HL Deb 29 January 1973 vol 338 cc430-84

4.44 p.m.


My Lords, I beg to move that the House do again resolve itself into Committee on this Bill.

Moved, That the House do again resolve itself into Committee.—(Lord Aberdare.)

On Question, Motion agreed to.

House in Committee accordingly.

[The LORD MAYBRAY-KING in the Chair.]

Clause 40 [Special Hospitals]:

On Question, Whether Clause 40 shall stand part of the Bill?


On this clause may I revert to a point which I made on a Motion proposed by the noble Lord, Lord Grenfell, on handicapped people. Then I was dealing with a section of handicapped people, namely, mentally handicapped and indeed only with one section of those, namely, those in the special hospitals. A book called Bound for Broadmoor, had recently been published by a man who I am glad to know now occupies a position of responsibility. He had been for two years in Broadmoor; he was released on an application to a mental health tribunal and told to go within 24 hours. His effects, in his boxes, were put outside the gate, and there he was. I understand, of course, that there are welfare officers in the special hospital groups, but no special provision seems to have been made in that case and what he has since pleaded is, first, that it is rather a pity that the establishment is still called "Broadmoor" because there is no doubt that the public as a whole think it is a criminal lunatic asylum, as it was. Now it is not; it is a special hospital and there are a number of people there who have never committed any criminal offence at all. They are there purely for secure custody. But it is not of much help when you go to a prospective employer and he asks: "What have you been doing lately?" and you have to reply "Well, for the last five years I have been in Broadmoor". I do not see why the name should not be changed.

The second point which I was raising was the evident need for a hostel or halfway house. Anybody coming out of an institution after a period of years finds it difficult to come back into society again. For obvious reasons I should have thought anybody coming out of special hospitals would find that difficulty accentuated and I suggested that there was a great need for halfway hostels where such men could live, where they could be together and could share their common experiences. At the end of that debate the noble Lord, Lord Aberdare, was kind enough to refer to what I said and he ended by saying: I would only say that certainly this question is still under discussion and I know that what the noble and learned Lord has said this afternoon will be carefully considered. Some eight or nine months have now gone by and therefore I hope I may shortly ask what the result of that further consideration has been.

I feel the more justified in doing so because in the last few days we have had the report of the Aarvold Committee. The Aarvold Committee themselves point out a number of things that I have said. They say in paragraph 27: A most critical decision which has to be taken about a mentally disordered offender is that regarding his discharge from hospital. At this point he loses the support of institutional care to which he may have been accustomed for many years, and usually has to face competitive economic and social pressures for which medical treatment may not have been able to prepare him fully. Then, dealing with the process of discharge, in paragraph 39 they point out that in the local National Health Service hospitals there is a gradual process of rehabilitation, starting perhaps with short recreational outings under escort and proceeding by way of leaves of increasing length and, where appropriate, outside employment". They then go on to point out that that does not happen in the special hospitals and they say: It seems to us that only if there are strong arguments for doing so should a patient be discharged direct from a secure special hospital to his family or to casual lodgings. As a first step the patient should preferably go either to a local hospital or to a hostel for an initial period". We have been told that in some parts of the country hospital accommodation is at a premium. The recommendations go on to suggest, first, That a patient leaving a special hospital should wherever practicable go first to a national health service hospital or a hostel for an initial period of rehabilitation. We regard this as of particular importance in the case of patients requiring special assessment". The second recommendation is That the process of transition from the secure hospital to the community should in all cases be as gradual as possible and to this end discharge should not be completed until all who will be concerned with continuing care have studied the case fully and are satisfied with the arrangements". I venture to think that those conclusions of the Committee very much fortify what I, in a much more ignorant way, had been trying to say in that debate, and I should be very grateful if the noble Lord, Lord Aberdare, can tell me what further conclusions may have been come to in the last nine months.

4.50 p.m.


May I say one word before my noble friend the Minister answers the noble and learned Lord? One of the greatest difficulties is the fact that if a patient goes to a legal tribunal and is discharged, he has to be discharged at once. If one is discharged by medical people and others like that one may have time, but if it is a discharge by the legal tribunal there is no time. In the particular case of Broadmoor, I know the social workers there very well and they do not have the facilities for finding accommodation for the patients who are discharged as quickly as that. I do not know which way round it goes or how it should be altered, but I know that these social workers have the utmost difficulties on that particular point. I have often talked on this subject to the physician superintendent at Broadmoor. He cannot change what has been laid down by the Department. I should like to support the noble and learned Lord, Lord Gardiner, when he says that something else must be thought of. I go to Broadmoor a great deal and I know not only patients there but also many of the medical staff and the social workers, and I know that they are in very great difficulty. I hope that my noble friend the Minister is going to be able to do something to help in the discharge of patients from the special hospitals.


I should like to follow my noble and learned friend and the noble Lady in pressing this case of aftercare which, significantly, we have been able to get into the Bill—because it is entirely ignored—only by attaching it to a permissive clause for building more special hospitals, a matter to which I shall come in a minute. It is ironical that it was about fifteen years ago that Mr. Peter Thompson, the gentleman to whom my noble and learned friend referred, together with my noble friend, Lord Longford, started a committee to investigate the question of aftercare for discharged prisoners. Now, after fifteen years, a little—not a great deal but a little—has happened in that direction. It has been nationalised, which is very proper, and it is beginning to become effective. The need for aftercare for mental patients was, of course, just as great then as it is now, and this friend of ours, Mr. Peter Thompson, is, curiously enough, at this very minute organising a committee of exactly the same kind to look into the question. I believe he has the money to start it and something will come of it. I feel, however, that it is rather dreadful that we should have to wait for private individuals, who in this case have themselves suffered bitterly from the system, to start work of this kind which we all know is required. There is not a single person in the Service who does not know that more aftercare for mental patients is required.

If your Lordships read the excellent Report by Sir Carl Aarvold you will find that he talks as if there was such a system. He talks about a team which has to look after these people (and he suggests that there will be some hundreds of them) that have to be specially considered before they can be easily freed. There is no team. There is not only no team but there is no sign of such a team. Often the outside man responsible for these people will be a probation officer with a load of 60 or 65. With that kind of burden how can he look after the man who is potentially dangerous? It does not make any sense at all, and I hope that in spite of the fact that this subject is significantly omitted from the Bill we can persuade the Minister to include it, because it is a very important part of the reorganisation of the National Health Service.

May I say one word about the stage behind this? Clause 40 is a permissive clause giving the Government the right, which they have had for the last thirty or forty years, to build special hospitals. Neither this Government nor any other Government have built any for about thirty or forty years, and if one talks to people in the business one finds that the situation is terrible. I remember that six years ago Dr. Rollin, who runs the Horton Mental Hospital at Epsom, gave evidence before Lady Reading's Committee, of which I was a member, and said words to the effect: "I am in desperation. I am trying to run a rehabilitative mental hospital, looking after people who are sick and giving them every advantage and help to get well, but I have to lock up my corridors because I am given people whom it is not safe to have walking about." I rang him up the day before yesterday and asked how it was going, and he said, "It is worse than ever it was." I then talked to Dr. Grey, who is the medical superintendent of Grendon Prison, near Aylesbury, and he said—a fact which I knew already—"My whole work of dealing with people who are really criminal is made impossibly difficult by having people who are mentally so disturbed that they do not react to the ordinary sanctions." So both the Prison Service and the Hospital Service are shunting these people out as fast as they can.

This clause reaffirms the permission which the Government have had for many years to build these special hospitals. We must ask the Minister to give us some indication of ministerial thinking on this matter. To wait for the Butler Committee is not a satisfactory answer. That Committee has to go into a lot of very deep matters. It takes a long time to build special hospitals and we must have some assurance that they are going to be built. This point goes fairly deep. The special hospital has to be a hospital and not a prison, because a prison is a place which keeps people in and a hospital is a place which tries to get people out, and there is an enormous psychological difference. Therefore, in so far as we must have secure buildings for people who are dangerous and liable to be delinquent, it is far better to have them in the form of a hospital than in the form of a prison. People can be sent there from a mental hospital which at the moment finds it difficult to get them into one of the special hospitals because they are so crowded. If there were enough hospitals, people who are dangerous could be sent there without difficulty. Prisons which have people who seem to be psychotic can send them now under Sections 17 and 72—or whatever it may be—of the Mental Health Act, and this should be made easier. I believe that they ought to go direct from courts. The police have the right to send people to hospital but they rarely exercise it. The new bail hostels which are being set up are perfect places to examine people who are in difficulties and suggest that they would be much better in a place that was secure rather than in a place that they can get out of. I hope that we can have some indication from the Minister that this extremely difficult, and in many ways dangerous, position is being treated seriously and that if not to-day then in due course we may expect something constructive from the Government on these lines.


I am interested that we are able to have this short debate on the aftercare of patients from mental hospitals, but although the noble Lord, Lord Donaldson of Kingsbridge, seems to indicate that the Bill is at fault in not having made mention of this extremely important subject. I would suggest that it is he who is at fault, in that this Bill is to reorganise the National Health Service to provide a new administrative set-up for it, and does not affect policies of this sort. But, that said, I am glad that the noble and learned Lord, Lord Gardiner, initiated this short debate, because it gives an opportunity to mention a subject which, I absolutely agree with all your Lordships who have spoken, is of extreme importance.

The noble and learned Lord, Lord Gardiner, began by mentioning again some of the points that he had made on a previous occasion. The first one was on the subject of the discharge, the rather sudden discharge, of mental patients from the special hospitals, and I think my noble friend Lady Ruthven of Freeland gave a very intimate sidelight on what happens in these cases and the difficulties that are sometimes presented. The first point I should like to make is that in fact 90 per cent. of the patients from the special hospitals are discharged to other psychiatric hospitals. As the noble and learned Lord mentioned, that was in the Report of Sir Carl Aarvold and his colleagues, which recommended that this was the right way: a steady progression from a special hospital into an open hospital and thence back into the community. As I say, 90 per cent. of the patients do go to other hospitals.

In the case of the other 10 per cent. who are discharged into the community, the social workers at Broadmoor, for example, and indeed the other special hospitals, take the utmost care possible—I am sure my noble friend will agree—to make sure that in the community to which they are going there is the possibility for them to find somewhere to live and the possibility to find some work for them. Where the Mental Health Review Tribunal is concerned there can be the difficulty that my noble friend mentioned, that nobody can foretell what view the Tribunal is going to take; and if they do discharge somebody immediately he is free to go he packs his bags and is out. This does not give the social workers the chance to make proper arrangements to make sure that he is all right when he does get out.

I would mention that these tribunals have a power, which in our experience they frequently use, to adjourn consideration of a case to enable further social reports, on the availability of suitable accommodation and so forth, to be obtained. I can only think—I have no reason for saying this other than an intelligent guess—that in the case of Mr. Peter Thompson they did know that probably he had many friends who would look after him on his discharge. There is this possibility open to the Mental Health Review Tribunal. However, there is the difficulty, as I have said, that the person can leave the hospital rapidly, and this does not give the social workers the chance that they would otherwise have.

So far as the name "Broadmoor" is concerned, we have considered this very carefully, especially after the noble and learned Lord raised the matter on the last occasion, but my right honourable friend is not convinced of the merits of making a change at this stage. One wonders how effective it would be. I am sure the change of name would attract a great deal of publicity and no doubt everybody would come to realise what the new name was, but I do not know whether it would really be as effective as one might have thought at first sight. Certainly there may well come an opportunityy, when Broadmoor itself is rebuilt, to make a change.

The noble Lord, Lord Donaldson of Kingsbridge, mentioned the question of building special hospitals. As I think he knows, it is our intention to build a fourth special hospital. I can tell him that the planning is now very well advanced, and I hope we shall be able to make progress with that. The last point that the noble and learned Lord, Lord Gardiner, made, as did the noble Lord, Lord Donaldson, was on the question of the half-way house. We are as anxious as anybody to see better provision in the community for people discharged from mental hospitals. On balance, we think it is better to provide these generally for those people coming out of mental hospitals, rather than provide special half-way houses solely for those from the special hospitals, because this again might become associated with the special hospitals and not quite such a generally acceptable type of community provision. But certainly we are encouraging the local authorities to develop their hostel provision, and we hope in the future, following the recommendations of the Aarvold Report, which, of course, only covered restricted patients, for a progression so far as possible from the special hospitals to the psychiatric hospitals and thence into the community. I hope that I have answered all the points that have been raised. I can only re-emphasise that we attach very great importance to the aftercare.


Before we finally close this debate, in view of what the Minister has said about re-building special hospitals and so on, I wonder if he could tell me whether the Department has any special plans for young people. I am told by people who treat psychological disorders in adolescence that it is extremely difficult to find a psychiatric hospital which at the same time has provisions for controlling young people who really are a danger to the community. It is not a subject I know much about myself, but I should like to know whether the Department is interested.


I think the noble Lord is referring to the provision of secure accommodation for young people, and this is very much in our minds. We already have one junior centre, the St. Charles' Youth Treatment Centre at Brentwood, Essex, for the very disturbed young person. Two more are planned, and we are also hoping to provide increased secure provision generally in the new community homes or the present approved schools.


Before we finally leave this point, may I say that one of the great problems here is surely that of staffing. I was interested to hear my noble friend say that there are plans well ahead for the building of a new special hospital. I do not know whether he can say where the hospital is likely to be sited, because there are areas of the country which are a long way from the present four special hospitals which we have in England and Scotland. Therefore, if people are going to be transferred locally there may be some difficulty in some areas in finding a local place. We read of these special hospitals, like Rampton and Broadmoor and so on, which are desperately understaffed and overcrowded. Surely, one of the great problems in effective rehabilitation is being able to match the security which is necessary with the therapeutic treatment which is equally necessary; we must recruit more staff. I wonder whether in this connection my noble friend can say whether plans are going ahead in this particular sphere.


Before the noble Lord replies, perhaps I may raise one small point. First of all, I agree with him strongly that hostels should not be restricted to the restricted patients but should be open to all people from mental hospitals. That is an important point. Secondly, it is going to be quite impossible to carry out Sir Carl Aarvold's recommendations without allocating extra resources. I want the Government to realise this. To have teams of people properly looking after 400 or 500 people, who are being released at risk, involves a lot of money. It cannot just be added to people's duties at the moment, and it is very important that that should be taken into account.

May I make one last point. The Minister says—and this I knew—that there are advanced plans for the provision of one further special hospital. If they exist, could the Minister let me have the figures which suggest that this is satisfactory? I should have thought, without having any figures, that if you made a careful examination of the number of people that were at risk both from the Prison Service and from the mental health hospitals, you would need four or five additional special hospitals. I should like to know whether there are any facts on which that can be based.


I should not like to enter into too much of a debate on these particular facts, because, although noble Lords were kind enough to give me some notice of the points that were going to be raised on the Question, That the clause stand part, they are not really relevant to the Bill. I will certainly see what I can find for the noble Lord, Lord Donaldson of Kingsbridge. In answer to my noble friend Lord Auckland, the fourth English special hospital at the moment is planned to be nearby Moss Side. Of course, it is perfectly true that there is overcrowding at Broadmoor, and one hopes that the provision of better and more hospitals, by reducing the overcrowding, will not only make the treatment of the patients easier but will also enable us to recruit more staff.

Clause 40 agreed to.

Clause 41 [Nursing homes and mental nursing homes]:

5.11 p.m.

LORD ABERDARE moved Amendment No. 116A: Page 38, line 37, leave out paragraph (d).

The noble Lord said: I beg to move Amendment No. 116A, and I should like to speak also to Amendments Nos. 116B, 126B and 129A. The purpose of this group of Amendments is to maintain the present statutory position concerning the exemption of Christian Science nursing homes from registration under the legislation governing nursing homes. Section 193 of the Public Health Act 1936 enables the Secretary of State to exempt from registration as a nursing home a home carried on in accordance with the practice and principles of the body known as the Church of Christ Scientist", on condition that an exempted nursing home should adopt and use the name of Christian Science house. Parliament inserted this provision because Christian Scientists seek healing through prayer, and the use of medical means and methods is contrary to their religious convictions. They may, however, need practical nursing care, and if it were not for the specific exemption in the 1936 Act their nursing homes would require to be registered even though by their nature they could not comply with the medical requirements laid down for what one normally considers to be a nursing home.

The present Bill provides for regulations to be made exempting nursing homes of particular descriptions. This was framed solely with the Christian Scientists in mind, and it was intended to use the power in their favour. We have, however, received representations from the Christian Science movement that the more explicit provision contained in the 1936 Act should be preserved. While I can assure them that there was no intention to alter their position in practice, we appreciate their desire to retain the present specific statutory exemption for their homes, and that is the reason for these Amendments. I beg to move.


May I take this opportunity, not to comment in substance, but just to say that I have been in touch with the people who have discussed the matter with the Minister and his Ministry, and I know that they would like me to express their very great appreciation for the patience, consideration, and understanding shown by the Minister and his officials in this matter.

On Question, Amendment agreed to.


I beg to move Amendment No. 116B.

Amendment moved— Page 39, line 34, leave out ("and 193 to") and insert (", 194 and").—(Lord Aberdare.)

On Question, Amendment agreed to.

Clause 41, as amended, agreed to.

Clause 42 agreed to.

Clause 43 [Miscellaneous functions of Secretary of State]:

5.15 p.m.

LORD GARNSWORTHY moved Amendment No. 117: Page 40, line 39, leave out subsection (2).

The noble Lord said: I beg to move Amendment No. 117. Clause 43 deals with the miscellaneous functions of the Secretary of State, and subsection (2) authorises him to permit, for the purpose of private practice, the use of facilities available at accommodation provided under the National Health Service. The White Paper, in Section XVIII, paragraphs 166 and 167, sets out the general views of the Government on this point. I feel that it would not be proper that the issue should pass without consideration, and indeed challenge, for there is a very considerable body of opinion, inside and outside the Service, that is opposed, in principle and in practice, to exploitation of a public service for private gain. Inescapably, the intrusion of private practitioners, whether medical, dental, pharmacists, opticians, or anyone else who is given access to the facilities of this publicly provided service, gives rise to justifiable concern as to standards and priorities.

Let me at this point place on record the view that the Service itself should employ directly all the specialists and all the staffs necessary for manning the establishments essential for the provision of comprehensive treatment in all fields of medical care. The White Paper, in paragraph 166, says: The Government recognises the contribution made by the private sector of medicine to the sum of health care, through a wide variety of private hospitals, nursing homes and other institutions and through individual practitioners. That statement is, I suppose, a recognition of the obvious. The paragraph continues: It"— the Government— thinks it right for people to have an opportunity to exercise a personal choice to seek treatment privately. Within reason, I have no wish to deprive anyone of that freedom. I should wish them to have the opportunity to exercise it, providing that it does not at any point conflict with the public interest.

I come to the next sentence: The existence of facilities for private treatment, both within and without the NHS, provides this opportunity. It is here that the obvious and the acceptable no longer obtain. It is one thing to have private treatment provided without the National Health Service; it is quite another to have it provided within that Service. Why should the public sector support and perhaps subsidise the private sector? If there are those who wish to have private treatment, what is wrong with their obtaining it in private establishments maintained by the private sector? I want a National Health Service that offers to all the highest possible standards of treatment available on the basis of health need alone, and without any regard to a person's economic position. So far as possible, I want that Service to be staffed by full-time employees of all grades, directly employed by the Service in such numbers and possessing such qualifications and skills as will ensure those standards.

The idea of perpetuating private treatment within the National Health Service is seen as a possible jeopardy of the very idea of priorities for admission, and a failure to ensure that standards are related solely to the health condition of the patient. Inevitably, when patients can be accommodated in private beds there is suspicion that in many cases private patients get priority other than on grounds of urgency. Therefore the presence of private patients in our State hospitals gives rise to suspicion that there are two standards of attention.

Let me here pay tribute—and unstinted tribute—to those who do such magnificent work in our hospitals. Over the years, I have been in many different types of establishments, visiting patients, and the credit due to dedicated staffs is quite immeasurable. Some have worked, and still to-day work, under conditions which are the inheritance of an outmoded past. Others rightly, work in an environment which is the product of modern concepts and of recent creation. In the less good establishments I have not seen much evidence of the private patient; but, be that as it may, I believe it is not to the credit of the National Health Service that there should at any point be grounds for suspicion that two standards obtain in the same building.

It may be claimed that the private patient pays for the privacy and for the seeming advantages that follow from that privacy, and that, anyway, the room would be unused if it were not so occupied for private use. I doubt whether the private sector subsidises the public sector in this field. Possibly the position is rather the reverse: that if there is any question of subsidy the public sector does the subsidising when it is used by the private sector. I doubt very much whether private treatment within the public sector is as expensive as private treat- ment wholly within the private sector. Also, I have the feeling that the list of those awaiting admission to hospital is sufficiently long to make full use of the beds available, and, perhaps more particularly, of the staffs available to man the beds.

I myself had experience some years ago of attending what was then my doctor's surgery. On the first occasion that I visited it I was somewhat horrified to discover that he had two entrances, one for National Health Service patients and another for private patients. It is little use anyone telling me that the reception was the same behind either door. I know that it was not, because when the doctor saw me on the National Health Service side he invited me through to the other side, so I had a pretty good insight into the different standards of treatment available. Of course that was a case of a doctor exercising his right to maintain a private practice, even though he was engaged in the treatment of National Health Service patients; but suspicion must run throughout where there are those who pay and those who take as of right what the Service has to offer. I imagine that many of us are aware of patients who have been told of the difference between going into hospital as a private patient and waiting in the queue as a panel patient; one has heard of too many cases of that kind in the past.

Shortly after this Bill was issued, the threat of a first-class storm appeared on the horizon when there was a report in the Press regarding a takeover bid by an American company, which was said to be seeking to expand private patient facilities in our National Health Service. I stated a little earlier that I have no wish to deprive anyone of the freedom to choose private treatment, but not—I want to state most emphatically—at the expense of the National Health Service. So I find myself alongside people like Dr. Hugh Faulkner, secretary of the Medical Practitioners' Union, who, if Press reports are accurate—and I believe they are—regards proposals such as those recently advanced by American Medical International Incorporated as being immoral and threatening, as he is reported to have said, to cream off doctors and resources for the benefit of the few. The paragraphs in the White Paper to which I have referred give rise to much concern. They would seem to encourage those who seek to exploit illness for private gain. They have been seen as an encouragement to people like American Medical International Incorporated to go ahead with their proposals to seek advances of the kind that were so recently reported in the Press.

I am proud of our National Health Service, and I believe it to be infinitely superior to what they have in the United States of America. With regard to the economic consequences to the people who go into hospital in America, as compared with those who go into hospital here under our National Health Service, I believe that our position in this country is, if one may use such a term, supremely superior to what they have in the United States. I certainly want to see no Americanisation of the Health Service in this country. I want the Service to become close to the original concept of a National Health Service. I, and those who think like me, wish it to be a Service wherein priorities are based solely on health needs. I want to see it as a Service where priority cannot be purchased: it has to be deserved; it has to be needed and really merited.

With regard to caring for those in need medically, I am a believer in the religion of priorities. I see the continuance of the private sector within the National Health Service as a threat to those priorities, and as an undermining influence on that religion. I trust that in moving this Amendment I have not been unduly provocative; and I hope that your Lordships may be persuaded that this is an issue which should be taken seriously, and that the National Health Service would be the better and would be placed above suspicion if there was no question of anyone being able to purchase priority of admission or better conditions of treatment than anyone else. I beg to move.

5.30 p.m.


There is a side of me which, in some kind of perfect egalitarian world, agrees with all the ideals which the noble Lord, Lord Garnsworthy, has put before us. But, unquestionably, that world does not exist and I think it would be a very bad day for British medicine if everybody was employed full-time in the Health Service. I speak as one who was originally a physician in private practice but who later became a professor of medicine and saw no private patients at all; so to some extent I can see both sides of this situation. I know, in the present state of society, the enormous educative effect that private practice has. You are challenged by somebody, perhaps of your own intelligence and status, or better than your own, in a way that you are not challenged by people who are doing more day-to-day manual work and that kind of thing. They do not ask you the same questions. I think that most of the best specialists I could recommend to any one of your Lordships to-day—most of them: I will not say all—are people who spend part of their time in private practice, and I think it would be a great pity if there were no facilities for them to do so.

Quite apart from those in the medical profession, I think that, so long as there is a world in which people are not equal, either in monetary resources or in other capacities, there are people who want certain amenities. What I have always hoped is that they do not buy priority to the detriment of somebody who is getting treatment entirely under the National Health Service. On that point, of course, I entirely agree; but I think there are amenities which it is possible to buy. There are people who have more money to spend and a position in life to uphold; people who go to better and more expensive shops when they want clothes, or something of that kind, and I see no reason why such people should not have some of the conditions which one expects in private practice.

I hope that this clause is not going to be the beginning of some Americanisation of the Health Service in this country, because I believe that that would be absolutely disastrous. If I thought that that was what this provision meant, then I should very strongly support the Amendment. But I hope it is not. The fact is, of course, that medicine nowadays is so complicated. If we agree that there should be a private sector, and if I go to a specialist, say, and need certain treatments or certain complicated radiological examinations, the fact is that they cannot always be provided in a nursing home. It may be that in a place like London, which has a great many, rich foreign visitors and so on, it is possible to run a place with such facilities; but very few places can. Certainly it could not be run, I am sure, in a town the size of, say, Bedford or Derby. So if you are going to treat private patients at all, you find yourselves compelled to make some kind of use of facilities which are primarily provided by the Health Service.

I think that perhaps the words of which we are in danger of losing sight are, on such terms as the Secretary of State may determine". I should like to hear from the Minister—and I hope I shall—that there will be no question of one sector subsidising the other, and that the terms which the Secretary of State will determine will be the use of certain beds which have been put aside for private patients, the use of laboratory facilities and, to a limited extent, perhaps, the use of X-ray facilities when necessary, for which I assume a fee would be exacted. It is a great advantage if doctors who are in private practice can have their consulting rooms as near to the hospital as possible, and if possible within the hospital; and, of course, there are many hospitals in which it is possible to have the use of consulting rooms for a fee, where private patients can be seen quite separately from the rest of the hospital.

I think we need to preserve this arrangement, and I can assure the noble Lord, Lord Garnsworthy, that the advantages are not by any means always on the side of the private patient. I know private wings of hospitals in which there are continual complaints, especially of the nursing, unfortunately, and where the private patients ring bells 20 minutes before anybody comes anywhere near them, whereas in a ward where there are many other people that kind of thing cannot happen. Sometimes, too, the private wing or the private nursing home lacks facilities that can be found in any good hospital. So I am somewhat divided in my mind over this Amendment because I want the best for the National Health Service and its patients, but I believe that in the present state of society, which I think will always be the state of society, there is room for the two types of practice to continue.


Before the Minister replies I should like to tell your Lordships a little story. At Queen Mary's, our children's hospital, not long ago we had a private patient, a little Greek girl, with hydrocephalus, which is water on the brain. Her mother could not speak a word of English, but she was so deeply grateful that she learned two words, which were, "England, good—England, good". We managed to get hold of a priest of the Greek Orthodox Church to help her out with the language. That child has now gone back to Greece, and we hope to great success. Our consultants give a tremendous lot of their time to the health of this nation. In our children's hospital we have only five beds open to private patients, and they have been of infinite value to people coming from abroad who would otherwise have had to come on the chance of getting a bed. I trust that this will not be taken any further, and that my noble friend will resist this Amendment.

5.38 p.m.


I rise to give support to the Amendment so ably moved by my noble friend Lord Garnsworthy. Some of us have very long memories, and we can go back into the past and well remember the tremendous battle that took place in relation to the introduction of the National Health Service in this country. The noble Lord who has just resumed his seat gave as an example the service that was rendered to an unfortunate child from another country. All this amounts to is reciprocity. If the facilities which operate here operated in other countries, to which many of our people go on holiday, so that they were not faced with tremendous hospital bills as a result of illness during the course of their holiday; if there were that sort of reciprocity by some form of association between nation and nation, then this situation would not arise. This is one aim that the Ministry of Health ought to be striving for; and during the course of our Administration we endeavoured to get more reciprocity, as we did even during the period when Mr. Kenneth Robinson was in office as Minister of Health.

If the Government reject this Amendment I can see a return to what happened before the National Health Service came into operation. Many of the hospitals in this country would never have been able to function at all if it had not been for the voluntary contributions that used to come through flag days, and so on, and also the contributions that used to come from hard-working men and women within industry. I can quote the case of my own county, and of the colliery that I came from. Because of the amount of contributions we made to benevolent organisations, the deductions noted on our pay packets were such that we used to say in those days, "I would rather have what is on the 'off-take' side and take that home, than the gross wage". Because of our contribution to the R.V.I. in Newcastle some of us were made governors of that particular hospital. The hospitals of those days would never have been able to operate had it not been for the voluntary contributions made so willingly, not only from employees but also from industrialists themselves, up and down the country. We must bear in mind that each of us, irrespective of his standing or station in life, is an integral part of a great nation. Therefore every member of society has a right to equality of treatment and opportunity, and for such succour as we are in a position to give because of the policies we introduce and seek to pursue.

I listened with great interest to what the noble Lord Lord Platt had to say. He said that he had been a general practitioner, then a professor, and so on. He said that he was listening to this particular Amendment with great interest. As an independently minded man I must say that this pay-bed system is something to which we have been opposed ever since the Health Service came into operation. I sat on two hospital management committees before becoming a Member of Parliament. From that experience I know that we in this country have some of the finest young men and consultants in the profession. I sincerely hope, with the noble Lord, Lord Platt, that we never adopt the American system of operation. I know that at one time a number of people in the medical profession left this country because, so far as they were concerned, the capitation fees were not satisfactory. They had been giving their services to the noble cause of working within our hospitals; but there was some agitation among the medical profession within the Health Service because young people felt that they were not being allowed to reach positions in the profession to which they thought themselves entitled. This kind of thing always operates and always will operate. If we are to give way now, what is to stop this system spreading like an octopus—putting out its tentacles perhaps even into local government activities? It may be that sanitary officers, surveyors and architects with spare time on their hands will then take up forms of private practice alongside the practices and duties imposed on them by the local authorities. We have got to be careful about where we are going and what we are seeking to do.

One thing the people of this country will never forget. It is that the Tories voted against the Second and Third Readings of the National Health Service Bill. At election times the Conservative Central Office argument was that they did not vote against the principles of a National Health Service but only in order to make certain amendments and alterations to improve the Bill. But it must be said that once you vote against the Second Reading of a Bill, you vote against the Bill as such; you vote against a National Health Service. The Tory Party of to-day is not in that position. They believe in the Health Service because of the work it has been able to accomplish in the past. In fact, we have had some good Ministers of Health from the Tory Party. I can think of one who, if he had not been sacked would have been one of the best Ministers of Health ever produced in this country, so far as the Tory Party is concerned. At the moment he happens to be the Father of the other place.

I make my speech extemporaneously, not from notes, allowing my mind to operate in the best way it can in difficult circumstances and it gives me pleasure to support my noble friend in the Amendment that he has so ably moved. We sincerely hope that the Minister will not fall for a form of extension of the pay-bed system. This could only generally injure those who are waiting for admission to the hospitals. I hope that noble Lords will give this serious consideration before making up their minds. Some of us remember that in the old days, if you had £50 in your pocket, you could get a bed in the R.V.I. and have special treatment immediately. But at the same time there were very long queues in the industrial centres of the North, queues of people who could not get into the hospitals—although they were paying pennies hard-earned at the coal face to keep the hospitals going. Now the hospitals belong to the State and the State has a responsibility. I hope the State is going to face up to that responsibility and see that the majority of the people, rather than the minority, of this nation are properly taken care of.


Before the noble Lord sits down may I ask him if he remembers what I remember: that the National Health Service was brought into fruition by Aneurin Bevan, who was not a member of the Tory Party? It was, I think, the intention of the Government of either colour to bring in the National Health Service; but it actually fell to the Labour Government of that day and it started with the private sector. I do not think that it has grown like an octopus. I know that there are always some people who will not play fair in any circumstances. I do not say that unfairness does not exist; but this was the way the Health Service was designed. I do not think it has been a calamity.


I agree with the noble Lord, Lord Platt, that Aneurin Bevan was the first Minister of the Health Service. That is true. Many of our people had their arguments, even with the Minister of Health on our side of the House, as to how the Service should operate in respect of the setting up of Regional Boards, management boards and so on. As the noble Lord, Lord Platt, knows, Aneurin Bevan at the time had a difficult battle with the medical profession to get the National Health Service into operation.


I do not wish to delay the Committee because there is a great deal of work to be done, but after listening to my noble friend I recognise that he has put the case very well. I would say to the noble Lord, Lord Platt, that the question before the Committee is not the one to which he addressed himself. He put the case for private practice and for a public service. He said that in his career he had derived much benefit from the fact that he had been in a position to practice as a physician privately and subsequently to have a public appointment. I agree with him that it must have been an interesting experience, from which he derived much benefit.

But the question before the Committee is not whether we should abolish private practice, or whether we should allow private practice to proceed with public practice. That matter has been accepted; the doctors felt that it would be injurious to them that their freedom should be taken from them. We recall the arguments advanced when the Bill was first introduced, about what would result if they were not allowed to practice privately. But that is not the question. The question which the noble Lord, Lord Platt, did not answer and which is before the Committee is: should the Government give doctors practising privately the opportunity to have accommodation in what primarily is a public institution; namely, the hospital?

I should like to hear the answer to that question from the Minister. So far as I am concerned if doctors wish to practice privately they may well do so. But I feel that the time has come when the people of the country will feel a little aggrieved if they find that accommodation which should be reserved for the public is, and will be under this Bill, offered to private practitioners.

5.53 p.m.


With respect to the noble Baroness, Lady Summerskill, I must make clear that the question before the Committee is not: should the Government give doctors accommodation in hospitals? The effect of this Amendment would be to prevent the Secretary of State from making available to doctors facilities for private treatment in health centres and similar institutions.




But not in hospitals, although this is a much wider question. I should like to confirm to the noble Lord, Lord Platt, and other noble Lords who have mentioned the matter, that the Bill in no way changes the present situation. As in so many other cases that we have been discussing, the Bill merely repeats the present powers of the Secretary of State, in this case the powers relating to private practice. The second point, which is a curious one, is that not only were the origins of the National Health Service in a measure put forward by Members of the Party opposite, and especially, as has been mentioned in the debate, by Mr. Aneurin Bevan, but also the legislation now governing private practice was introduced by the Party opposite.

The treatment of private patients in hospitals and the powers conferred on the Secretary of State to authorise facilities and to determine charges are governed by Sections 1 and 2 of the Health Services and Public Health Act 1968, which was in the time of the last Government. This Bill does nothing to disturb those powers. So the powers of the Secretary of State so far as concerns private practice in hospitals remain as they are at present. Therefore to some extent we are going rather wide of the present Amendment in discussing private practice in hospitals.

I think it would be less than courteous to the noble Lord were I not to say a word in reply to what has been said to-day; although I think the remarks of the noble Lord, Lord Platt, who has such wide personal experience of the medical profession, gave most of the answers to the noble Lord. He did not dispute the existence of private practice, nor did the noble Baroness, Lady Summerskill. What I think is in dispute is whether facilities should be made available in National Health Service hospitals.

The first point which I am sure is well known to your Lordships—although I do not think it has been specifically mentioned—is that in respect of urgent cases, which are treated straightaway on their merits, there is no discrimination between private patients or non-paying patients. I am sure that all your Lordships who have had the misfortune to suffer any kind of accident would willingly bear me out. The second point I should like to make is that the privilege of a private patient is to choose his consultant and to pay for a private room. But when it comes to the cost of this to the Health Service I can assure your Lordships that he pays the full economic cost. This is reviewed annually and those of your Lordships who have seen what are the charges in the National Health Ser- vice hospitals will be sure that it is the full cost. A great many private patients grumble and disbelieve that it is the full economic cost, but certainly it is. The private patient is paying his tax which supports the National Health Service just as much as any other patient.

This really is what I should like to say in answer to the noble Baroness. I think that one of the advantages is that the consultant has all his patients together in one hospital. I am sure that the Committee will know many eminent consultants who are thereby able to spend a great deal of time in the hospital and may very often spend more time with the National Health Service patients than with private patients. Certainly in London where travelling is difficult, there are great advantages if the patients are in one hospital. In general, I would say that we believe that there are great advantages in allowing private practice as it always has been allowed and we have no intention of changing the situation. The Bill will make no difference whatever to the present situation, nor is there anything sinister to be read into this clause. It is merely a repetition of the present powers of the Secretary of State and he will continue to exercise his powers responsibly, as he always has. Of course private beds have to be authorised by him and there is no intention of affecting the present Service.

I should say a word about the effect of this Amendment. As I have said, in respect of private patients in hospitals governed by the Health Services and Public Health Act 1968 the effect of this Amendment would be to deprive the Secretary of State of the power to permit family practitioners to provide services under the National Health Service from accommodation provided by him, which in most cases is health centres, and also to use these premises for private practice. There are many services which these practitioners can offer to patients and for which there is no reason why they should not make a charge. For example, examination for purposes of insurance; for employment reasons; innoculation for overseas travel; certain items of general dental treatment; the sale of some common household remedies for which no prescription is necessary or the provision of private spectacle frames. It would cause considerable inconvenience to the public if they could not obtain these services in the premises where they get their National Health Service treatment. These are powers which for general medical practitioners have existed since 1949 but the power to permit the other three types of family practitioners to undertake private practice from publicly provided premises dates also from 1968 in the Health Services and Public Health Act of the last Government.

I think noble Lords opposite will realise that there are great advantages in allowing general practitioners to give these services in health centres and publicly owned premises. It is not contemplated that the Secretary of State would wish to permit private practice on other than a limited scale. The intention is to continue to follow the two basic principles which are at present observed in dealing with requests for authority to practice privately at heath centres: first, that no person is permitted to practice privately who is not prepared to offer the full range of appropriate services under the National Health Service to those requesting them; and secondly, that those seeking advice or treatment under the National Health Service receive no less favourable attention than private patients. So I believe that there is nothing sinister in this clause. Taking it wider, and speaking generally of private practice in hospitals, this Bill will not in any way change the present position. I hope that with these assurances the noble Lord will see his way to withdraw the Amendment.


I raised the question of the bid of the American Medical International Incorporated for pay beds in hospitals and the matter of taking over a hospital or a considerable part of a hospital. The noble Lord gave no indication as to what the attitude of the Secretary of State would be to proposals like this. I appreciate that this bid came to naught, but it seems to me that this is a first-class opportunity for the Minister to make clear the Government's view on this matter and also on what the noble Lord, Lord Platt, and I referred to as the Americanisation of the National Health Service.


As I have said, I did not come along prepared to debate the whole of private practice in hospitals, and I apologise if I have not satisfied the noble Lord on all the points that he raised. As he rightly says, this particular bid did not even reach the Secretary of State; it was refused before it came to the Department. Therefore it is difficult for me to answer what is really a hypothetical question. However, I cannot imagine, with our present shortage of hospital beds, that there is ever likely to be any question of selling off part of an active and well-used hospital.


It is reassuring to have that reply from the noble Lord, but I think it would be even more reassuring if he could deny the report which I confess I was surprised to see in The Times at the beginning of the year, which said that the Department of Health is considering possible forms of co-operation between the public and private sectors of medicine. This was quoted as a statement from a Department of Health official. I will not read the rest of the quotation from The Times. It appeared in other papers as well, and caused real concern among those of us who are committed to a National Health Service of the kind that my noble friend Lord Garnsworthy described.


I am astonished that there should be any cause for alarm in any such statement. It would refer, I should think, to talks that my right honourable friend had with a number of charitable bodies that run private hospitals. This, I should have thought, would be eminently to the benefit of us all. The talks were most useful, and I should like to pay a sincere tribute to many of these organisations—a number of them are religiously based—who give an enormous amount of assistance to people requiring that sort of service.


I think the last words of my noble friend will give reassurance in all quarters of the Committee. We certainly do not want a specialised system of American medicine in this country. I am sure that, although there are some outstanding physicians in America, this is agreed on all sides. The point I want to make is that there are in the Bill the words, "as the Secretary of State may determine". This, as I see it, is the vital part of this clause. If there is a danger of National Health Service patients (I may say that my family and I are all on the National Health Service and receive excellent treatment) being left in the cold, so to speak, because private patients are receiving unreasonable priority in treatment, then this is wrong, and of course under this clause the Secretary of State may intervene.

Some of your Lordships may have seen a short time ago a programme on Panorama which went, rather slantedly I thought, into the whole question of private practice and the National Health Service. I believe that the region chosen was Birmingham. If my figures are correct, I think that something like 1.8 per cent. of the patients treated by National Health Service doctors and nurses were private patients. That, I think, is a fairly small number. It Is true that certain men patients prefer to be in a ward rather than a private room. I know people who have been in a private room as private patients who have not received the treatment for which they paid.

There is also the question of the pharmacist and the optician. I am not suggesting that National Health Service pharmacists are under-employed; far from it. There is a great shortage of pharmacists, and indeed of radiologists, in the National Health Service. But unless it can be proved that National Health patients are suffering delays through pharmacists being used exclusively by private patients, I feel that this Amendment, as drafted, meets the problem which noble Lords are seeking to remove in the clause.

6.9 p.m.


I should like to say, first, how grateful I am to the noble Lord, Lord Aberdare, for his seemingly unfailing courtesy in replying to the case that has been presented in support of this Amendment. I am sorry if he did not appreciate what I hoped the Amendment might achieve. It is difficult on this side to produce Amendments that when examined by those who are in the employ of the country do not prove to be faulty. Let me say right away that my Amendment, as I have been advised, would prevent the Secretary of State from allowing consultants et cetera from using National Health Service facilities for the purpose of private practice. It may have seemed to the noble Lord that I was going somewhat wide of the Amendment, but I do not think I went beyond that. In any case, if the debate has gone a little wide, I nevertheless think that a useful purpose will have been served because we have probably dealt with points in the clause on which it might have been necessary to put down Amendments.

Let me say right away that I believe we are still somewhat unhappy—or perhaps I should say dissatisfied—at what the noble Lord had to say about the bid by American Medical International Incorporated, because there appeared in The Times of January 2 the following Dr Stanley Balfour-Lynn, chairman and managing director of the Harley Street clinic, said the project was proposed after it had been found that cash shortage was delaying development in some private wings. He was commenting on a report that American Medical Internaional Incorporated wanted to take over and expand private patients' facilities in the health service. The Department of Health confirmed that Sir Keith Joseph, the Secretary of State, had had discussions with representatives of the clinic in 1971. That certainly gave rise to a good deal of speculation as to whether the Secretary of State had at any time contemplated movement into the National Health Service by the private sector in the way proposed by the American Medical International Incorporated. I want to say that we still have considerable misgivings and we should like to know beyond any doubt that the Secretary of State is at no time likely to accept proposals of this order.


I am very grateful to the noble Lord for giving way, but I have now perhaps a rather better answer for him than I had before. My right honourable friend replied in another place to Dr. David Owen, and perhaps I could quote his words: I met the Director of the Harley Street Clinic in April 1971 at his request to discuss ways in which private enteprise might collaborate with the National Health Service. One suggestion put to me was that the Harley Street Clinic might take over a private wing of a National Service Hospital, and develop it as a separate private hospital. I made it clear that I could consider such a proposal only if it came from the hospital board concerned and then only if it adequately safeguarded National Health Service interests and National Health Service patients. I have in the event received no such proposals. I have no plans for handing over National Health Service facilities for development by commercial companies."—[OFFICIAL, REPORT, Commons; 23/1/73, col. 79.] I am very grateful to the noble Lord for allowing me to intervene.


I am most grateful to the noble Lord and I trust he will appreciate that because of that reply there is still some concern as to whether we can rely on the Secretary of State always to resist in this way. It seems to me that the reply he gave on that occasion is not as clear or as definite as many of us would like it to have been. Nevertheless, I am extremely grateful to the noble Lord for repeating it here.

I listened with the greatest interest to the noble Lord, Lord Platt. He always gives your Lordships' House something to think about. But in this instance he has given others something to think about as well—I think he has possibly given those who might be inclined to go into private beds something to thing about, before they do so, because it indicates that advantages are not always on the side of the private patients. I hope I am not putting too liberal an interpretation on what he said, but I thought that here was a pretty good warning of: "Look out! you may not get value for your money." I hope that a great many people will take note of what he had to say. Certainly I did not at any point suggest that everybody should be employed in the National Health Service. The noble Lord said it would be a bad thing if everyone was so employed. I made it perfectly clear that I respect the right of people to use private practice and private services, but that I thought they should do so outside the National Health Service. I am grateful to the noble Lord for what he has said. If I had made the point that the advantage does not always lie on the side of the private patient, my word may not have been as cogent as his.


May I just make one point. A friend of mine, who is a consultant to a very well-known teaching hospital in London which has a dearth of accommodation, advises his private patients to go into a general ward because they will get in much quicker.


There you are. It seems to me that my Amendment would better serve the interests of those who think that they can buy something that is not available for them. May I say this to the noble Lord, Lord Grenfell: St. Mary's Hospital at Carshalton has done quite remarkable and outstanding work over the years. One knows of the tremendous support given by the noble Lord to that hospital. I doubt that this country could not make five beds available to people from overseas who desperately need the services of Queen Mary's. One appreciates the unique character of the hospital. One recognises its tremendous achievement and I think all of us would feel extremely sad if we thought that any child, no matter where it came from, if it needed the specialisation of Queen Mary's could not be given treatment without regard to ability to pay. I thought that my noble friend Lord Slater to some extent referred to that matter when he said that that could be dealt with on grounds of reciprocity. I am also grateful to my noble friend Lady Summerskill for what she had to say.

I believe the debate has served a very useful purpose. I have the feeling that we shall want to come back on this at Report stage. I have no intention of pressing this Amendment to a Division but I think it might be as well, if the Committee so desires, to negative it at this stage. I feel that this is a matter of considerable importance and that the Committee should allow its voice to be heard.

On Question, Amendment negatived.

6.19 p.m.

LORD ABERDARE moved Amendment No. 118: Page 41, line 11, after ("medical") insert ("or dental")

The noble Lord said: If I may, I should like to speak to Amendment No. 119 as well as to Amendment No. 118. These Amendments involve no change of policy but put beyond doubt our intention that the duty imposed by this clause should include provision for facilities for dental clinical teaching and research concerned with clinical dentistry. I beg to move the first Amendment.

On Question, Amendment agreed to.


I beg to move Amendment No. 119.

Amendment moved— Page 41, line 13, at end insert ("or, as the case may be, clinical dentistry"). —(Lord Aberdare.)

On Question, Amendment agreed to.

On Question, Whether Clause 43 shall stand part of the Bill?

6.20 p.m.


Without delaying the Committee for too long, may I say that I have noticed that when we were discussing the Amendment we forgot one word here, because it is not only accommodation that is needed, but facilities. Despite the excellent answer that the Minister gave about the use of facilities by the whole gamut of qualified people—surgeons, consultants, pharmacists, and others—I would point out that "facilities" is a big word in modern scientific medicine. I know of machines now that cost thousands of pounds, and I see them used nearly every day. They can make an analysis in a matter of moments, whereas the old practitioner, and even a highly qualified chemist, may have to spend days carrying out an experiment on blood counts. These can now be done in seconds on expensive machines. Consequently, when we are talking of facilities I take it that these machines would be available for the doctors to use. The relative words which qualify this are: … on terms as may be determined by the Secretary of State". Therefore, if expensive machines that had been paid for by public money were being used, and each time they were used the cost was high, the Secretary of State should see that, without being exorbitant, a fair price was being paid for them.

Despite our criticisms on both sides of the Committee, throughout the nation in a general way we are proud of the National Health Service, and I should like a statement from the Minister before we pass this clause that if any such fundamental change as the Americanisation of the Service were to take place, not just the Minister but Parliament would have the opportunity of debating and determining upon such a Draconic change in the Health Service.


This clause relates to general practitioners using health centres, and the chances of very expensive equipment being used there are rather less than they would be in hospitals. In general, there will be no change whatever from the present situation. So far as Americanisation is concerned, we have heard a lot about it in this debate. Our system is quite different at the moment, and will remain quite different. As my eldest son was in hospital in America very recently I am very well aware of what that system is.

Clause 43 agreed to.

Clause 44 agreed to.

Clause 45 [Notices of births and deaths]:


I beg to move Amendment No. 120. This Amendment is necessary to make the provision intelligible.

Amendment moved— Page 42, line 4, after ("to") insert ("be"). —(Lord Aberdare.)

On Question, Amendment agreed to.

LORD ABERDARE moved Amendment No. 120A: Page 42, line 15, leave out subsection (3).

The noble Lord said: The purpose of Clause 45(3) was to continue, so far as possible, the present procedure whereby local authorities are informed of the birth of children in their area. Section 203 of the Public Health Act 1936 provides that a person attending the birth of a child shall, within six hours of that birth, notify the medical offer of health for the council which is the welfare authority for the area. This requirement is additional to the requirement to register the birth, and is intended to enable the medical officer of health to arrange for a health visitor to attend the mother, and for the provision of any care which should be provided for the mother and child under Section 22 of the principal Act. With the abolition of the appointment of medical officer of health, the notification of birth would be made, in pursuance of subsection (2) of Clause 45, to the prescribed medical officer of the Area Health Authority. Subsection (3) would ensure that the prescribed medical officer passed the notification to the local authority through the director of social services. A review of the proposed procedure has suggested that notification so soon after the birth would not provide information of use to the director in identifying mothers of families at risk. About 90 per cent. of all births take place in hospital. Social services departments are not equipped to follow up all notifications of birth, and it has never been contemplated that they should do so; this would be the task of the health visitor at the instance of the prescribed medical officer of the Area Health Authority.

A statutory requirement on the prescribed medical officer to pass notifications of birth to the director of social services would be justified if it was necessary to ensure collaboration between the health and social services. However, the routine passage of this information so soon after birth would present the social services department with a volume of unprocessed information which might hinder, rather than help, them in the discharge of their duties with regard to mothers and young children. Close collaboration between the Area Health Authority and the local social services authority is essential, and social problems noted by social workers in the hospitals, by midwives and by health visitors, should be brought to the attention of the social services authority. On review, we consider that the procedure proposed in subsection (3) would not achieve this, but that the joint consultative machinery proposed in Clause 10 should ensure the development of a proper system of collaboration between the authorities. That is the reason why we are proposing to delete subsection (3). The Association of Directors of Social Services, the County Councils Association and the Association of Municipal Corporations have been informed of the proposal to withdraw the subsection and have raised no objection.

On Question, Amendment agreed to.

Clause 45, as amended, agreed to.

THE EARL OF ONSLOW moved Amendment No. 121: After Clause 45 insert the following new clause:


". An Area Health Authority or any Board of Governors of Hospitals listed in Schedule 2 to this Act shall have the authority to appoint such full-time or pert-time chaplains in the Health Service as they think fit."

The noble Earl said: This Amendment which I and my noble friend Lord Grenfell are moving arises out of a weekend that I spent with a friend who does great work for the Royal Marsden Hospital. She tried to "touch me" for some money for a fund she was trying to raise to enable that hospital to employ a chaplain. Surprised, I asked, "Does not the Health Service provide one?" She informed me that there was a circular in existence which limited the employment of chaplains to hospitals of 750 beds or more (I believe this is Circular 63/80). It would seem unnecessary to regulate the employment of chaplains on the grounds of numbers and numbers alone. The Royal Marsden is a hospital for cancer, with 214 beds. Several of those are doubtless terminal cases. Cancer still has a dread attached to it that no other fatal disease seems to attract. Perhaps I am being a little cynical, but the imminence of death tends to bring people slightly nearer to God than is their normal wont. Relations also need comfort and succour. The Royal Marsden Hospital have said that they regard a chaplain as, and I quote, "an essential part of the ward team". The local vicar, in this case the Vicar of St. Mary the Boltons, does all that he possibly can. He has an enormous parish whose spiritual needs he cares for, and thus cannot give all that is required.

In this Amendment we are not trying to force any religious creed down somebody's throat, or force a parson to the bedside of a dying atheist. There could be a hospital which is dealing with, say, 2,000 patients who are not nearly so seriously ill as those at the Marsden. Such a hospital may have a lesser need for a full-time chaplain than a hospital such as the Royal Marsden. This Amendment is designed to allow Area Health Authorities and boards of governors, whichever is applicable, to use their discretion as to their own needs. There is nothing mandatory about the Amendment; it is only permissory. Of course it will be assumed the decision would be taken only after consultation with the appropriate section of the Ministry and the Churches themselves. I beg to move.

6.30 p.m.


I rise to support my noble friend who has so eloquently made the case for the Royal Marsden Hospital. As he says, in the past it has been the rule of the Ministry that full-time chaplains would be authorised only when the hospital concerned had 750 beds of the denomination of the chaplain concerned. Is it not time that we in this reorganisation should cease playing the "numbers game" and really consider the character of the hospital and the real spiritual needs of the patients, and indeed the relatives and staff? My noble friend has described the needs of the Royal Marsden, and I wish to give your Lordships some indication of the needs of Queen Mary's Hospital for Children at Carshalton, which is in my group. In this hospital children come in at a few hours old for emergency operations for spina bifida and hydrocephalus, and we have emergencies such as road casualties and burns which come in at any time of the night or day. One can fully understand the need of the parents in their desperate circumstances for some form of spiritual care; and even if they are not active Christians they wish to talk to someone who is, although attached to the hospital, not (dare I say it?) of the establishment. Hence it is highly desirable that the chaplain should be available immediately, day or night.

The chaplain at Queen Mary's has four hospitals to deal with, with the help of an assistant chaplain, with special responsibility for St. Ebba's, the adult mentally handicapped hospital in the group. He is fully of the opinion that the whole of his time could be fruitfully spent among the patients, parents and staff at Queen Mary's, but as we have under 750 Church of England patients we cannot employ him full-time. A dedicated man in the Church simply cannot break off a conversation with a parent or child, as one sees it on television, by saying, "I'm sorry. That's all we have time for. Goodbye." The fact is that in some hospitals the chaplains are asked to do far more than they can possibly do, and I know they would all agree that the "numbers game" must cease and discretion be given to the Area Board, with the consent of the Ministry, to take into account the type of hospital and the needs of the patients and staff in making the decision as to whether a full-time or part-time chaplain should be appointed.

Maybe I should explain to the Committee that the duties of a part-time chaplain are usually carried out by the local vicar, who, after all, also has his own parishioners to look after and cannot be on call all the time. I know that the Chaplains Advisory Committee of the South-West Metropolitan Board, of which I am chairman, fully support this Amendment as it is a real step forward in the humane, spiritual treatment of patients. We have just given two examples of the urgent need for this Amendment. I feel there will be widespread endorsement of our action in moving it, so I trust that my noble friend will be able to accept it.

6.33 p.m.


I should like to say how grateful I am for the fact that the work of our chaplains has been brought into consideration because, with all the changes coming over the National Health Service, it is important that the chaplains should know where they stand. I have seen this work for very many years. In years gone by, when I was Bishop of Leeds, I was responsible for the chaplaincy services in the Leeds General Infirmary, and for a number of years I have been chairman of the Hospital Chaplaincies Council of the Church of England and chairman of the joint committee in which the Roman Catholics and the Free Churches and ourselves combine. I have noticed a very definite shift in the emphasis of the work. In years gone by it was perhaps quite frequently the duty of the chaplain to go into a ward and conduct a ward service. That may sometimes be done now, but increasingly the chaplain is finding that the way in which he is most appreciated is by visitation among individuals and going round to patients bed by bed.

It is obvious that work of that nature is highly time-consuming. This gives emphasis to the point that the figure of 750 cannot always be taken as a suitable yardstick in regard to whether or not a full-time chaplain should be appointed. In addition, the chaplain is finding his work very time-consuming because of the way in which anxious relatives are sometimes only too thankful to have him to talk to at a time of great stress. That again, is a reason why we hope that, whenever possible, a room will be available for a chaplain, so that he may have a place where he can conveniently interview people of that kind.

Another point that the Churches have frequently emphasised to the Department is the fact that the chaplain's work cannot be assessed simply by the number of patients, because such an assessment does not adequately take into account the chaplain's duty to the staff. I know that the Department, and the Ministry before them, have always said, "The figure is the yardstick and the work among the staff is taken for granted with the work among the patients." All right: I understand that. But the fact is that the staffs in our hospitals are now enormous; and, further, among our staffs, we have a great number of overseas nurses. I have served on the Birmingham Regional Hospital Board for many a year and, as I have said before now in your Lordships' House, in regard to some of the hospitals I do not know where we should be from the nursing point of view without that kind of devoted work that we receive from these people. Very often these nurses have not homes in these parts to go to. They need someone to help them, to care for them. I am not denying that the hospital authorities will do all they can. But, as was said just now by the noble Lord, Lord Grenfell, it is sometimes of help to these people if somebody who is not quite in the hospital hierarchy himself is there to assist. We are finding that our chaplains increasingly are having to give a great deal of time to work of this kind. So I would add my voice to this plea that the—I was going to say "almost sacred figure of 750" should not be taken in future as necessarily the yardstick.

Here I would pay tribute to my Roman Catholic and Free Church friends, who have said that they would support the efforts that we are making to see that whenever possible there is a full-time chaplain in the district general hospitals. These district general hospitals are enormous places, with enormous staffs, and the patients in them come from a wide area. For instance, in the hospital where I was visiting a patient only the other day, the local incumbent is part-time chaplain, and I have no reason to believe that he does the work, together with his curates, other than excellently. Nevertheless, as I looked at that colossal hospital I felt to myself, "Here, surely, is a place where there should be a full-time man." Of course I do not deny for one moment that for many a year to come the great majority of the work will be done by the part-time chaplains. Here, again, I would say how appreciative I am of the splendid work that is done by the parttimers—not merely those of the Church of England, but those of the Church of Rome and the Free Churches, as well. I would pay tribute to the partnership that exists between our Churches in this work because I have found it most exhilarating and encouraging. Therefore, as I have said, because a number of the hospitals will be smaller they will have part-time men; but what I would plead for is that we should not use this figure of 750 necessarily as always the yardstick.

I should like to be absolutely fair: and the fact is that the Department have not been quite so inflexible recently as used to be the case. I know of hospitals where the figure of 750 of a particular denomination is not reached and yet there is a full-time man. For that I am most grateful. But I also know of a case where there used to be a full-time man and where the auditors came along and said, "The number of patients has now gone down and the full-time man must cease." But that is the one case I know of as compared with several cases where the Department have allowed a full-time man, despite the fact that the figure of 750 was not reached.

I should be most ungrateful if I spoke this evening without paying a tribute to the way in which the Department have supported the chaplaincy work in the hospital service. Time and time again we have had really first-class support, and the fact that we have such a large training programme for our would-be chaplains and new chaplains is due entirely to the generous financial support which the Department have made available. What is particularly interesting is that the demand on the part of the clergy for these training courses is steadily increasing, and I think I am right in saying that we hardly ever have such a training course—and we normally have three a year—which is not over-subscribed. This shows that there is an increasing desire on the part of the clergy to equip themselves efficiently for this specialised work.

I do not deny for one moment that the great majority of the clergy will be deployed in the parishes. Certainly in my job I am always trying to get as many as I can into the parishes. But there is also room for a very definite, specialised ministry, and what the Churches are most anxious to do is to see that we make our contribution as well as we possibly can; and if that figure of 750 were always insisted upon I should say there would be occasions when we should not be able to do all we hope to do.

So I am most grateful to those who have drawn our attention to this matter this evening and I greatly hope that when the Minister replies he will give careful consideration to the points that have been made.


Before the Minister replies may I plead for support for this Amendment? It seems to me to be eminently suitable in one way which so far has not been mentioned: it is a decentralisation from the centre of authority to the local area, which is something we wish to see extended. As regards the actual proposal, I happen to have had a close relative in a hospital for many months and I cannot pay sufficient tribute to the work which I saw the chaplain in that particular hospital doing. It is not only the spiritual guidance and care for the patients, but he himself—and one assumes that the general body is as good as this man—is a dedicated man who can do so much for all the patients; and whether they be Christians or whether they be Humanists does not matter. He cares for them in his Christian way, and I believe that we in this House cannot afford to let pass an opportunity to give those who know best—the area people—the authority to obtain the services of men such as I have just mentioned and as the right reverend Prelate has just been speaking about.

6.45 p.m.


How very fortunate we are in this House, for every debate I attend I am impressed with the wealth of experience that is brought to bear on our discussions. I think this Amendment is a case in point. My noble friend Lord Onslow raised the matter, which had been brought to his attention and which he thought was a strong case. My noble friend Lord Grenfell, with great knowledge of the administrative side of the National Health Service, has supported it, and there are many other noble Lords here to-night—and I can see several on the Benches opposite—who have immense experience of this kind of thing. Then we had rising from the Episcopal Benches the right reverend Prelate the Lord Bishop of Lichfield, who himself turns out to be a hospital chaplain. That is the kind of thing which always rejoices my heart when I attend debates in your Lordships' House.

We are all concerned to ensure that the human aspects of this service shall be as good as we can possibly make them. I am sure it is unnecessary for me to add a word to what has already been said, and that when my noble friend replies he will show his sympathy for the points that have been made and will do his very best to meet them.


May I be allowed to support this Amendment as strongly as I can. It is quite unnecessary for me to say anything more in detail because I am in complete agreement with the speeches that have been made. I cannot say how glad I am that this point has been put forward, because I am quite sure that its acceptance is absolutely essential.


From this side of the Committee may I support this Amendment. I happen to have experience, in a case of long illness of somebody very close to one—a wife—of what can be done in a hospital, and also I know that in one mental hospital that I used to visit and that my wife still goes to, the lonely and the sick are given the kind of succour that they need through a meeting with a chaplain there.

Finally, I was delighted to hear the right reverend Prelate speak about special training for this type of chaplaincy. I am quite sure that this kind of contribution can make great human progress inside a hospital. I am delighted because in this arid, material world that we seem to be living in at the moment here is an opportunity for introducing—without counting the cost, which will not be all that much—a human note which shows that other things beside medicine can cure a man's soul.


I do not want to detain the Committee but I seem to be the only person present who has spent his life, almost, working in a medical field in a hospital and I should like to support everything that has been said in favour of this Amendment and to vote strongly in its favour, unless the noble Lord in his reply says that all this can be done without putting it into the Bill. So I just have that qualification for speaking and I should like noble Lords to know how strongly I support it. I have perhaps one other qualification, and that is as the "statutory atheist".


I think it is indicative of the priorities of your Lordships' House that this should have been the first Amendment tabled on this particular Bill. It was the first on the Marshalled List when it was tabled by my noble friend. I have certainly listened to what has been said with the greatest sympathy and with respect, if I may say so. The right reverend Prelate is typical of the very best of the sort of cooperation that we have from the Churches —himself a hospital chaplain and now a member of a Regional Hospital Board. We are indeed most grateful for this cooperation and most anxious to see it continue into the new National Health Service.

I can only say on this particular Amendment, as I believe the noble Lord Lord Platt, thought I might, that it really is not necessary. Already under the Bill Area Health Authorities will have discretion to employ such officers as they determine—this is paragraph 10 of Schedule 1 —subject to any regulations that may be made by the Secretary of State. But I hasten to add that these regulations will relate to remuneration, qualifications, manner of appointment, and so forth, and will not restrict an Area Health Authority in their appointment of chaplains, either whole-time or part-time.

May I say how glad I was to hear my noble friend Lord Balfour of Inchrye mentioning the importance of decentralisation in these matters. I am sure it is right that the responsibility should lie with the Area Health Authority. But as I say, they have it under the Bill already, and there are reasons why it is not very desirable to mention just one single category of staff whom they have the discretion to employ. It would certainly be inconceivable to list them all and, therefore, I should like to suggest to my noble friends that after I have spoken they might consider withdrawing this particular Amendment.

Although the discretion will lie with Area Health Authorities, we think it right that the Department should issue revised guidance for the new National Health Service and we are at the moment in consultation with the Churches on what that guidance should be. We have no desire at all to interfere centrally with the Area Health Authorities' freedom of appointment, but there are several reasons why we think it right that there should continue to be guidance. First of all, I believe that in many hospitals there is considerable advantage in part-time appointments simply because the chaplain will then be working both in the hospital and in the community. That is one of the aspects of the Bill that is very prominent. One of the objects for the Bill is to bring together hospital treatment and treatment in the community and in people's homes, and it would seem that there might well be advantages that chaplains should work both in the institution and in the community. The right reverend Prelate spoke of the district general hospitals and the need for a full-time chaplain there. That may be so. Equally, it might be more appropriate to appoint more than one part-time chaplain, should they be available, simply for the reason I have given, that the link with the community is very important to people who are coming and going from hospital.

The second reason we believe some guidance is useful is the fact that appointments of this sort have certain manpower implications for the Churches. I do not know what the right reverend Prelate thinks about this, but it could be undesirable if there were too many whole-time chaplains taken up with hospital work in an area where chaplains generally were short in the community. I repeat, in the last resort it will be for the employing authority to decide, after consulting their appropriate Church authority, whether there are circumstances which justify the appointment of a whole-time chaplain for fewer than the number of patients which may be in the advice that is given.

May I just say a word to my noble friend Lord Onslow on the subject of the Royal Marsden Hospital? I have the greatest sympathy with that particular case and it was one on which the Department were consulted. As my noble friend knows, they gave their view that, even taking into account the very special nature of this hospital, there was some difficulty in advising the Marsden to appoint a whole-time chaplain. The guideline of 750, as the right reverend Prelate has said, has often been breached, but in this case, I think I am right in saying, the situation was that there were about 150 patients of the Anglican faith; and one has to ask oneself whether it is right to employ one chaplain whole time to look after the needs of an average of about 150 patients. Is this in fact the best use of a chaplain's available time? I should not like to be dogmatic about it because I recognise, as my noble friend does, the very special situation at the Royal Marsden. But the advice we gave, after careful consideration, was that we thought that 150 was a bit on the low side. My noble friend has spoken to me about this and I shall certainly continue to talk to him about it, if I can be of help. I hope that, with my assurance that the powers lie with the Area Health Authority; with the caveat that we shall be issuing central guidance and that we are in consultation with the Churches on this, and that it would be rather awkward to mention chaplains when there are many other categories of staff whom Area Heath Authorities will be employing, that my noble friends will feel able to withdraw the Amendment.


Before we cease this argument, I believe I heard the Minister say that the Department would be giving advice on numbers. If they are giving advice on numbers, and the figure goes back to, or is incorporated at, 750, we shall be back where we started. I wonder whether the Minister would give an assurance that, if it is a question of numbers, the number will never be as high as that and that consideration will be given to the hospital rather than to the number of patients. Even if it is only the hospital, the number of patients and the staff, that would be of some help.


I did say that this revised guidance was under consideration with the Church authorities. I should not like to commit myself on exactly what the advised number will be. All I would say is that, as the right reverend Prelate has said, this number has been breached on occasions recently and that in future it will be a case for the Area Health Authority to consider very carefully the particular needs of the hospital in mind against the norm which we should hope to discuss and agree with the Church authorities.


Would the Minister make clear one small point? He suggested that this Amendment was unnecessary because powers already exist, and he quoted the word "officers". The point I should like to make is that some boards of governors, possibly even some Area Boards, might interpret the word "officers" in a narrow form and not realise that it does include chaplains. Would the Minister take steps to make quite clear, if he does not want the word "chaplain" put into the Bill, that the word "officers" would include chaplains within its terms?


Yes, I certainly undertake to make that quite clear.


I should like to thank everybody who has spoken far better than I, and with far greater knowledge than I possess, in support of this Amendment. I would also thank the Minister very much, because I have been "bending his ear" on and off for the past six weeks and he has been very sympathetic. I believe that my noble friend Lord Grenfell and myself are happy with his reply, and I therefore ask leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

Clause 46 agreed to.

Clauses 47 to 51 agreed to.

Clause 52 [Acquisition and use of land and other property]:

7.0 p.m.

LORD BELSTEAD moved Amendment No. 123A:

Page 44, line 36, at end insert— ("(1A) Section 128 of the Town and Country Planning Act 1971 (which among other things provides that where a Minister acquires consecrated land or land comprised in a burial ground compulsorily he may, subject to the safeguards provided by that section, use the land for the purpose for which he acquired it notwithstanding any obligation or restriction imposed by ecclesiastical law or anything in any enactment relating to burial grounds) shall apply to consecrated land and land comprised in a burial ground within the meaning of that section which is held by the Secretary of State for any of the purposes of the health service and has not been acquired by him as mentioned in subsection (1) of that section as if the land had been so acquired for those purposes.")

The noble Lord said: Under Section 128 of the Town and Country Planning Act 1971, if the Secretary of State acquires compulsorily any consecrated land or land comprised in a burial ground he is empowered to use that land for any purpose for which he acquired the land, subject to the requirements of any regulations made under that Act. The Amendment to Clause 52 would extend the Secretary of State's power under Section 128 of the Town and Country Planning Act 1971 to all land held by him (including special hospital land) for any purpose of the Health Service as defined by this Bill. The powers currently conferred by Section 128 are not available to the Secretary of State in respect of land vested in him under Statute, which will vest in him by virtue of this Bill or which he acquires by agreement.

Some hospitals vested in the Secretary of State include burial grounds, and there are at present serious legal obstacles to development of this land for hospital or other Health Services purposes. The one real difficulty, and the one which I am submitting to the Committee this evening, is that it is contrary to Section 3 of the Disused Burial Grounds Act 1884, as amended, to put a secular building on a disused burial ground. It is possible to obtain exemption from this section by special Act of Parliament, but such a course would involve the Hybrid Bill procedure. This would mean a Private Bill introduced by the Department which has to go through all the stages of a public one. I should add that the use of powers under Section 128 is subject to regulations currently in force which prescribe the conditions governing the use of land containing a place of worship or used as a burial ground. The regulations also include conditions relating to the removal and reinterment of human remains and the disposal of memorials and registers. These regulations will apply to the more comprehensive powers under Section 128 sought by this Amendment. I beg to move.

On Question, Amendment agreed to.

Clause 52, as amended, agreed to.

Clause 53 [General ancillary provisions]:

LORD ABERDARE moved Amendment No. 123B:

Page 44, line 42, at beginning insert— ("(1) If the Secretary of State considers that by reason of an emergency it is necessary, in order to ensure that a service falling to be provided in pursuance of the Health Service Acts is provided, to direct that during a period specified in the directions a function conferred on any body or person by virtue of those Acts shall to the exclusion of or concurrently with that body or person be performed by another body or person, he may give directions accordingly and it shall be the duty of the bodies or persons in question to comply with the directions; and the powers conferred on the Secretary of State by this subsection are in addition to any other powers exercisable by him.")

The noble Lord said: The subsection which this Amendment seeks to add to Clause 53 would empower the Secretary of State to take appropriate action in an emergency to secure the effective continuance of health services. It would enable him to direct that the function of any body or person under the Health Service Acts should be performed by any other body or person during the period of the emergency. The only significant difference from the comparable power provided in Section 54 of the National Health Service (Scotland) Act is that the Secretary of State would have the option to direct that the functions in question should be performed by one person or body to the exclusion of the person or body normally performing such functions or should be so performed in parallel by both, so that where, for some reason such as a natural disaster destroying premises, the functions were insufficiently performed, they might be supplemented without there being an obligation for complete substitution.

This provision would fill a gap in the Secretary of State's present powers. Under the present Act he has power, after inquiry, to declare a Health Service body to be in default and to authorise any person to act in its place until a new body is appointed; but this is a blunder-buss weapon which he would not wish to use to meet a purely temporary difficulty. The new provision would enable the Secretary of State to make arrangements for dealing with such a situation of difficulty in the future and for discontinuing any such arrangements, without resort to the use of his default powers. This would be a very exceptional use of these powers, but it could be important in a major civil emergency or some similar difficulty. I beg to move.

On Question, Amendment agreed to.


This Amendment is to correct a drafting mistake. The word "appointment" should be "apportionment". I beg to move.

Amendment moved— Page 45, line 16, leave out ("appointment") and insert ("apportionment"). —(Lord Aberdare.)

On Question, Amendment agreed to.

Clause 53, as amended, agreed to.

Clause 54 [Interpretation etc.]:


This is consequential on Amendment No. 100B. I beg to move.

Amendment moved— Page 46, line 8, at end insert (""preserved Board" has the meaning assigned to it by section 15(6) of this Act;").—(Lord Aberdare.)

On Question, Amendment agreed to.

Clause 54, as amended, agreed to.

Clause 55 [Orders and regulations etc.]:

LORD BELSTEAD moved Amendment No. 125: Page 46, line 38, leave out ("sections 14(2), 53 and 57(2)") and insert ("section 14(2) or 53 of this Act or orders appointing a day in pursuance").

The noble Lord said: In the Bill there are many references to "the appointed day "which is defined in Clause 54(1) as being such day as the Secretary of State may by order appoint. Under Clause 55(1), as drafted, these orders are subject to the Negative Resolution procedure, whereas "appointed day orders" under Clause 57(2) are not. The purpose of this Amendment is to provide that both types of appointed day order, although having to be laid before Parliament after being made, are not subject to Negative Resolution procedure. I beg to move.

On Question, Amendment agreed to.


This is consequential on Amendment No. 106C. I beg to move.

Amendment moved— Page 46, line 44, leave out ("and 23(2)") and insert (", 23(2) and 24(2)").—(Lord Belstead.)

On Question, Amendment agreed to.

Clause 55, as amended, agreed to.

Clause 56 agreed to.

Schedule 4 [Minor and consequential amendments of enactments]:


This is a drafting Amendment to correct a technical defect in the consequential Amendment made by paragraph 21 to Section 35 of the 1946 Act. I beg to move.

Amendment moved— Page 59, line 32, leave out from ("proviso") to end of line 36 and insert ("after the word "Council" there shall be inserted the words "or Area Health Authority").—(Lord Aberdare.)

On Question, Amendment agreed to.


This is a drafting Amendment. I will go into some detail if noble Lords wish, but it is purely a matter of drafting. I beg to move.

Amendment moved— Page 61, line 11, leave out ("Board").—(Lord Aberdare.)

On Question, Amendment agreed to.

LORD ABERDARE moved Amendment No. 126:

Page 63, line 24, at end insert— ("40A. In section 80(1) of that Act (interpretation), in the definition of "medicine", for the words "includes any prescribed chemical re-agent" there shall be substituted the words "includes such chemical re-agents as are included in a list for the time being approved by the Secretary of State for the purposes of section 40(1) of this Act.")

The noble Lord said: The definition of "medicine" in Section 80(1) of the 1947 Act includes "any prescribed chemical reagent". The list of chemical reagents which may be prescribed is sot out in Part II of Schedule 3 to the National Health Services (General Medical and Pharmaceutical Services) (Scotland) Regulations 1966 as amended by the Regulations of 1971. This Amendment simplifies the procedure by providing for chemical reagents which may be dispensed to be set out in a list approved by the Secretary of State for that purpose, so that changes in the list made in consultation with representatives of the medical and pharmaceutical professions can be implemented without awaiting amendment of the Regulations. It follows the pattern of paragraph 40 of Schedule 4, which provides that appliances which can be supplied by pharmacists should no longer need to be prescribed by Regulations but may be included in a list approved by the Secretary of State. I beg to move.

On Question, Amendment agreed to.

7.10 p.m.

LORD ABERDARE moved Amendment No. 126A:

Page 65, line 21, at end insert— ("(1A) In subsection (2) of that section, for the words "under the said Part 11" there shall be substituted the words ",otherwise than under Part IV of the said Act of 1946,".")

The noble Lord said: I beg to move Amendment No. 126A, and perhaps I may also speak to Amendment No. 129B. These Amendments involve no change of policy, but by correcting a technical drafting defect maintain the present position under the National Health Service Act 1951, that no charge may be made in respect of a dental or optical appliance supplied by a hospital to a patient for the time being resident in a hospital.

On Question, Amendment agreed to.


I beg to move Amendment No. 126B, which is consequential on Amendment No. 116A.

Amendment moved— Page 74, line 39, leave our paragraph 97. —(Lord Aberdare.)

On Question, Amendment agreed to.

LORD ABERDARE moved Amendment No. 126C: Page 77, line 34, leave out from beginning to end of line 46 and insert— ("114. —(1) In section 48 of that Act (which provides for the reporting of cases of notifiable diseases and food poisoning to local authorities), for subsection (2) there shall be substituted the following subsection— (2) The officer who receives the certificate aforesaid shall, on the day of its receipt (if possible) and in any case within forty-eight hours after its receipt, send a copy of the certificate—

  1. (a) to the Area Health Authority within whose area are situate the premises whose address is specified in the certificate by virtue of paragraph (a) of the foregoing subsection; and
  2. (b) if the certificate is given with respect to a patient in a hospital who came there from premises outside the district of the local authority within whose district the hospital is situate and the certificate states that the patient did not contract the disease or the poisoning in the hospital—
    1. (i) to the proper officer for the district within which the premises from which the patient came are situate, and
    2. (ii) to the Area Health Authority for the area in which those premises are situate if that Authority is not responsible for the administration of the hospital, and
    3. (iii) to the proper officer of the relevant port health authority constituted in pursuance of section 2 of the Public Health Act 1936 if those premises were a ship or hovercraft situate within the port health district for which that authority is constituted.")

The noble Lord said: I beg to move Amendment 126C. Paragraph 114 of Schedule 4 to the Bill makes a number of minor and consequential amendments to Section 48(2) of the Health Services and Public Health Act 1968, which relates to the reporting of cases of notifiable diseases and food poisoning. However, Section 48(2) did not provide for notification of the port health authority where the premises from which the patient comes is a vessel. This Amendment remedies the omission. The opportunity has also been taken to redraft the subsection and to amend the references to "medical officer of health" to "proper offices", which is the appropriate term under the Local Government Act 1972.

On Question, Amendment agreed to.

LORD ABERDARE moved Amendment No. 126D:

Page 77, line 47, at end insert— ("114A. In section 62(1) of that Act (which provides for references to vessels in the Public Health Act 1936 and references to ships in the Food and Drugs Act 1955 to include references to hover vehicles), for the words from "hover vehicles" to "air" there shall be substituted the words "hovercraft within the meaning of the Hovercraft Act 1968".")

The noble Lord said: I beg to move Amendment No. 126D. Section 62(1) of the Health Service and Public Health Act 1968 includes reference to "hover vehicles", which are defined as "vehicles designed to be supported on a cushion of air". The purpose of this Amendment is to bring Section 62(1) into line with the Hovercraft Act 1968, by replacing the words "hover vehicles" by "hovercraft, which are defined in Section 4 of that Act.

On Question, Amendment agreed to.

On Question, Whether Schedule 4, as amended, shall be a Schedule to the Bill?

7.15 p.m.


I hesitate to intervene as the Committee is now making such rapid progress towards the end of a very long Marshalled List, but I should like to ask the noble Lord a question about paragraph 124 of the Schedule, which amends the Chronically Sick and Disabled Persons Act, 1970. I was a little concerned to read this. The noble Lord may recall the long debates that we had on this particular area of concern during the passing of that piece of legislation. I well recall the noble Baroness, Lady Masham of Ilton, speaking on this question of the need to separate younger patients from older patients in our hospitals. As I read it, this particular paragraph in Schedule 4 will transfer from the present Regional Boards to the Secretary of State the responsibility for securing, so far as is practicable, that younger patients are separated from older patients in hospital. I am not quite sure how the Secretary of State would do this. Presumably he would do it through circulars and exhortation. I personally should have thought that the Area Health Authorities, which are to be the prime operational units for providing health services, might be more appropriate—or possibly the Regional Boards.

I should be grateful if the noble Lord could tell us of the Government's thinking behind this paragraph, and most particularly how he thinks the Secretary of State is going to see that, so far as is possible, younger patients are separated from older ones in the hospitals up and down the country.


There is nothing sinister about this matter. It is simply that references to the previous Regional Hospital Boards and Boards of Governors had to be superseded by some new words, and it was thought convenient to leave this to the Secretary of State (who has the ultimate authority in the National Health Service), who will no doubt exert his authority through the new Regional Health Authority. In turn they will lay the responsibility on the Area Health Authority, who are the executive bodies concerned with the hospitals. I can assure the noble Baroness that the Secretary of State himself is just as determined to see that, so far as is practicable, the older and the younger patients are kept apart. I would claim that we have had a pretty good record in our building programme for the younger chronic sick. This is basically a matter of words. There will be no diminution of effort in the individual hospitals to achieve the right end, but it will come down the line of authority from the Secretary of State. I hope that that answer is satisfactory.


I was delighted to hear the last sentence of the noble Lord's reply, namely, that pressure will continue to be exerted to achieve the objectives which we all have very much at heart. I find the trail a very long one, from the Secretary of State to the Regional Board and then to the Area Health Authority, and then no doubt from the Area Health Authority in due course to the district management team. This is a matter that has to be arranged locally, although, of course, it is subject to building programmes, both major and minor. I make the point now, and perhaps the noble Lord would be prepared to consider it.

The duties of the Secretary of State under this Bill are really enormous. I should have thought that this was one of the burdens that could have come off his shoulders and been administered locally in the area, or possibly by the region, rather than in the way suggested by the Bill. I have made the point. I know that in a sense it is a minor one, particularly in the context of this very long Schedule, but it is a matter of great concern to many people, and I hope that the noble Lord will accept that I have raised it to-night in that spirit.

Schedule 4, as amended, agreed to.

Schedule 5 [Repeals]:


I should like to move Amendments Nos. 128 and 129 together. These Amendments rectify an incorrect description of the enactment which is subject to partial repeal.

Amendments moved—

Page 83, line 4, leave out ("Registration of"),

Page 83, line 5, after ("Deaths") insert ("Registration").—(Lord Aberdare.)

On Question, Amendments agreed to.


I beg to move Amendment No. 129A, which is consequential on No. 116A.

Amendment moved— Page 83, line 8, column 3, leave out ("193") and insert ("194"). —(Lord Aberdare.)

On Question, Amendment agreed to.


Amendment No. 129B is consequential on Amendment No. 126A. I beg to move.

Amendment moved— Page 85, column 3, leave out lines 24 and 25. —(Lord Aberdare.)

On Question, Amendment agreed to.

LORD ABERDARE moved Amendment No. 129C: Page 86, column 3, leave out lines 24 to 27.

The noble Lord said: This is a minor tidying-up Amendment, designed to ensure that there is no change of substance in the arrangements for prosecuting nursing and residential homes, other than that which follows naturally from the transfer of responsibility for registering the former from local authorities to the Secretary of State. I beg to move.

On Question, Amendment agreed to.


This Amendment is consequential on the Amendment to Schedule 4, paragraph 114 of the Bill; that is, Amendment No. 126C. I beg to move.

Amendment moved— Page 88, line 6, leave out from ("48") to end of line 9. —(Lord Aberdare.)

On Question, Amendment agreed to.

Schedule 5, as amended, agreed to.

Clause 57 [Citation, commencement and extent]:


This Amendment is consequential on Amendment No. 126, and provides that paragraph 40A of Schedule 4 shall apply to Scotland. I beg to move.

Amendment moved— Page 48, line 29, after ("40,") insert ("40A,"). —(Lord Aberdare.)

On Question, Amendment agreed to.

Clause 57, as amended, agreed to.

House resumed: Bill reported, with the Amendments.