee upstairs on clauses such as this; and is it available to your Lordships? I notice that the noble Lord, Lord Merthyr, is nodding his head—so I gather we may take it that such a report would be available. If it were to go to him in Chambers downstairs, as it were, would there then be a verbatim report? —the noble Lord indicates that there will be no verbatim report. That is an additional, strong reason why we should ask that this Motion should be accepted so that we, as well as the noble Lord, may study the evidence.
§ On Question, Motion agreed to.