Sitting of 16 March 1944

Preamble
[Mr. SPEAKER in the Chair]

BRITISH MUSEUM
The Chancellor of the Duchy of Lancaster (Mr. Ernest Brown): I have been asked by the Trustees of the British Museum to present a Petition which they have to submit to this House annually, explaining the financial position and praying for aid. The Petition recites the funded income of the Trustees and points out that the establishment is necessarily attended with an expense far beyond the annual production of the funds, and the Trust cannot with benefit to the public be carried out without the aid of Parliament. It concludes with this Prayer:
"Your petitioners therefore humbly pray your Honourable House to grant them such further support towards enabling them to carry on the execution of the Trust reposed in them by Parliament for the general benefit of learning and useful knowledge as to your House shall seem meet."—[King's Recommendation signified.]
Petition referred to the Committee of Supply.

ORAL ANSWERS TO QUESTIONS
  NATIONAL WAR EFFORT

    Women, Deferments (Wigan District)
    Mr. Evelyn Walkdenasked the Minister of Labour if he is aware of the local complaints and general dissatisfaction in Wigan district concerning large numbers of single and married young women who, by reason of obtaining various types of certificates, are deferred off work for long periods or not directed to useful employment; and if he will reexamine all local records and causes and wherever circumstances or evidence warrants action take it without delay.
    The Minister of Labour (Mr. Ernest Bevin): No, Sir. I have no knowledge of any complaints or general dissatisfaction on this subject in Wigan. If my hon. Friend has any specific cases in
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    mind and will let me know, I will have inquiries made.
    Mr. E. Walkden: While thanking my right hon. Friend for his assurance, may I ask him whether he is not aware already of the loose method of issuing medical certificates, and the weaknesses in the regulations, which are general and are well-known throughout the country? Cannot he take more drastic action to tighten up existing procedure?
    Mr. Bevin: I really cannot lay down any regulations as to what a doctor should say the hon. Member is suffering from.
    Mr. Foster: Is my right hon. Friend aware that, as Member for Wigan, I have had no complaints whatever; that both the Ministry of Labour officials and the Mayor of Wigan have denied these charges, and that they resent interference by a Member from another constituency?

    Woman-Power
    Sir Irving Alberyasked the Minister of Labour if he is aware that, in many cases, the heavy call-up of women for various national services and work of national importance has had the effect of diminishing the efficiency of the home, with a resulting decline in the war service efficiency of its members; and if he will review the position, and take further steps to prevent the wastage of woman-power in some Government Departments, services and factories engaged on war work.
    Mr. Bevin: The necessity of full mobilisation of woman-power has undoubtedly placed on the housewife a heavy task, and I am glad of this opportunity to give public recognition to the value of their contribution to the war effort. In calling up women for war work, individual consideration is given in every case to the domestic responsibilities of the woman concerned according to war-time standards, and cases of doubt are referred to independent women's panels. The use of woman-power now employed in Government Departments and war factories is, primarily, a matter for the Government Department concerned.
    Sir I. Albery: If I give the right hon. Gentleman information concerning the

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    effect of this call-up on certain persons, including the families of soldiers, will he give the matter further consideration?
    Mr. Bevin: Certainly, Sir.
    Sir Herbert Williamsasked the Minister of Labour whether he will arrange to publish a return on the extension in the employment of women in industry during the war, on the lines of the return published on page 216 of the Labour Gazette of June, 1918, which recorded an increase of 44 per cent. between July, 1914, and January, 1918.
    Mr. Bevin: It is not in the public interest that a return such as that referred to should be published at present.
    Sir. H. Williams: Why is it not in the public interest to do in this war something which was repeatedly done in the last war without any damage to the public interest? Why this excessive desire for secrecy?
    Mr. Bevin: I am glad to say that a lot of things which were done in the last war are not being done in this war.
    Sir H. Williams: Was not the last war won sooner than this war is being won?

    Coalmining (Compulsory Recruitment)
    Lieut.-Colonel Dowerasked the Minister of Labour if he has any statement to make with regard to the prosecution of Bernard Bradley, of Leeds, a young man of 18 years of age, who has been sentenced to three months' imprisonment for refusing to work in the coalmines.
    Mr. Bevin: I understand that in this case an appeal is pending, and I cannot, therefore, make any statement.
    Lieut.-Colonel Dower: Is the right hon. Gentleman aware that this young man was a Home Guard, who volunteered for anti-aircraft duties, which any soldier would say was equivalent to regular service? Is it right that with these qualifications, he should be directed into the mines?
    Mr. Bevin: I am afraid I cannot enter into discussion upon a case when it is going before the court.
    Mr. Gledhillasked the Minister of Labour whether a man who goes through the ballot and is not drawn for coalmining is affected by subsequent ballots.
    Mr. Bevin: No, Sir. Such a man does not have to go through any further ballot.

    Unemployment, Spennymoor
    Mr. Murrayasked the Minister of Labour the number of unemployed men who were signing on at the various employment exchanges in the Spennymoor Division, County Durham, for the week ended 4th December, 1943; how many are now signing on for week ending 11th March, 1944; and whether he can hold out any prospect of those still unemployed obtaining a job.
    Mr. Bevin: I am obtaining such information as is available, and will write to my hon. Friend.
    Mr. Murray: Is the Minister aware that I am indeed grateful for what lie and his Department have done for the unemployed men in my division but is he also aware that men are still idle, who have worked for two years out of doors, in all kinds of weather, who cannot obtain a job at the present time, and who are certified as medically unfit for work inside a factory? Can he not do something to remove the depression of these men?
    Mr. Bevin: I am having inquiries made, and will try to deal with the matter.

    Young Workers (Holidays)
    Mr. Kenneth Lindsayasked the Minister of Labour whether he will take steps to encourage employers and trade unions to release young workers for an additional week's holiday so that they can attend pre-service, forestry and harvesting camps.
    Mr. Bevin: As I informed my hon. Friend, in reply to his similar Question on 1st April, 1943, I am sympathetic with the object he has in mind, and I have brought the idea to the notice of those concerned in industry. I hope that employers will give every possible encouragement to their young employees to take advantage of these opportunities.
    Mr. Lindsay: In view of the fact that, through the intervention of my right hon. Friend, over 100 firms and some 50,000 boys took advantage of this scheme last year, will he make the decision known early, so that some staggering may take place?
    Mr. Bevin: I have just made it known.

  MILITARY SERVICE

    Medical Grading (Errors)
    Mr. Bellengerasked the Minister of Labour whether he is aware that 2,443 other ranks of the Army were discharged during 1943 as unfit for service within less than six months after having been medically graded A1 by his medical officers before call-up; and what steps he is taking to prevent this recurring.
    Mr. Bevin: From an analysis which has been made of the cases to which my hon. Friend refers, it is estimated that less than a third could be regarded as avoidable errors in grading. This is so small a proportion of the total medically examined and posted to the Army, that I do not think it can in practice be avoided. I may add that cases which are considered to be definite errors in grading, are reported by the Service authorities to my Department, and where my medical advisers agree that the error may have been avoidable, the case is brought specially to the attention of the chairman of the medical board concerned.
    Mr. Bellenger: Does my right hon. Friend know that after his Department has examined these men for call-up for the Service another examination by the military authorities takes place? Is it not possible to avoid some of this by cooperation between his own Department's doctors and the military doctors, before the man is pulled away from his home, and great hardship caused?
    Mr. Bevin: I think I should create a very great injustice if I did that. The time of the medical examination by my Department may be a considerable time before the actual call-up. Therefore, I have asked my right hon. Friend to be very careful when these men arrive in the Army. One may be well to-day and ill to-morrow.
    Mr. Bellenger: If that is the case, will my right hon. Friend take steps to see that before the man is called up for the Army, another medical examination shall take place?
    Mr. Bevin: No, Sir, I really could not do that. The whole deferment machinery would break down if I tried it. The best evidence of the care that is taken is the figure I have given.
    Colonel Greenwell: Will the right hon. Gentleman explain how a man who was passed by his own Department's doctors as unfit, through heart trouble, for work as a docker, could subsequently be passed as A1 for service in the Army?
    Mr. Bevin: I cannot answer that question.

    Direction
    Mr. Kirbyasked the Minister of Labour if he will give his reasons for directing to military service No. 14713364 Private W. Hughes, P.T.C., Ballykinlar, County Down, aged 39, and formerly of 57, Allington Street, Liverpool, 17, who was transport manager in a food distributing firm, whose wife was killed by enemy action in 1941 and whose seven children, aged seven to 15 years, have been left in the care of their grandmother aged 72; and if he will consult with the Secretary of State for War with a view to the early return of this man to his former civilian employment in which he can care for his children.
    Mr. Bevin: I am having inquiries made in this case, and will write to my hon. Friend.

  INDUSTRIAL WAGES
  Mr. Colegateasked the Minister of Labour what applications for increases of wages have been submitted by workers in the major industries of the country since the date of the Porter Award on wages in the coal industry; and what are the particulars of such applications.
  Mr. Bevin: Applications for increases of wages made on behalf of workers are not notified to my Department, unless there is a failure to reach a settlement. I am not aware of any such applications having been influenced by the Award referred to by my hon. Friend.
  Mr. Colegate: In cases where a settlement is not reached and an award has to be made and it is notified to him that there is a blunder in the award, which makes it unworkable, will either my right hon. Friend or some Member of the Cabinet examine such an award, before the industry concerned is thrown into confusion by its attempted enforcement?
  Mr. Bevin: I do not accept what my hon. Friend says. I do not know a single

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  award that has been made which has caused any upset at all. [HON. MEMBERS "Oh‡") What I do know is that there was an upset, which arose before people had studied an award.
  Mr. Shinwell: Does my right hon. Friend seriously suggest that there has been no upset as a result of the Porter Award?
  Mr. Bevin: I assert, with conviction, that the Porter Award did not cause the upset. The Porter Award has not been carefully examined or applied.
  Mr. Shinwell: By whom was it not applied?

  POST-WAR WORKING HOURS
  Mr. Thorneasked the Minister of Labour whether there have been any conversations between the various Governments about an international shorter working day to come into operation after the war.
  Mr. Bevin: No, Sir.

  INDUSTRIAL AND STAFF CANTEENS (WAGES BOARD)
  Mr. Bellengerasked the Minister of Labour whether he has considered the Wages Board recommendation from the Catering Wages Commission; and whether he has come to any decision on it.
  Mr. Bevin: Yes, Sir. I have received from the Catering Wages Commission a recommendation for a Wages Board for industrial and staff canteens, and I have made an Order establishing a Wages Board. Copies of a Command Paper embodying the report and recommendation, together with copies of the Order, will be available to Members at the Vote Office after Questions.

  FACTORIES (ACCIDENTS)
  Mr. Rhys Daviesasked the Minister of Labour the number of accidents in the factories of this country, fatal and nonfatal, for each year 1939 to 1943, inclusive.
  Mr. Bevin: As the reply contains a number of figures, I will, if I may,
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  arrange for its circulation in the OFFICIAL REPORT.
  Following is the reply:

  Accidents Reported under the Factories Act.

  Year.

  Number of Fatal Accidents.

  Number of Non-fatal Accidents.

  1939

  …

  …

  1,104

  192,371

  1940

  …

  …

  1,372

  230,607

  1941

  …

  …

  1,646

  269,652

  1942

  …

  …

  1,363

  313,267

  1943

  …

  …

  1,205

  309,937

  * The figures for 1943 are provisional.

  HOUSING (AIR-RAID VICTIMS)
  Mr. Dribergasked the Minister of Health the total number of houses reserved by local authorities for those rendered homeless by enemy action; if the need for keeping them empty is reviewed from time to time and balanced against the general shortage of accommodation in districts relatively immune from bombing; and if he will consider allowing each of the larger of such houses to be occupied rent-free by a Service man's wife or other dependant who is willing to act as caretaker.
  The Minister of Health (Mr. Willink): The number of houses at present reserved unoccupied for this purpose is approximately 4,000. The answer to the second part of the Question is, "Yes, Sir." Some of the larger vacant houses are already occupied by caretakers chosen from the families of Service men, and their claims will, of course, be borne in mind in any case where it is found necessary to instal a caretaker.
  Mr. Driberg: Is the right hon. and learned Gentleman aware that some local authorities are not aware of the fact contained in the last part of his answer? Will he have it generally made known to them?
  Mr. Willink: I expect that the usual publicity will arise from this answer.

  INSTITUTION INMATES (POCKET MONEY)
  Mr. Sorensenasked the Minister of Health whether he is aware that the Essex County Council Public Assistance Com-

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  mittee have been compelled to cease paying amounts of 1s. to 1s. 6d. per week to certain elderly patients in Public Assistance Committee's hospitals; that this has created indignation among members of the Committee and the public; and whether, in view of the ill-effect of the former practice being declared illegal, he will now take steps to enable public bodies to make such payments of small amounts.
  Mr. Willink: I would refer my hon. Friend to the reply given on 7th March to my hon. Friend the Member for Plaistow (Mr. Thorne) and to previous replies on this subject.
  Mr. Sorensen: Is it any use to keep on referring back to what was said before? Is there not an urgent need to tackle this question, in view of the experience of the public assistance committees that the payment of these small amounts is distinctly beneficial?
  Mr. Willink: No, I cannot agree. The law is quite recent, dating only from 1938, and I do not think that the introduction of legislation at this time would be desirable.
  Mr. Sorensen: Am I to understand that the Minister contemplates no action?
  Mr. Willink: I said nothing of the kind. I said that all these matters were under discussion.
  Mr. Sorensen: In view of the unsatisfactory nature of the reply, I beg to give notice that I shall raise this matter on the Motion for the Adjournment.
  Mr. Lipsonasked the Minister of Health, if he will introduce legislation to permit the established practice of paying pocket money in suitable instances to inmates of public institutions below the age of 65 to continue, which would be generally welcomed.
  Mr. Willink: No, Sir. I would refer my hon. Friend to the reply which was given to him on 2nd December, and to other replies on this subject.
  Mr. Lipson: Is my right hon. and learned Friend aware that his attitude on this matter is most disappointing, and will he not, at least, take steps to find out whether legislation of this kind would be non-controversial?
  Mr. Willink: I have already dealt with that very point, in reply to an earlier Question. It cannot be unsatisfactory that one of my officers should have pointed out what is the law as enacted by Parliament only five years ago.
  Mr. Lipson: My right hon. and learned Friend has not answered my question whether he will take steps to find out whether such legislation would be non-controversial.
  Mr. Willink: Whether it would be non-controversial or not, I think it would be most unsatisfactory to deal with it in isolation from the whole issue of social insurance questions now under consideration.
  Mr. Lipson: Owing to the unsatisfactory nature of the reply, I beg to give notice that I shall raise the matter on the Motion for Adjournment.
  Mr. Sorensen: On a point of Order. I have already given notice that I intend to raise a certain matter on the Adjournment. The hon. Member for Cheltenham (Mr. Lipson), apparently, has now given notice that he will raise a similar matter.
  Mr. Lipson: The point on which I have given notice is the refusal to introduce legislation.

  PUBLIC HEALTH

    Mental Deficiency Act (Detentions)
    Mr. Bowlesasked the Minister of Health what steps are taken to ensure that young people detained under the Mental Deficiency Act, 1913, are not detained for their lifetime.
    Mr. Willink: The law requires these cases to be brought under review from time to time, in order to ensure that they are not detained unnecessarily. I am sending my hon. Friend a memorandum by the Board of Control, setting out in detail the procedure by which this review is effected.
    Mr. Bowles: I addressed this Question to the Home Secretary, because he is the person who commits people to these colonies. May I be told whether a person who has been detained, say, for a year before the next review takes place, and who still does not know how many pennies there are in a half-crown—which is one of the questions put to these people—is taught such things?
    Mr. Willink: The actual education of these people hardly arises on this Question. If the hon. Member will look at the Memorandum which I am sending him and then ask any further questions, I shall be glad to answer them.
    Mr. Bowles: In view of the fact that I have a large number of these cases, I beg to give notice that I shall raise the matter on the Motion for Adjournment. I hope that not only the right hon. and learned Gentleman but also the Home Secretary will be present on that occasion.

    Tuberculosis (Allowances)
    Mr. W. J. Brownasked the Minister of Health whether he will take steps to secure that the new allowances granted on certain conditions to sufferers from tuberculosis are applied to all tuberculosis subjects who are unable to work.
    Mr. Willink: I would refer my hon. Friend to my reply to my hon. Friend the Member of East Birkenhead (Mr. Graham White) on 2nd March.
    Mr. Brown: Is the Minister aware that that reply was quite unsatisfactory, and that the reference to that unsatisfactory reply is equally unsatisfactory?
    Mr.Willink: No indication was given to me that that reply was unsatisfactory. It did not give rise to a supplementary, and no further Question was put down.
    Mr. Shinwell: Are we to understand that only if we put a supplementary is a reply considered to be unsatisfactory? I hope, Mr. Speaker, that you will take note of that.
    Mr. De la Bère: The longer it goes on, the more unsatisfactory it becomes.

  LOCAL AUTHORITIES

    County Councils (Travelling Expenses)
    Mr. E. P. Smithasked the Minister of Health whether he will take steps to amend the law relating to the payment of travelling expenses of members of county councils, their committees and sub-committees, which are at present non-recoverable, in view of the fact that these committees are to-day often poorly attended because many of their members, travelling from a distance, cannot afford the cost of transport.
    Mr. Willink: County councils have wide powers to pay the necessary travelling expenses of members of the councils and of committees and sub-committees. I do not contemplate the extension of their powers in this respect.

    Powers
    Sir Leonard Lyleasked the Minister of Health whether it is proposed eventually to restore, at the earliest possible moment, the powers of which during the war local authorities have been deprived.
    Mr. Willink: I would refer my hon. Friend to the replies given by my right hon. Friend the Deputy Prime Minister to my hon. Friend the Member for Penryn and Falmouth (Mr. Petherick) on 29th July and 5th August last, of which I am sending him copies.
    Sir L. Lyle: Does my right hon. and learned Friend not consider that the time has come when some of these powers which have been usurped might be restored?
    Mr. Willink: The whole matter was dealt with comprehensively by the replies of the Deputy Prime Minister, in which he stressed the fact that the powers which have been taken away are extremely few in number.

  EVACUATED CHILDREN (BILLETING ALLOWANCE)
  Mr. Toucheasked the Minister of Health whether he is now in a position to make a statement regarding the amount of billeting allowance paid to householders in respect of unaccompanied schoolchildren.
  Mr. Willink: I regret that I can at present add nothing to my reply to my hon. and gallant Friend the Member for Darwen (Captain Prescott) on 9th March, a copy of which I am sending to my hon. Friend.
  Mr. Touche: Does my right hon. and learned Friend appreciate that this form of billeting allowance compares very unfavourably with any other form of billeting allowance, and that it imposes the maximum burden on the householder?
  Mr. Willink: As I said on 9th March, we are very grateful to these people who are taking care of the women, children

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  and others; and, as I said only a week ago, this matter is at present under consideration.
  Bellenger: What is delaying the Government's decision on this matter, which has been before them quite a long time? Will my right hon. and learned Friend answer?
  Mr. Willink: In any matter of this kind a number of factors have to be considered. This matter is under active consideration, and I hope to be able to make a statement shortly.

  TOWN AND COUNTRY PLANNING (LAND ACQUISITION)
  Mr. Keelingasked the Minister of Town and Country Planning whether he is aware that local authorities are anxiously awaiting further legislation about land to facilitate their plans; and whether such legislation will be introduced this Session.
  Mr. Boothbyasked the Minister of Town and Country Planning whether his attention has been called to the reiterated appeal of the lord mayors and mayors of certain bombed cities for legislation to enable them to prepare the necessary plans for reconstruction; and whether he proposes to take any action in the matter.
  Mr. Manderasked the Minister of Town and Country Planning what action he proposes to take in response to the appeal by the lord mayors of Plymouth, Portsmouth, Norwich, Hull, Sheffield, Bristol, the mayors of Exeter, Swansea, Birkenhead, Salford, Wallasey, Bootle and Coventry, to the Government to introduce forthwith the long-promised legislation to enable preparations to be made for demobilisation by planning towns and purchasing land.
  The Minister of Town and Country Planning (Mr. W. S. Morrison): I have seen the appeal referred to and can assure hon. Members that a Bill will be introduced during the present Session, as promised in the King's Speech.
  Lieutenant-Colonel Dower: Will there be a statement similar to that which the Minister of Health made the other day, so that we can have an indication of what is to be in the Bill?
  Mr. Morrison: I think hon. Members will have the Bill itself first.
  Mr. Shinwell: The Minister says the Bill will be introduced in the present Session. Will it be introduced before the legislation on housing promised by the Minister of Health is introduced?
  Mr. Morrison: I should like notice of that question. The Bill will be introduced in time, I hope, for it to be passed, in order to secure the purposes for which it is designed.
  Mr. Shinwell: Is it not necessary, in view of what transpired during the Debate yesterday, and in view of the general dissatisfaction of the House with the housing proposals of the Government, that the Minister's Bill should be introduced before the legislation on housing promised by the Minister of Health?
  Mr. Morrison: I will consider that question and see if I can do anything to meet the point.
  Mr. Mander: In view of the delay in dealing with this matter, can the Minister say whether he is dealing with it on the basis that we have all eternity before us?
  Mr. Morrison: No, Sir.
  Mr. Silverman: Will the Minister say when it is proposed to appoint the Commission that was contemplated by the Act under which his office was created?
  Mr. Morrison: The Commission's powers will have to be defined in the legislation before it can be appointed.
  Mr. J. J. Davidson: Surely, this is a matter in which the Leader of the House can now advise the House whether actual co-operation is taking place between the various Departments concerned in housing?
  Mr. Morrison: I can myself assure the hon. Member that co-operation of that kind is taking place.
  Mr. Boothbyasked the Minister of Town and Country Planning whether His Majesty's Government have now reached any conclusions on the Reports of the Barlow, Scottor Uthwatt Committees; and what action is proposed to be taken to implement them.
  Mr. W. S. Morrison: I would refer my hon. Friend to the answer which I gave to

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  the hon. Member for Skipton (Mr. H. Lawson) on 17th February, 1944, of which I am sending him a copy and to which I have at present nothing to add.
  Mr. Boothby: Can the Minister tell us why it has taken, not only months, but years, for the Government to reach any conclusions on these Reports?
  Mr. Morrison: I have been in office during only a comparatively recent period, but I can assure the hon. Member that the issues involved are of extreme importance and great complexity, and it is a matter that affects every home in the country and ought to be well considered.
  Mr. Boothbyasked the Minister of Town and Country Planning whether he will give an assurance that it is still the policy of His Majesty's Government that payment of compensation in respect of land purchased by public authorities shall be made on the basis of the values which obtained in 1939.
  Mr. W. S. Morrison: I would refer my hon. Friend to the latter part of the answer which I gave to the hon. Member for South Croydon (Sir H. Williams) on 28th October, 1943, of which I am sending him a copy and to which at present I have nothing to add.
  Mr. BoothbyIs the Minister aware that speculative purchases of land are continuing up and down the country; and does he not think it would be rather better to apply the ceiling of 1939, without unfairly affecting a number of people?
  Mr. Stokes: May I ask the Minister whether, if I put a suitable Question down, he will explain what the 1939 ceiling is, as there was no valuation then, and it cannot be applied?
  Mr. Morrison: I shall be very interested to see my hon. Friend's essay at drafting a Question which would elicit that information.
  Mr. Manderasked the Minister of Town and Country Planning whether any decision has been arrived at by the Government with regard to the proposals of the Uthwatt Report for vesting development rights in unbuilt-up land in the State.
  Mr. W. S. Morrison: No, Sir; but the Government hope to make a statement at an early date.
  Mr. Mander: Can the Minister say whether it is the case, as stated in the Press, that the Uthwatt recommendation on this point has been turned down by the Government, together with the Minister's own proposals?
  Mr. Morrison: I can assure the hon. Member that my proposals have not been turned down. They are being considered.
  Mr. Mander: Have not the Uthwatt proposals been turned down?
  Mr. Morrison: A large number of the Uthwatt proposals have already been accepted.
  Mr. Mander: On a point of Order. I asked the Minister about a specific point. I did not want a reply of a general nature.
  Mr. Morrison: On this matter, it is impossible to give a categorical reply. There are features in the Uthwatt proposals which may be embodied in the ultimate proposals put before the House. It is not one single set of proposals, but a vast, interlocking system.

  ARMED FORCES AND CIVILIANS (PENSIONS AND GRANTS)
  Mr. J. J. Davidsonasked the Minister of Pensions the total number of pension applications refused by his Department during the past 12 months on the grounds that the person killed was not previously contributing to the upkeep of the household.
  The Minister of Pensions (Sir Walter Womersley): I assume that my hon. Friend is referring to applications by the parents or other relatives of deceased members of the Armed Forces. I regret that the information asked for is not available and could not be obtained without a disproportionate expenditure of time and labour. I would, however, point out that, while in the case of other relatives previous dependence on the member is a condition of an award, pension is awarded to parents if they are in need and there is a reasonable prospect that the member would, had he survived, have contributed to their support.
  Mr. Davidson: May I ask the Minister if he is aware that the term "contributing to the upkeep of the household" is a very elastic term, and, in view of the fact that casualties will increase as the war

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  intensifies, will he review the whole question, as many of these young boys were apprentices, on very low wages, to whom the parents were, however, looking for some increased remuneration in the future?
  Sir W. Womersley: I can assure the hon. Member that we will take into account what the boy would have been earning if he had survived.
  Mr. Rhys Davies: Is it not possible for the Minister to reconsider this whole problem? Is he aware that, in the last war, parents received a pension as a solace for the taking of their sons; and is he also aware that there are mothers to-day receiving these pensions in respect of sons lost in the last war?
  Sir W. Womersley: I am well aware that the rule in the last war was this—that, if a Serviceman was under 26 years of age and had no other dependants of any kind, then a pension of 5s. per week could be awarded to the parents. I am well aware that some people are drawing it to-day and also are including it in their Income Tax returns.
  Mr. Silverman: Does the Minister not agree, after all the experience he has had, that this is one of the questions on which the practice of the last war was preferable and very much fairer than the practice of this one?
  Sir W. Womersley: No, Sir, I am not aware of that. Our present practice is by far the best, and it was adopted in accordance with a recommendation made by a Committee of this House, which went into this matter at great length, and I think it is far better to give most where most is needed than to hand out 5s. a week to a very limited class who do not need it.
  Mr. Collindridge: Does "pecuniary need" disallow an assumed improvement in the standard in the home, where a young boy or girl gets into the earning capacity range of an adult?
  Sir W. Womersley: I take into account all these points.
  Mr. Tom Brownasked the Minister of Pensions the number of applications for pensions he has received from the parents of single men and women who have lost
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  their lives in the war since 3rd September, 1939, to 31st December, 1943, stating each sex separately; the number of applications refused on the grounds that they failed to satisfy his Department that they were in pecuniary need; and the number and the amounts of pensions granted.
  Sir W. Womersley: Approximately 47,000 parents' applications in respect of men, and 900 in respect of women, members were decided during the period in question. Pensions ranging from 5s. a week to £120 a year were awarded in over 19,000 cases of men and in some 350 cases of women members. In some 23,000 cases of men and 250 cases of women entitlement was accepted but the requirement of pecuniary need was hot satisfied. In these cases, the applicants have been informed that they may renew their applications in the event of a change in their financial circumstances, but in the great majority the father is at present in full employment and earning normal wages.
  Mr. Brown: Will the Minister be good enough to define what his Department means by "pecuniary need"?
  Sir W. Womersley: It is a very broad definition, as recommended by the Committee which I mentioned earlier. We take into account the question of whether the head of the household is in full employment and earning normal wages. We take all this into account and deal with it very generously.
  Mr. Brown: Is the Minister aware that some parents are already selling their furniture to maintain their existence?
  Sir W. Womersley: No, Sir, and if the hon. Member will bring cases of that kind to my notice I will inquire into them at once.
  Mr. John Dugdale: Is the Minister aware that I have received numerous complaints about the insulting nature of the reply he gave me on this subject last week—insulting, not to me, but to the parents of men killed in action—and will he withdraw that answer?
  Sir W. Womersley: No, Sir, I do not regard that as insulting at all; it was a statement of fact.
  Major Lyonsasked the Minister of Pensions if he will indicate the inquiries made and the examination applied by way of means test, to arrive at a decision

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  whether a pension be awarded to the parent or parents of a deceased Service man; and on what basis of income or earnings it is made.
  Sir W. Womersley: I would refer my hon. and gallant Friend to the full reply I gave to a similar question by the hon. Member for Deritend (Sir Smedley Crooke) on 28th October last; of which I am sending him a copy.
  Major Lyons: In view of the great dissatisfaction that exists against this manifest bad working, would my right hon. Friend consider taking powers to deal with these cases and give the parents of all Service men a flat-rate pension automatically?
  Sir W. Womersley: If my hon. and gallant Friend will read the very long reply which was given to the hon. Member for Deritend he will see that his point is fully met.
  Sir Charles Edwardsasked the Minister of Pensions what complaints he has received from the British Legion about the refusal of pensions to men who have had amputations during or as a result of the war; that some applications submitted in July last have not yet been decided; how many general re-applications for pensions have been made; how many granted and how many are still undecided; and will he taken steps to hasten his procedure.
  Sir W. Womersley: I have not received any general representations from the British Legion of the nature referred to. If the hon. Member has any individual cases in mind and will give me particulars I will look into them. With regard to the second part of the Question, I would refer my hon. Friend to the reply which I gave to the hon. and gallant Member for Lonsdale (Sir I. Fraser) on 24th February last. So far as the last part of the question is concerned, I can assure my hon. Friend that everything possible is done to obviate any avoidable delay in the settlement of these cases.
  Mr. E. P. Smithasked the Minister of Pensions whether he will consider instituting a fund from which pensions can be paid in cases of proven necessity to the dependants of members of the Armed Forces killed while on active service through their own negligence or misconduct.
  Sir W. Womersley: I do not feel justified in adopting my hon. Friend's suggestion. As he is no doubt aware I have power, in those cases where payment at the full rate would not be justified, to make a modified award. It is only in exceptional cases that I am constrained totally to withhold the grant of a pension.
  Mr. Smith: In view of the limitations imposed by question and answer, I beg to give notice that I shall take the earliest opportunity to raise this matter on the Adjournment.

  DISCHARGED SERVICEMEN (MENTAL CASES)
  Mr. Fosterasked the Minister of Pensions if he has any further statement to make regarding the discharge of mental cases from the Forces, since meeting a deputation on the matter on 9th March.
  Sir W. Womersley: I will communicate with my hon. Friend as soon as I have completed the inquiries which I undertook to make of the other Departments concerned in this question.
  Mr. Foster: May I ask the right hon. Gentleman whether, in his consideration of this matter, he will have before him the scheme which was applied in the last war in these cases and give some consideration to it?
  Six W. Womersley: I am very sorry indeed that my hon. Friend did not avail himself of the offer I made to him to come to my room, with other hon. Members, to discuss the whole matter. If he had, he would not have put that question to me now.
  Captain Cobb: Is the Minister aware that there is a great deal of feeling about this question on the part of local authorities, who feel, quite rightly, that this should be a national charge and not a charge on the rates?
  Sir W. Womersley: That may be so, but it is not a matter with which I can deal.

  INDIA

    Assam Frontier (Bengali and Punjabi Units)
    Major-General Sir Alfred Knoxasked the Secretary of State for India how many natives of Bengal and how many

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    of the Punjab are now serving on the Assam frontier.
    The Secretary of State for India (Mr. Amery): I am afraid that it would not be in the public interest to publish the figures.
    Sir A. Knox: Can my right hon. Friend state whether there are any Bengali regiments serving on the Assam frontier?
    Mr. Amery: I have not the actual figures, but it would not be in the public interest to give the distribution of troops on the Assam frontier.

    Civil Servants' Wives (Travel Facilities)
    Rear-Admiral Sir Murray Sueterasked the Secretary of State for India whether, in view of the ban having been lifted for wives going to Australia, the Indian Committee appointed early in the year have reached any decision with regard to the 200 wives of civil servants who are desirous of rejoining their husbands in India, as many have not seen them for over four years.
    Mr. Amery: The Committee in question announced that no recommendations would be made before 1st March in order to ensure an equal chance of consideration for all applicants. No recommendations have yet been received. As I informed my hon. and gallant Friend on 2nd December last, the number of berths likely to be available is very small indeed and there is, I fear, little prospect at present of passages to India for women and children except in cases of special hardship.

    Political and Industrial Situation
    Mr. Sorensenasked the Secretary of State for India if he has considered the presidential address given to the Federation of Indian Chambers of Commerce, a copy of which has been sent to him, which emphasised that the time had come for the release of political leaders in detention, the need of greater industrial development in India and a guarantee that the operation of the United Kingdom Commercial Corporation will end with the armistice; and what steps he has taken to meet this demand.
    Mr. Amery: I have so far only seen a Press report of the address in question. As regards the points to which the question refers, I would refer the hon. Member
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    to the various official statements that are on public record.
    Mr. Sorensen: Will the right hon. Gentleman accept an assurance that a copy has been sent to him, and is he aware that in any case there is a report in the bulletin issued by his Department, and, in the circumstances, does he not think that the contents of this address deserve particular attention?
    Mr. Amery: I certainly read it with interest.
    Mr. Sorensen: Does the right hon. Gentleman agree that something should be done on the lines suggested?
    Mr. Amery: I am afraid that in answer to a question I could not go into the whole contents of a speech of which I have only read a telegraphed Press report.

  GOVERNMENT DEPARTMENTS

    Accommodation, London
    Mr. Gledhillasked the Prime Minister if he will instruct all Government Departments to consider taking over large houses in the West End now standing empty, thereby releasing hotel accommodation required for members of the Forces on leave or passing through London.
    The Prime Minister (Mr. Churchill): Yes, Sir. We are pursuing this policy.

    Ministry of Health
    Mr. De la Bèreasked the Prime Minister whether, in view of the exceptional number of matters which come under the purview of the Ministry of Health, he will consider taking appropriate steps to reduce the field of its activities with a view to enabling the Department to deal with the matters of prior importance.
    The Prime Minister: The proposals which the Government will shortly be making in regard to social insurance will involve reconsideration of the responsibilities of several Departments, including the Ministry of Health, but apart from this question and the possibility of minor adjustments in departmental boundaries, I am satisfied that the functions of the Ministry of Health cover a well defined and manageable field of action.
    Mr. De la Bère: Is my right hon. Friend aware that I welcome the first part of his

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    statement; and is he further aware that there is a considerable volume of overlapping at the present time and that many departmental officials are not quite clear where their duties begin and end, and it is very difficult for them?
    The Prime Minister: This is a time when departmental boundaries are a little fluid, because of the many extraordinary problems with which we are endeavouring to grapple, but I have no doubt that the frontiers will be precisely delimited.
    Mr. Austin Hopkinson: Will the right hon. Gentleman be careful not to increase the number of Ministries to such an extent that the whole of the Members of the House of Commons will be in official positions?
    The Prime Minister: I have several times deprecated the idea that difficult problems can be solved by making new Ministers. I gladly give the assurance asked for by the hon. Member that no attempt will be made to include all the House of Commons in the Ministry.
    Mr. Shinwell: Does the Prime Minister realise that that assurance will cause profound disappointment?

  BRITISH TANKS
  Mr. Stokesasked the Prime Minister whether, in view of the unsatisfactory reports which he has received both as to the inadequacy of British tanks in the field and the waste in production in this country, he will tell the House what action he proposes to take in default of holding an inquiry.
  The Prime Minister: I repudiate the allegations of the hon. Member. The next time that the British Armies take the field, in country suitable for the use of armour, they will be found to be equipped in a manner at least equal to the forces of any other country in the world.
  Mr. Stokes: Is the right hon. Gentleman aware that the information on which I based the first part of my Question came from fighting officers in North Africa and the Bridgehead, and will he tell the House whether he has had a report from the Select Committee on the latter part of the Question?
  The Prime Minister: I have received an advance copy of the Report of the Select Committee and its various criticisms will be carefully considered. I am not interested to know from what sources the hon. Gentleman receives his information. I am sure it would have been very gratifying to him if the information were of an adverse character.
  Mr. Bellenger: Does not the right hon. Gentleman know that there is a feeling of disquiet in certain quarters including Select Committee quarters; and would it be possible to give the House an opportunity of conveying some information to the right hon. Gentleman by discussing this matter?
  The Prime Minister: Yes, Sir, we were to have had a Debate on this subject in Secret Session, on the Motion to move Mr. Speaker out of the Chair on the Army Estimates, but it was found that that would not be entirely in accordance with the Rules of Order. An opportunity will be found however in a very short time —during the next series of Sittings—for a Debate in Secret Session, when anything can be said. And I should like to say that it is not part of my submission, that no mistakes are ever made by this Government.
  Mr. Stokes: Arising out of the right hon. Gentleman's second reply, is the right hon. Gentleman aware that, disregarding his facetious remark to me, thousands of soldiers have lost their lives as a result of the inaction of the Government in this matter?

  ATLANTIC CHARTER
  Mr. Rhys Daviesasked the Prime Minister whether he will arrange for a Debate on the Motion standing in the name of the hon. Member for Westhough-ton relative to the Atlantic Charter, supported by a considerable number of right hon. and hon. Members.
  [That this House, bearing in mind the specific promises contained in the Atlantic Charter regrets recent statements made on behalf of His Majesty's Government conveying the impression that its provisions do not as a matter of right apply to Germany or any other enemy country, believes that these statements have brought the Charter into disrepute,

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  depressed the spirit of considerable sections of the allied population, stiffened the support of the peoples of enemy countries behind their leaders, are calculated thereby to prolong the war, make the prospects of permanent peace difficult, if not impossible, and therefore urges His Majesty's Government to make it clear that the principles of the Charter are of world-wide application.]
  The Prime Minister: Although this Motion is not sponsored by any organised political Party, it is couched in hostile terms, is supported by 70 Members and wears the aspect of a Vote of Censure. If this interpretation is correct, His Majesty's Government would be willing to afford an opportunity for Debate at a convenient date in the near future. Whether it is correct or not can be ascertained through the usual channels.
  Mr. Rhys Davies: May I ask the right hon. Gentleman whether he is not aware that there is considerable disquiet, both in this country and America, as the result of the recent Government statements, made by himself and the Foreign Secretary, abandoning a number of the principles of the Atlantic Charter, and does he not think that the honour of our country is involved in this business?
  The Prime Minister: That would be a very proper question to urge in the Debate, should one be demanded on a Vote of Censure.
  Mr. Mander: Will the right hon. Gentleman bear in mind that an Amendment to this Motion has been put down by the hon. Member for East Wolverhampton?
  [In line 2, leave out from "Charter," to end of Motion, and insert "is of opinion that these should be applied in practice universally so far as is consistent with the supreme object of making German aggression impossible in future, including in that connection such proposals as the transfer of East Prussia to Poland on security grounds."]
  Mr. Petherick: Is my right hon. Friend aware that the desire for a Debate is not confined only to the hon. Member for Westhoughton (Mr. Rhys Davies), and those who think as he does, but is also shared by those who maintain that the Atlantic Charter, where it is not platitudinous, contains conditions highly
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  dangerous to the British and Allied cause?
  The Prime Minister: It is late in the day to begin these sweeping condemnations of the Atlantic Charter, which, at the time, received a very cordial welcome and was not protested against by the hon. Gentleman—
  Mr. Petheriek: I did protest.
  The Prime Minister: I can only say that, if those who put their names to this Motion desire it to be considered as a Vote of Censure, having regard to its terms and having regard to the number of Members concerned, His Majesty's Government would feel it their duty to find the time, on the ground that it is a Vote of Censure. There being no official Party opposing the Government, consequently a sufficient number of private Members, banding themselves together, ought, in my opinion, to have an opportunity of putting their challenge to the test. If, however, it is not a Vote of Censure, then we could not give time, because the Session is already crowded and it would not be convenient, from the point of view of public Business, just to take an ordinary Motion and give it a special part of Parliamentary time. I think it is perfectly plain that the answer I have given is in full harmony with the traditions of the House.
  Mr. J. J. Lawson: May I ask the right hon. Gentleman to take it that a considerable number of hon. Members on these benches are hostile to that Motion?
  Mr. Silverman: Does not the right hon. Gentleman consider that sufficient ambiguity has been introduced into the discussions on the Atlantic Charter by recent events and recent speeches to deserve a Debate by way of clarification of the matter, quite apart from one by way of censure?
  The Prime Minister: Opportunities for Debates of clarification occur frequently in the regular annual routine of Parliamentary Business, and I think it quite natural that some opportunity should be taken on one of those occasions. But here is a particular Motion condemning the Government in scarifying terms. I want to know if that is to be treated as a Vote of Censure or not. If it is to be treated as a Vote of Censure, His

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  Majesty's Government are entirely at the service of those hon. Members who put it down.
  Mr. Mander: Is it not the case that some of those hon. Members who put their names among the first six are opposed, and have been wholly opposed, to the war from the beginning?

  AGRICULTURE

    Farm Buildings
    Major Yorkasked the Minister of Agriculture when the Report of the Committee on Farm Buildings will be published.
    The Minister of Agriculture (Mr. R. S. Hudson): I expect to receive the report of the Committee on Farm Buildings during the next two months. The question of publication will be considered when the Report has been received.
    Major York: While thanking my right hon. Friend for that reply, may I ask whether he is aware that a high proportion of the farm buildings in this country do not make for efficient farming, and could he bear that in mind in the course of his decisions on the four-year plan?
    Mr. Hudson: It is because of that I have set up my Committee.
    Mr. De la Bère: Will the right hon. Gentleman bear in mind that we cannot get efficiency without proper buildings?

    Farm Tenancy, Breconshire
    Mr. Ness Edwardsasked the Minister of Agriculture if he is aware that Ty Gwyn Farm, Gilwern, near Abergavenny; was sold by auction for £6,500 and was subsequently sold for £8,000 to a contractor when he gave his consent to a notice to quit to the tenant who had farmed the land for the whole of his lifetime and without knowing what type of tenant was to take his place and what steps he is taking to prevent such speculative transactions in land.
    51 and 52. Mr. Jacksonasked the Minister of Agriculture (1) if his attention has been drawn to the fact that Mr. Llewellyn, Ty Gwyn Farm, Gilwern, Breconshire, was given notice to quit on 2nd September, 1943, after his farm had been twice sold and whether it is the
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    policy of the Ministry to allow uncontrolled speculation in farms to take place;
    (2) whether his Ministry conferred with the Breconshire War Agricultural Executive Committee before he gave his consent to a notice to quit to Mr. Llewellyn, Ty Gwyn Farm, Gilwern, and with what result.
    Mr. Hudson: An application by the purchaser of Ty Gwyn Farm for consent to a notice to quit to be served on the sitting tenant, received last September, was referred to the Brecon War Agricultural Executive Committee for investigation and report in accordance with the normal procedure, and the decision to consent was taken after full consideration of the Committee's report. The price paid by the purchaser was not reported. No evidence was found to suggest that the purchase by the present owner was speculative in character and my Department was satisfied before consent was given that there was a good prospect of increased food production as a result of the notice becoming operative. It is my policy to prevent uncontrolled speculation in farms, but my powers under Defence Regulation 62 (4A) have to be exercised judicially, and in this case no sufficient justification for refusing consent was found.
    Mr. Ness Edwards: Is not the Minister aware that the war agricultural executive committee did not favour the termination of the tenancy of this farm; that this farmer is a perfectly good farmer, and that the notice to quit was given before the new tenant had been chosen? In those circumstances, is not the Minister facilitating the robbing of decent farmers of their livelihood?
    Mr. Hudson: I cannot accept the implications of that supplementary question. My information is that the new tenant is known to be in possession of capital, and of the advice of first-class farmers to carry out his intention of increasing food production on this farm. The present farmer is only a B farmer and not an A farmer and I am satisfied that food production will increase and not decrease as a result of my action.
    Mr. Ness Edwards: Should not that decision have been made by the war agricultural executive committee? Are they not competent to decide what should happen?
    Mr. Hudson: No, Sir, the responsibility is mine.
    Mr. Ness Edwards: In view of the unsatisfactory nature of the reply, I give notice that I shall raise the matter again at an early date.

  CHANNEL ISLANDERS
  Sir William Davisonasked the Secretary of State for the Home Department whether he is aware of the hardships being endured by the British subjects in the Channel Islands, who suffer from insufficient food, fuel and clothing; whether arrangements can be made for Red Cross parcels to be sent to the Channel Islands through the International Red Cross; and will representations be made to the International Red Cross with a view to the amelioration of the hardships now being suffered by residents there.
  The Under-Secretary of State for the Home Department (Mr. Peake): My hon. Friend has been good enough to send my right hon. Friend the Home Secretary some particulars which have been supplied to him about an individual case, but collation of the information which has reached the Home Office from numerous sources does not show that the statement given to my hon. Friend is typical of conditions in the Channel Islands. On the question of what can be done to ameliorate the position, I cannot for the present add anything to the reply to my hon. Friend, the Member for the Combined English Universities (Mr. E. Harvey) on 2nd March.
  Sir W. Davison: Would my right hon. Friend explain how it is that parcels cannot be sent direct by the International Red Cross to people in the Channel Islands, when parcels which are sent to deportees from the Channel Islands in German concentration camps are being forwarded from there, with the consent of the German authorities, to the Channel Islands, and are very gratefully received?
  Mr. Peake: Yes, sir, I could explain that, but I could hardly do so within the limits of a Parliamentary question and answer. I would ask my hon. Friend to have a word with me about it afterwards.
  Sir W. Davison: I certainly will, but will some steps be taken with the Inter-
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  national Red Cross to see if some of these parcels cannot be sent direct to these unfortunate people, many of whom are dependent largely for food on carrots and turnips boiled in sea water because there is no salt?
  Mr. Peake: We all have the greatest sympathy with the hardships these people are suffering, but I would direct my hon. Friend, on the general question—and it is a broad one—to refer to the speech of the Minister of Economic Warfare made in another place yesterday.
  Mr. Driberg: Could the Home Secretary consult with the Postmaster-General with a view to making representations to the Portuguese authorities asking them to facilitate the transmission of parcels?
  Mr. Peake: If the hon. Member refers to the speech of the Minister of Economic Warfare, he will see that that matter has been taken up.

  SUNDAY OBSERVANCE ACT (PETITION)
  Mr. Sorensenasked the Secretary of State for the Home Department if he has considered the petition of the Whitefield Urban District Council, Lancashire, asking for the repeal of the Sunday Observance Act and supported by 196 local authorities; and what reply he has given to this petition.
  Mr. Peake: My right hon. Friend has considered the petition referred to but it does not affect the conclusion which he reached and which he stated in replying to my hon. Friend when he raised this matter on the Adjournment on 3rd February.
  Mr. Sorensen: Does not my right hon. Friend appreciate that the 196 local authorities represent the public opinion of their area; and, in those circumstances, could he, at least, recommend to his right hon. Friend that local option should be granted to those authorities?
  Mr. Peake: The number of authorities to which my hon. Friend refers is 196 out of a total of nearly 1,500 but what my right hon. Friend indicated he desired to see was a change not in local government opinion, but in Parliamentary opinion.
  Mr. Sorensen: Does the right hon. Gentleman realise that while his right

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  hon. Friend said that, he gave no indication of facilities for this Parliament to express its opinion on the matter?
  Mr. Evelyn Walkden: Can I put a straight question to the right hon. Gentleman? Has he informed these local authorities that powers are already in the hands of the Army Council to provide Sunday entertainment of troops in theatres in this country, wherever the need exists? Cannot advice be given that they make use of the powers, where troop shows are needed on Sundays, and neither the Lord's Day Observance Society nor any other society can object?
  Mr. Peake: That is a wider question.

  PLACE NAMES (PUBLIC DISPLAY)
  Mr. Dribergasked the Secretary of State for the Home Department if, in view of the general restoration of signposts, he will rescind the Order forbidding the public display of place-names on shop-fronts, offices, etc.
  Wing-Conunander Hulbertasked the Secretary of State for the Home Department if he will now consider relaxing the restrictions to permit full address of traders to appear on commercial vehicles.
  Mr. Peake: The restrictions referred to are imposed by the Removal of Direction Signs Orders, made under Defence Regulation 4B. Administrative relaxations are made from time to time as circumstances permit, but the time has not yet come when these Orders can be revoked. The question whether further relaxations can now be permitted is under consideration.

  JOINT POLICE FORCES (COST)
  57. Sir L. Lyleasked the Secretary of State for the Home Department how the present cost of the police in amalgamation districts compares with the pre-amalgamation cost of the police in the same districts.
  Mr. Peake: Until the accounts for the present financial year are completed it will not be possible to say how the expenditure on a joint force compares with the expenditure on the constituent forces in the previous year. My hon. Friend will, however, appreciate that, even when the accounts are available, it will be diffi-
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  cult to isolate savings or expenditure directly or indirectly due to amalgamation from the savings or expenditure resulting from other war-time factors.

  EDUCATION

    Ophthalmic Service
    Mr. Wakefieldasked the President of the Board of Education the number of ophthalmic surgeons, now and pre-war, employed in school clinics; and the number of medical officers or assistant medical officers employed on eye-work in these clinics without the full qualifications of an ophthalmic surgeon and who have not even obtained one of the recognised diplomas in ophthalmology.
    The President of the Board of Education (Mr. Butler): In 1938 the number of ophthalmic surgeons employed by local education authorities in the School Medical Service was 418. Comparable figures for the war years are not available but I have no reason to think that the number has fallen materially. Two hundred and twenty-six school medical officers and assistant school medical officers were also employed by local education authorities on eye-work in 1938, but the records do not show how many of them possessed specialist qualifications. Before the Board approve the employment of a school medical officer on eye-work they satisfy themselves that he possesses adequate qualifications and experience.
    Mr. Rhys Davies: May I take it that all school children are covered by ophthalmic surgeons?
    Mr. Butler: I cannot give such a sweeping generalisation as that, but we try to do eye-work in the schools in the best way we can in present circumstances.

    School Medical Services
    Mr. Lipsonasked the President of the Board of Education if, in view of the necessity of maintaining the School Medical Services, he can now give an assurance that no more school medical officers will be called up for the Services.
    Mr. Butler: In the allocation of medical man-power between the various fighting and civilian services proper regard is had for the necessity of maintaining the school medical service at an efficient level, but

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    the needs of the Fighting Services must be the paramount consideration.

    Allied Ministers' Conference
    Mr. Kenneth Lindsayasked the President of the Board of Education whether the conference of the Allied Ministers of Education has now set up a continuing organisation; and whether liaison is maintained with U.N.R.R.A. in so far as assistance in school equipment and books is contemplated.
    Mr. Butler: Yes, Sir. The organisation is on a continuing basis and the work of the Allied Ministers' Conference is steadily developing. I do not think that books are likely to fall within the scope of U.N.R.R.A., but the Conference are in consultation with U.N.R.R.A. about the provision of school equipment.

    McNair Committee (Report)
    Mr. Edmund Harveyasked the President of the Board of Education the date of publication of the Report of the McNair Committee.
    Mr. Butler: I cannot give my hon. Friend a precise date for the publication of the Report of the McNair Committee, but unless there are any unexpected delays it should be published during the latter part of next month.

  WAR EXPENDITURE
  Mr. Lipsonasked the Chancellor of the Exchequer what is the present daily expenditure for war purposes; what financial limit has been placed on expenditure for the war effort with a view to avoiding the danger of inflation; and when was it nposed.
  The Chancellor of the Exchequer (Sir John Anderson): During recent weeks Vote of Credit expenditure has averaged about £15,000,000 a day. At this time of the year it is normally higher than usual and the average daily rate over this financial year to date has been about £13,500,000. In reply to the second and third parts of the Question, no financial limit has ever been imposed on war expenditure; but the financial and economic implications of increases in that expenditure have always had to be carefully weighed.
  Mr. Lipson: Does not my right hon. Friend's statement that no financial limit is placed on war expenditure make nonsense of the argument that increased pay and allowances to our Service men would cause inflation?
  Mr. Maxton: Is the no limit principle quite all right?
  Sir J. Anderson: It has to be watched very carefully.
  Mr. Stokes: Does the Chancellor mean that there is no restriction of expenditure an account of the money in circulation, and, if so, can he, at a future date, tell the House how much new money has been created?
  Sir J. Anderson: I have already answered a question on that subject.

  ATLANTIC OPERATIONS (PUBLICITY)
  Mr. Kirbyasked the Minister of Information why he permitted the name of the port from which the Battle of the Atlantic is being directed to be named in a B.B.C. broadcast on 20th February, 1944, and the name of the actual building used for the purpose to be named in at least one newspaper on 23rd February, 1944; and what steps he proposes to take to prevent such vital information being imparted to our enemies in this manner in the future.
  The Parliamentary Secretary to the Ministry of Information (Mr. Thurtle): The broadcast to which the hon. Member refers contained nothing that has not long been public property and there was therefore no security objection to its being delivered. The item in the newspaper was a quotation from a published book that had already been passed for security. For these reasons I do not think that it can be said that the enemy derived information of any value from either of these sources.
  Mr. Kirby: Does my hon. Friend mean to say that mention, either in the broadcast or in the book to which he referred, caused no breaking of the security rules in disclosing the port from which the Battle of the Atlantic is directed? Cannot he stop that sort of thing happening again?
  Mr. Thurtle: On both the question of the broadcast and the statement in the book we had to rely on the Service point of view and in each case the Service was satisfied that no harm would be done by this disclosure.

BUSINESS OF THE HOUSE
Mr. Arthur Greenwood: May I ask the Leader of the House to state the Business for the next series of Sittings?
The Secretary of State for Foreign Affairs (Mr. Eden): Yes, Sir, the Business for the next series of Sittings will be as follows:
First Sitting Day—Committee stage of the Education Bill.
Second Sitting Day—Second Reading of the Consolidated Fund Bill. Debate will take place on War Decorations and Medals.
Third Sitting Day—We shall make further progress in Committee on the Education Bill.
Fourth Sitting Day—Committee and remaining stages of the Consolidated Fund Bill. A Debate will take place in Secret Session on the Tank position.
During the week we hope to obtain the Motion to approve the Government of India (Distribution of Revenues) (Amendment) Order.
Commander Sir Archibald Southby: In view of the very large number of Members who will, doubtless, wish to speak in the Debate on War Decorations and Medals, do the Government propose to suspend the Rule on that day? Further, can my right hon. Friend say whether an opportunity will be given in the near future for discussing the Motion standing on the Order Paper in the name of various hon. Members on the question of Regulation 18B. [That this House is of opinion that the time has come for reconsideration of Regulation 18B and of the practicability of bringing to trial those now in detention on the sole responsibility of the Home Secretary.]
Mr. Erskine-Hill: Is my right hon. Friend in a position now to give a date for a Debate on delegated legislation?
Mr. Eden: With regard to the suspension of the Rule I have not had any representations about that. I am usually reluctant to suspend the Rule if it can be
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avoided but perhaps I might be allowed to sound the usual channels to see what demand there is for suspension. With regard to a Debate on delegated legislation I cannot give a day now, but I have it in my mind that there is a widespread request for such a Debate. I cannot promise it before Easter but we shall arrange it as soon as we can. I also cannot give a date now for the Debate on Regulation 188.
Mr. Shinwell: Has the Leader of the House yet come to a decision on the proposal to have a Debate on Dominions economic policy?
Mr. Eden: Yes, Sir. If we stick to our present programme, I have a date in mind before Easter.
Mr. Shinwell: Has the right hon. Gentleman considered the representations made to him that if we hold the Debate after Easter, we might have two days?
Mr. Eden: Yes, Sir, I did, but so far as I could discover I thought that one day would probably suffice. I think the Debate may be held before Easter.
Sir H. Williams. Is it not the case that the Consolidated Fund Bill is exempted Business and that there is no need to suspend the Rule?
Mr. Eden: My hon. Friend is quite right, and I was quite wrong.
Mr. Quintin Hogg: Is my right hon. Friend in a position to say whether a Debate on the coal mining situation can be held in the near future?
Mr. Eden: I did not contemplate that in the Business with which we are dealing at the moment, beyond which I cannot go now.
Mr. John Dugdale: Will the Debate on Imperial affairs be confined to economic policy or will it be a wider Debate?
Mr. Eden: I think it is desired that it should cover a wide field.
Mr. George Griffiths: Would it not be wise to leave the Coal Debate alone until you have squared it out with the Ministry? It will be better for the men in the field.
Mr. W. J. Brown: Does the Leader of the House anticipate that we shall get the Committee and remaining stages of the

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Pensions (Increase) Bill before we rise for the Easter Recess?
Mr. Eden: Yes, I rather hope so.
Sir Granville Gibson: Has a date been fixed when the House will go into Committee of Supply on the Civil Estimates?
Mr. Eden: No, not in the Business that I am announcing now.
Mr. Gallacher: In view of the desire to make progress with the Education Bill, will the right hon. Gentleman advise Members who are not particularly interested in it, not to descend suddenly on the Committee and explode with irrelevancy?
Mr. Stokes: With regard to the Debate in Secret Session on Tanks, will the Government take such steps as may be necessary to facilitate participation in the Debate by Members of the Select Committee? Obviously the House would like to hear what they have to say.
Mr. Eden: I do not think that is a matter for the Government.
Mr. Maxtor: Is the Indian business likely to be controversial?
Mr. Eden: I am always cautious with the hon. Member on Indian matters but I should hope not.
Mr. Austin Hopkinson: With regard to the promise of a day to discuss delegated legislation, is it not possible to bring in the whole question of Regulation 18B in that Debate and combine the two in one, since 18B is, obviously, an example of delegated legislation?
Mr. Eden: I have it in mind that delegated legislation should have priority.
Major C. S. Taylor: With regard to the Debate on the Second Sitting Day, is it intended that a Government spokesman shall open it? Some of us feel that it should really be opened by a back Bench Member and the Government should wind up, after hearing the views and suggestions of hon. Members.
Mr. Eden: I did not contemplate any thing of that kind. I thought it would be more convenient if the Prime Minister opened with a statement.
Mr. Buchanan: In view of the unsatisfactory nature of the Debate on housing
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and the deep concern in the House and in the country on the question, will the Government consider making an early statement and allowing the House to debate the question again?
Mr. Eden: Of course the Government will be bringing in legislation, when there will be wide opportunities for Debate.
Lieut.-Colonel Dower: May I ask a question upon the Business for the Second Sitting Day and the decision of the Prime Minister to speak at the beginning of the Debate instead of at the end? May I ask the Leader of the House whether that means that our proposals will not be taken into consideration but that his decision will have been made before?
Mr. Eden: The Prime Minister and I thought it would be much more convenient to the House that the result of the Government's reflections on the matter should be made available for discussion. That is all. Of course, hon. Members will be free to make suggestions, and it is for that purpose that we are having the Debate.

SELECT COMMITTEE ON NATIONAL EXPENDITURE (MEMORANDUM)
Mr. Stokes: I wish to seek your guidance, Sir, on a matter of which I have given you notice. It concerns a notice on the Paper yesterday which reads:
"Sir John Wardlaw-Milne reported from the Select Committee on National Expenditure, pursuant to the Order of the House [3rd December] That they had addressed a Memorandum to the Prime Minister for the consideration of the War Cabinet."
My submission is that the Select Committee is a Committee of the House and I understand they are perfectly entitled to report in secret to the Prime Minister and War Cabinet if they choose, but what useful purpose does it serve to put this announcement on the Order Paper unless there is some indication at the same time as to what the Report was about? We have no indication of any kind and we are not able to ask questions about it. Perhaps the procedure could be so altered that, when a Select Committee sees fit to make a report in secret, they should indicate the subject on which the Report has been made.
Mr. Speaker: The hon. Member will realise that the whole procedure is

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governed by a decision taken in the House, and the Committee is entitled to make a secret memorandum to the Prime Minister if it chooses. Therefore, no indication need or can be given as to what it is about. If one were to give an indication, it might be giving information away. If, for instance, it were stated on the Order Paper that a memorandum had been submitted to the Prime Minister on the defences of the road to Timbuctoo, or something like that, it would obviously be giving something away which it would be undesirable should be made known. Therefore, under the present procedure, it is not necessary, and it is also inadvisable, to state what the memorandum is about.
Mr. Bellenger: When the House goes into Secret Session on the fourth Sitting Day, can any reference be made to this document in the course of the Debate?
Mr. Speaker: We know nothing about the document. We only know that a memorandum has been submitted to the Prime Minister.
Mr. Bellenger: Does it mean to say that during the Secret Session no Member of the Select Committee, who of course must be cognisant of the contents of the document, can refer to it in any way?
Mr. Speaker: It is not permissible to quote from a document which has not been laid before the House. This document has not been laid, and no Member of the Committee can quote from it.
Sir A. Southby: Will it not be open to the House, in Secret Session, to ask that a memorandum which has been submitted by its own Committee should be produced and discussed during that Session?
Mr. Speaker: No. By Order of the House, the Committee is entitled to submit a secret memorandum to the Prime Minister, to which no one has access but the Prime Minister.
Mr. Stokes: May I draw your attention, Sir, to the fact that at Question time today the Prime Minister admitted having received a Report on tanks from the Select Committee which has not been reported to the House. We know, therefore, that the contents concern tanks and tank expenditure. Is there any reason why it should not be laid on the Table and disclosed to the House in Secret Session?
Mr. Speaker: By the Order that I have just referred to, the document cannot be laid on the Table and its contents may not be disclosed.
Mr. Stokes: Was the Prime Minister then out of Order in stating that he had received the Report?
Colonel Sir Charles McAndrew: Is it not the case that if a document which has not been presented to the House is quoted it does not have to be laid if its production would be inconsistent with the public interest?
Mr. Speaker: It is in Order far an hon. Member to speak of matters of which he has recollection, but not as a quotation from the document that I am speaking of. In such case I cannot tell where his information came from.
Sir William Davison: Is any useful purpose served by putting on the Order Paper the fact that a memorandum, which cannot be discussed or referred to, has been sent to the Prime Minister? What is the object of putting that notice on the Order Paper?
Mr. Speaker: That is not a matter for me.
Mr. Silverman: In answering a Question earlier, the Prime Minister referred to a document about tanks. He did not say that it was a secret document, and I infer that it was not. As he referred to it, would not the House be entitled to ask for its production?
Mr. Speaker: Assuming that it was a secret document—I assume that it was—the document by Order of the House cannot be produced.
Mr. Shinwell: Is it not highly improper to discuss the nature of the Business with which we are to deal in a Secret Session? We know nothing about the contents of this document. Some Members appear to know all about it but most of us know nothing about it. If it is to be discussed, surely it ought to be discussed when the Secret Session takes place.
Mr. Silverman: I am not referring to any of those matters at all. I am referring only to the answer given by the Prime Minister. I do not know whether we are to infer that it was referring to any secret document. He did not say so

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but, assuming that he was, how can the Ruling that you have just given, Mr. Speaker, be reconciled with the general practice of the House that, if a Minister refers to a document, the House is entitled to see the document?
Mr. Speaker: That is what I call a hypothetical question. The hon. Member starts by assuming that the Prime Minister referred to a secret document. We can see in HANSARD to-morrow exactly what was said.

NATIONAL EXPENDITURE
Third Report from the Select Committee, brought up, and read; to lie upon the Table, and to be printed.—[No. 58.]

MESSAGE FROM THE LORDS
That they have agreed to,—
Amendment to—
India (Attachment of States) Bill [Lords], without Amendment.

NATIONAL HEALTH SERVICE
The Minister of Health (Mr. Willink): I beg to move,
"That this House welcomes the intention of His Majesty's Government, declared in the White Paper presented to Parliament, to establish a comprehensive National Health Service."
Just over a year ago, the Government declared their intention to establish a comprehensive and unified health service for the people, a service covering the people as a whole, a public, organised and regulated service for every man, woman and child. To-day, the Government seek the approval of Parliament for the broad principles running through the White Paper presented to Parliament four weeks ago, so that they may proceed with the next stage, the stage of closer detail, the stage of negotiations, and so to the preparation, with no undue delay, of legislative proposals.
I desire to commend these proposals, and my chief concern at this moment, when I know how many right hon. and hon. Members can make valuable contributions, is how to keep within reasonable limits what I have to say on proposals which are so wide in scope and so very conducive to digression. In the time I have, for I do not wish to be too long, I feel sure that I shall be right to concentrate upon principles and not upon any point of detail. The hon. Lady the Parliamentary Secretary to the Ministry, to whose help I owe so much in this connection, will be able, I hope, early upon next Sitting Day, to deal in greater detail with points that to-day's discussion shows to be of special interest; and my right hon. Friend the Secretary of State for Scotland, in winding up the Debate, will obviously be infinitely more competent than myself to deal with the specifically Scottish features of the scheme. And so, in this opening speech, the House would, I think, wish me to try to bring into clear focus the basic principles of the proposals that we ask the House to welcome. As I have referred to two of my colleagues I would wish, in the most public way possible, to refer to a third, my right hon. Friend the Chancellor of the Duchy of Lancaster, for without his labours it would have been quite impossible for me to put into final shape this scheme which I submitted to my colleagues in the Government, with
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the Secretary of State, little more than three months after my appointment.
Is it not right to think of a National Health Service as one of the main pillars upon which our post-war social structure will rest—education, health, housing, social insurance, and there will, of course, be others? Each of these pillars needs to be well fashioned and well founded, and then the structure will be good. This is the stage at which we are fashioning and founding. Education has already reached the stage of legislation, health has followed not too far behind, and it will not be long before social insurance reaches the same stage; and so, I think, we may truly say we see the whole structure steadily taking shape. Big as this scheme is, it is really to be regarded, I feel, as part of a bigger process still, the process of reshaping the background of individual life in this country. It is really a counter-process to all the destructiveness of war. I think it is true to say that we are discussing to-day a project which will be the biggest single advance ever made in this country in the sphere of public health. We have had other great public health landmarks in the past, but this dwarfs them all in its scope and conception. Bold though it is it is only right that it should be bold, for the health of the nation, the health of every citizen, young and old, is at the very root of national vigour and national enterprise, and this should be the scale, I venture to suggest, on which our discussions should be framed to-day and on the next Sitting Day. There will be time and opportunity for discussion of small details in the coming months and when the time comes for legislation.
What is our real object in this new National Health Service? The object, like the name of the service, is national. It is to fit the nation for its great responsibilities, to free its members, so far as it is humanly possible to free them, from the anxieties, the burdens and the pains of ill-health. This is no scheme for giving charity to individuals or State help to particular classes or groups. This scheme does not concern itself with poverty or wealth. It is a plan to raise national health to a higher plane and keep it there, and to use the nation's full resources to raise it ever higher. Nobody can guarantee health or get rid of sickness. What we can do is to improve the opportunity of

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health, and we can get rid, I have no doubt, of much of the wear-and-tear that goes with ill-health. We know the anxieties—the anxiety about paying bills, the anxiety about getting the best advice, an anxiety which is worse when we are considering our dependants than when we are considering ourselves. This scheme is an attempt to get rid of all that, to see what it is that the nation needs, to see that it is there and to see that advantage can be taken of it easily and readily.
In one or two places in the White Paper the word "free" occurs, and I should like to say a word about that, because it is not really an appropriate word. It is far less true in connection with this service than it is in the field of public education. A service of this kind has to be paid for—it cannot be free—and the real position is that the method by which our medical and health services will be paid for is going to be changed. Everyone will pay for a service for everyone and by three means—taxation, rates and the social insurance contribution. The only sense in which the word "free" is appropriate—and I do not really think it is appropriate at all—is that there will be no charge to those who use the service when they use it or because they use it.
The extent of the social insurance element in this scheme is not yet settled. That will appear in the Government's social insurance proposals, but it is not inconvenient, I think, to assume for the moment Sir William Beveridge's suggestion of a contribution of £40,000,000 out of the Social Insurance Fund towards the health services. Then, on a rough estimate, 27 per cent. of the cost of this service will be met on the contributory system, leaving about 36 per cent. for taxation and about 36 per cent. for the rates. Perhaps it would be convenient to compare these percentages with the percentages which obtained in our partial services in the last year before the war. In those services the contributory element amounted to no more than 20 per cent., the contribution from the Exchequer was far smaller than the 36 per cent. to which I have referred—it was a mere 6 per cent. —and the ratepayers' contribution was proportionately far higher, 74 per cent. This scheme is a novel blend of three systems, a novel blend of central organisation and expenditure, local government administration and expenditure, and a
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contributory system, and, woven into the whole a wide range of arrangements of a contractual kind for services by voluntary organisations of many sorts.
In the time at my disposal I do not think it is necessary or that it would be right to say much about our present services. We know what magnificent work has been done in many fields, and we know, too, the deficiencies. The present situation is set out very fully, and I hope conveniently, in the first Appendix to the White Paper, but, just summarising it, we know that there are local government units of half-a-dozen kinds, with different services put upon them at different times, with limited objects in view. We know that there are hospitals for general cases, chronic cases, acute cases, special cases, infectious cases, the mentally ill and the mentally deficient. There is a wide range of welfare services. There is the widest range of hospitals—voluntary hospitals, general, special, teaching and cottage hospitals. There are the public hospitals, which have made such great progress in recent years. But whatever be the wealth of good material, no one can say that it forms anything like an organic whole. There is in many places no inter-relation between the voluntary and municipal hospitals, no sufficient link between the general practitioners and the clinics, over-lapping, unnecessary competition. Perhaps the greatest deficiency of all is that our present services provide no personal doctor for the wives and dependants of insured persons. And there are real difficulties of access to the appropriate hospital for the particular case. There are new services which we need—dental services, ophthalmic services and others. What we have to do, I feel sure, is to see that this great new service evolves naturally out of what we have. We do not want any doctrinaire scheme; we want a natural evolution. We want a scheme that will work, and into which every one of the present elements can put their best.
The proposals in the White Paper, I think it is true to say, are built around certain principles which the Government believe to be fundamental. I would say that there are four main principles and, after stating these, I shall pass to a number of features in the plan which derive from these principles. The first principle, which I have already mentioned, is that of comprehensiveness. The whole range

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of health care must be made available to every person, starting with the family doctor and ranging through all kinds of clinic and domiciliary services to the consultant and the specialist—another service entirely absent at present in any organised form—and the hospital. I would emphasise again what I think is as yet hardly realised by the general public—the immense advantage of including wives and children and not merely the insured contributor.
Then, there is the second principle, the freedom of the individual. No one, patient or doctor, must be dragooned into any part of this service, or any form of treatment, unless they want to use it. We want it to be there for everybody, but not thrust upon anybody. There must be no compulsion of the doctors, or the nurses, or any others whose job it is to give the service. On the whole, professional people know their own professional job best, and should be left as free as possible to practise it in their own way. A certain amount of organisation is essential. The State is taking the the responsibility of providing the service and we must see that it is there, when and where it is needed, but we must do everything to see that organisation spells neither bureaucracy nor red tape.
The third principle, which runs clearly through the whole of this Paper, is the principle of democratic responsibility. We feel that the new public responsibility to see that the whole service is there and that it is good must rest, both centrally and locally, with the elected representatives of the people, that is, with Parliament and with Ministers directly responsible to Parliament, and with local government in the general sense in which we know it in this country.
Mr. George Griffiths: Democratically appointed?
Mr. Willink: We will come to that. The fourth main principle is that of professional and vocational guidance. The ultimate responsibility must be fully democratic, but the whole service must benefit throughout from the very best professional and expert advice and guidance that we can obtain. If this service is to achieve the best professional standards, it must enjoy and take note of the best professional counsels.
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With those four principles in mind—and I hope the House will accept all four—I should like to turn to the actual organisation and point out a number of main features—perhaps six or seven—which the Government feel to be fundamental to their proposals. The first I would mention is that well-known principle, the free choice of doctor. There is no doubt that the personal and intimate relationship of doctor and patient is inherent in medical practice in this country. There are very few people who do not attach the greatest importance to being free to choose their own medical adviser and to change to another when they want to do so. Very few people want to be doctored by a service. They like being doctored by the doctor of their choice, and if people want this principle to remain, remain it must just so long as they want it.
Dr. Edith Summerskill: I should like to ask the Minister how he reconciles that statement with the fact that everybody who attends a hospital is doctored by the hospital service. Such people do not choose their doctor.
Mr. Willink: Of course, if you want to go to a hospital, that is a different matter entirely from choosing a personal doctor. Myself, I see very little likelihood of this attitude of mind in our fellow-countrymen, to which I have referred, coming to an end.
Secondly, there is, in the belief of the Government, no case for anything which could reasonably be called a regimentation of the medical profession. Some people believe in a salaried medical service; some people believe in the present basis of practice, under which a doctor, broadly speaking, is remunerated according to the number of patients whose care he undertakes; some people believe in practising in groups; some people believe in practising as separate individuals. These varying beliefs are not only found among the doctors; they are found among the patients; and so, in this matter, I would emphasise that, whatever rumour may say, the Government have no intention of seeking to establish a full salaried State medical service. We do believe that where doctors practise in public health centres, there must be a system of payment which does not involve competition between one another,

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and that is a proposal which is to be found in the Paper with regard to practice in health centres. But it would be a mistake to universalise one system at this stage. Let the service, we advise, be big enough to give scope to all these points of view. Let us try them all, side by side, the public will steadily find its own preferences.
This attitude of experiment is particularly true of the health centre idea. The White Paper contemplates experiments of many kinds which we are encouraged to suggest by the fact that health centres of many kinds have been suggested by the profession itself. Many in the profession believe that the best work of the general practitioner can be done in a health centre, specially designed and specially equipped, where the team of doctors would profit from the pooling of their experience, from up-to-date resources, and from the saving of their time by the provision of ancillary staff. Patients in an area where there were such health centres would choose their own doctor just as they do now. They would see him in his consulting room. He would have consulting hours and would visit his patients at home just as he does now. But there seem good grounds for suggesting that doctors practising in that way would have a considerable advantage—and their patients would have advantages, too—from the fact that the team could cover emergencies. They could deal with time off, holidays, and refresher courses more easily than they can now in solitary individual practice. The whole idea seems to us sensible and attractive and we want it to be tried out fully and fairly. The doctors and the people will want to see how it develops.
Thirdly, with regard to general practice, the Government do not believe that practice under private arrangements should be either prohibited or isolated. If people are to have the right to seek private advice where they want it—and it would be a strange proposal that people should not have that right—it follows that the doctors must be free to treat them. Nothing, in the view of the Government, could be more unfortunate than to divide the profession into two classes, those who practise publicly, and those who practise privately. What we want is to see the whole of the best of the profession engaged in this service, not to divide it into two camps. But there are one or two points
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which should be made in regard to that. We do feel that a doctor who has more private patients should have a smaller number of public patients, and the scheme provides for professional regulation of that balance. We think, too, that doctors in big practices will need young assistants and that there is a strong case for requiring all young doctors first entering on general practice, to serve an apprenticeship with an experienced general practitioner, especially in a publicly financed service where the patients have the right to rely on the doctor being an experienced practitioner.
The fourth point I would mention in this connection is in relation to a sentence which has, perhaps, as a sentence, caused more controversy than any other in the Paper. I was even asked a question about it when I visited the county of Suffolk a week or two ago. I have had only one discrepancy between the White Paper and the abridged version brought to my notice and considering all the difficulty of abridgement, that is not, I think, unsatisfactory. In the sentence dealing with the proposal that in certain cases the Central Medical Board ought to be able to require a young doctor to give his whole time to the public service, in the longer version the word "where" appears—"where this is required": in the shorter version the word is "when." The word should be "where" in each case, but, even after making that small correction, I think that the sentence might read more appropriately in slightly fuller form. The White Paper, on page 35, might say:
"The Board must also be able to require a young doctor entering the public service to give his full time to that service during the early years of his career in cases where the needs of the service require this."
This sentence does not point the way to any direction of the kind to which we are accustomed during the war. All it is intended to mean is this—I give the following as an example. A young man thinks of Practising in Wakefield. He says, "I should like to enter into the public service in Wakefield." The Central Medical Board should in these circumstances be able to say, "Of course you can practice in Wakefield in private practice, but before we authorise you to take up public work in Wakefield we wish to tell you there is a great shortage of public service practitioners, and we feel that for five years you should give your whole time to that

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service and should not have any private patients." That is the meaning which that sentence was intended to have, and I am sorry if it was not quite clear.
On the general practitioner's side, we feel that the scheme proposed in this Paper will give him immensely greater opportunities. It is only a week or two since the Prime Minister described the attempt that we are going to make in connection with this service as war with disease as the enemy. That great man Sir William Osler once, in an address to medical students, described the family doctor as "The man behind the gun." That is how we regard him in connection with this service. We believe that in various fields he will be able to contribute far more in this service than before, and in particular we want to link his work far more closely with child welfare, maternity work, and all the different activities of the local clinic.
Here I would put in a word about the nursing profession. In a Paper of this kind it is natural to stress the doctor and the hospital, but I should like to say here that that does not mean that we underrate the vital part to be played by the nurse, the midwife, and all the medical auxiliaries, as they come to be called in war. The success or failure of this scheme will depend in large measure on the nurse, not only in hospital and clinic, but in the home, because the intention is to provide a real service of home nursing and ways and means must be worked out with the nursing profession itself. That is one of the next jobs to do. Here, too, we want to build on good existing foundations. I should like to pay a tribute in passing to the work being done to-day by the district nursing associations and the Queen's Institute of District Nurses. The nurse in this scheme will not be merely an executive. She will have a proper share in the whole machinery which is proposed for professional and expert consultation in running the scheme. The nursing profession will have its place, too, on the Central Health Services Council and on the local health services councils, and we intend that nurses shall find their place, too, on the expert inspectorate which we propose for the hospital service.
I pass from the general practitioner to the hospital. The voluntary hospitals of this country are a typical and successful
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product of this country's methods. A long history lies behind them. Many people believe in the voluntary hospital as an organisation and as a principle. Many, too, believe in the hospital service of local government, which, as I have already said, is going rapidly ahead and has a great future. But in building up this service we want everything good that is available; we want both types of hospital. The voluntary hospitals, I believe, are going to render valuable service in the new scheme. The proposal is that they should be paid—not as the paupers of old according to their needs, but like partners in relation to the service they give—by way of standard payments from joint authorities and by central payments representing social insurance contributions. We propose to take the voluntary hospitals by the hand; we do not propose to carry them and I cannot think that they would wish to be carried. For this very reason they will continue to need the support of those who want them to continue their work and to maintain their independence and autonomy. I would like to read one sentence from the White Paper:
"It is certainly not the wish of the Government to destroy or to diminish a system which is so well rooted in the good will of its supporters "
There is, I think, some misunderstanding as to the financial effect of our proposals upon the voluntary hospitals. That is not, in one particular, entirely unnatural or surprising, because in the Government's statement of October, 1941, is was contemplated that in the partnership which was to be built up the voluntary hospitals might well be largely served financially by the contributory schemes which have been so remarkable a development of recent years. After close consideration, the Government have come to the conclusion that to launch a major social insurance scheme which did not cover the contributors against perhaps the greatest normal contingency of life, prolonged illness involving residence in hospital, would be impossible. That being so, one of the two main objectives of the present contributory schemes must be affected. The contributor will no longer have that particular contingency to cover, and I feel certain that if that fundamental principle is accepted by the voluntary hospitals, they would be the last to suggest that contributory schemes

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should be maintained simply in order to continue the existing basis of their finances. Provision is made in the scheme for a change in this basis and I should like to give one or two figures. Taking the figures of the last normal pre-war year, 1938, so far as we can work them out from returns from about 80 per cent. of the hospitals, the payments received through contributory schemes and direct from patients through the almoner system would come to £5,300,000. The new Exchequer payment proposed to be made to the hospitals, worked out on the basis of 1938, would have given them in that year a payment of £6,500,000. There is a further factor. In 1938 the voluntary hospitals received for public services, almost entirely from local authorities, something like £900,000. That is in addition to the £5,300,000 to which I have referred. In substitution of this sum of £900,000, it is proposed that they shall receive from the joint authority, with whom they will be in contract, the service payment referred to on page 23 of the Paper, which will certainly be far larger than £900,000. In addition to these two provisions, there is a third factor. The Government, as is stated in the Paper, will most certainly be prepared to review the question of financial assistance in respect of teaching work at the teaching hospitals. The financial side is to that extent very fully provided for. If, as I believe, the voluntary scheme contributors were not merely paying an insurance premium but were paying to maintain a system in which they believed and to which they were attached, taking into account, too, the fact that there will surely be scope for the development of contributory schemes on other bases, and that there will be gifts, subscriptions and legacies which have for generations been given to the voluntary hospitals, I cannot believe that the anxiety which has been shown is really justified.
I pass to the fifth point, on which I have noted very little disagreement—the question of the rationalisation of our hospital services and the building up of hospital areas. The old conception of the local hospital is outworn. Specialisation increases, and special treatments mean special organisation. We must in this service plan a hospital system as a whole, ensuring that the people can get to the right hospital at their time of need. So
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we propose an area plan, worked out with local knowledge but submitted to my Department for confirmation. I pass from that plan because I have heard and seen very little criticism of it.
The next point I would mention is the consultant and specialist service. There is little in the Paper about this and there has been little discussion with representatives of the consultants and specialists, for we must on this, await the report of Sir William Goodenough's Committee. Two things only are clear to us at the moment. There will be need for considerably more consultants and specialists and there will also be a great need for an improvement in their distribution over the country.
Last of the main features of the plan is the local government structure. We have no doubt that the foundation of this scheme should be in local government. Much is said of the removal of functions from local authorities, but here is a new service which will add great new duties to local government. It represents an opportunity for an enormous advance in local responsibility, and I believe that the scheme is an immense opportunity for those who take a deep interest in the hospital and health services of their particular part of the country. I ought perhaps to say a word about a major feature of this part of the scheme. The hospital service areas will in almost every case be larger than existing counties or county boroughs. That, too, I have hardly heard criticised, and there is no doubt that many of those who have thought about it feel that most of the counties and county boroughs are too small to serve as a satisfactory hospital area. In those circumstances we believe that the joint board as the hospital authority, which will plan services for its area, in addition to the hospital service, is really the most reasonable system.
As I indicated at the beginning of my speech, this service is one about which any of us can talk at great length. I have pointed to the main principles which we hope will be accepted by the House so that we may go forward. We have set our hand to a great task, which calls for courage and which calls for patience and broad vision in many quarters. We ask for the support of the House, because we believe that the day when we bring this plan to fruition will be a day long to be

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remembered for good in the history of the British people.
Mr. Gallacher: Before the Minister sits down may I ask him to arrange for something to be said about the remuneration of doctors and nurses who are going into the public service? It is very important to do so, if the scheme is to be a success.
Sir Joseph Lamb: Would the Minister at the same time say whether the areas to be served by the joint committee will be the same for general hospitals and for special hospitals or whether the general hospitals have another scheme for collaboration with special hospitals in a larger area?
Mr. Willink: There will probably be two or three services in which there will be fewer centres in the country than the number of hospital areas. I think of cancer treatment and neuro-surgery, in which probably the centre will be linked with a university or teaching hospital. Apart from very specialised services of that kind, it is hoped that the areas will cover all hospital services.
Sir J. Lamb: Thank you.
Sir Ernest Graham-Little: I propose to try to represent the views of the medical profession, and I suppose that my selection to speak now has been determined for reasons which I shall give in a moment. I have been for 30 years on the honorary staff of a great London teaching hospital and for 20 years I have represented in this House the University that has, by far, the largest medical faculty of any university in the world. I very much wish that a more persuasive person than myself had been chosen, but I shall do my best to give the House some idea of the feelings of the medical profession in regard to these proposals.
I may say that, in January, 1941, when there was a prospect of planning for future medical service by the British Medical Association, I asked the Prime Minister not to let that question he decided by a private body, but to appoint a Royal Commission which would take evidence from all sections of the community concerned with health services. I submit that that would have been a very much more sensible course to take, and
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might have resulted, if it had been appointed three years ago, in the accumulation of much more positive evidence than we have now on how these services should be carried out. The Minister has made a statement in which he said that professional people "know their business best," but I think it is a fact that they have never been consulted in the preparation of this scheme. May I give some facts which support that contention? The Beveridge Report appeared in December, 1942. In March, 1943, the then Minister of Health invited some very prominent medical organisations, chiefly centred in London, to draw up some plans of their own. That body was called the Representative Committee of the Medical Profession. It was met by the Minister of Health in March, 1943, and the Committee were told in the very first session what had been decided. I have here the words reported as having been used.
Mr. Willink: I am sorry to interrupt the hon. Member but I think it should be stated that there is no doubt that all the talks that took place between my predecessor and his officials, on the one hand, and the representative body on the other, were expressly on a confidential basis.
Sir E. Graham-Little: That makes it much more difficult. Conversations did take place, and the result of them appeared in the Press. On 12th March of that year "The Times" said that the medical profession must recognise that a settlement of the future of medical practice had been reached. In September of that year, the chairman of one of the larger committees of the B.M.A. came to a specially convened meeting of the profession in London, and gave us information which he authorised me to put into a letter in "The Times." It was published in "The Times," and the statement ran:
"Negotiations must be based on the acceptance of the decision by the Cabinet, that a single unified health service, covering 100 per cent. of the population, would be instituted, and that local administration would be in the hands of local authorities and under the ultimate control of a Minister who would be responsible to Parliament."
At the same meeting, as subsequently reported in the medical Press, the Minister off his own bat informed the Representative Committee that it was proposed to secure control of the medical profession, "in order to keep a firm hand on the

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issue of sertificates", and it was stressed in the Beveridge Report that strict certification would be necessary, in order to shorten the period of benefit on the scales contemplated. I submit that the proposals in the White Paper follow, essentially, the pattern of that "decision" of the Cabinet as announced. It was accepted as being the basis that would be followed in subsequent procedure. Therefore, I contend that these present proposals are essentially the same as those which have been before the profession and the public for at least a year.
What has happened during that year? In a recent answer to a question by myself the Prime Minister declared that the issue whether proposals are controversial would be best tested by Debate in the House of Commons. I am sorry that I have to contest the validity of that suggestion. Can a two days' Debate in the House of Commons, in the turmoil of political activity, when the Government are very strongly entrenched, with little opposition, and with the pressure that can be exercised by the Whips and all the other paraphernalia of Procedure, be regarded as a better index to public opinion than the free Press of this country, lay and medical? I think that contention would not be accepted in a free democracy. Therefore I hope the matter will go beyond a Debate in this House and that the question will be decided by a wider circle. May I put the matter from the angle of the medical profession? Surely it is impossible to work a scheme, if those who operate it are intensely resentful of the conditions imposed upon them.
Dr. Summerskill: The hon. Member claims that he represents the views of the medical profession. I belong to the medical profession, but I do not agree with his views. Would he substitute "a small section of the medical profession"?
Dr. Russell Thomas: The vast majority.
Sir E. Graham-Little: I would say that less than 10 per cent. of those who would be asked to work this scheme are in favour of it. Several quite notable events have taken place supporting this statement; I would ask the House to realise that the authentic voice of the medical profession is somewhat difficult to ascertain. The medical profession is
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divided, roughly, into three sections—general practitioners, consultants and those in the public service. The large majority of the profession are to be found in the general practitioner section. Figures have been given to me that suggest the proportion to be something between 60 per cent. and 70 per cent. Clearly, that section is much the most important in the operation of any scheme, and without their co-operation, any scheme that we could devise would be merely beating the air. If the present scheme cannot be operated, the Government are wasting the time of the country and of the House of Commons. Let me recall what has happened. On 16th May, 1943, there was a very big mass meeting, with an attendance of doctors of over 1,000.
Mr. Mathers: What proportion did that represent of those who were entitled to attend?
Dr. Summerskill: About one-seventieth.
Sir E. Graham-Little: A sufficient number attended to constitute a trend which we cannot mistake—
Mr. Mathers: The hon. Member seems to misunderstand me. I was asking, purely for information, what proportion this mass meeting represented of the medical profession for whom he is speaking? I am not versed in this. I do not know anyone concerned.
Sir E. Graham-Little: It has been estimated, and this is an official estimate, that there are 50,000 doctors who are actively engaged in practice. The total on the Register is 70,000 but many of them are not practising. About half of these general practitioners at the present time are serving in this country and half abroad. With half the profession engaged in war service of some kind, the other half are desperately overworked, and for them to have come along to this meeting, as they did, is a very remarkable thing. I submit it is a very significant trend, in the statistical sense of that word. That was in May, and throughout that year there were cities and large areas in the country which made their views known—Sheffield, Manchester, Birmingham, Worcester and a number of local divisions. Questionnaires were taken covering the practitioners in the area, that is, doctors actually practising and not on the shelf. These questionnaires seeking the opinion of those persons upon the proposals which

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were laid before the profession, showed a very remarkable result. Over 90 per cent.—the percentage ranged from 90 to 95—of the answers, representing a cross-section of the district, were against the proposals which involved
"lay control of the medical profession."
The answers were especially against the control suggested by the Minister, that is by the local authority, which is to be especially strict in relation to general practitioners.
A little later that year the British Medical Association gave an opportunity to general practitioners to express their views on this particular suggestion of control. This opportunity was given through the Representative Body of the Association, which meets once a year. Those who are not familiar with the British Medical Association should know that decisions in the name of the Association are largely voiced by a council which corresponds roughly to a Cabinet, but the rank and file of the profession are represented much more effectively by what is know as the Representative Body. It is the resolutions of the Representative Body, which really indicate the reaction of the profession—resolutions reached often in spite of the extreme difficulty of making an agenda which was open and fair. In spite of the control exercised in restraining the exuberance of that meeting, the result of the meeting in September, 1943, was an explosive rejection of one of the principal items which is now proposed, that is the reduction of the profession to a salaried medical service. That is what this proposal must eventually come to. The voting was extraordinary—200 against 10—and the meeting consisted of seven-eighths of the whole of the Representative Body. Any more conclusive evidence of the opinion of the general practitioners' section could, I think, hardly be suggested. A still more recent questionnaire has been sent out to 30,000 medical practitioners in this country in active practice and the result has been 70 per cent. opposition to this control.
Mr. Willink: The hon. Member says "opposition to this control." What control?
Sir E. Graham-Little: To lay control by a central authority.
Dr. Summerskill: How is the vote of 200 doctors representative of 70,000?
Sir E. Graham-Little: These are chosen representatives of the members of the B.M.A. They are elected, and it is a very democratic election.
Mr. Alexander Walkden: Were they selected or elected?
Sir E. Graham-Little: Elected.
Dr. Summerskill: If the hon. Member says that this body is representative, why is this questionnaire sent to all doctors asking for their views, in order to show what is the view of the medical profession?
Sir E. Graham-Little: I think that is a sensible procedure. The House knows very little indeed about what is happening in the profession. Surely it is right, at any rate it is wise, to let the House know as far as possible the opinion which has been voiced outside?
Dr. Summerskill: I agree with that, but how can the hon. Member say that a decision has been arrived at, when the doctors are still being asked for their views?
Sir E. Graham-Little: I said that the decision which was taken at the meeting was a resolution passed by the meeting, a very definite resolution, and it was passed by that majority by a body representative of the members of that Association.
Dr. Morgan: I am sorry to interrupt the hon. Member, but I happen to be a member of the Council of the British Medical Association, and while I realise that it has a very democratic constitution indeed, and does represent the profession, I want to say quite frankly that the hon. Member is misleading the House as to the actions that are being taken. I was at the meeting of the Representative Body, and I know how the vote was taken and the circumstances in which it was taken. It was representative of the profession, but this questionnaire deals with an entirely different matter—not policy or principles but details of the scheme. I was present at a meeting of the Council of the British Medical Association last week, at which the issue of this questionnaire was decided. It deals with details of the scheme, not questions of policy and principles.
Sir E. Graham-Little: I should like to take up that point. I have been informed

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authoritatively that the British Medical Association is proposing, at long last, to consult the members of the Association who are serving overseas. There was an announcement last night in one of the evening papers about five tons of paper being dispatched. That representated the document. It is a document of several pages with 28 different questions each with Sub-sections, and I think it will be exceedingly difficult for any serving officer to master that accumulation of questions with any sort of due consideration. With regard to the Council of the Association, I am glad that the hon. Member has raised that. In an answer I received a few weeks ago, I was informed that the Council of the Association since October, 1940, has delegated its duties for the most part to an executive committee, which is a very small body consisting of the higher officials of the British Medical Association. It has the least democratic origin I can imagine. I want to insist on the difference between the two voices in the British Medical Association, the voice of the Executive Committee and the voice of the bodies representing the rank and file.
I wish to deal with some of the points made by the Minister. He said at the beginning of his speech that 27 per cent. of the health services are to come from the Insurance Fund, that the Insurance Fund will furnish, roughly, a quarter of the expenditure on health services. The chairman of the National Municipal Councils Association, speaking about what would be put on the local authorities if these proposals came into force, told me that a rate of at least two shillings in the pound would be required to meet that expenditure, and that would have to be met by the local authority. He added that obviously he could not put upon his local ratepayers expenditure of that nature without having a very strong control of the personnel who were practising under that authority. Further contributions have to come from the taxpayer—£48,000,000–36 per cent.—from the taxpayer and £48,000,000–36 per cent.—from the ratepayer. So that what seems to me probable is that the insured person is being "sold a pup." He thinks he is to get something for nothing, or that he is to get a shilling for threepence—the slogan used to be ninepence for fourpence but we have gone a little better and it is
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now a "shilling for threepence." But most citizens of this country are either ratepayers or taxpayers, or both, and the individual expenditure that has to be faced will be much more considerable than the sum representated by the Insurance contribution. That, I think, has never been sufficiently explained.
I would like to say a word to the Minister about the health centres. I admit that that was a proposal which originated in the Interim Report of the Planning Commission of the British Medical Association. They are not quite so much in love with that idea now as they were then. In the last issue of the "British Medical Journal," for 11th March, there is a rather hesitating suggestion that the health centres have been devised really to put the medical practitioners into the service, and to make it a salaried service. But let us take it on its merits. The health centre is supposed to be an entirely new idea. It has very attractive features, as set out by the very competent salesmen who have been putting the idea over. But is it at all possible for there to be a free choice of doctors with the institution of the health centre?
I cannot myself see that possibility, and it has been questioned by more authoritative persons than myself, including a very prominent Socialist practitioner, in a recent book. He derides the desire of the average patient to choose his doctor or that he should have the same doctor throughout his illness. He would approve of the suggestion that the doctor in any town should have a beat, like the postman, the policeman, and the dustman, that one doctor should be assigned to all the houses in one area. That is an idea which is not, I think, welcomed either by the medical profession or by the private patients. The health centre idea is not a new one. We have had, for a very long time in this country an admirable series of cottage hospitals. They have been based on the idea of team work. The cottage hospital is staffed by a team of local practitioners. They meet and consult each other and that is valuable. But where is the infusion of specialist assistance to come from in the new Centre. The prospect of a number of specialists which is held out in connection with these centres is illusory. Yet it is one of the essential features of the scheme. I do not see the average health centre having the run of a number of

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specialists in anything like the profusion which is suggested here.
The Minister said that there would be no difficulty about keeping on private practice, that the public and private practice would go on side by side, and that those who did not want to do public work would be quite at liberty to decline to do so. But, as I understand the suggestion, which was repeated to-day, every new entrant into the profession would be required to serve an apprenticeship in the public service as a condition of being taken into this new universal service.
Mr. Willink: With exceptions.
Sir E. Graham-Little: I imagine that that would be a vanishing point. The Beveridge Report is much more frank, much more honest I would say, than some of the proposals we have had to-day; for it pointed out, quite definitely, in one of the paragraphs of that Report that the scope for private practice, with a universal service, must be so restricted as to be practically not worth while retaining. Can the Minister contend that the prospect of any worth while measure of private practice surviving is hopeful? I think not. I think it is quite impossible to suggest the contrary. I would like to deal, for a moment, with the question of control. It is expressly stated, in a very ominous sentence, that the control of the general practitioner would be much stricter than that of any oher section. One does not quite know the extent of this control but it is at any rate certain that the control of the general practitioner will be much more complete than it is at present, and than it will be of other sections. The Minister said that there will be no direction of the general practitioner to work by whatever body is set up to control these activities. A few weeks ago I was approached by one of my constituents, a young doctor who is medical officer to a hospital in Kent. He had an invitation to go to Dumfries, which is his home town, to take charge of a larger hospital there, with very much better remuneration. He applied for permission from the Minister of Health, and permission was refused, because, it was said, it would be very inconvenient to replace him at his present hospital. When asked by me on what authority he thus interfered with the liberty of a private medical practitioner in that way, the Minister quoted Defence
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Regulations. Is that the type of direction which is going to be perpetuated in future, merely a continuation of what is done under those Regulations now?
I want to say a word about the hospitals. There I am on my own ground, because I have been in intimate association with a great voluntary hospital, first as a student, and then as a teacher, and again as head of one of its departments, for over 40 years. What is the fate of the voluntary hospitals to be under the present proposals? The Minister said that every effort would be made to maintain them, but he went on to say that the contributory schemes would no longer continue. Let me tell hon. Members what that scheme means to the hospital. It means very much more than the payment of certain sums. I do not suppose that this House realises what the development of the voluntary hospitals system of medical treatment has meant in recent years. It has become a great co-operative system of medical service, widely appreciated by the public.
Some years ago Lord Iliffe, then Member for Coventry in this House, asked me to go to Coventry to give an address on voluntary hospitals. There were two hospitals in Coventry, one voluntary hospital and one municipal hospital. The meeting at the voluntary hospital attracted great interest; the whale place buzzed with excitement. The chairman of the hospital was the managing director of the largest motor firm in Coventry. The Mayor of Coventry was, I think, the chairman of the municipal hospital. He was in the audience, and Lord Iliffe—Mr. Iliffe as he then was—said, "Now, I think your hospital will have to be abolished long before mine." I mention that to show you what is behind these contributory schemes. [HON. MEMBERS: "What is behind them?"] The interest of those who take advantage of the service, and the interest of the hospitals themselves. Many Members of this House are members of hospital boards, and I feel sure they will know much more about the conditions of voluntary hospitals than about the conditions of practice. I hope for more support from the general body of Members on this point than on technical details of medical practice. I quite admit that much advance has been made with the public hospitals since the Local Government Act, 1929. But the

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voluntary hospital and the municipal hospital has been side by side for centuries and a very interesting account of the different developments of the two systems is given by Dr. Daley, the present chief medical officer to the London County Council. He points out that 400 years ago a divergence took place. One section became the voluntary hospitals, and the other became the poor law infirmaries, asylums for the sick. From the latter the public hospitals have sprung. As a rule the voluntary hospital is very much more popular with every section of the community than the municipal hospital. I will mention an example which has been told me concerning the father of the hon. Lady the Member for West Fulham (Dr. Summerskill).
Dr. Summerskill: As my father died very recently, I would be very much obliged if the hon. Member would not take his name as an illustration. Would he mind quoting somebody else?
Dr. Haden Guest: May I urge, in the name of good taste and common decency, that this matter should not be pursued?
Mr. Mathers: What is the point of mentioning the name at all?
Sir E. Graham-Little: My point is that the most robust advocates of the public hospitals when it comes to a choice for themselves between voluntary and public hospitals, commonly choose the former. That is a point which I think is worth mentioning. Why is it that the voluntary hospital, on the whole, is more generally liked by patients? There are several reasons. One is that the staff of the voluntary hospital is very much larger than the staff of any public hospital; although the position of some of the largest L.C.C. hospitals compares with that of general hospitals in London, the proportion of staff to patients remains much larger at the voluntary hospital, the comparison being about 10 per cent. at the voluntary, 1 per cent. at the public hospital. The services of the honorary physicians and surgeons at a voluntary hospital are given without charge.
Dr. Morgan: They get it all right in other ways.
Sir E. Graham-Little: The hospital is not put to any expense to provide these physicians and surgeons.
Dr. Morgan: Yes, but they get paid in other ways.
Mr. Deputy-Speaker (Major Milner): Will hon. Members kindly address their, observations to the Chair.
Sir E. Graham-Little: The services of highly skilled physicians and surgeons are very much in demand at these hospitals. The present Home Secretary, two years ago or less than that, said—that when he was leader of the London County Council—it was suggested that the L.C.C. should take over the voluntary hospitals in London, that he did not cotton on to the idea because it would have meant a rate of 1s. 6d. in the £, if the honorary staff were paid. The public have a very exaggerated idea of the "profits" of a consulting practice. Some spectacular figures of fortunes made in medicine appear in the papers from time to time, but they are earned chiefly by operating surgeons, forming a very small group, and they give people the idea that this is the rule. Now let me ask the Minister what provision is to be made for the body of consultants who will be required, and what plans he has to attract them to this scheme? It is a very arduous and difficult section of the profession to follow, but it is attractive to a small section of the profession precisely because it offers opportunities for medical research and advancement, and it also offers a certain measure of leisure and interesting work in a hospital where there is a centre of research. Why should these hospitals be centres of research? It is because there is a very large percentage of surgeons and physicians extremely interested in their work and able and willing to give far more time than would be possible if this were not the case. What will happen to this large body of consultants, and under what conditions are they going to work? We know that the general practitioners are going to be under the very definite and very strict rule of the Central Medical Board, and some of the conditions of employment I have already mentioned. I think the conditions will not be denied by the Minister. But what is going to happen with regard to consultants? I understand that there is a Motion to be moved in another place regretting that more attention has not been paid defining

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in the White Paper the conditions under which the consultant is called upon to work. I should like to pursue this trail but I think I must now sit down and I thank the House for the patience with which they have listened to me.
Dr. Haden Guest: I am sure the House has listened with some surprise to certain of the statements of the hon. Member who has just spoken. I feel justified in saying that, speaking as a medical Member of Parliament, I may perhaps be allowed to speak in that capacity here. I do not claim to represent the whole of the medical profession, but I entirely deny my hon. Friend's claim to represent any large part of it. Let me say quite definitely; so that this can be taken down and if necessary checked, that the hon. Gentleman does not represent the views of the British Medical Association. I do not pretend to agree with them entirely, but the hon. Member does not represent them, and, in fact, I do not know any section of the profession for whom he can claim to speak with authority. I feel obliged to say that, because of the nature of some of his remarks, which I think have been very painful for anyone who belongs to the profession of medicine, as well as for others. The hon. Gentleman used some extraordinary phrases, from which we may get an insight to his psychology. He speaks of the health centres being in charge of a competent salesman who has to "put the idea over." I do not know whether that is intended to refer to the Minister of Health.
Sir E. Graham-Little: That is not what I said. I said the idea was in the hands of a competent salesman.
Dr. Guest: That commercial phraseology does not seem to be applicable to this subject.
Dr. Russell Thomas: It is very true.
Dr. Guest: The party has increased, I see, by two. The hon. Member asked, "Can there be free choice of doctors in a health centre?" Well, I do not think there is any doubt, in the main, that most medical persons, and members of the British Medical Association and others, would agree that there can be as free a choice at a health centre as there is else-
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where, but I must correct the hon. Member in one remark he made. He said that Socialists, meaning Members of the Socialist Medical Association, say that one doctor is as good as another, and he has some idea of a doctor being on a beat, like a policeman, or a dustman. Really, what that means I find it very difficult to understand, but I can assure the hon. Gentleman that it is not the opinion of the Socialist Medical Association.
Sir E. Graham-Little: This proposal was made by a Vice-President of the Socialist Medical Association.
Dr. Guest: The hon. Member also said that this scheme now to be brought forward by the Government was a desire to secure control of the medical profession in order to secure control of certification. In my most bitter moments of opposition to the Government, I have never thought that they had sunk as low as that, and I am perfectly convinced that the ideas now put forward in this White Paper are acceptable, in their main outlines, to a large proportion of the medical profession. They are a reasonable basis, which those of us who have different views as to how the medical profession, hospital services, public health services and everything that has to do with health services, should be organised can discuss. I believe the White Paper is a reasonable basis for discussion—
Dr. Russell Thomas: Of course, the hon. Member does.
Dr. Guest: If one indulges in the kind of criticisms in which the hon. Gentleman who has just spoken has been indulging, I do not think we shall get very far, because we must look forward, and I think it is pretty plain that the hon. Gentleman is engaged in constantly looking backward, and that is no way to get on. Let me take one example. It is not my business to defend the Ministry of Health, but I cannot refrain from taking up one statement about voluntary hospitals. The hon. Gentleman said they would be killed, or seriously prejudiced, if the contributory system of contributions ceased to exist. The Minister has clearly pointed out that, while in the last normal year, 1938, there was an amount of £5,300,000 received from contributions, the equivalent Exchequer payment to the voluntary hospitals under the

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scheme suggested in the White Paper would be in the nature of £6,500,000.
Mr. Craik Henderson: Will the hon. Member also admit that, according to the figures, between 1930 and the present time, there has been an increase in hospital costs of 50 per cent.?
Dr. Guest: The point of the Minister's figures was the comparison, and I hope we shall find the Minister just as reasonable when we came to consider things in the future. But the point is the comparison, which remains. I do not want to take up the point, except to indicate that it is quite unreasonable to suggest that that is going to destroy voluntary hospitals. The hon. Gentleman who has just spoken did not really begin to consider the main and very important problems of the health services of the future, because he was not looking at them in, if I may say so, a reasonable way and with a balanced mind. What we have really to consider is whether the proposals in the White Paper give the opportunity to Parliament and to the country to bring into existence a comprehensive health service which will be what so many doctors, belonging to all kinds of parties, have longed for. This is a service which shall place the great scientific knowledge of the medical profession and its auxiliaries at the service of the community fully and completely, without any question at all of money consideration.
That is what we want to do. We want to do that among the general practitioners. It is proposed in the White Paper that there shall be health centres, with groups of doctors working together, and also private practitioners. It is as certain as anything can be that of the thousands of doctors who will come back to this country after the war from the Services—where they have been paid salaries and employed in a service doing invaluable work, as they are doing at the moment—many will feel most drawn to the health centres and will be willing to work in the group practice. That is the kind of thing that they have been doing, on the field of battle and in regions close to the field of battle where the sick and wounded are attended, that and their work has made an enormous difference to our sick casualties and our casualties from wounds in the present war. Those lessons which have been learnt in
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war-time will be brought back and used for the benefit of the civil population. But there are many thousands of those doctors and some, perhaps, will desire to become private practitioners.
I would like to see this House take a decision that the duration of the commercial side of private practice should he definitely limited. I do not expect that you can transform overnight the very diverse and very numerous services and institutions in this country from their present basis, into a unified and comprehensive medical service of a complete kind. That you cannot do. The process is bound to take a period of years. The Government, in their White Paper, are proposing that private practice shall be allowed to go on side by side with the health services' practice, the man in private practice being remunerated on a capitation basis and the man at the health centre on a basis of salary. Perhaps the Minister who is to reply will let us know whether those private practices which are to be set up in the future—not those already set up —will be saleable practices or not. I think we would say on this side that, if they are to be saleable—I hope they will not—the period during which that commercial element in practice should continue should be limited as much as possible. I am not one of the younger doctors now, but I think I can speak for my younger colleagues in the medical profession when I say that the majority of the profession would like to see the commercial element quite out of it.
Sir Robert Tasker: Will the hon. Gentleman say whether he wants State control of all doctors and the elimination of private practice?
Dr. Guest: I want, ultimately, every doctor and every nursing service and hospital in the country to be a combination of service to the State and to the nation, with the retention of the principle of voluntary initiative in certain ways, which I will proceed to indicate. There are some new ideas possibly in some of these things other than mere Civil Service regimentation, and I have no hesitation in saying that.
I want to say something about the voluntary hospitals. I believe the voluntary hospitals, in which all doctors at the present time are educated, and for which all doctors have an affection, will be able

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to continue to exist, if they wish to do so, and they have before them, at this time, the greatest opportunity of service that they have ever had. May I remind the House—perhaps every one in the House does not know this—that during this war we have had a system inaugurated in London and in other parts of the country under which voluntary and municipal hospitals, and indeed, all kinds of hospitals, have been put into groups as an emergency medical service. The emergency medical service has meant the getting of all hospitals grouped together as constituting something like the kind of service that, on the general lines of organisation, we may get at the end of the war. In that grouping the voluntary hospitals have taken a most important part.
If the voluntary hospitals were foolish enough to say that they would stand out from this White Paper scheme of a unified hospital service in areas and in regions, and would have nothing to do with the State and with the local authority, then their power, influence and authority would dwindle away. But if Guy's Hospital, Bart's. Hospital and the London Hospital and other great hospitals in London, and the hospitals in Scotland, and the hospitals in Birmingham, and many of the great voluntary institutions in this country are wise they will say, "We will join this regional grouping of hospitals; we will give to that regional grouping everything that we have that is good to give in the way of scientific knowledge, our consultants, our apparatus, everything we have we will pool for the general improvement of the hospital system." In many parts of the country the hospital systems, apart from voluntary hospitals, are very bad. In London, since 1929, very great improvements have been made in the hospitals under public control and many of them are not only very good, but first-class and, in some respects, leading the way. The chief post-graduate research hospital in London is a London County Council institution, the Hospital in Ducane Road. There we have in vague outline an indication of how great a thing this future hospital service can be.
I have the privilege of working frequently with leaders of the main London teaching hospitals and I know the minds of some of them. I feel convinced that
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they will be willing to throw their weight, their authority and their tremendous capacity into this unified hospital system. Doctors and those associated with hospitals are concerned, of course, about a large number of the details of this plan. The hon. Member for London University (Sir E. Graham-Little) referred to certain documents of the British Medical Association but he did not, I am afraid, give a fair interpretation of the attitude of that association to the White Paper. I believe that a good many Members of the House have in their hands a copy of the document from the British Medical Association described as "The White Paper Analysis," and other Members can certainly get it, if they wish to do so. They will find there that the British Medical Association—for which I do not speak and with which, I wish to say again, I do not entirely agree—agrees to a very large extent with the White Paper, and that it is in matters of detail, though not only in matters of detail, that the British Medical Association disagrees.
There are some rather fundamental points, in the opinion of the Association, with which they disagree, but they are not the points to which attention was drawn by the hon. Member. If Members wish to acquaint themselves with what the British Medical Association really believes, they had better consult the papers to be obtained from the British Medical Association and not the report in HANSARD of the speech of the hon. Member.
I appeal to the House and to the whole medical profession in this country to put themselves, not behind every detail, but behind the spirit of these new proposals for a unified and comprehensive medical service. Those of us who are doctors, Heaven knows, have felt frustrated many a time in our work by the misery and poverty all around us, and by the fact that we have not had the tools with which to work and have not had the hospital facilities when we wanted them and have not been able to call in consultants. Here we have a scheme that provides a great future for every man and woman who enters the great profession to which I am very proud to belong. In this provision we have the organisation of the hospitals altogether into one service for the community as a whole; and in the hospitals also we want to see that no commercialism remains.

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I am told that some hospitals are contemplating that they will continue their pay wards for patients, which means that you will have two standards of treatment in the hospitals—the treatment that you get when you pay in private wards or the standard of treatment you get when you go into the wards without payment. It is no good telling me as a doctor that there would be the same standard and the same kind of treatment. If one ward is being paid for and another ward is not, there will be differences of some kind; and even if there were not any differences, except perhaps in the quality of the mattresses and the cutlery and perhaps the quality of the food, we want to have no differences at all. There should be one standard of hospital treatment, and that standard the best treatment that we know how to produce. That could not happen at the present time.
I will not emulate the hon. Gentleman the Member for London University by speaking for a much longer time but I can say that, although many of us disagree on some of the points of this scheme, we realise that a completely new scheme of the kind of which some of us have dreamed, and which we would like to see in operation, cannot be brought into operation immediately. We see here in the scheme before us that the hospitals are being organised, that the medical profession is getting organised and all the other services will be organised in such a way as to enable the new structure to grow out of the old. If we put a time limit to the existence of the commercial factor in medicine as regards the purchase and sale of practices, and there is no question of pay wards in hospitals, or anything else which introduces a difference between one man and another according to how much one can afford to pay for medical attention or for nursing services —if we do that, then I am confident that, whatever else is put to the credit of this Government in the future, when historians look back they will see, in this period, a great development of the medical and health services of this country putting Great Britain in the forefront of the world in that respect.
Mr. Craik Henderson (Leeds, North-Fast): The hon. Member for North Islington (Dr. Haden Guest) has, as usual, expressed his views with vigour and clarity, but I was slightly puzzled by his
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constant use of the word "commercial" in reference to his own profession. I thought the expression was ill-advised and unjustified. If he meant that the man of outstanding ability who had spent a long time in acquiring medical knowledge, and was prepared to devote long hours to his profession, might get better pay than the less efficient, less able, and less energetic doctor, I hope that that form of commercialism will continue. I prefer that type of commercial doctor to one who will be an office man working office hours, from 9.30 to 5.0 with a fixed salary which depends not at all upon his ability but merely on a question of seniority.
Dr. Guest: May I explain to my hon. Friend that I was referring very largely to the buying and selling of practices, and to the whole apparatus by which the rich can get better medical treatment at present than the poor.
Mr. Craik Henderson: I am glad to have the hon. Member's explanation. The proposals in the White Paper are very important indeed and I am sure we shall all want to approach them in the most objective way possible. This is, perhaps, the best example we can get of the House being given an opportunity to frame and assist the Government in carrying through far-reaching proposals. It has been said that democracy is government by discussion, and surely we can have no better example than an occasion such as this, when the House is given an opportunity to put forward individual views. I hope we shall do so with open minds, and I hope and believe that the Government will listen to what is said with an equally open mind, anxious to evolve the best system possible. I think, however, that there is some justification for a mild protest that there has not been a little longer time between the publication of the White Paper and the present, for the views of the medical profession, the voluntary hospitals, and the general public to be ascertained and made known. It seems to me, that with a large proportion of the medical profession fighting in Italy, in Burma, and all over the world, these men should have an opportunity of making their views known to hon. Members and this House. There is no doubt that the Government have had years to consider this matter, but voluntary hospitals and the medical profession are

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asked, in a few weeks, to apply their minds to these very far-reaching proposals.
In the White Paper there is one phrase which we on this side welcome. At the foot of page 8 it is stated:
"Organisation is needed to ensure that the service is there, that it is there for all, and that it is a good service; but organisation must be seen as the means, and never for one moment as the end."
These are very wise words and I hope, though I am not quite convinced, that the White Paper has been compiled in conformity with these views. Nothing would be worse to my mind, when you get into this realm of endeavour and of research, of planning, and of intellect than to reduce everything to standardisation, uniformity and regimentation. If that is done, it certainly will not be to the advantage of medical research and medical advance. I think we all agree that much as has been done by organisation, vastly more has been done by the discoveries of individual men. This is a profession where science advances by the endeavours of the individual. I think there is no question that the discovery of chloroform, of antiseptic and aseptic treatments, the discovery of the new group of drugs of which "M and B" is the best known, and of penicillin have done more for the health of the community than all that organisation could possibly do. That does not mean for one moment that we should not, at the same time, endeavour to build up the very best possible organisation we can, but we should never forget that medical science will be advanced by the efforts of the individual and that, in the last resort, a good health service depends upon the skill of the individual. I do not think anyone would dispute that.
What are the essentials of a good health service? I think it is sometimes well to get away from merely looking at the machinery and to consider for a moment what are the essentials. Of course, one of the first must be to attract to the profession men of ability who are prepared to go out and work hard for the benefit of the patient and with a desire to advance knowledge.
Mr. A. Edwards: The hon. Member asked a few moments ago for the highest rate of pay
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for the men who made the greatest efforts. He has just said that the men who have really made the greatest contribution are those who have made discoveries. Is he suggesting that these are the men who got the greatest amount of money?
Mr. G. Griffiths: What about Banting?
Mr. Craik Henderson: If my hon. Friend will allow me to reply, these people who have made great discoveries have got their reward in the thanks and in the esteem of the general public. I suggest to my hon. Friend that these discoveries could not have been made by a man in an office serving under someone else. They could only be made by the individual working by himself.
Dr. Russell Thomas: Whose soul is free.
Mr. Craik Henderson: Whose soul is free, and whose time is also free to work out a theory for himself.
Mr. Driberg: Has the hon. Member heard of the very remarkable results achieved by research scientists in the Soviet Union, where medicine is completely socialised?
Mr. Craik Henderson: I have heard of certain results achieved in the Soviet Union, but my hon. Friend makes a great mistake if he imagines that the Soviet Union regard people as equal. [HON. MEMBERS: "We did not say so."] That was their original idea, and they had to give it up early on. But I do not want to be drawn into a discussion of that kind. The point I am making is that if we are to get a really efficient medical service, we must attract to the profession the ablest men we can possibly get. There will be no dispute about that. However my hon. Friends on the other side may not agree when I go on to say that if the idea is that the State service is to be, as my hon. Friend the Member for North Islington has said, entirely a State-controlled service with private practice eliminated, that will turn away from the profession many men who otherwise would have entered it.
Dr. Guest: May I ask whether regular naval service and regular Army service turned away men from those Services?
Mr. Craik Henderson: That is not a fair comparison. I really must not be

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interrupted at every turn, though I am willing to give way a certain amount. The next important thing is that we must have the highest standard of teaching and training in the profession. That, again, is essential in order to build up the health service required. There must be every encouragement for research. One point with which I was rather disappointed in the White Paper has been cleared up by my right hon. and learned Friend, and I was very grateful to hear him say so. I was rather disappointed to find in the White Paper no reference to district nursing. If there was one I overlooked it. To-day, my right hon. and learned Friend paid a tribute to the district nursing, and promised that every effort would be made to extend home nursing. I believe that an enormous work has been done by the district nurses, who are quite insufficient in number, and that this side of the work must be vastly increased. It is not always possible or desirable for the working man or woman, when it is not a case of critical illness, to go off to hospital; there are the claims of the children, and so on, and they are unwilling to go. I am sure that nothing would do more for the health of the community than a great and well-planned development of home nursing. I was, therefore, relieved to hear the Minister say that he had that very much in mind.
Dr. Guest: As a salaried service?
Mr. G. Griffiths: The hon. Member wants it under private enterprise.
Mr. Craik Henderson: I really think my hon. Friend should refrain from being facetious. If the House cannot treat this matter seriously then it is a reflection on the House. I want to say a few words about the subject, in which I am, perhaps, most interested—
Mr. G. Griffiths: May I put this point? The hon. Member has been talking about the nursing association. I have been the chairman of a private nursing association for 25 years. We have discussed this question three or four times, and what we are perturbed about is the pennies and halfpennies we have been collecting. The White Paper states that it is hoped that the voluntary nursing association will accept salaries, and so forth. They hope that, but I want to say "Give us the money and let us pay the salary," What is the 'idea of the hon. Member on that?
Mr. Craik Henderson: I have finished with that special matter and the hon. Member will make his own speech. I do not care what the system is, provided it is an efficient one which will give the required service to the community. Now, with regard to the voluntary hospitals. I think the House is well aware of the services which the voluntary hospitals are rendering to the community. I believe the supply of beds, according to the last figures available, was approximately 100,000. Their income in the last year for which the figures are available was, I think, £17,000,000. The number of inpatients was about 1,400,000 and the number of out-patients over 6,000,000. Nobody would dispute that the voluntary hospitals, which are also the teaching hospitals in the majority of cases, are the keystone of the hospital system. Nobody who is reasonable would deny that, generally speaking, the voluntary hospitals are the most efficient and the most popular with the general public.
I want to talk quietly and persuasively about this matter. I do not want to get into controversy with hon. Members opposite, because I know that many of their constituents have the same view. Voluntary hospitals owe a great deal to the support they get from workers' committees and to working men and women on the committees. Nobody can pay too great a tribute to the personal interest which is taken in the voluntary hospitals and I am sure that no party in the House wants them to be prejudiced. They have rendered great services in the past and are capable of rendering still greater service in the future. This enormous system has been built up over the last 250 years. Before the 18th century I think there were only two hospitals—St. Bartholomew's and St. Thomas's. I have no idea of the value of all the hospitals in the voluntary system amounts to but it must be many millions — probably £l00,000,000 or £200,000,000, including their up-to-date equipment and appliances. Also, the voluntary hospitals have endowments amounting to a large sum of money. The White Paper admits that the voluntary hospital system is essential to this scheme in the immediate years.
How is it proposed to deal with the voluntary hospitals? The bodies which will be concerned are, principally, three

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in number. There will be the Ministry of Health and there will be a Central Health Committee, which is an important Committee, but on which the voluntary hospitals, presumably, will have comparatively small representation. Even those which are represented will not be nominated by the voluntary hospitals themselves but will be appointed by the Minister only after consultation. Surely, the great voluntary hospitals, bringing to the State this enormous advantage, by handing over assets worth hundreds of millions of pounds are entitled—
Mr. McNeil: Will the hon. Member explain what he means by, "handing over the assets to the State"?
Mr. Craik Henderson: I do not want to split hairs but it is directly stated in the White Paper that the joint authority shall have direct responsibility for all hospitals.
Mr. McNeil: Should they choose to come in.
Earl Winterton: I am chairman of a hospital and I would like to point out to my hon. Friend that the White Paper does not mean that endowments of hospitals are to be handed over.
Mr. Craik Henderson: I am sorry if I have given a wrong impression. Of course, there is no question of them being handed over directly, but they are being put into the national scheme. The question is: Under what terms are they going into that scheme? I have read the White Paper two or three times with the greatest care. As I was saying, there would be a central authority under which voluntary hospitals will not have the right to nominate anyone; the Minister will appoint after consultation. That may be a small point, but it is important. Now we come to a very much more important point, the question of the joint authority which is entirely a body of public authorities. On page 17 of the White Paper it is stated:
"The new joint authority will, therefore, be charged to examine the general needs of the area from the point of view of the health service as a whole—not only in the hospital services for which it will itself be responsible but also in these more local services."
Dr. Morgan: That does not mean handing over.
Mr. Deputy-Speaker (Mr. Charles Williams): If there are too many interruptions it will make the hon. Member's speech much longer.
Dr. Morgan: I have not interrupted very much.
Mr. Deputy-Speaker: It is not only a matter of one person interrupting; it is the number of interruptions that take time.
Mr. Craik Henderson: I would like to deal with the point of handing over. I do not mean handing over in a legal sense but in a sense which will be well understood. Under the scheme as a whole, you have a comprehensive health service, and into that all hospitals in the country must go. The few who want to stay outside might be turned into nursing homes, but the voluntary hospitals are going into the State scheme.
Mr. McNeil: I am sure they are, and on very generous terms.
Mr. Craik Henderson: What terms are to be offered? I have referred to the Central Health Council and now we come to the joint authority which is to be in control of the hospital services. The actual day-to-day management will be still left in the hands of the voluntary hospitals. What is this joint authority to be? It is to be the hospital owning body of the municipal hospitals. I do not think there can be any question that it is very unjust to ask the voluntary hospitals to come under such an authority and that all the power should be given to the body owning the alternative form of hospital service, where they have no direct representation on the hospital administration of the area—the joint authority—I suggest that is most unfair to the voluntary hospitals, and not to the advantage of the scheme as a whole.
I would like to make some constructive suggestions, some small but some probably more far-reaching. As regards the Central Health Council I think the Minister should agree that voluntary hospitals should have the right to nominate their own representatives to that body. It would be a great advantage, and would relieve the minds of those responsible for voluntary hospitals very much if there were set up a central hospital advisory committee which would consult with the Minister. This committee would contain representatives of the voluntary and State

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hospitals and it would be an advantage to bath to be in close association with the Minister and able to discuss problems with him at close quarters. I do not think there is any dispute between us on that point. It would do a great deal to relieve the anxiety of the Voluntary Hospitals' Association. I think there ought to be a district joint hospital committee or a local joint hospital committee for each area which, again, should contain representatives of the voluntary and State hospitals. That seems to be the only way in which you can have a partnership.
If these two system are to continue in friendly rivalry—as I hope they will—there should be a body in which they can meet to discuss common problems. If necessary there could be a neutral chairman. I am not sure how it is proposed that contributions should be made by the local authorities to the voluntary hospitals. It is not too clearly stated in the White Paper and personally—and in this I am speaking for no one but myself —I think there should be laid down clearly in the legislation which will be introduced the sum which must be paid by local authorities in respect of the number of beds in the voluntary hospitals in the particular areas. It should not be left to arrangements between various areas and various voluntary hospitals. I think that would be an unfortunate result which would lead to friction and would not give the voluntary hospitals a correct idea of what income they have to rely upon. It may be that it should be put into a special pool to be administered —that is a matter for discussion. I should like to see grants to voluntary hospitals administered very much in the way as the University Grants Committee deal with payments to a university. I think there ought to be something analagous to a University Grants Cornmitee—a Hospital Grants Committee. I hope the Minister will consider whether it is not possible to do something along that line.
I am sorry that some hon. Members above the Gangway have been led into controversy with me. I had no desire to do so. On this subject we are dealing with something of vital interest to the future and in the House of Commons we must be allowed to express our own individual views. If we do not do that, the House of Commons ceases to exist.
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I feel that this White Paper which is of extreme interest and which is, certainly, revolutionary in some respects will require—I am sure the Government never expected anything else—some modification particularly as far as voluntary hospitals are concerned. They are still the keystone of the hospital position. They have a great contribution to make in preserving the health of the community. They must be regarded as partners and should not be made subservient to other forms of hospital administration by being put under a Committee representative of these hospitals. I ask for modification of the White Paper in that respect and I am sure the Minister will give the matter his best attention.
Mr. Jewson: The hon. Member for North Islington (Dr. Guest) has said that the White Paper should be looked upon as a basis for discussion. With that I entirely agree. He modestly disclaimed the right to speak for any large section of the medical profession. I do not speak for them at all; I am afraid my family doctor would tell you that I have not qualified very well even to speak as a patient, but I think it is right that we should put our individual points of view and, if my individual points of view are too individual to suit hon. Members opposite, I hope they will be patient with me. I suppose everyone will agree that full medical treatment within the reach of all is a thing that we must do our very best to attain. I have not the slightest objection to levelling, provided it is levelling up and not levelling down. I hope we shall see, as a result of what comes out of the White Paper, a very great deal of levelling up and improvement in all the medical services that we at present have, great as some of them are. But, as the White Paper itself says, there is a certain danger or, as I should put it, there are certain dangers and I want to indicate a few that occur to me as I read it. My right hon. and learned Friend in opening the Debate said we are re-shaping the background of individual life, but we must be a little careful to avoid, in framing legislation on the basis of the White Paper, too much interference with individual life itself. I do not say that there is very great danger of that, but there is a danger, and that is one of the points that ought to be kept very much

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in the foreground. We must safeguard that self-reliance and freedom which are essential to the full development of the man and the citizen.
I think our aim has been very well expressed in the words of St. Paul about the fulness of stature of the perfect man. That is what we must aim at, and I think the White Paper is intended to show the way to secure at any rate some part of that. We must always remember that, important as the physical side of things is, and also what is medically called the mental side, that is not everything and, if we could create a nation of healthy robots, we should have done no good but only harm and should only have created a potential danger to mankind. One cannot read the White Paper without being reminded of "Erewhon" and wondering whether we are getting towards the idea of making illness into a sort of crime, with doctors as a medical Gestapo. I hope we shall avoid doing anything of that sort, but we may perhaps, possibly with advantage, adopt the Chinese system whereby doctors are paid while the patients are well but not while they are ill. Illness should be the exception and not the rule. I do not think the comparison with roads and water in the White Paper is right at all. Roads and water are external things and we are dealing with something which is very much a personal thing. We must, therefore, take care not to let that point of view get too far with us. We must maintain the right, and also the responsibility, to manage our own lives. Without that we cannot get the sort of citizens that we want.
I have always very great sympathy with the right reverend prelate who said he would prefer to see England free rather than England sober, and I think freedom comes even before the imposition of heatlh, if we are going to impose it on anyone. Therefore, within the framework of this system which we are trying to create, we must see that the individual has his freedom. I can see that that is a difficult matter to attain if you are going to create a service on the lines of the White Paper. I do not know whether it has been considered, whether it would be possible to adopt a system of medical coupons, which would allow people to obtain the medical service they want in their own way and according to
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their own desires. Possibly, with all the experience we have had in war-time, something of that sort might perhaps be a practical way of retaining the freedom of the individual to deal with his own matters.
I was very glad to hear what my right hon. and learned Friend said in regard to the description of the service as a free service. It occurs several times in the White Paper and every time I came to it I had to remind myself that it was very much of a misnomer. We are not providing a service free of charge, and I think we ought to make it quite clear, and keep it continually in mind, that it is not "something for nothing" that we are going to get. It is something for which we shall all have to pay, whether we want it or whether we do not. I am not complaining of that. Perhaps it is a good thing to add this very important item to our system of social insurance. Moreover, I think it is true that we shall have to pay more than we pay now, for the reason that we are going to pay through taxation, and that means we have to pay the man who collects the tax and distributes it as well as the doctors, to whom what is left of the taxes then goes. From that point of view it is a very expensive method of dealing with the matter; nevertheless, it may be well worth while if it gives us a healthy nation and does away with the enormous waste at present in industry and elsewhere caused through illness and loss of time. But we must keep it in front of our people that they are not getting something for nothing and that this is not a free service, and I am very sorry that those references occur in the White Paper. I am glad the Minister drew attention to this in his speech and I hope what he said will be widely noted.
I am hardly qualified to say much on the question of the medical profession. I have my own ideas, but there are many Members who are well qualified to speak at first hand on the subject. I should like to say, however, that I think our doctors, like our judges, should be entirely free from political control. I do not want the surgeon or physician to whom I am going to owe his appointment to the fact that he is a good Liberal. I hope we shall be safeguarded from that, which is a real danger, when we are bringing into being a comprehensive service like this. I hope the payment of salaries will

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not become universal. There is a type of mind which works very well on the basis of a salary, with a pension to follow in due course, but I do not think as a rule it is the creative type of mind, the mind to which we owe most of our medical advance, which has been so very noticeable in the last 100 years. I should like to take up the reference made by the hon. Member for North Islington to the way our soldier doctors are working on salary. Soldiers and sailors do not do their work, at any rate in war-time, just for their pay. Their work is done from entirely other motives and I do not think that was quite a fair thing to say.
I have been asked to raise the question of voluntary hospitals. In my part of the country we are extremely proud of our voluntary hospitals, and the people who are proud of them include very large numbers of working people. In Norfolk as a whole there are 150,000 contributors to the contributory scheme. In the village where I live I have seen this at work, and I know it is a very valuable piece of social work, gathering in these contributions and looking after them. Of course, it is done entirely on a voluntary basis, and the actual hospital to which they belong has 150,000 contributing members. It will be a very serious matter if we are going to destroy this particular piece of work though it may become necessary. What I want to suggest is this. I presume we are going to take from these contributors by taxation the money they are now contributing voluntarily. That will be inevitable if we bring this scheme into existence. Then, we are told, we are to give the money back to the hospitals and, therefore, the hospitals will be all right. Even so, that does not quite work. We are told that it does not destroy the voluntary hospital, and, in a sense, that is true. But shall we not he told that this money which we take from contributors by taxation and then give back to the hospitals becomes "public money" in the process of passing round, and, therefore, must be publicly controlled?
I had a report last week from a discussion group at a centre of the R.A.F. on this subject of the health proposals which said that we must have the voluntary hospitals maintained, and that it must be done in some way that will avoid causing them to
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fill up innumerable forms so as to justify the expenditure of public money. I thought that a very good point, and what I want to make sure of is that money which is taken by taxation instead of by voluntary contribution will not be used in such a way as to force these hospitals to come under a control they have not yet had, and I would suggest that the present members of the contributory scheme, or any others who desire, should have the right to earmark their taxation contributions, if they wish, for their own hospital's contributory scheme. If that were done the money would not become "public money." It would remain, as it is now, a contribution to the hospital and the contributors would then have their same share as they have now in governing their own hospital, and we should avoid destroying what I believe is a very valuable feature in our hospital life.
The right hon. and learned Gentleman referred to the great traditions of our hospitals, and I think that there is no one here, however strongly he may desire to put everything under public control, who wishes to see them disappear, but I am afraid the spirit of them might disappear if we were simply to hand over the voluntary hospitals to public control. Another thing which would disappear, of course, would be the men and women who at the present time are giving public service and who work on these hospital boards, but who are not suited, temperamentally, I suppose, or for some other reason, to what we commonly call political life. I think it would be an unfortunate thing if the only sort of public service open to anyone was service in some form or other in the political world. I wish the efforts of the right hon. and learned Gentleman every success and hope that after these discussions he will be able to frame legislation which will bring about this thing, which, as I said at the beginning, we all want—the very best medical service available to everyone in the country.
Mr. Alexander Walkden: I do not purpose making any attempt to follow at all seriously the somewhat mournful discussions we have listened to up till now. I think the House would probably like a change. I speak on behalf of my party, and once more, on behalf of the T.U.C. I have just had a letter from them asking me to welcome this White Paper wholeheartedly and to

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say that we will do our utmost to help the Minister to get the scheme carried through when he has it in the shape of a Bill. I am not worrying about the hon. Members who put down Amendments. They seem to be dissembling their love. They actually want to kick the Minister downstairs and I hope the House is not going to encourage them in any such effort.
I have been asked, and with great pleasure I do it, to congratulate the Minister on producing this wonderful White Paper which we regard as the basis for another great Bill. We have one great Bill before the House. It is getting on slowly, but steadily, and I want to congratulate the Minister and all his helpers on producing this scheme, not forgetting Sir William Beveridge who inspired us all to look forward to this type of legislation. I am also glad that the Minister himself, quite spontaneously, gave expressions of approval to a most important preliminary sentence in the White Paper. It is most significant, and I rejoice that he himself drew attention to it. It is at the bottom of page 10 and it says:
"The subject of health, in its broadest sense, involves not only medical service, but all those environmental factors, good housing, sanitation,"—
May I say also good water supply—
"good conditions in schools and at work, good diet and nutrition, economic security, and so on, which create the conditions of health and prepare the ground for it. All of them must receive their proper place in the wider pattern of Government policy and in post-war reconstruction."
The Minister himself spoke in the sense of those words and we do welcome his assurance that the Government intend to proceed with the whole plan of the great public service that is being evolved. The House is glad of that because it gives hon. Members some inspiring tasks to look forward to, not only at the moment but in the future life of this Parliament, and it relieves them of their thirst for doing some good work. Many of us are tired of hearing a lot of carping criticisms on minor matters without a chance of getting on constructively with something better. I am reminded of the great people in the free cities of antiquity. They kept their swords bright and ready. We are not sheathing our swords; we are going on with the war. They also had their trowels
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and they got on with the building of their cities, and defended them, and, at the same time, made progress with their national affairs. This House could do the same. We need not be restricted any longer.
The scheme is about complete and now due for enactment and all pleadings for delay and anything suggesting negative opinion about it are most untimely and unfortunate. The present public health service, is endowed with something like £60,000,000 a year. It is good as far as it goes, but it is only a patchwork arrangement and not good enough for present-day requirements. It represents all that has been done since the Public Health Act of 1848. We have done many things since then, but not anything like enough, and, at present, putting it on its best interpretation, only about half the population is provided for, as the Minister himself said, and, particularly, millions of women and children are entirely unprovided for. We must do something more if we are to be worthy of the great days in which we are living.
The new plan will be—indeed it has been—welcomed by all the people, and especially by the women of the country. We have to remember that the women are in the majority in the electorate, and their views matter very much. They have institutions for studying such questions as this, and they want to have this service established. It will be of enormous help to them, including the middle-class women. There are a lot of hard working middle-class women, wives of professional men and black-coated workers, of whom there are millions in the country, who have never sent for a doctor. Often they omit to send for a doctor when they ought to, and they drag on although they are seriously ill. They dare not send for a doctor because they know that when he has gone there will be a bill, and they know that their husbands are committed up to their eyes. They know that there are all sorts of accounts coming in regularly, especially if they work on the system of quarterly and monthly bills, and there is no margin. Therefore, women often sacrifice themselves for want of medical service.
One of the best sentences in this White Paper is that which says that this great service is to be free to all. It will be a fine thing for women to know that they

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will be free to call in a doctor for themselves and their children. I am one of a family of nine, and we had all the ailments to which children are prone, but mother rarely called in a doctor because she knew that his account would embarrass father, and she nursed them through all their illnesses herself. Bad results often follow on children's ailments through not calling in a doctor. All that will go under this scheme. The second feature of the scheme which women will most welcome is the home nursing service. Many a time in her life a woman would have loved someone to help her in time of trouble and sickness. I know that there are voluntary agencies which provide nurses, but everybody cannot subscribe to them and an honest woman will not send for a nurse from one of these agencies if she has not subscribed to it. Instead she will carry on and wear herself to skin and bone in consequence. The nursing service is one of the best features in the scheme from the home point of view.
I do not want to be critical, but I must draw attention to a strange omission from the scheme. I feel confident that the Minister will take note of it and give it a place. There is no mention whatever of any treatment arrangements for the rheumatoid class of diseases. These diseases are a very large and serious class, and they are very agonising. In the White Paper there is reference to special treatment for tuberculosis, cancer and a whole range of other diseases, but not a word about this class of disease. The figures about it from an industrial point of view, which will interest hon. Members opposite as it means loss of labour power, show that the loss is greater than from almost any other disease. I will quote from the "Post-graduate Medical Journal," an organ which is read by the younger men in the profession. There is an enlightening article beginning on page 4 entitled "Tuberculosis and rheumatic diseases," by Dr. Philip Elman, M.R.C.P., who has great qualifications for dealing with this subject. The most serious words in his article are:
"As far as disablement is concerned it has been reckoned that the rheumatoid diseases are responsible for ten times as much as pulmonary tuberculosis, and the loss of working days through such disablement amount in England to one-sixth of the total disability from illness."
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That is a serious statement. The author says later in regard to curative treatment:
"In point of fact, correctly handled and given therapeutic facilities comparable to those available for pulmonary tuberculosis, with similar after-care and vocational guidance and rehabilitation in all its phases in no group of diseases are results likely to be more successful, and they will certainly compare favourably with those of pulmonary tuberculosis."
These agonising troubles are curable. I have had some trouble from this kind of disease, and I know that it can be cured by good treatment, remedial massage and exercises, which I myself practise every morning—37 varieties of them. This disease can be cured, especially if taken in hand when a person is young.
There is also no mention in the White Paper of convalescent home treatment. There are a large number of convalescent homes, many of which are organised and run by working men through the trade unions, which have acquired suitable houses once belonging to formerly wealthy people. Most of them provide facilities for men to recover after serious illness. After the doctor has done with you, you need two or three weeks to get your strength back. Convalescent homes are worth taking into consideration in this scheme, especially as there is hardly any provision for women in these homes. They need a fortnight away rather more than men when they have come through a long illness.
That brings me to the subject of voluntary hospitals. All of us have had communications of all kinds, some of them interesting and some of them very surprising. In view of what is stated in the White Paper I cannot understand what the apprehensions are founded on, especially after listening to the Minister's speech to-day. He showed that the voluntary hospitals are to have nearly £2,000,000 more revenue more easily under this scheme than they could get it by contributory collections. I should have thought they would have jumped for it, and so avoided all the miserable business associated with getting funds for the hospitals. For medical students to guy themselves up in comical attire and to rattle tin boxes and dance about on our railway stations is a very undignified way of raising money. If I were a governor of a hospital I would say to the Government, "Thank you; you can have our hospitals, and we will do all we can to help you to run them better than they have been run

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in the past." I do not know why anyone should take a different attitude in view of the proposals in the scheme. I know that there is a bit of consequence about being a hospital governor, but what does that matter? To have all this pomp and circumstance about being associated with a board of governors seems silly. This sort of thing is sheer snobbery and is one of the worst aspects of the voluntary hospital system.
The Minister made clear that the real service of hospitals can continue. Any one who desires it can find his or her place in continuing to help in public work. There is plenty of scope for public work in this country, the most gloriously democratic country in the world, from this House down to the smallest parish council. If anyone wants some public work he can have it. All our trade unions are open for them to do some service, and there are all sorts of other institutions. I do not know why anyone should mourn about the possibility—I do not think it is entirely a probability—of our hospitals coming under the care of the Minister instead of continuing as they now are, in this miserable state of poverty.
However, some of the communications are not quite so bad as I have indicated. I had one from an institution called the Children's Hospital, at Bristol. It finished up with these rather nice words:
"The Government has set its hand to a task which, in nature, is revolutionary, and which, as the White Paper concedes, can be accomplished only by a process of evolution, and with the utmost co-operation, understanding and good will of all the parties concerned. Those parties include the Central Government, the local government, the medical profession, the nursing professions, the voluntary hospitals and the British public."
That is a good, acceptable statement. If the hospitals will work in that spirit I do not think we shall have much trouble, but if they pursue a different attitude I am afraid they will be getting themselves into the same unhappy state in public life as the voluntary schools. "The British public," referred to in the last sentece quoted by me, want this scheme very much, and they will not be hapy till they get it.
I would like to emphasise one or two other features about the hospitals. The Minister has made provision for their inspection in all departments, reaching down to the commissariat. That is quite a good thing. Some hospitals have been
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a little mysterious about what is going on. The working people have wondered rather how they are run, and do not feel altogether comfortable about them. Further, the Minister is providing for the preparation and circulation of annual reports. That is most helpful. I wish we had an annual report from the London Passenger Transport Board. This House might be able to see it and use it as a basis for discussion. Annual reports are very good things, because they sometimes make an undertaking careful, in case awkward questions arise during the consideration of the report.
We want to increase the ordinary person's confidence in the hospitals. In spite of all the particulars Which have been given to-day, there is, in the minds of thousands of working people, a suspicion that if they go into a hospital they will be experimented upon, and that the clever medical gentlemen who run them want to go on running them, so as to get patients who will give them a little more experience which they can use in the treatment of the rich. That is in the mind of the working people. The publication of a report would help to remove that suspicion and to develop confidence in the minds of the ordinary people.
Another point which I wish to commend, as an old trade unionist, is the stipulation that there should be proper rates of pay and conditions of employment for the nurses, midwives and the other members of the staff. I am glad that that is laid down on page 23. When I was on the General Council of the Trades Union Congress we had most pathetic complaints about the bad pay and awfully excessive hours of the nurses. There was thoroughly bad exploitation of very good girls in those hospitals and the girls came to us with tears in their eyes. They did not know what to do about it. They did not know how to form a union; they were afraid to form one. The fear was very real, and I was ashamed that such a mentality could exist in a British institution. I rejoice that the Minister has included that stipulation.
I would ask that there should be a sort of Whitley Council or appeal board. A large number of people are involved and there will be many more. There should be recognition of trade unions and there should be a body to consider cases of disciplinary action. This is the human side

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of the work. It is not a question only of duty or rates of pay, but of the human relationships inside the organisation. We have readied a perfect state of things in the railway world, wherein a man or woman charged with wrongful conduct has to be informed of the complaint. At the bottom of the form there is a query: "Do you wish to appeal against the charge? You can appeal to Mr. So-and-so, and, if you like, you can have a friend. Please say if you wish to be represented at the inquiry." It is Army practice. You can have a friend, who may be a trade union official.
We have got further; if the person concerned does not get satisfaction from interviewing the immediate superior, there is a right of appeal to the general manager, and a very responsible man on his behalf can hear the whole case. It is very often discovered that there has been wrong treatment or a wrong attitude of mind and that the person should not be punished. Or an arrangement can then be made to give him another chance. There will be these troubles in the hospitals. Indeed, there are indications on another page of the White Paper of personal troubles among the medical staff. Anyone who has read books like "The Citadel," by a great literary doctor, or "Dr. Bradley Remembers," one of the loveliest books I have ever read, by Francis Brett Young, knows the troubles of the young doctor vis-à-vis the old doctors, who are sometimes too pompous and important in their profession and impatient with the young men. It leads to difficult situations, and perhaps to injustice. There may be a damping down of a young man, and young doctors are very frightened and nervous about this sort of thing. If there could be an appeal court for the whole staff, I think there would be happier running—not that everyone would be going to the court, but that its very existence would make things better. We have an arbitration arrangement for the superannuation scheme in the railway world, and annuitants who are dissaisfied can go to arbitration. They never go, because the administrators are aware that they must give absolute justice, and in complaints about a border-line case the person concerned is given the benefit of the doubt. Therefore my suggestion would make for the happier running of the medical institution.
Now I come to the doctors themselves. I have been rather surprised and
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amazed to hear what was said about them to-day. I really thought better of them. I thought they were better informed. Their senior representative talked a good deal about democratic procedure, but I was amazed when he claimed as his chief point, which he made at great length, that 95 per cent. of the profession were absolutely against any lay control. That confirms what was stated to me by a doctor who came to see me. The doctors want to run this scheme exclusively. That is an extraordinary claim. One of my model industrial institutions is the London Passenger Transport Board. It is run by seven directors. Two of them are great professional transport railwaymen—Lord Ashfield and with him was the late Mr. Frank Pick—I am not sure who is with him now—and five representative men from the L.C.C., London borough councils and public bodies of that kind. It is under "civilian" control to the extent of five as against two. In our work as trade unionists from time to time the trouble crops up of having to dispel from workmen's minds the notion that they should have the industries for themselves, the mines for the miners, the railways for the railwaymen, the post office for the postal workers. That is called syndicalism. It is one of the most abominable principles in industrial life. We have to fight it and knock the nonsense out of people who cling to that notion. And yet we have a most eminent man claiming that there must be that principle in connection with this medical service. I trust I may be excused for speaking rather emphatically but it is something which we have been fighting against and I am sure that the Minister could not sustain that plea so far as the medical service is concerned.
Another object submitted to me—and I have had a lot of doctors to see me, and letters from them and so on—is that they are against any number of their profession giving full-time service. [An HON. MEMBER: "Hear, hear."] They do not say why. We may presently hear why. I cannot see any reason why, I cannot think of any reason why they should object to full-time service. The majority of people who are employed persons, are employed full-time. There is no disgrace in being employed persons. The judges on the bench are employed persons. So are His Majesty's Ministers—hon. and right hon. and learned everything else. I am amazed at this queer attitude of mind on the part

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of the doctors. All through the years, there have been fully-employed doctors in the public service. We have them in the Ministry of Health, we have them in the Home Office. There are medical officers of health under every county and borough council and they are doing very good work too. I have never known that they are considered less satisfactory members of their profession than the men who attend to us individually when we are ill in bed. I consider that they are as worthy of honour as the men who run the profession as private practitioners. Therefore, those who object must not expect us to entertain much regard for pleas of that kind.
Then comes the question of group practice. That has been deprecated to-day, but the young doctors I have seen and medical students who have been to see me—we have a medical college near where I live—welcome this idea of full time employment in health centres. "This is something fine," they say. "We can work together co-operatively. We shall escape the awful doom of being tied up, which a doctor suffers from all the year, by day and night, through being on call, with no one to send in his place. We can organise our work, get to know everybody and do all the better because we are working together." Then, having clerical and secretarial assistance in these centres will be a godsend. Instead of a doctor having to write out a report in his own hand he will have a typist to do it for him, and a secretary to look after his correspondence if that gets too abundant, and some of us know what that means. I can see that that will be a very great blessing.
Above all, the young doctors and those who aspire to become doctors feel that the Minister is giving them an escape from the awful problem they have to face when they have become qualified and are ready to practise. They have to buy their way in. There is no other way. Many of them, clever young men, have no money with which to buy their way in. As a result some borrow money but what then? The borrower has the loan round his neck for years and years, harassing his life, and preventing him from getting married —a most shameful thing. The first of the rights of man is to get married. Things like the situation I have mentioned deter
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a good man from getting married while he is young and enthusiastic. At an age when people are in love there is nothing more shameful than to be prevented from being married. Such a man will have his chance in group practice under the Minister's scheme. They will see that the salary is all right. The doctors have a strong enough trade union. But the young doctors welcome the Minister's scheme whatever the elderly gentlemen may say or think. I think the Minister can go ahead with it, feeling assured that he will have enough recruits when the scheme is launched.
They also welcome the scheme for superannuation. I think that is another very good thing that has evolved in the last hundred years. Think what superannuation means. I think Charles Lamb eulogised it once. When you are in a scheme, and know that if your health gives way, or when old age overtakes you, there will be reasonable provision for you for the rest of your life you are free minded. I am speaking of us poor men—you are all wealthy men on that side—and one is relieved in one's mind if one is sure of a pension. One can then enjoy civic life or professional life, or working life unworried by that awful carking care that one otherwise gets with advancing years. At 40 it is there; at 50 it is increasing, at 55 it is acute, at 6o you hear "It is time you went" and you say "I have not enough put by to keep me and my wife." That is the sort of thing that makes many people look so ill when they should be in the prime of life, enjoying the fruits of a life's labour. Superannuation is being provided here, and the young doctors welcome the prospect. They will all get fair play under local authorities. I would beg the doctors not to be afraid of certain words.
Dr. Summerskill: We are not.
Mr. Walkden: The hon. Lady is afraid of nothing. But words are being bandied about, very queer words—"regimentation," "bureaucracy." A lot of people frighten themselves with them. A bureau is only an office. The man in charge, is, in French, a bureaucrat. We should call him a clerk in charge in English. As for "regimentation," as applied to any civilian occupation it seems like "bureaucracy," only a bogy word. We are not going to be frightened by them. We get

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plenty of regimentation in industry, and I can assure hon. Members, as regards bureaucracy, that there is more of it in private railway companies than in the Civil Service.
Still we are not frightened of it. When necessary, we can fight it I am sure doctors can do so, too. I am afraid I have been a little severe, but I have tried to give a better picture to the House than has been given so far by the medical profession. I do not read "The Lancet" regularly—I believe something dreadful happens to you if you read it for 40 years —but "The Lancet" gave a very nice welcome to the White Paper when it came out. It said that the Government's scheme was bold, as well as reasonable, and it added:
"Much remains to be decided and defined, but, within the framework suggested, it would be possible soon to increase the value of medical knowledge to the public, to give most doctors more satisfaction in their work, and, in so doing, to prepare the way for a really fine service in years to come. On the whole, it is considered that the White Paper gives the doctors a square deal."
It suggested that the new national service
"must set itself from the first to make more economic use of the doctors available. This, it is asserted, can only be achieved by the rapid development of health centres, which would do something to conserve the doctor's time and energy."
You cannot have anything better than that from "The Lancet," which represents the profession much more truly than the speakers we have heard to-day. I am amazed at their being selected to speak for the profession. I was reminded of what the Minister of Education said the other day. Looking up, he saw certain people in the Gallery, and he said to them:
"Ye fearful saints, fresh courage take.
The clouds ye so much dread
Are big with mercy, and shall break
In blessings on your head."
That is what this scheme will do for the doctors, for the hospitals and for everybody else concerned. I come last to the objections made—not only by doctors, although they were made by one doctor here to-day—on the matter of expense. Small-minded people—some of them with big bank accounts—are saying that the country cannot afford these schemes. The answer is that the country cannot afford not to have them. We cannot afford to have sickness and illness and a feeble
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Population. Only a small proportion of our people live on the land: we are mainly an urban and industrial population; and the maintenance of health is no light matter. The country cannot afford ill-health and weakness in its people, just as it cannot afford to have an ignorant population. We must be strong, we must be well, and we must have our capacities well developed; we must be educated. We are a comparatively small nation, on a small island, but we have very great responsibilities; I do not know any country which has responsibilities comparable with ours; and we have illimitable possibilities. We have a great history, and I believe we have a very great future, even greater than our past. But we must be strong, we must be healthy, we must be intelligent, we must develop all our capacities, if we are to continue to be great.
Major Leighton: The hon. Member for South Bristol (Mr. A. Walk-den) made a point which leads me to a question which I invite the Minister seriously to consider. He said that there was nothing in the White Paper dealing with the treatment of rheumatism. I want to ask the Minister whether he will go into the question of developing British spas. We all know that British spas are very much behind Continental spas. I went to a spa in Switzerland before the war, and when the war came, I had to look round to see what I could do. I found one in Wales. I asked my London doctor about it, and he said he had never heard of it; but he made inquiries, and said to me, "That will do you all right." So I went there. It is a very tiny place, and very primitive. There are a few sulphur baths, and there was no skilled doctor there to say what one should do. When I went abroad, the doctors examined sue very carefully, and prescribed exactly how long I should stay in the bath and how many baths I should have. At this place, I prescribed for myself. If we are to develop our health service, surely it is time we set about it; we have just as good health resorts here as there are on the Continent. In fact, the sulphur water at this place to which I went is as good as it is anywhere in the world. There are different sorts of wells, at Llanwrtyd Wells and at Llandrindod Wells, and there are brine baths. I found that there had been an association called the Association of British Health Resorts and Spas.

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I wrote to them, and I was answered by a firm of accountants, who said that the association was in liquidation. That association was started in 1931. It had some very eminent medical people on it, and for some years they evidently did good work; but when the war started they could not carry on. It might have been as well if the Minister of Health at the time had tried to keep such an association going.
The Minister may think it worth while now inquiring whether such an association could be restarted. After the war there will be a great demand for these places. Thousands of people who used to go abroad will probably not do so again, and there will be a chance for our British spas to come into their own. After the last war the Germans invited a lot of our specialists and leading doctors to inspect their spas. A large number accepted that invitation. From the time they left Victoria to the time they got back to Victoria they did not have to pay a penny, and they were entertained magnificently the whole time. They went to different spas in Germany, and were lectured and shown the various treatments, and I believe they were very good. What was the result of that? They recommended people to go to Germany, and, when they went to Germany, they were treated very well, and when they came back they were pro-German. I hope we are not going to have that again. If we have these health-giving waters in this country, would it not be as well to make use of them? I hope the Minister will seriously go into this. I had already written a letter to him on this subject, and he will probably find it in his office and be able to read all the details. I hope he will try to do something to help the British spas.
Mr. Graham White: I do not wish to follow the previous speaker in the somewhat specialised field on which he has spoken. I wish, as briefly as may be, to express, on behalf of my right hon. and hon. Friends, our general and cordial support for the proposals set out in the White Paper. Modesty perhaps ought to prevent me from saying that it does so happen that the main outlines of these proposals are very similar indeed to the proposals of the Liberal Committee on the National Health Service which re-
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ported some 18 months ago. [An HON. MEMBER: "Why condemn it like that?"] Be that as it may, the right hon. and learned Gentleman has set up a signpost on the road to health for all, and it will be our ambition in this matter, with such ability and knowledge as we can assemble, to help him to clear that road and keep it open. I do not know whether the right hon. Gentleman realises it—the point was brought to my mind by the hon. Member for South Bristol (Mr. A. Walkden)— but a very remarkable thing has been happening in this House yesterday and to-day, in which the Minister has played a leading part. Here we are, in the second half of the fifth year of a total world war—in contrast to the debilitated condition of the people of the Continent and the abominable tortures of mind and body that go on from day to day—in this House of Commons, giving two days, under the leadership of my right hon. Friend, to the consideration of housing and health.
We cannot be too grateful to all those who have made that state of affairs possible, and it has strict relevance to something else which my right hon. and learned Friend mentioned and to which I will shortly refer. No Minister of Health has ever had a greater opportunity for public service that he, and the whole House and the country will wish him well. He did say yesterday that he welcomes criticism. It is perhaps as well that he should, because he is most certain to get it. I do not want to criticise him to-day, but I want to refer to criticism generally, because it seems necessary that we should remember that there are dangers in criticism to-day. The danger is a real one. With the march of events now proceeding it is of the utmost importance that the Government should speak with the greatest authority possible, and any criticism which might lead people to suppose that we were divided in our purpose would, indeed, do the utmost mischief.
The delay in reaching decisions in various matters, and the delay in bringing to the House of Commons the proposals we are considering now, has produced a feeling in the minds of masses of people that the Government are not as serious in their attitude to peace as in the prosecution of the war. My right hon. and learned Friend the Minister without Portfolio told us some months ago that there would be a White Paper on the subject

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of social security as a whole, and I could not agree more than I do already with the Minister of Health that we must not consider these matters separately, but realise that they all hang together. Encouragement is given to us by the fact that the proposals of Sir William Beveridge are to be improved upon. My right hon. and learned Friend told us the other day that he was working on them now, and the Minister of Pensions said, in the very heartening and exhilarating atmosphere of a by-election, that the proposals of the Government would out-Beveridge anything that Sir William Beveridge had ever thought of. Robert Louis Stevenson, in one of his better-known works, wrote: "It is better to travel hopefully than to arrive." It is a statement which I do not think works out truthfully in practice, but the Beveridge proposals have been a very long time on the way, and we can only hope that, when their journey's end does come, they will be, in fact, better than was made out by the Government on earlier days.
I leave that, because I want to return to the point that all these things hang together. This is a part of the social security proposals. With regard to assumption A of the Beveridge proposals, we are still waiting for details of one of the most important arrangements, the scheme for full employment, because apart from the pronouncement in another place by the Minister of Reconstruction, we know nothing whatever about these proposals. They are in the hands of various Departments. The danger from this criticism is that the critics themselves should think that, if they have launched their criticism, they have accomplished something and their duty ends there. I am quite convinced that there is no short cut to prosperity, well-being or any other desirable state of affairs, simply through the method of adroit legislation in the House of Commons. My right hon. and learned Friend said in the course of his speech that we were engaged here in reshaping the background of the life of the people of this country. I venture to suggest, quite humbly, that we are doing something very much more than that. These events have much more than a mere domestic significance. We must, in these days, never close our minds to the kind of rôle we are to play in the world of the future. We know that our population will prevent us ever playing a decisive
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rôle as a military Power, even if we wished to do it. I yield to nobody in my intense belief in what we can accomplish in the field of industry, but my belief is that, if we are to be supreme in the postwar world, it must be in political and moral leadership.
It is my profound conviction that we can render no greater service to a shattered, devastated and bleeding Europe than to present to it, as an example, a living and working democracy, to which they can turn for help and for guidance. Therefore, I am entirely in agreement when it is said that all these things must be grouped together—health, education and housing—into one great scheme. I hope that someone on behalf of the Government will soon put a concrete scheme before the country, and that as a result we shall see the outward and visible sign of the attempt to rebuild Britain not only physically but morally as well.
The medical aspect of this scheme has our approval. The suggested central medical service has had a good reception. I imagine that there will be some criticism of it and I will proceed at once to make one criticism. It may be that it is an oversight or an omission, but perhaps my right hon. and learned Friend the Minister will give consideration to the point. The Central Council has the right to make representations on matters the Minister refers to it. It has the right to report to him on matters of urgent importance which ought to be reported to him. It is the duty of the Minister to present a report to Parliament annually. There is one thing lacking in the independence and utility of this Central Council. It ought to have the right to publish, on its own account, a report on matters on which it has tendered advice to the Minister and which advice has not been taken by him. That is the important thing.
We have to remember that we must keep all these things on the most democratic lines possible. That is the only criticism that I would make. I am now speaking of the administrative body. If that body were to be used, as conceivably it might be, to look after vested interests, either professionally or in any other way, it might become a close corporation and develop a Fascist tendency. It should be made clear at the outset that it has to be a public service. It will have very great power and we ought at some stage

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to consider whether there ought not to be a right of appeal from decisions of the Council to the Minister in certain circumstances.
There are two matters on which I still want to say a few words. It is only machinery that we are considering to-day and it is obvious that a great deal will depend on the capacity and the personnel of the new medical boards. I doubt whether the Minister has sufficient power of direction over these boards, as I understand them from the White Paper. Local government bodies vary in quality from place to place, and it will not be surprising if the quality of these boards does not vary a great deal from place to place, and the Minister ought to have some power to see that their functions are carried out. There is a great deal to be said for making the regions under these boards even bigger than suggested in the White Paper. The case for that really rests upon the hospital services. A bigger area is proposed for Scotland, and I am rather inclined to think that a proposal that is good enough for Scotland might, in this connection, perhaps be good enough for this country. It may be possible to raise more quickly the standard of outlying hospitals by relating them to the medical schools. That is an aspect of the matter which requires further consideration and discussion and we will deal with it on a future occasion.
I am sorry that opportunity has not been taken in connection with the Education Bill and with these proposals to try to deal with the administrative and departmental difficulties which would be involved in making the Minister of Health really Minister of Health for the whole country and giving him the control—I know I shall be at cross purposes with the Minister of Labour in this—of industrial health and also the school medical service. These are two matters which, while we are making these major changes, should be dealt with at once. Conversely I would take the opportunity on the Education Bill to hand over to the President of the Board of Education the control of the Home Office schools and also the Poor Law schools. These are matters which I merely mention in passing.
I now come to the last matter—the subject of finance. The estimates struck one at first sight as being on the moderate
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side when compared with the tentative estimate put forward by Sir William Beveridge. I guess that in the compilation of these estimates allowance is made for the shortage of consultants and practitioners and for various other matters. If the estimates had been based on an attempt to provide for a full service they would probably have been very much bigger. I want to draw attention to one particular object of the finances of this scheme. We have all been impressed—and some parts of the country have been very much alarmed—by the growing burdens being placed upon local authorities. The Education Bill already places very heavy burdens upon them in many cases. It proposes to place, over a period of years, an additional burden of £32,500,000, and if I understand the Bill, it proposes to add another £7,500,000.
This process cannot go on for ever. There have been many proposals for lightening the burden by pooling and by other arrangements. They have been considered and found wanting; at all events they have been rejected. I am not sure that there is not in these proposals a basis on which, without infringing our previous practice or our democratic ways of procedure, we could do something to relieve the rates. It arises through the arrangements made for the conduct of business by the joint boards. It has been the principle—and I think a proper principle—of Exchequer practice in this country that where the piper calls the tune control should follow. When a corporate body, local or otherwise, is solely financed by the Exchequer control should follow. No local authorities would wish to see their authority and control damaged, but here we are proposing to diminish the authority of local authorities over a very considerable field. I ask whether we could not bring about a great relief to local authorities, without infringing any of our former principles, by bringing our present procedure more into conformity with our principles and applying the cost of the proposal to the central Exchequer.
Captain Cobb: When the hon. Member talks about relieving the rates he does not mean really relieving the ratepayer. How is he going to relieve the ratepayer if he asks him to pay higher taxes? It simply means taking the money out of a different pocket of the same pair of trousers.
Mr. White: I do not want to argue upon the comparative incidence of rates and taxes, but the point I was trying to make would be clearly understood, whether it is right or wrong, by any local authority and by the authorities of the Exchequer. That is the point which I mention and to which we shall return in due time. We congratulate the right hon. and learned Gentleman on his opportunity and on the work which he has done in presenting these proposals to the House. We are grateful, too, as he reminded us we ought to be, to my right hon. Friend the Chancellor of the Duchy of Lancaster for his work in helping to prepare the scheme and bringing it up to its present state. There are matters —and I have tried to mention some of the more important of them—with which we shall deal as the scheme goes forward, and in the meantime we wish the right hon. and learned Gentleman good luck and will do what we can to help the process.
Dr. Howitt: The Minister must realise that the White Paper has had a good reception. As for myself, I welcome it, and I know that the great majority of the medical profession welcome it, and the people of the country, too. It is a well-written document and interesting, and, contrary to many White Papers, is very easy to read. That makes it a great deal more attractive than many White Papers with which we have had to deal. I am most anxious that any criticism I make shall be helpful criticism. This Debate has been given to us so that our criticisms may help the Minister to make the health services more successful, but I feel there is a wide feeling in the profession, and among the people, that the voluntary hospitals have had but a poor deal in the White Paper as it stands to-day. The Minister spoke very kindly of voluntary hospitals, and I am sure that he will do his best to see that they and the people who support them are more satisfied and more likely to support him in building up his service. We owe so much to the voluntary hospitals, not only for the work they have done in the past but also for what they are doing to-day, that I am sure the public, and the medical profession too, would deeply resent anything that took away the usefulness of these beloved institutions.
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The White Paper undoubtedly shows that the contributory scheme is dead. I think we have to face that. It will be a major disappointment to a great many people who have been in the habit of working hard and continuously for years to make the contributory scheme a success, but I want them to feel that their voluntary hospitals are not going to be shut, and I want to ask the Minister if he will do something to make them feel that they are having a bigger work to do in the national scheme. After all, medical teaching all through the ages in this country has been undertaken by the voluntary hospitals, and the vast majority of the best research has been done by them. For that one owes them a very heavy debt. I know that not all voluntary hospitals are big teaching hospitals, but, taking the small voluntary hospitals up and down the country, they are on the whole very good, though some have their faults I have seen them and we all know them. We want to help those voluntary hospitals to be better rather than to abolish them, and we do want to keep up the initiative and the independent spirit for which our voluntary hospitals have been famed. If we do not do that it will a great set-back to research, a set-back to the wonderful feeling that has existed throughout all these years between the people and what they call "our hospitals." Therefore I ask that, in respect of the voluntary hospitals, the Minister will make the consultant services and the lay people working for the hospitals feel they are doing more in the reconstituted health service of this country.
Now I want to speak about the medical profession, the doctors themselves. I expect all hon. Members know, and certainly the Minister does, that a questionnaire has just been sent out to all members of the medical profession. It is a long questionnaire and has to go not only to people in this country but to others who are out with the Fighting Forces abroad and in the Colonies too. It is not expected that the answers will be received at headquarters until July, but I feel pretty sure that when they are received there will be strong representations that we do not want a great increase of the salaried services, that the vast majority do not want to become what might be called "Whitehalled" because, if they are, the valuable relationship between patient and doctor. which

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means so much to both of them, will be destroyed. If you do this, you will get, if you are not careful, far too many forms for the doctor to fill up. The average doctor to-day is frightened that he will have more forms to deal with and we do not want that because already we have too many. It reminds me of a case in my own constituency after there had been a bad blitz. The commandant of a first-aid post was very anxious about the patients, and an official came up to see how they were getting on. The question which was asked first was, "Did you get form MBC.44 properly filled up?" That question was asked long before any inquiry was made as to how many casualties there were, and what was their condition. We do not want that type of mind introduced too much into the medical profession. We do not want to be dragooned, and we have been assured by the Minister to-day that we are not to be. If he says so, I hope it is going to be so.
We have to realise that to-day we have a very great shortage of doctors, and to run this National Health Service satisfactorily there ought to be an increase of 5o per cent. of doctors. It takes a minimum of six years to make a doctor, and we must adapt this system a little bit slowly and make it attractive for the young people who go into it. I am afraid that the White Paper, as it stands to-day, When it is read by parents and young men and women, will not attract perhaps the best people into the profession. The majority of people going into the medical profession to-day are the sons and daughters of doctors. If you do not make a doctor's life attractive, if you do not allow him initiative and enterprise and a reward for hard and good work you will not attract into the profession the people you want to attract. That will be a very serious thing. Therefore, I ask the Minister to ensure that he will make the profession an attractive one for parents to send their children into, that he will leave ample scope for initiative, hard work and independence on the part of those going into the profession, so that they may feel they will be rewarded and will not be going into a dull profession in which they will rise inch by inch.
I want to refer to one or two details. As regards the Central Health Services Council I think it would be far more use-
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ful if the Minister asked representative bodies to elect their own representatives, instead of choosing individuals himself. In that way I think he would get a better Council. With regard to the Central Medical Board the Minister told us that he does not intend to dragoon young doctors into the health centres for five years or any such period. I hope that the Board will be able to use their powers of persuasion and not their powers of compulsion, because medical men do not like to be compelled to do things. They do much better work if they have some choice in the matter. With regard to the Local Health Services Councils I feel that the Minister can help the voluntary hospitals by having on them equal numbers from the voluntary hospitals and the local authorities. By so doing the Minister would get the advantage of the great knowledge of the representatives of the voluntary system and it would help to make the voluntary hospitals feel that they were pulling their weight more. In regard to health centres, I hope the Minister will not start by having an enormous number of them straight away. There must be an experimental stage. He knows little to-day about health centres, because there have been very few of them, and, therefore, I hope he will say that they must be tried out before they become universal. I would also urge upon him that there should be a few beds in these centres, as this will make them far more useful. In the White Paper there is no mention of such beds.
I am very keen that the Minister shall have the co-operation and support of the medical profession. I think it will make the scheme work much better if he has that support. The suggestions I have made are entirely with that abject in view. I hope he may help to make the medical profession and the voluntary hospitals feel that they are taking a more active and leading part in the work that lies ahead. I would like to make one more suggestion. I do not think—although I may be wrong—that the Minister has had much personal contact with these people, and I suggest that he has a round-table conference with three representatives of the voluntary hospitals, three of the Nuffield Trust and three of the British Medical Association. If he did this, I am sure that his persuasive powers would make a great deal of dif-

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ference to the outlook of the work that lies ahead. Finally, I wish to preserve the character and the reputation of the voluntary hospitals, and I would urge my right hon. and learned Friend to do all in his power to make the representatives of these hospitals, both doctors and laymen, feel that they are working with him, that they have an important job on hand and that the voluntary hospitals will be able to continue to do the same kind of work, in the same kind of way, as they have done hitherto. I want my right hon. and learned Friend to realise, most particularly, how urgent it is that he should make the medical profession so attractive that the right people will enter my profession. We do not want in it the average humdrum person; we require in it people who will have initiative and ambition.
Dr. Morgan: I would like to pay my humble tribute to the White Paper. There has been a long period of incubation over it and I must say that I expected a certain abortion, if not a monstrosity. At last the infant has been produced; it is not a very healthy infant; it is rather emaciated, emasculated, but, such as it is, it is certainly a step in the right direction—although that I think is the wrong metaphor to use. However, if only half of what is in the White Paper comes to fruition we will have made a real land-mark in the health services of this country. A great many Members to-day have put up sore heads of their own and have knocked them down. The hon. Member for Reading (Dr. Howitt) forgot that the central idea of a health centre is health, and not disease. He asked for beds in these centres. The idea of a health centre is a separate centre entirely for health, health education, culture, knowledge, the prevention of disease and—
Dr. Russell Thomas: Red tape.
Dr. Morgan: It is blue tape in the hon. Member's case. On the other side is disease, which we have not been able to prevent, and having all the services at hand—general practitioners' service, with domiciliary facilities, laboratory department, statistical department, nursing facilities, secretarial assistance and dispensing facilities, and all that is necessary for a good opinion, with secondary opinions ready at hand—in that way to do the best that can be done for a patient,
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giving him that prime consideration which at present he does not get. There are benefits associated with this White Paper and the scheme. True, it is not a comprehensive national health service. It is a medical service, with the stress laid on the medical side at every stage of the White Paper. The nursing side, the side of the health workers from top to bottom is completely neglected. Conditions of service, environment, good teaching are all left absolutely alone. We are to have a Central Medical Board. Why not a central health board, to include not only the doctors in the service but a central board as the employing authority with all the institutional workers, health visitors, nurses and everyone in the hospitals combined under it? Surely they are entitled, as are doctors, to good negotiating machinery, good Whitley Councils for discussion of their working conditions.
That is one of the faults of the White Paper. Another, again on the medical side, is that it stresses the point of disease and medical services. Take the four divisions of medicine, Personal hygiene, Public health, Social Medicine and Industrial Health. Health education is still under an ad hoc body, with a selected personnel, with no representation of the workers, at all, nor medical inquiry referees. You select the men and you know the sort of report they are going to make before they make it. Anyone who knew the composition of the Rushcliffe Committee could have written their Report before it was presented, especially if he knew the Chairman. This is constantly going on. The hon. Member talks about representation of voluntary hospitals on any future Board. He has not reached the point when it comes to proper and adequate representation of the different grades of workers in the health services. In this comprehensive scheme the whole of that is left out.
Take the second section of health, which is not mentioned because it is not a health service, the question of public health. It is grossly neglected. Take the question of social medicine. There is only one school in the whole of Great Britain which has a lectureship in social medicine, and it is due to the generosity of a manufacturer—an excellent thing for him to do —and is in Oxford University. The whole question of social medicine, with the questions of good milk supply, prevention of

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disease, good food and nutrition, good housing, good recreational facilities, prevention of mental disability in its early stages—all this has been left out of the White Paper. There is medical education, an important subject which the laity in the House know very little about. I speak with diffidence and misgiving in the presence of one of my own professors, who, when I arrived a young student with £20 in my pocket to study medicine, first opened before me the great door of science and taught me to look into the vista of the foundations of medical education, the hon. Member for the Scottish Universities (Sir J. Graham Kerr), who in my young days was such an inspiration and help to me. I hope, in listening to me, he will think that I am keeping my proper biological balance. Biology is well done, but physics is not. It is not related to the later phases of medicine, nor is chemistry. As to the medical curriculum, social medicine is not taught.
Take another question of great importance to the workers—occupational mortality, the relationship between occupation and disease, the whole question of industrial medicine. In South Wales, the miners are asked to go down to the bowels of the earth with new mechanical appliances and they are being almost ravaged by silicosis. Asbestos workers are all being subjected to the risks of asbestosis. There is not one lecturer on industrial medicine in any medical school, or attached to any of our hospitals, in this pioneer industrial country, which has led the world in the production of goods. You will say there is no relation between industrial medicine and general health. There is. The miner who gets silicosis is liable to tuberculosis. He goes home under bad conditions and is a focus, a pivot of disease, not only to the people in his own household, but to the rest of the community. So that in the four sections of medicine, not a word is put down about a preventive policy. It is all left to be got up later by the Health Services Council, because the Central Medical Board is a purely executive body. None of them knows anything about industrial disease. The doctors have not been taught. There are very few experts on industrial disease in the country. It was left to the Trades Union Congress General Council to ask the General Medical Council, a body nearly 100 years old, unreformed, with 36
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members, average age 72—it used to be 77—to put industrial disease on the curriculum so that students of the present day could have some knowledge of the relationship between industry and disease and health. All these things are of tremendous importance to the workers as workers. You cannot divide preventive from curative medicine. In the White Paper such an important subject as industrial health is scarcely mentioned. Sometimes it is the Ministry of Health, a body which should be wide awake, which is asleep. The right hon. and learned Gentleman made a speech yesterday which showed he had reached the Rip Van Willink stage.
Take the question, little known to this House and the public outside, about Rag Flock Acts. We have been asking for reform and amendment about this for years. A Departmental Committee was set up by the Ministry of Health to deal with the question of the filthy, dirty and insanitary fillings of beddings, upholstery, cushions and things of that kind. The whole thing is a perfect disgrace. New York has State laws about it, and what cannot be passed in certain American States can be sent over here. It is sheer rubbish, stuff they would not allow to be used in bedding over there. They send it over here in order that it should be put in our bedding and upholstery. It is put into the disintegrating machines and then used practically unwashed, the present standards being so low. I gave evidence before the Departmental Committee, in company with the trade unions concerned and the best employers. We produced samples and the dust was seen falling from them. The Report of that Committee has been written and the Ministry of Health has received deputations since. This Ministry, which has health administration in the hollow of its hands, say they cannot do anything about it because the chairman of the Committee, Lord Merthyr, has been away on military service for five years. No matter what sort of filthy filling is put into a mattress or a cushion, no charge can be made against those selling it even if it is sold under a guarantee. I only mention that in order to demonstrate that here is the Minister of Health telling us to reform our health services, while he himself, at the centre, is not doing something which he could easily do. He could easily get Lord Merthyr from mili-

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tary service for a month or two in order to sign this Report, which I know has been written, if it is not in the hands of the Government. For years nothing has been done in this matter and yet we have this body, the Ministry of Health, telling us that it is going to start devising schemes for our health.
The Minister of Health was described by one of my hon. Friends as the health centre, but it is not a fact that health matters are all centred in the Ministry. Factory legislation comes under the Ministry of Labour. The General Medical Council, which is its own master, deals with medical education. Medical research, a vitally important matter, is in the hands of a separate body under the Privy Council. It is in a Department of its own and it selects the subjects for research. It, too, is its own master. There is no inter-Departmental committee linking up medical education and research and all the various phases of the health problem. There is no inter-Department liaison or comprehensive health service as is mentioned in the Motion. Although I think this scheme is a great advance, I think I am right in asking the House to believe that a scheme for a medical service alone is not sufficient. The problem is one of general health.
A great deal has been said to-day about the voluntary and municipal hospitals. Those of us who have been trained and retrained in voluntary hospitals—and I took the trouble to take again the medical course 20 years after I qualified—have a great regard for voluntary hospitals. We were taught there and we know the excellent work that is done there. Voluntary hospital managements have no right to shelter behind the excellent umbrella of the brilliant medical and surgical work which is done there. We must be fair to the voluntary hospital system. We must realise that the system by which there is a specialist in charge of a case, who is responsible for the case and to whom the patient can look with confidence because of his special knowledge, does not exist in many cases in municipal hospitals. Many municipal hospitals have done wonders in the last decade and in a few years they will be of such influence and knowledge and such efficiency that they will rival the best voluntary hospitals, even those with teaching schools.
There is a lot of fuss made about grants to voluntary hospitals and the dual system
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of control. There is a dual system in education and if you contract out you are penalised, but in the dual system which is proposed for hospitals in the health service, if you contract out you will get extra payments. I have been asking for years for a uniform system for hospitals under which voluntary hospitals would come in a coordinated unified system with the municipal hospitals. Instead of that the Government propose to allow the dual system to continue, and those which contract out will have the whole of their costs paid. They will not only get £100 per bed used and contracted for but extra grants to cover additional costs, and grants for teaching schools. I want some of the teaching schools to see how much they will get. The grants will cover practically all their costs, but the taxpayer will be without representation or control on the board. The principle of no public money without representation or control has been surrendered as far as the voluntary hospitals are concerned. Under the contributory scheme the contributors subscribe anything from £6,000,000 to £10,000,000 a year. The British Hospitals Association, which represents the contributors, consists of 76 members. The total cost of voluntary hospitals, according to the last figures is £17,500,000, out of which £10,000,000 is subscribed by contributors. Yet of 76 members on the Board of the Association only six represent the contributors. The Government are now to take the place of the contributors, but they are to have no representatives.
This is a scheme which has been well compromised according to the demands of the profession. I have to see both sides. I am a member of the Council of the British Medical Association, but no word has come from me as to the arguments and policy of the Association. I also hear the arguments on the other side from the organised democratic movement, but again I have kept my mouth tight and have made no disclosures. I happen to have the opportunity of hearing both sides, and I know what is going on. I think I have seen the way out. I think we can have a very excellent service, and that the Minister's scheme is the start of it on the right lines, with adequate representation, good consultants and seeing that the thing is done properly. It does not matter if one institution has to give way. It does not

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matter if a municipal hospital has to give way to a voluntary hospital in one area and in another a voluntary hospital has to give way to a municipal hospital. The thing is to have hospitals and doctors properly distributed.
Take London. The big hospitals are badly sited and are in industrial areas. They have not followed the drift of population. Many suburban areas are denuded of real hospital facilities. In London itself, because it suits the consultants there are a number of hospitals. The consultants are well paid for their work, not in actual cash, but by their students, when they become doctors, sending their private patients to the consultants. [Interruption.] You cannot tell me how well they do or how well they do not, because I know. Many of them are friends of mine. To say that consultants on the staff of voluntary hospitals do not get paid, is trying to throw dust in the eyes of the intelligent public.
Dr. Russell Thomas: The hon. Member ought not to make statements of that kind without qualifying them. It is a fact that many consultants spend many years of their lives in hard work before they can build up a practice of that kind. Their school is a school of hardship, in which many hon. Members of this House would never want to take a course.
Dr. Morgan: That intervention seems to me perfectly jejune. Really, it is not worthy of an elementary schoolboy, much less a doctor. Of course, I agree that consultants work hard, and of course I know that theirs is a school of hardship. We have all had hardship. How does the hon. Member think that I became a consultant on industrial diseases? Does he think it fell upon me like manna out of Heaven.
Dr. Thomas: God forbid that I should be drawn into a discussion of the hon. Member.
Dr. Morgan: No, I should prefer to discuss myself, because I think I should stand a better chance.
Mr. Deputy-Speaker (Mr. Charles Williams): I do not think we can have a discussion on either of the hon. Members.
Dr. Morgan: Let me come back to the subject of the voluntary hospitals. They
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are badly distributed and they are there for the convenience of the consultant. They were built originally for the convenience of the consultants. If things are changed, a consultant may find that in a municipal hospital he can do finer work with better equipment and instruments, instead of borrowing them, as he may have to do in the voluntary hospitals. Many of the consultants are hard workers. Many of them are my personal friends. If I were ill, I would not go to the medical superintendent of a municipal hospital. I regard him as an administrator. He has a specialised job in administering the hospital. The consultant specialises in his own job. I feel sure that, under any system, whether employed by municipal hospitals or voluntary hospitals, and whether he gets his money from doctor students, from the local authority or from the central authority or in any other way, he will be keen on his work and still do good work for the good of the community.
I have said sufficient to show that there are possibilities in this scheme. We may rest assured that the doctors are very anxious to give the public a very good service, but if, because of the lack of a preventive policy, the doctors are put to work under bad conditions, what can the doctor do? Suppose he is in a slum or overcrowded area, with a bad water supply and with all the flats or tenements streaming with parasites, and a patient comes to him in the initial stages of tuberculosis; what can he do? The present tuberculosis scheme is so badly designed that it does not deal with the chronic cases, which are already very resistant to tuberculosis. I ask the Minister to have some courage and imagination. Here we have the tuberculosis scheme in the hollow of our hand, to do good, and we miss the opportunity by leaving out the chronic case, which has shown that it can stand up to tubercle infection.
Doctors have a peculiar relationship with their patients. A plumber, an architect or a lawyer becomes qualified and can stop dead, and need do no more reading or study. In the medical profession we must go on studying. Doctors need study leave, because medicine is a changing science. Doctors must be given every opportunity to study the development of medicine, whether they want to become specialists or merely want a refresher course to keep them up-to-date. As a matter of fact, many doctors have been

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so busy that they have had no opportunity to study medicine for anything up to 15 years. The doctor should have such opportunities that he can become an efficient person and give efficient service.
My last point is about the Central Medical Board. Doctors are afraid, and truly afraid, of bureaucrats, especially medical bureaucrats. It may be a delusion on their part and an obsession, but when they look at the medical services that exist they have grounds for their misgivings. The Colonial Medical Service is one of the worst in the world. I represent the colonial doctors on the British Medical Association in certain parts of the world, and I can tell hon. Members that the Colonial Medical Service is a disgrace. Opportunities of medical and psychological research are allowed to slip by in our present Prison medical service, in which there has not been a man of international reputation for the last 30 years. There may be one or two exceptional men with a national reputation, but the opportunities are slipping by.
In all the services run by the Government there seems to be a blight to keep the doctors down and keep them from developing that initiative which they want to develop. The doctors therefore, and I think wrongly—because they are working under bad and difficult conditions—have the delusion that they do not like bureaucratic service. I am afraid of the directionary powers of the Central Medical Board. I want to know whether it is really intended that the Board should have power to distribute doctors from one place to another. In some places, such as Cathcart in Glasgow, we are told that the doctor proportion to patients is one in 700, while in Greenock it may be one in 3,000. The present distribution of doctors is bad. Is the Central Medical Board going to distribute not only the young doctor who has qualified perhaps after an apprenticeship in a health centre or otherwise, into a bad practice or a general one, when he is perhaps better fitted to be a specialist? Is he to be directed into a place or parish where he will have to work under social conditions which he does not like or hates? Is a doctor who has been 10 or 15 years in a certain place to be told that he must go and relieve a situation somewhere else, after his wife has made friends in the other place, and his children have all been going to school there?
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I am putting these things to the Minister, not because I believe the scheme will be worked in that way—I think things will be done very much better—but because doctors have come to me very fearful and with great misgivings. They have asked me whether it is possible that they or their sons now being trained will be in situations where there is any possibility of this thing happening. When I tell them that there is no possibility, they do not believe me. They say: "You are biased in favour of this scheme." I want the Government to make a pronouncement that the directionary powers of the Central Medical Board will be used with discretion and discrimination in the endeavour to give the public a good service.
I can only say, finally, that I think the Central Health Services Council is a very good thing. I think the voluntary hospitals later on will accept the whole scheme and will come in and come into the plan for their areas. I think that joint authorities are very excellent except that the powers of the larger local authority must be closely watched, because the policy—health and otherwise—of many smaller authorities is sometimes very far advanced as compared with the larger authorities. That has happend in many cases. I wish the Ministry of Health—I hope the hon. Lady will not mind my saying this—would be a little more honest and just with certain localities. In Gateshead, for example, which I have visited recently, I saw an excellent hospital being constructed, a composite hospital, a most excellent building, very well done, but to my pain and regret I heard that the Ministry of Health had stepped in and would not allow the nurses' home to be built attached to the hospital, so that these nurses who have to work in that hospital will have for some time to be billeted outside.
The Parliamentary Secretary to the Ministry of Health (Miss Horsbrugh): This has not to do-with the White Paper, but I visited Gateshead, and particularly this new hospital. Buildings are being put up. As the hon. Member knows, the shortage of materials and labour is extreme at this moment. What has been arranged is that the building of this new hospital should go on. That has not been stopped, but at the present moment there is not the labour or the materials for building

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a nurses' home as well. Therefore, the alternative will be to have a half or a portion of the hospital for hospital purposes and the other portion for the nurses, or some other arrangement will have to be made. The position is that at this moment of pressure a new hospital is being built, but we cannot find the material for the nurses' home until the time of pressure is over.
Dr. Morgan: I am very grateful for that information, but my information from people on the site there was—
Mr. Deputy-Speaker: This is a very wide Debate and I recognise the importance of the point, but I think it would be in the general interests of other speakers if we did not discuss this actual local detail.
Dr. Morgan: I agree with you, Mr. Deputy-Speaker, but this is typical, and I am mentioning it as an illustration of what the Ministry of Health can do. It is a health service and the Resolution deals with a comprehensive health service.
Mr. Deputy-Speaker: That is the point I made, but an illustration should not be made a subject for argument on both sides.
Dr. Morgan: I am sorry, but I can only look after my side. I was expressing my regret that even at this moment the Ministry of Health cannot make proper plans for the proper accommodation of a nurses' home attached to this hospital. It must be recognised that the nurse is important. Recruitment is down to the vanishing point. In certain voluntary hospitals tuition is not as good as in municipal hospitals. Where in voluntary hospitals only 5o to 52 per cent. pass, the figure for municipal hospitals is 80 to 89 per cent. I have bored the House overmuch. [HON. MEMBERS: "No."] But the House will forgive me. This is a subject on which I have practically spent my life, on which I have been addressing meetings in the country by request almost every week-end. I feel deeply on the subject. I think it is the right thing to point out the difficulties and the advantages of the scheme. I can only give the opinion that this little infant, if properly nurtured and fed as it should be, will grow into something of which we can all be proud.
Mr. Storey: If I am critical of some of the proposals in the White Paper—and I shall endeavour to see that that criticism is constructive—it is not because I do not welcome the White Paper proposals as a whole. I do welcome them, and I should like to congratulate my right hon. and learned Friend and also his immediate predecessor, on the very sound basis they have provided for discussion, both in this House and elsewhere. I welcome the White Paper, because I regard it as a first step towards a National Health Service which will not only relieve and cure sickness, but will create the conditions in which good health is possible, and will spread the knowledge of how it may be achieved. If our National Health Service is to be really comprehensive, all its parts must be developed into a coordinated whole, and steps must be taken to see that we make the service attractive to the essential personnel, and that sufficient research is undertaken. The White Paper, perhaps of necessity, is mostly devoted to the treatment of disease and I think it right therefore to emphasise that we will make a mistake if, in our further negotiations, these other factors are not taken into full consideration.
I want now to consider the actual proposals for the hospital and consultant service, for it is idle to deny that both the administrative proposals and the financial proposals have caused great concern to the voluntary hospitals. If our hospital service of the future is to be built, as is the Government's declared intention, upon existing foundations, then it is right that we should seek to establish the right relations between the local authorities and the voluntary hospitals which my right hon. Friend the Member for Ross and Cromarty (Mr. M. MacDonald), in his too brief tenure of the Ministry of Health, was at such pains to emphasise as of the first importance. Neither in administration nor in finance do I consider the White Paper proposals create the right relations between the voluntary hospitals and the local authorities.
I will take administration first. The ideal area for the administration of a hospital and consultant service is one which is co-terminus with the ideal area for the co-ordination of an efficient service. Such an area must be one which can carry economically the most highly

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specialised forms of service, which would probably be concentrated upon a teaching hospital art the centre, as well as the more general services which would be dispersed through general and smaller hospitals, radiating out from the centre throughout the area. Such an area must have regard to the natural flow of hospital patients due to transport and geographical factors —.for instance there is a natural flow of patients from North Wales to Liverpool—and that area must also, if it is to carry these highly specialised forms of service economically, be of necessity a large one.
The White Paper is right, I think, when it says that the establishment of a local authority, directly responsible to the electorate for such an area, would be a major alteration in the structure of local government, which could not be undertaken without a general review and consequent legislation. Therefore, I think that the system of joint boards which is proposed—objectionable as joint boards are as a form of local government—is the practical approach at the present time. But if the local authority is unwilling to accept joint boards which are coterminous with the natural hospital area, or if it is felt that such an area is too large for efficient administration, I see no reason why the planning and co-ordination of our hospital and consultant service should not be done—indeed, I think it is essential that they should be done—for the natural area as a whole, so that we shall get not only co-operation and consultation between the voluntary hospitals and the local authorities, but between one local authority and another. Upon the constitution and the status of such a planning and coordinating body will depend whether we find those right relations between the local authorities and the voluntary hospitals, the necessity for which I have already stressed. As the statutory duty of securing an adequate hospital service is to be placed upon the joint boards, upon which the voluntary hospitals will have no representation, the voluntary hospitals must have adequate representation upon the planning and coordinating body, if they are to feel that that full partnership, which the Government has repeatedly foreshadowed, is to be real; and, that body, although excluded from power, must have influence and the means to make that influence felt.
I, therefore, urge upon the Government that, not only in Scotland but in
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England and Wales, we should have area hospital planning and co-ordination advisory committees which shall consist of equal numbers of representatives of the local authorities and the voluntary hospitals, with independent chairmen, and representatives of the medical, nursing, teaching, and other interests. I would go further, and suggest that not only should the joint boards be encouraged, as is proposed in Scotland, but that it should be incumbent upon the joint boards to consult the area planning committee before preparing their own schemes, and that the meetings of the planning committee should be open to, and their reports to the Minister and to the joint boards available to, the Press. If we had a body on such lines, we should have a body which could not be ignored except for very valid reasons, and we should go a long way towards getting that co-operation which would make the voluntary hospitals feel that they were partners in our health service.
I come now to the financial proposals in the White Paper. They also cause the voluntary hospitals considerable, and justifiable, concern, for, while the White Paper pays tribute to the way in which the voluntary hospitals have, to a degree so far unsurpassed, provided specialist and general hospital resources, which must for many years make their cooperation in a National Health Service a necessity, although the White Paper proposes to take over the contributory schemes which are the main, and growing, source of the voluntary hospitals' income, although it removes all incentive to voluntary subscriptions to the ordinary work of a voluntary hospital, by requiring all to subscribe to the National Health Service, yet it proposes a financial settlement which is based on the principle of paying substantially less than cost for the services rendered. When one studies the White Paper proposals, it is hard to refrain from the conclusion that those who framed them, deliberately framed the scheme, so that the voluntary hospitals could continue in business, only if they were prepared to provide a service at less than cost, so that, at no far distant date, it would be possible to acquire the voluntary hospitals, their buildings and equipment, at scrap prices, to build them into a full State service.
I cannot believe that this is the real intention of the Government. I prefer to

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believe that the proposals are based upon a complete misunderstanding of the essentials of the voluntary system. There are, I think, some grounds for this view in the White Paper's description of a voluntary hospital as
"in essence, an independent charitable organisation, deriving its money from voluntary subscriptions or donations or endowments of benevolent individuals or associations."
That is a thoroughly antiquated idea. The modern voluntary hospital is, in essence, a paying hospital, where the very poor are treated free, but where a growing number of patients—even now a majority of patients—pay for their treatment, either when they receive it or by weekly contributions, either direct to the hospital or through a contributory scheme. The essence of a voluntary hospital is not its charitable funds, but its tradition, its experience, the facilities it offers for independent experiment, independent research, and individual teaching, and also the opportunities which it offers for voluntary public service. Here let me say that the remarks which fell from the hon. Member for South Bristol (Mr. A. Walkden) about voluntary workers and the jeers which he uttered were most unworthy, and were not the kind of thing we expect from one who has usually exhibited in this House a kindly and genial spirit. But, to go back to my argument, those things which I mentioned are what the Cave Commission had in mind when they wrote that the voluntary system was part of the heritage of our generation, and that it would be lamentable if, either by our apathy or by our folly, we suffered it to fall into ruin.
Is it possible to devise a financial structure under which the voluntary hospitals can maintain a large measure of independence, so that they may continue to make 'their particular contribution to a National Health Service, and yet be able to afford to carry on? I believe that it is. But we must first abandon this idea that when the State contracts with a private enterprise to render it a service, it can pay less than cost for that service. I think we can do that if we recognise that the voluntary hospital renders two forms of service to the community: one, the provision of general and specialist hospital treatment; the other, what is freedom, as the Hetherington Committee rightly
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pointed out, makes it well fitted to do, the trying out of new techniques, new equipment, new methods of treatment, which are at a stage which, although promising, have not reached the point where it would be right for a public authority to incur expenditure in introducing them. If the voluntary hospitals faithfully carry out their part in the National Health Service of providing medical and surgical treatment, they can reasonably expect to be paid the price for the job, without burdensome conditions, and with only liaison, and not dominating local authority representation, upon their governing bodies.
If the fair charge is paid for such a service, and the fair charge should include something towards the capital cost entailed, then the voluntary hospital will still be left to find the funds for its other service—independent, experimental work. To this, I think, they should devote the income from their invested funds, for it would not be right if this money was taken to reduce liabilities undertaken by the State, and they should also devote what money they are still able to raise in voluntary subscriptions. The latter, in my opinion—and I speak with a fairly long experience of voluntary hospital administration—would not be inconsiderable. Although few would continue to subscribe to pay the charges which would fall to be met out of taxes, out of rates and out of compulsory contributions, there will still be many who realising the value of the voluntary hospitals would be prepared to subscribe to maintain them. I will go further and say that if the many workmen who take an interest in their local voluntary hospital, and who will, in future, contribute compulsorily what previously they paid voluntarily, are still allowed, as I feel they should be, to take their part in the management of the local voluntary hospital, they will continue to subscribe to what they regard as their own hospital.
There are many other matters about the hospital and consultant services in the White Paper upon which I should have liked to comment, but I think they are mainly Committee points that can best be discussed when the negotiations have started with the interested parties. I will, therefore, pass on to one or two other points in the White Paper. The first is the Central Health Services Council. As with the area bodies that I have suggested, its value in giving confidence to

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the professional and experts bodies which will be represented thereon will depend on its status and influence and therefore I join with the hon. Member for Reading (Dr. Howitt) in urging upon the Minister that the constituent bodies should appoint their own representatives rather than that he should nominate them, and I think too that the Council should report, through the Minister, to Parliament, rather than the 'Minister report to Parliament on the work of the Council.
Just a word on health centres. I welcome the proposals, but I do regret that so much emphasis has been devoted to one particular type of health centre—the communal consulting room. I do not think it is the intention of the Minister that the experiment should be limited to this one type. Again, I join with my hon. Friend the Member for Reading in asking that we should have many types, and particularly that we should try the type in which beds are available to the general practitioner, and I would suggest that this type of centre might well be worked in connection with the smaller hospitals of the cottage type. Then, too, some of the health centres might combine general practitioner service with preventive and curative work of the maternity and child welfare type, which might well be carried on on a part-time basis by the general practitioners working at the centre, while others might link the general practitioner with the consultant and specialist services. The main consideration that we should recognise is that in the early stages health centres will be largely, in fact entirely experimental, and we should concentrate on getting as many and as varied experiments as we possibly can. Therefore I think that the local authorities should be encouraged to experiment with various types, and that the experiments should be coordinated, and the results weighed up centrally by the Ministry of Health.
In conclusion, I trust that all will approach this matter with a determination to build up a really effective health service. We shall only do that if, whether we are local authority, voluntary hospital or medical profession, we are prepared to put our best into a common pool and are not too stubborn on our own particular interests. In present circumstances, there will be no real progress without the co-operation of the voluntary hospitals and the medical profession. Therefore,
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the Government and the local authorities should go a long way to meet their views and give them that essential freedom which they believe is necessary if they are to give their best work to the community. On the other hand, the voluntary hospitals and the medical profession must be prepared to show a co-operative spirit. For instance, the voluntary hospitals, should, I think, welcome on their boards, representatives of local authorities and the medical profession should be prepared to join in devising ways in which we may have a 'better distribution of doctors throughout the country. Only if we practise this kind of give and take, will we get that good will, without which we shall not build up a truly national health service. Much progress in the past few years has been made in promoting a better understanding through the voluntary efforts of the Nuffield Provincial Hospitals Trust. They have done a remarkable piece of work in bringing together the local authorities and the voluntary hospitals and the medical profession, and these joint voluntary coordinating bodies have had considerable success in coordinating the work of the hospitals of their areas. If we all work to further that better understanding, I think we shall be able to build something of real value to the citizen and we shall go a long way towards lifting that dead weight of ill-health, which is such a cause of waste in our national economy.
Sir John Graham Kerr: I find it very embarrassing to speak after the kindly and exaggerated remarks about the hon. Member for the Scottish Universities, and I ought in honesty to explain that it is a matter of distance lending enchantment to the view. I only wish I could take credit to myself for having inoculated the hon. Member who spoke earlier with some of the admirable ideas he expressed to-day with such eloquence, and I hope the right hon. and learned Gentleman will not be scared away from it, hut will realise that, among the eloquence, there are points of extraordinary value. I do not propose to criticise the White Paper as a whole, neither do I propose to criticise its details, because the moment you criticise in detail a complicated thing like that, you open the way for arguments for and against each detail and it is very difficult to arrive at the absolute truth. I will

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simply take some of the points that have already been made and help to drive them home with the weight of a little experience, and not try to make any new points. I would say about that experience that I have passed a pretty long professional life of 33 years as an active member of the medical faculty in one of the great medical schools of the country. I was also on the board of management and, what is perhaps more important, upon the medical committee of that board of one of the great voluntary hospitals of the country—that voluntary hospital of which it has been not unjustly said that it was the birth-place of modern surgery. I also happened to be a governor of the chief extra-mural medical school in Glasgow. These are the credentials on which I base the few remarks I have to make.
It is obvious that the success of a great scheme like what is foreshadowed by the White Paper must be due to the capacity of the personnel who have to carry it out. Perhaps the most important factor in that personnel are the doctors. Their quality as practitioners naturally rests, in great part, upon their training; not entirely, because of course a great deal depends upon innate ability. I happen to have examined many thousands of students, not merely of medicine but also of arts and science, not merely in Glasgow and Edinburgh but in a number of the chief universities of England. I am able to give this assurance, that the medical students as a body are students of a very high average ability and include a considerable number of really brilliant, promising persons. And it must be remembered that it is not merely the general average that makes success, it is the leadership by specially gifted individuals. We see that in the history of science; the great advances in science have been made not by organised science but by great individuals. Isaac Newton, Charles Darwin, J. J. Thomson—all of those were great individual leaders. So it has been also in the development in medical science in particular. Lister, that great man who took the chemical results established by Louis Pasteur in connection with the phenomena of putrefaction and fermentation. He had the vision to seize upon those results and to make use of them for fighting the microbes which attack man.
Dr. Morgan: What did Pasteur do?
Mr. G. Griffiths: What did Banting do?
Sir J. Graham Kerr: Then, again, it was no ordinary humdrum individual who hit upon that great idea the other day, the means by which the loathsome fungus that we see growing on various substances protects itself from the attacks of microbes by secreting a particular poison. That admirable man reflected that what would serve to protect the fungus, what nature had evolved for the protection of the fungus, might be diverted from that purpose to protect mankind; and to-day we have got penicillin.
It is very much the same thing when we are fighting those deadly microbes of disease as when we are fighting the great war which we are fighting now. Our success, no doubt, is conditioned by the ordinary men but, above all, it depends upon the great outstanding leaders—the Churchills, the Stalins, the Roosevelts. So it is with the war against hostile human beings as with the war against microbes of disease. We get these very highly qualified young men and young women entering and training for the medical profession. How are they trained? They are trained, again, by leaders, by people who, by experience, by innate ability, by success in the various departments of medical science, have achieved their great position in the medical and surgical world. These individuals are willing to play their part in teaching students. That is a very great thing, and the place in which they have done their clinical teaching up to now has been Mainly the ward and laboratory of the hospital. One of the most wonderful things in this country is that we have these voluntary hospitals which have their so-called honorary staff, the leaders in medical science. They are there, of course, as has been pointed out, because there are attractions of a material kind. The great specialist of one kind or another teaches in the ward of a voluntary hospital and there he establishes his connection with the prospective practitioners of the future who bring him in for consultation on operations.
Dr. Morgan: But in places like New Zealand the professors and the tutors in the medical schools teach not in voluntary hospitals but in hospitals belonging to the State and to the community, and the New Zealand students who come here as

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qualified men are just as well taught and do as excellent work in New Zealand as we do here.
Sir J. Graham Kerr: That is very interesting, but I happened to know it before. There is no doubt about the fact. The trouble is, what is the probability now for the future? On the whole, from my experience, I believe that the possibility of making a relatively large income, of attaining a great position in society, of attaining to dignity and recognition, these various things seem to me more likely to attract the brilliant young men into this particular profession than the no doubt safer course of mounting up slowly step by step in a safe, organised profession. It is only my own opinion, but I hold it pretty strongly, although I do not deny for a moment that in New Zealand, or in Glasgow, Edinburgh, or other centres of our own country, we might get that same thing happening. However, I feel there is a very great danger involved. I have said far too many words already, but may I just make an appeal to the Government to consider very carefully the enormous value of the voluntary hospital system, to see whether somehow or other they cannot devise a system which will carry it on in the great work it has been doing, without involving a real risk, as I am afraid is the case at present.
Mr. Douglas: May I, in the first place, add my congratulations to the Government on the preparation of this White Paper, which certainly marks a very great extension and advance in our medical services? It opens up problems of administration and finance and other things which are complex and involved and it also raises the question of relations between the State, the local authorities and the medical profession. However, I do not want to discuss these matters to-day; I want to consider for a moment what is the fundamental basis of these proposals. They are described as a National Health Service, but that description is a misnomer. The description should rather be a national disease service. The basis of these proposals is to extend to the whole population some, at least, of the facilities for the treatment of sickness which are at present available to a section of the population. That, I do not deny for a moment, is a thing of great importance and urgency, but I submit that it is very far from being
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sufficient. It touches only the fringe of the problem of public health.
The White Paper refers to long life, the lowered mortality rates and the decline in the incidence of the more serious diseases which has taken place in recent years. If a comparison be made with the conditions at the beginning of the last century, there is, undoubtedly, a vast contrast, but do not let us forget that if a comparison is made with a century or more ago it is made when the condition of public health in this country was at its very lowest ebb, when the population was living in most distressing and disgraceful conditions, and when urbanisation and industrialism had worked their worst upon public health. What we have to think about is not the improvement that has taken place since that time but the extent to which the population of the country is suffering from sub-acute disorders which lower vitality and ultimately lead to acute disease and sickness, and nothing is being done to deal with that.
Our public health statistics are all based upon mortality and upon the records of the treatment of active disease, but there is an indication in such research as that which was undertaken by the Pioneer Health Centre at Peckham. It is recorded in a very remarkable book published recently under the title "The Peckham Experiment." There you had a sociological examination of great importance, a cross section taken of the community, not of a particularly depressed part of it but a reasonably normal section of the London population. Taking a group of 500 families, about half women and half men, 21 per cent. both of the men and women were suffering from disease, that is to say, an active disease which was causing them discomfort which they recognised to be such. But of that 21 per cent. less than half were receiving medical treatment. There was a still more remarkable result of this inquiry. Of the men, only 16 per cent. were found to be without disorder of any kind, and of the women only 4 per cent. There were 63 per cent. of the men and 75 per cent. of the women who were suffering from disorder of some kind or other which was not causing them active discomfort, which they did not recognise as a disease, which in many cases, no doubt, nature, with its wonderful adaptability, by means of compensa-

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tory adjustments enabled the human being to go on living upon a lower basis of vitality, not feeling that he was actively ill.
There is nothing in the scheme of the White Paper which is actively directed towards dealing with the vast majority of the cases of disorder which are not recognised as illness, and which continue day after day or year after year and lay the foundation of permanent disease, which is tackled too late to enable a complete cure to be effected. The best that this scheme is likely to provide in its present form is care and advice for one portion only of those who need it if these figures are a typical example of the condition of public health. The step forward that is proposed is extremely valuable, but it is not sufficient. A radical change of outlook with regard to the whole problem is needed. Measures must be devised which will provide for the health examination of the people so that the incipient stages may be detected, as they can be, and the proper remedies taken if we are to avoid having the enormous mass of invalidity and sub-normal health from which the population is suffering. It is, I agree, not merely a question of medicine. It is a question of education in health problems, a question of housing, and a question of nutrition.
The whole of Western civilisation is a prey to the same conditions. The human organism has not been able to adapt itself to the conditions of so-called civilised life. Life is the result of an evolution which has taken place over vast periods of time, and the process of adaptation is not sufficient to enable men to live healthy lives under completely abnormal conditions. We have to look at the foundations of our system of living in order to see if it is adapted to the requirements of the human frame and stop fostering the idea that mankind can be twisted and warped to agree with an entirely artificial condition of life. Great legislative changes of the kind which are envisaged in the White Paper occur only at infrequent intervals, and I ask that consideration shall be given to this question of the positive attainment of health and genuine preventive measures to ensure that people do not become the subjects of treatment in order to remedy disease and disorder. That is the most important step which ought to
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be taken. If it could be taken it would reduce to an enormous extent the need for clinics, hospitals and the other means which have had to be devised in order to treat sickness. If sickness could be detected and dealt with at the earliest stages the need for a great deal of this vast, cumbersome and expensive mechanism would disappear. I ask the Minister to see that, in the framing of this scheme, it shall be laid upon such a basis as will enable the preventive work to be developed steadily and sensibly, without interfering with the immediate remedial work which is necessary in order to treat existing disease, with the object of reducing to its lowest possible extent the amount of disease which develops in the future.
Mr. Colegate: I will make probably the shortest speech in this Debate. I want to make only two points. I want, first, to congratulate the Minister and his predecessor most heartily on this scheme, and to express the hope that in the week-end speeches which Ministers deliver we might have one or two, not so much about the future, but about the schemes which are actively under consideration in this House. Such are this scheme and the education scheme, which reflect great credit on a Government which is so preoccupied with the burdens of the war. I want, second, to reinforce the appeal made to the Minister to consider carefully the two questions of the independence of doctors and the position of voluntary hospitals. I speak under pressure from two constituencies. My colleague, my hon. Friend the Member for Shrewsbury (Mr. A. Duckworth) is away from this country, and I have had to receive representations from the Shropshire and Mid-Wales branch of the British Medical Association and from many private doctors in a large part of Shropshire. I cannot believe that the number of people I have met, who are, if anything, above the average intelligence, should be so greatly disturbed about certain possibilities in this scheme if there were not some serious foundation for their apprehension.
There is great apprehension at any suggestion that the independent position of doctors should be replaced by a salaried service. The doctor is not only important from a scientific point of view, but he is also important from a political point of view. We are entitled to consider the

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political effects of any Measure brought before the House. One of the great drawbacks at the present time is the tendency for independent individuals to disappear, and one of the most satisfactory features is the fact that doctors as a whole are extraordinarily independent. They belong to all parties and they are in a position of being under no obligation to any municipal authority or Government Department. They are independent, and their views are of great value because of their independence. In regard to the voluntary hospital, that is another aspect of the matter, because the voluntary hospital is admittedly the leader in medical progress in this country. Without it, it would be impossible to contemplate the continuation of the progress which we have seen in the past two or three generations. I agree that there may be a time when that may come about, but it is being totally unrealistic not to face the fact that the State or municipal hospital to-day is not the field where the greatest progress is being made.
Mr. G. Griffiths: I want to contradict that.
Mr. Colegate: In that connection I suggest that further consideration be given to whether it is possible to preserve in some way the contributory scheme. The hon. Member for South Bristol (Mr. A. Walkden) made some reflections on that point which did not commend themselves to many Members of this House. The contributory scheme of the voluntary hospitals has had a wonderful effect on the people who are patties to it, because it has given them a pride in their local hospital and an interest in its progress which has been of enormous, not merely financial but moral, value to the people who are carrying on the hospitals and trying to improve them. We should preserve that spirit in some way or other. It should not be beyond the possibilities of my right hon. and learned Friend, when he meets the representatives of the voluntary hospitals, to secure that some part of that voluntary co-operation between the public using these hospitals and the authorities should remain. He would undoubtedly in that way remove part of the apprehensions which have been aroused by the scheme set forth in the White Paper.
In conclusion, I would say that the two criticisms I have made relate only to a small part of the scheme, and that the
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scheme as a whole is a first-rate effort of imagination and work on the part of the Department concerned. I am sure that when it is made known to the public it will receive as wide a support as any scheme of this kind could possibly be expected to receive.
Ordered:
"That the Debate he now adjourned"— [Captain McEwen.]
Debate to be resumed upon the next Sitting Day.
The Orders of the Day were read, and postponed.

PETROL PROSECUTION (REGIONAL TRANSPORT COMMISSIONER'S LETTER)
Motion made, and Question proposed, "That this House do now adjourn."—[Captain McEwen.]
Mr. Keeling: This is the story of a well-known firm of civil engineering contractors employing many lorries on Government work, one of which broke its tipping gear. The firm adopted the only method which was possible to get this tipping gear repaired; they sent it back to the makers. The journey was reported to the Petrol Officer in the ordinary way, and the Petrol Officer made no comment. But a police constable happened to stop the lorry on its return journey, and it turned out later that the licence for petrol did not cover this journey. A prosecution followed. The firm was fined £2, but the Bench stated that they had listened sympathetically to the firm's explanation and were satisfied that they did not wilfully break the Regulations. The Bench were satisfied that there was no wilful breach, but the Regional Transport Commissioner was not satisfied. His chief assistant sent the defendants a letter which, after reciting the facts of the conviction, went on as follows:
"My Commissioner takes a serious view of the irregularities which have come to light, and I have to give you notice that in the event of evidence being received of any further irregularities on your part, or on the part of your servants, he will have no hesitation in taking the strongest possible action against you. Receipt of this letter should be acknowledged within seven days."
I suggest that it is an English tradition that

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after a man has been tried and fined and has paid his fine he has purged his offence. He should not be submitted to castigation and threats by a Government Department. My hon. Friend the Parliamentary Secretary yesterday made a most remarkable statement. He quoted the defence which had led the bench to impose a nominal penalty, and he argued that the defence was unsound. He said:
"The defence was that they had not known what they ought to do. They ought to have known, and the warning"—
That is the warning of the Regional Transport Commissioner—
"was intended to make it quite plain that such a defence would not carry any weight again with the Commissioner."—[OFFICIAL, REPORT, 55th March, 1944; col. 218, Vol. 398.]
This statement by my hon. Friend seems to me to amount to a claim that the decision of a court, come to after hearing the evidence of both sides, which the Regional Transport Commissioner did not hear, may be questioned by the Executive. That is an extraordinary claim. It undermines the principle of the separation of the judicial power from the executive power, to which the Donoughmore Committee on Ministerial Powers drew attention. My hon. Friend said that the purpose of the letter was to warn, and that it was the practice in his Department to issue warning letters after petrol offences. I say that it is not the business of civil servants, after judicial proceedings have taken place, to warn. Nor does it make the slightest difference whether the penalty is a substantial or a nominal one. If the penalty is a nominal one, if the magistrate says, as in this case, that the offence was purely technical, to warn is harsh and unfair. If, on the other hand, the penalty is a substantial one, surely it is in itself a sufficient warning. My hon. Friend the Parliamentary Secretary admitted that the civil servant might have been overzealous. That seems far too mild a word. I say that the practice of issuing this letter —for it is a practice—is tyrannical, subversive of liberty, entirely unnecessary, even in war, and ought to cease.
I have a second complaint to make about this letter, but it is a subsidiary one. The tone of the letter is objectionable. It is not a letter which ought to be sent by a civil servant, who, in the eyes of the law, is the equal, and not the superior, of the ordinary citizen. The Minister said
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that this was not a threatening letter. I have looked up the word "threat" in the Oxford Dictionary, and I find two definitions of it there. One is, "An indication of coming evil"; the other is, "A declaration of an intention to punish or hurt." I submit that the words used, which I have read, answer both definitions; and, quite clearly, a civil servant ought not to threaten. But the attitude of this civil servant is illuminated by the final words of the letter, which are:
"Receipt of this letter should be acknowledged within seven days."
What right has a Ministry of Transport official to demand acknowledgment of his letter within seven days? This sentence seems to me to read much more like an order from a court of law than a letter from a servant of the public; and I could use harsher language than that. I am not making any general attack on the Civil Service. It would be foolish to base a general attack on a single practice of the Ministry of War Transport. But, as the hon. Member for Rugby (Mr. W. J. Brown)—who I am sorry is not here—who is the parliamentary secretary of the Civil Service Clerical Association, once said:
"There are signs that here and there civil servants have forgotten that they are the servants of the public."
I suggest that it is the function of this House to remind them.
Lieut.-Colonel Dower: I rise to support what has been most eloquently and very accurately stated by my hon. Friend the Member for Twickenham (Mr. Keeling). I hope that the Minister will realise that this is a serious matter. It is not a small matter, but a matter which we have to watch very carefully, to make sure that it does not increase. As my hon. Friend said, this case was tried by a bench of magistrates. I can only think that the Department considered that the award made by the magistrates was not adequate, was not sufficient, and probably was not correct, and, therefore, they sent what is undoubtedly—I have a copy of it here—a threatening and abusive letter. Since this war started it has been necessary to increase bureaucracy and bureaucratic powers immensely. We all realise that it is a necessity of the war; but it is also necessary for us to see that these powers are not misused. It is a very

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grave duty of this House to see to that. I believe that in one of the letters the Minister said that there was no actual damage done by this letter.
Mr. Tinker: Will the hon. and gallant Member tell us where this happened? The hon. Member for Twickenham (Mr. Keeling) did not say
Mr. Keeling: Is it relevant?
The Parliamentary Secretary to the Ministry of War Transport (Mr. Noel-Baker): The journey was from Sudbury to London.
Mr. Keeling: From Sudbury to Twickenham.
Lieut.-Colonel Dower: I gathered that no actual damage resulted from sending this letter, but that is no answer. That is equivalent to saying that it does not matter how rude and how abusive the letters sent by a Department to an individual are, so long as no damage results. I hope that my hon. Friend, when he replies, will have the courage to say that in this single instance an official has exceeded his duties, that it does not meet with his approval, and that he will take such steps as are possible to prevent that kind of occurrence again.
Major Manningham-Buller: I rise to support what has been said. It seems to me that this raises a most important question. This House cannot possibly judge whether the penalty imposed by the magistrates was right or wrong. I would like to know whether any letter of this sort was sent to those responsible for the conduct of the prosecution, and whether any complaint was made that the full facts were not put before the court. I do not know whether anything will be said about that, but it seems to me that once a court has judicially determined a question, neither side should seek to override it by letters of this sort, and particularly not those responsible for the prosecution. If a man is acquitted no one can appeal against his acquittal, save by way of a case stated that the case has gone wrong in law. I hope we shall he told that this is an isolated instance, that this letter is not a regular-type letter sent out in hundreds when anyone incurs the displeasure of a Regional Transport Commissioner, or, alternatively, that if that has been the
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practice in the past, it will be stopped immediately.
The Parliamentary Secretary to the Ministry of War Transport (Mr. Noel-Baker): I am most grateful to my hon. Friends for raising this matter. If I may say so, I take no exception to the language used. If I agreed with the facts as they have stated them, I should agree with everything they have said. Our difference really is about the facts. Founding himself on the case described my hon. Friend asked me to agree with him that my Regional Transport Commissioner made a mistake in sending out this warning letter on 29th December. He has asked me to disfavour this action and to give instructions that no Commissioner shall take any such action in cases which arise in future. I hope to persuade the House that it is wiser for me not to do as he suggests; that, in general, it is wiser to trust to the Commissioners' discretion, and to allow them to do what they judge to be right. If I understood my hon. Friends, and if I understand the feeling of the House, more importance is attached to the general principle than to the special case. If so, perhaps it will be convenient if I argue first the general principle, and deal with the special case, as an illustration, at the end.
I will begin by reminding the House of the general nature of the functions which Regional Transport Commissioners, under Act of Parliament, perform for the nation, the kind of authority they hold, and their relations with my Ministry and the public they serve. They perform certain statutory duties. They decide where omnibus services are to run, they fix the fares and they grant the licences; they decide what vehicles are required for road haulage work and they grant the licences; they have to make sure that the vehicles are kept up in good and roadworthy condition. They act in an independent, semi-judicial way. They consult us, and they consult each other on general questions as they arise. But the whole system would have become unworkable, the whole basis to which Parliament agreed would have become upset, if we had tried to make their decisions for them, if we had interfered before or after they had made their decisions, so much that their authority with the public would be undermined. In the war, it has been

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different, in this sense, that the regional commissioners agreed to become our executive officers. But we must still leave them a wide discretion, within the general policy which we laid down. That applies, and must obviously apply, to the detailed work of the rationing of fuel, which they must carry out.
I think perhaps the most arduous and difficult of all the tasks which the Commissioners have had has been the issuing of fuel rations to road haulage firms. It is a very arduous job and a job of the highest importance. The Commissioners are the nation's guardians of our petrol and rubber resources. At a certain stage of the war the petrol and the rubber front looked as though it might become perhaps our most dangerous front of all. It was vital then, and it is vital still, to save every ounce of rubber and all the petrol that we can. The transport industry were given a certain target figure, and so many tons of rubber per annum had to be saved by cutting down civilian transport. The savings of rubber and petrol had to be made. We could only do it by cutting down petrol allowed to omnibus companies and for retail distribution and road haulage.
The reduction of omnibus facilities was bad enough. At one time hon. Members were writing me 100 letters a week about the restrictions that we were obliged, very reluctantly, to put on. But road haulage was far worse. The Commissioners had to issue fuel rations for a month in advance. They had to decide, after consideration of the application of any given firm, whether the work on which the firm was engaged was really essential in the national interest. They had to decide whether the goods could or could not be sent on the railway or by canal. If the Commissioner refused fuel, as he often had to do, he knew he might be depriving the haulier of very profitable work or diverting him from more profitable to more essential work. Sometimes he knew that he might have been causing the vehicles of the haulier to stand idle and the drivers for a Commissioner to be unemployed. It would be very easy indeed to be generous in granting fuel, and, incidentally, more agreeable both to him and to all concerned, but it was vital in the national interest that he should do nothing of the kind, and that he should
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grant only the minimum quantities required in order that urgent and essential transport could be run.
Mr. Keeling: I would tell my hon. Friend that other hon. Members want to speak, and I hope that he will come to the point. He has not come to it yet.
Mr. Noel-Baker: I want my hon. Friend and the House to understand the very gravely important duties with which Commissioners are charged. [HON. MEMBERS: "We agree."] It was vital that the Commissioners should be ruthless in cutting out non-essential transport. A good deal of the time and energy of the Commissioners was taken up by checking mistakes, evasion and abuse. I have explained that the fuel had to be given a month in advance. It was very easy at the end of a month, when a Commissioner questioned a certain journey, for a haulier to say, "I understood that it was essential. I may have made a mistake but I was told that it was an urgent job." Sometimes the real purpose of the journey may have been to carry some very profitable traffic for which that road transport should never have been used. That would happen. The Commissioner would protest, and the next month there would be another excuse. There have been far too many cases of that kind. Sometimes these cases were genuine excuses, but even so, they were breaches of the law. In the case of a breach of the law, it is for the police to prosecute. The Commissioner provides a witness to explain the facts. It often happens that the defence of the haulier is that his irregularity was a mistake and he did not know what was wrong, he was ignorant of the right procedure, and it all happened through a most unfortunate inadvertence. That is defence which a Commissioner must naturally treat with great reserve. Sometimes it is capable of factual disproof, sometimes it is not.
Sometimes, though the Commissioner could not prove that the haulier had known the rules, he might have known in his own mind that the haulier ought to have known them, and that it was culpable negligence if he did not. Anyhow, when an experienced haulier with a large business and a number of vehicles has been let off with a light punishment, on the ground that the offence was committed inadvertently, the Commissioner was

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bound to do everything in his power to ensure that the thing should not occur again. That is why, the Commissioner sends out a warning letter. He sends out a letter to the haulier that it shall not happen again. My hon. Friend says that, as the court convicted, that ought to be the end of the matter. I agree, and so it is, if I can make myself plain to the House. It is, so far as that offence is concerned. I do not agree that letter comes under the heading of a "threat," as defined by the Oxford Dictionary. No evil will come unless another offence is committed. There is no question of disciplinary action about it; it is a warning to the haulier that, if the offence happens again, then disciplinary action will follow.
Major Manninger: Does it not say that if he errs again, a very severe sentence will be passed?
Mr. R. J. Taylor: Does "disciplinary action" mean that his petrol could be cut off by the Commissioner?
Mr. Noel-Baker: Yes, Sir. I was going to ask my hon. Friend to remember that it was not only within the power of the Commissioner, but it is the duty of the Commissioner to cut off his petrol, or to restrict his ration if another offence occurs whether or not there are any further proceedings in a court. Therefore, I think, with great respect, that it is desirable these letters should go. It is desirable in the interests of the haulier himself, that he should know exactly where he stands, and it certainly is the duty of the Commissioner to try to make him understand it.
Mr. E. P. Smith: Can my hon. Friend say whether a similar letter was sent to the Bench involved?
Mr. Woodburn: Do I understand the position to be that if the Commissioner did not send this letter giving the haulier warning, and he committed another offence, he might find himself having his petrol cut off without having been warned, and there might be complaints from hon. Members that he had not had the warning due to him?
Mr. Noel-Baker: Yes, Sir, certainly and it is better that the man should be warned. The language used is a different question, but, in principle, I think the House will agree with me that it is right,
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after this thing has happened, that the Commissioner should make it plain that, if there has been inadvertence once, there must not be inadvertence twice. After all, it is very simple. The haulier has simply to ask the Commissioner, in respect of any journey about which he is in doubt, whether the journey ought to be made or not. Let me come, as my hon. Friend wishes me to come, to the actual case. I do not agree with him altogether about the facts; my information is a li tie different. This 23 horse power vehicle, one of a fleet of 12 which the firm had at that time, was sent from Sudbury to London, a distance of 66½ miles. The firm had a fleet of 12 vehicles. They were an experienced firm but they said they did not know the rules. We say, and surely we are entitled to say, that they ought to have known them, and it is quite plain that they ought to have known that they had to apply for fuel for this journey before the journey was actually made.
If they had asked our local office, they would have learned that there were repair facilities on the spot. Again, there, my information is different from that of my hon. Friend. They would have found that a long journey was not necessary, that this 130 miles of empty running could have been saved. But I am informed that they did not ask the local office, that they sent this lorry off to London, that the police there prosecuted, which meant that my Commissioner had to send a witness. The magistrates convicted the firm, but my hon. Friend says the magistrates expressed the view that the offence had been committed through inadvertence which resulted in the Commissioner sending a warning letter so that they should not make the same plea again. I submit to my hon. Friend that, in principle, that was right. I ask my hon. Friend to remember the great responsibility with which the Commissioners are charged, the great difficulty of their task in dealing with infractions which occur—and they are many. I ask him to remember that the waste of petrol is not a technical or petty error; it is a matter of the highest gravity from a national point of view. In some cases, a Commissioner may act in a way which some hon. Member may think unwise. Maybe, in his choice of language many hon. Members think that this Commissioner went too far. A standard letter

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may be more appropriate in some cases, but may be less appropriate, in others. It may be that in this case as my hon. Friend thinks that no letter should have been written—[HON. MEMBERS: "Hear, hear"]—but I ask my hon. Friend to consider whether it is not right, in general, to trust the Commissioners to use their desire for and to show the fairness, probity, wisdom, and courage by which they have gained the high respect of the transport world.
Mr. Hutchinson: I think the House is not likely to be satisfied with the explanation which the Parliamentary Secretary has just given us. As I understand the facts of this matter, the magistrates who tried this case came to the conclusion that an offence had, undoubtedly, been committed but that it was of a technical nature due to inadvertence, and that they imposed a fine which corresponded with that view. It was for the justices to say whether that inadvertence was culpable or not. It is abundantly plain that the justices came to the conclusion that it was not culpable.
Mr. Mathers: Is not that tantamount to saying that the inadvertence was, in fact, ignorance and that what the Commissioner set out to do was to remove that ignorance? Is it not also a fact that the Members who are pursuing this case strongly support the hon. and gallant Member for Coventry (Captain Strickland) when he raises cases of the empty running of vehicles, as being contrary to the national interest and a waste of petrol?
Mr. Hutchinson: My point is that it was for the magistrates who tried this case to decide whether the inadvertence was culpable or not. That is the whole point of this matter, and I say again that it is abundantly plain, from the penalty they imposed, that the view they took was that this inadvertence was technical
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and not blameworthy. If they had taken another view, they would have imposed a penalty commensurate with the blameworthy inadvertence, but they did not do so. The justices having come to their conclusion after hearing the evidence, the point of this case is whether it is desirable that a Regional Commissioner should go behind a decision come to by justices and take a quite different view. I should have thought that the Parliamentary Secretary would have been justified in saying to these officers—and we all recognise the difficult duties they 'have to do—that where a case is dismissed by a court of justices, in the circumstances in which this case was dismissed—[HON. MEMBERS: "It was not dismissed."] I am much obliged. Where a case is dealt with in a court of justice in the manner in which this case was dealt with, and where the court make it plain that in their view the offence with which the person was charged was of a technical nature, I should have thought that an instruction might have been sent to the Ministry's officials that no further action ought to be taken.
Mr. Woodburn: As I understand the last speaker, there seems to be a misunderstanding. I gathered that the Parliamentary Secretary said that the letter referred to the future and not to the past. Obviously, discussion about inadvertence could not possibly refer to a future case. If a similar case occurred again, that could not be inadvertence because the offender would already know what should be done. Prevention is better than cure, and it is open to the Minister to punish the next offence through the courts, but it is much better, from the point of view of saving petrol and rubber, that the offence should never take place at all.
It being the hour appointed for the Adjournment of the House, Mr. SPEAKER adjourned the House without question put, pursuant to the Standing Order.

ROYAL NAVY
  W.R.N.S. (Privilege Leave)
  W.R.N.S. (Privilege Leave)
  R.N.R. Officers
  R.N.R. Officers
  ALLOTMENTS (POST-WAR TENURE)
  ALLOTMENTS (POST-WAR TENURE)
  BRITISH PRISONERS OF WAR
  BRITISH PRISONERS OF WAR
BRITISH ARMY
  Pay Allowances (Middle East)
  Pay Allowances (Middle East)
  Parcels, Italy (Thefts)
  Parcels, Italy (Thefts)
  RUSSIA (BRITISH AID)
  RUSSIA (BRITISH AID)
FOOD SUPPLIES
  Fish Supplies, Merseyside
  Fish Supplies, Merseyside
  Biscuits
  Biscuits
  Northern Ireland Poultry (Edinburgh)
  Northern Ireland Poultry (Edinburgh)
  Cheese Ration (Agricultural Workers)
  Cheese Ration (Agricultural Workers)
  Foods (Analytical Reports)
  Foods (Analytical Reports)
PUBLIC HEALTH
  Water Supplies
  Water Supplies
  Tuberculosis (Institutional Treatment)
  Tuberculosis (Institutional Treatment)
  Sewerage (Rural Districts)
  Sewerage (Rural Districts)
  Venereal Disease (Regulation 33B)
  Venereal Disease (Regulation 33B)
  HOTELS (STAFF)
  HOTELS (STAFF)
HOUSING
  Agricultural Cottages (Rents)
  Agricultural Cottages (Rents)
  Timber Supplies
  Timber Supplies
  Cottage Homestead Schemes
  Cottage Homestead Schemes
  Air Raid Repairs (Priority)
  Air Raid Repairs (Priority)
  Slum Clearance (Stalybridge, Hyde and Dukinfield)
  Slum Clearance (Stalybridge, Hyde and Dukinfield)
EDUCATION
  Education Bill (Consultations)
  Education Bill (Consultations)
  Ophthalmic Clinics
  Ophthalmic Clinics
  Teachers' Duties
  Teachers' Duties
  Medical Inspection (Skin Puncturing Tests)
  Medical Inspection (Skin Puncturing Tests)
  SOCIAL INSURANCE (UNMARRIED WOMEN)
  SOCIAL INSURANCE (UNMARRIED WOMEN)
  ROYAL ORDNANCE FACTORIES
  ROYAL ORDNANCE FACTORIES
COAL INDUSTRY
  Domestic Coke Supplies (Restrictions)
  Domestic Coke Supplies (Restrictions)
  Accidents (Mines)
  Accidents (Mines)
  MINISTRY OF INFORMATION (REGIONAL OFFICE STAFFS)
  MINISTRY OF INFORMATION (REGIONAL OFFICE STAFFS)
SCOTLAND
  Razor Slashing
  Razor Slashing
  Reproduction Rate
  Reproduction Rate
  LONDON UNDERGROUND RAILWAYS (TIME MINUTE INTERVALS)
  LONDON UNDERGROUND RAILWAYS (TIME MINUTE INTERVALS)
  BASIC ENGLISH (WHITE PAPER)
  BASIC ENGLISH (WHITE PAPER)
  REINSTATEMENT IN CIVIL EMPLOYMENT
  REINSTATEMENT IN CIVIL EMPLOYMENT
  POPULATION (REPRODUCTION RATE)
  POPULATION (REPRODUCTION RATE)
  ALARM CLOCKS
  ALARM CLOCKS
  ARMED FORCES (KIT BAGS, WOMEN)
  ARMED FORCES (KIT BAGS, WOMEN)
Preamble
The House met, The LORD CHANCELLOR on the Woolsack.
Prayers.

  GOVERNMENT OF INDIA (DISTRIBUTION OF REVENUES) (AMENDMENT) ORDER, 1944.
  THE PARLIAMENTARY UNDERSECRETARY OF STATE FOR INDIA AND BURMA (THE EARL OF MUNSTER): My Lords, I beg to move that the Draft Order as presented to Parliament, and reported from the India and Burma Orders Committee yesterday, be approved.
  Moved, That the Draft Order, as presented to Parliament, and reported from the India and Burma Orders Committee yesterday, be approved.—(The Earl of Munster.)
  On Question, Motion agreed to.

  REINSTATEMENT IN CIVIL EMPLOYMENT BILL.
  House in Committee (according to Order): Bill reported without amendment.
  PUBLIC WORKS LOANS BILL.
  House in committee (according to Order): Bill reported without amendment.

  INDIA (ATTACHMENT OF STATES) BILL. [H.L.]
  Order of the Day for the consideration of Commons Amendment read.
  THE EARL OF MUNSTER: My Lords, I beg to move that the Commons Amendment be now considered.
  Moved, That the Commons Amendment he now considered.—(The Earl of Munster.)
  On Question, Motion agreed to.

  COMMONS AMENDMENT.
  Clause 1 page 1, line 10, after ("Act),") insert ("being a State included in the Western India States Agency or the Gujarat States Agency on the twenty-fifth day of August, nineteen hundred and forty-three.")
  THE EARL OF MUNSTER: My Lords, in moving that this House doth agree with the Commons in the said Amendment, I might just mention to your Lordships the purport of the words which are being inserted. It was thought that as the Bill was drawn it covered a wider number of people and States than those in Kathiawar and Gujarat to which the Bill was intended to apply. It was thought desirable, therefore, to qualify the position, and that is the purpose of this small Amendment.
  Moved, That this House doth agree with the Commons in the said Amendment.—(The Earl of Munster.)
  On Question, Motion agreed to.

  NATIONAL HEALTH SERVICE.
  THE MINISTER OF RECONSTRUCTION (LORD WOOLTON)THE MINISTER OF RECONSTRUCTION (LORD WOOLTON) moved to resolve, That this House welcomes the intention of His Majesty's Government, declared in the White Paper presented to Parliament, to establish a comprehensive National Health Service. The noble Lord said: My Lords, as a great number of noble Lords have indicated their desire to take part in this debate, it has been arranged, subject to the general consent of the House, that the debate shall be adjourned at a convenient hour to-day on the Motion of the noble Lord, Lord Horder, and be resumed as the first business on the first sitting day of the next series of sittings. I do not propose to take up a great deal of your Lordships' time to-day in commending the Resolution which stands in my name. My purpose in putting this Resolution on the Order Paper was to obtain the considered views of your Lordships' House, many members of which, through long and devoted service to the cause of public health, are peculiarly competent to give advice and to be heard on this subject. I am bound to confess that I have some anxiety about how properly to present this subject to-day, and to present it with reasonable brevity. The Government have already published two Papers on the subject, one the conventional White Paper and the other a shorter version, in order to bring out with clarity the principal points that we had in mind.
  I may be a little over-anxious about this subject because it is one that is very near to my own heart, and one with which for some thirty-five years I have been

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  personally and intimately concerned. In my early days, when I was first trying to understand something about the economic problems of poverty, the thing that deeply impressed itself upon my mind was that so many of the people among whom I was then living, and who were very poor, seemed to be constantly suffering from ill health in one form or another. I remember very well—and I remember it, if I may say so, with some pride—taking part in the early movement to try to establish dental clinics in the schools of this country, so that we might begin by giving the child a reasonable chance of having a good digestion with which to face the world. In later years, when I was engaged in industry, time and again my mind was driven to the conclusion that there was some very close association between industrial incompetence in the individual and physical disability.
  I am not for one moment going to suggest that all these evils are going to be cured by the Government's proposals. I hope your Lordships will forgive my personal approach to the matter, but I ventured to make it because I wanted to give the additional weight of personal experience and very deep conviction to my advocacy of the substance of these proposals. I hope your Lordships will think that it is a bold and adventurous proposal that the Government are putting before you as the outline of a plan, advocating as it does the greatest single advance that has ever been made either in this country or in any other in the service of public health. We are entitled as a nation to believe in our capacity to realize these proposals. For let us look at the basis of our hopes. In this country we have made great strides in the service of public health. It has passed through many generations from private philanthropy to public administration. Men of the greatest medical eminence in the country have been unstinting in their personal care of the sick, and they have placed their professional competence and their professional services at the disposal of the poorest of the people without any thought of payment or reward. The spirit of private philanthropy and the value of voluntary effort in the hospitals of this country make us to-day look at their record, and make us regard that record both with pride and with
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  gratitude, whilst the service of our teaching hospitals and the researches of the medical schools of the universities in this country have spread knowledge and practice beneficently over the whole world.
  Now we look to the future. Twice in a generation this nation has been called upon to sacrifice its most virile people, and this factor arising from the war compels the Government of this country to concern themselves with repairing the breaches that have been made. The health of every individual making up a nation is at the very root of national vigour and of national enterprise. Therefore His Majesty's Government have tried to work out a scheme whereby, by the method of common insurance, we may secure for the people of this country freedom, in so far as it is humanly possible to get such freedom, from the misery, the worry and the economic consequences that come from the failure of health. This is not a scheme for relief. It concerns itself neither with poverty nor with wealth. It is a scheme that invites the whole of the community to join together in an effort to ensure for every individual the positive opportunity for good health in so far as that can be provided by the skill and the knowledge of the medical profession.
  I observe with some regret that it has been called by people a free scheme. Well, I do not like that term. It suggests that there is going to be something given for nothing. I do not like these proposals for giving something for nothing. The true position is that the method of paying for the medical and health services will change in the future. All will pay for the services of all. We shall pay through taxation, we shall pay through local rates, we shall pay, all of us, through a comprehensive social insurance contribution. So this is not a free scheme. People are going to pay for the services and because they are paying for them they will have a consequential full right to demand that it shall be a good service when they get it. Having paid for it, and paid for it by their weekly contributions, then they will be able to rely on obtaining it without any further worry or concern if by mischance ill health comes their way.
  I referred a few moments ago to the great strides that have already been taken in the public health services of this

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  country. But of course, in very characteristic British way, they have grown up—grown up without any particular plan or design. Local authorities have had the administration of various services put on them at various dates—services with a strictly limited object in view. Similarly the hospitals have grown up for dealing with all sorts of different aspects of ill health, mental as well as physical, clinics, and a whole host of services. The voluntary hospitals have combined the old tradition of philanthropy and private effort with, in some cases, all that is newest both in buildings and in research and equipment. There are hospitals that are publicly owned; some of them are relics of an old Poor Law system, and some of them are the most modern hospitals with the very latest equipment Well, here we have in the country a whole wealth of material, but we have never thought it necessary in the past to attempt to co-ordinate it into an organic whole. It is true, too, and we might as well face up to it, that sometimes the voluntary and the municipal hospitals have not in all places been working in the closest association; and whilst health insurance has done so much for the wage-earning section of the public, there has been no personal doctor for the wives and the dependents of insured persons, unless they were able to make private arrangements and to afford them. In our proposals we have tried to evolve out of all this material a new service, maintaining and extending the benefits of all that is good in current practice.
  The proposals in the White Paper build up a new service round certain principles which the Government believe to be fundamental. Firstly, there is the principle that the scheme must be a comprehensive one. A full range of health care must be made available, starting with the family doctor and ranging through all kinds of clinical and domiciliary service to the hospital, the consultant and the specialist. The opportunity for the means of health must be complete for everyone. Secondly, there must be individual freedom; there must be no attempt to dragoon people into any part of the service or into any form of treatment, unless they want to use it. Neither must there be any regimentation of doctors or nurses or others whose job is to take care of personal health. That is a professional job, and it must be left as free as possible
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  for the professional people to practise it, and to practise it in their own way. Organization we must have in order to see that the services are in fact there when and where they are needed, but we do riot want to form an organization that involves a bureaucratic control of professional and personal services, because the truth is that these two things do not live together.
  When legislation follows on this Report, if your Lordships are willing to commend it, then there will be a new public responsibility to see that the whole of this service exists in fact, and moreover to see that it is good. That responsibility must rest both centrally and locally upon the elected representatives of the people. It must rest with Parliament, it must rest with the Ministers directly responsible to Parliament, and in the country it must rest with local government in the general sense in which we know local government. Yet there must be, in addition to this, professional and vocational guidance of Government in this matter. The whole service must have the benefit of the very best professional and expert advice that is obtainable, and the plans we have outlined are designed to achieve this end.
  There are a few special points to which I think it is important that I should direct your Lordships' attention. Outstanding among them is the fact that the scheme provides for the free choice of doctor. The personal and intimate relationship of doctor and patient is inherent in medical practice. People must be allowed to choose their own doctor, and, having chosen him, to change to another if they desire to do so. You cannot regiment people in medical matters, neither can you regiment service. So we have suggested medical provision of several kinds and with a rather wide range. Some doctors will be remunerated according to the number of individual patients they undertake; in some places groups of doctors will practise together. Where doctors practise as groups, in public health centres, a system of payment which does not involve their mutual competition within the group will be provided for.
  In the Report we have laid great emphasis on these health centres. Noble Lords in this House have been considerably responsible for the advocacy of the principles behind these health centres, and I hope the Report will meet with their

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  acceptance. But let us be clear about this. When we talk of health centres we are talking about something that is new, something that is untried as yet, and we shall have to gain experience in the only way in which this country ever does gain experience—by methods of trial and error; and there is much to be said for that. It is a courageous way to dare to make mistakes and subsequently to put them right. Many people in the profession and outside of it believe that doctors can do their best work by collaborating in group practice in specially designed and adequately equipped premises, where they profit not only from the pooling of mutual experience but from up-to-date resources and, what has become a matter of very great importance, an adequate ancillary staff to help them to do the things that do riot call for medical skill.
  Let me look at the patient's point of view. Even in these centres they will be able to choose their own doctors. The doctor will see the patient in his consulting room in the health centre, where the doctor will have his "hours" and then he will visit the patients in their homes. The profession's own planning commission speaks very highly of this idea, and it sounds eminently sensible and attractive. It will have this additional advantage that it will give the doctors grouped together in co-operative practice in this way an opportunity of getting away from their work and going to refresher courses to bring their knowledge up to date. Let us try it out. Let us leave it to the judgment of people as to whether they like it or riot. If they like it, the centres will grow. If the patients do not like it, then they will have full opportunity of going to doctors not in the health centres.
  There is another aspect of this general question to which I ought to draw your Lordships' attention. We do not want to segregate private practice. Some practitioners, for their own reasons, may feel that they do not wish to join the public service. There is nothing to compel them to do so. More likely some will feel they would like to join the public service but do not wish to join for the whole of their time. They would like to retain a limited number of private patients. That is all right, but there must be no suspicion that private treatment is better than public treatment. A doctor taking both private
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  and public patients will only be allowed to take a smaller number of public patients than the doctor who remains free from outside commitments. This scheme is going to depend in the long run on the general practitioner. The White Paper calls him the "first line of defence". Other people have called him, in the fight against disease, "the man behind the gun". So much will, and must, depend upon him. The new scheme means a new opening and a new opportunity for the personal and family doctor. It gives him at last the chance to do so much that he has always wanted to do—to help his patients to avert and avoid ill health without the question arising in their minds whether they can afford to call in the doctor. It enables him also to link his activities more and more with things that have been too separate in the past—child welfare, maternity work, and all the different activities of the local clinic. We want to bring together all the different aspects of medical care.
  Many of your Lordships will be particularly interested in the voluntary hospitals proposals in this scheme. You will see that we are suggesting an organization to bring both the voluntary hospitals and the hospital services of local government to work together as partners. I want to emphasize that it is the basis of partnership that we are advocating. The use of voluntary hospitals is essential to this scheme of complete medical service. In respect of the service that they render they will be paid, not like paupers, according to their need, but like partners, according to the help that they give. They will be paid by way of a standard payment from joint authorities, the central payment representing social insurance contributions. This will do something to restore some of the support that the voluntary hospitals have received from direct contributory funds, but they will still need the support of all those who want them to continue their work as autonomous institutions. Many people in this country believe in voluntary hospitals. They believe in their autonomy, and they believe in maintaining their identity, because they know and believe that there is something good and vital in the system. The voluntary hospitals receive their resources from such people, and at the same time they add to them their contributory schemes that,

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  in fact, offer an insurance against the costs of hospital treatment in the event of the contributor having need of it.
  There will be no treatment charges to be insured against in the future, and it may be that the voluntary hospitals may lose income from contributory schemes, and of course, they will lose income that they have previously got from patients through the "Almoner" system. In the last pre-war financial year and from the available returns of about 80 per cent. of the hospitals, this would have meant that they received from this contributory source £5,300,000. Under the new Exchequer payment proposed in the White Paper, worked out on the same basis—that is, on the same number of beds involved as that on which the above figure was based—we would propose to give them £6,500,000 against the £5,300,000 they received from the source I have indicated.
  In so far as contributory funds arose out of a desire for protection for the individual, that protection will be given under the national scheme, but I am quite certain—and I speak from some personal knowledge—that a great many of the contributions not only from the wealthy but from the workpeople came not only from a desire to get protection for themselves but from a belief in the voluntary principle of hospitals. They arose, too, from a certain pleasure and pride that these people got from a sort of personal association with the beneficent work of hospitals. Once it is clear, as it must be clear, that the voluntary hospitals are to continue to retain their traditional status as voluntary institutions, they will continue to require the support of the people who believe in them, and I am sure they will get it. Under this insurance scheme we shall not pay out of public funds the whole of the cost of the services that the voluntary hospitals render. Voluntary hospitals will come into the service on the basis of a free contract and I hope that these words of mine will serve the purpose for which they are intended; that is to assure those who are interested in voluntary hospitals of the importance of their maintenance and of the necessity for contributions still to be made to them,
  I do not want to occupy your Lordships' time any longer. I have selected just a few of the points in the White Paper about which others have spoken to me since it was published, and which I
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  thought might be of sufficient interest to your Lordships to-day. No speech of mine on the subject could be comprehensive without being unduly long and unduly wearisome to your Lordships, but I hope that your Lordships will express your approval both of what we propose and of the method that we have adopted. Again, I submit that the plan is big and is full in its outline. There can be no suggestion that His Majesty's Government have not faced up to the issues that are involved, and that they have not quite boldly put forward proposals that are socially beneficent and, I submit, courageously conceived. On the other hand, if this outline of policy meets with the general approval of Parliament, then the responsible Ministers will enter into consultation with all the various parties—local authorities, voluntary hospitals and the several branches of the profession—in order to arrive at agreement and to hammer out the legislative details.
  A Government is always in this difficulty. On the one hand it is in danger of being accused of being very slow if it waits until it has hammered out the full and final details of intricate propositions. On the other hand, if it presents its plans in broad outline then, as has happened in this case, people say "It may be all right in outline but we would rather see the detailed application before we come to a conclusion." This plan for a National Health Service is an innovation so great that I submit it was proper for His Majesty's Government to present their proposals in this form and to seek the general approval of Parliament for them, and then, having obtained that approval and being fortified by it, to enter into negotiations with the several interests to which I have referred. My right honourable friends the Secretary of State for Scotland and the Minister of Health will, without delay, embark on these discussions if the approval of Parliament is obtained to the Resolution which His Majesty's Government is moving in both Houses of Parliament to-day. Then they will come back to Parliament with a Bill which will give the opportunity to this House and those in another place to enter into detailed consideration of their proposals.
  I must say that we have been very greatly encouraged by the general welcome that the public has given to the White

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  Paper, and I hope that the Motion which I submit to your Lordships to-day will be acceptable to you. As the mover of this Motion I shall occupy your Lordships' attention at the close of the debate on the next sitting day in an endeavour to reply to any specific points on which your Lordships feel it is proper that I should give you further enlightenment other than has already been given in the White Paper. I beg to move.
  Moved to resolve, That this House welcomes the intention of His Majesty's Government declared in the White Paper presented to Parliament, to establish a comprehensive National Health Service.—(Lord Woolton).
  LORD MORAN: My Lords, I beg to move an Amendment to the Motion of the noble Lord, to insert at the end of the Motion the words: "but regrets the absence of sufficient detail on many important matters, in particular on the consultant service, to enable the House to give a considered judgment." I think we can all of us commend the purpose of this White Paper. The aims are, indeed, unexceptionable. They have been advocated for many years by the profession itself, and I am quite sure that these aims are the explanation of the very friendly welcome which the noble Lord has just said has been given to the White Paper. But what really matters are not so much the aims of the Government as the means that are taken to achieve those aims, and I shall try and take a few points from the White Paper in considering the means. The noble Lord has spoken of a comprehensive medical service. I am a little puzzled, in spite of the arguments used on page 10 of the White Paper, why the term "comprehensive" is used. There is not one medical service, there are to be six, the Ministry of Health, the Ministry of Labour and National Service, the Ministry of Supply, the Board of Education, the Post Office and so on. Now what we had hoped for was that all these services would have been brought under one roof. It is true that that might possibly excite the opposition of the Ministers in charge of those Departments, and that perhaps would have created a difficulty. But the White Paper does not make mistakes of that kind.
  However, I would like now to pass on to the central machinery of this scheme.
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  When I had the honour of addressing your Lordships a year ago for the first time, I spoke of the misgiving which was felt by members of my profession when asked to serve on these Advisory Committees of Government Departments. I was on one such Committee; it did not meet for two years. Another Committee connected with another Department had no meeting for three years. What is felt about these Committees was voiced by the Secretary of the British Medical Association recently, when he said that "many are chosen but few are called." When this Central Health Council was proposed the members representing the profession felt that they must ask for some reassurance about it, because it serves no useful purpose when a Committee is formed but does not meet for many months. Indeed it is misleading to the public, who are given the impression that the Minister is receiving advice from prominent members of the profession, when in fact he may have completely forgotten the very existence of the Committee. I was uneasy because I began to feel that these Committees might not be a means of giving advice to the Minister but rather a method of reassuring the public.
  When therefore our discussions with the Minister of Health began by a proposal for just another Advisory Committee, the Central Health Services Council, the members representing the profession asked at once for some assurance that this Council would in fact exercise some influence over the course of events. They asked that it should be a statutory body, for at least it would be called together then, and that point has been conceded. They asked that it should not only be a statutory body, but that it should be able to elect its own chairman, and this was allowed. But they also asked for two further assurances, very much more important—that the Council should be allowed to publish its own proceedings, and that it should be elected by the profession or by the organizations representing the profession and not nominated by the Minister. We on the representative Committee were under the impression that these safeguards had been conceded in the discussions that had taken place, but I hasten to add that nothing that took place in those discussions had any binding value on either side. Still we were disappointed when the White Paper

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  appeared and we found that the Ministry had repented of its temerity.
  At these meetings I was impressed by the general search on the part of all sections of the profession to find some alternative to the Ministry of Health to guide our destinies. It is not a healthy sign that the profession should have that attitude -towards the Ministry of Health which is responsible for its direction. Ministers of Health come and go—some rather rapidly—but a new Minister comes with a fresh mind and I welcome him. I would like to say how glad we are to be able to work with him, and I would like to make a personal appeal to him. He can do much to end this state of affairs and to infuse a different spirit into the relations between his Department and our profession. Let him trust the profession; he will never regret it. This Council will give him loyal service, he will get the disinterested advice of men actually practising medicine, and he will bring his Department at last into real touch will the leaders of the profession.
  The other body which is part of the central machinery is called the Central Medical Board. This body is not an advisory board, as the Council is, but has executive functions. These functions are so unusual that I would ask your Lordships' leave to examine them for a moment. The White Paper proposes that the Central Medical Board, when it is satisfied that an area has sufficient doctors, should be able to refuse permission to any doctor in its service to go to that area. That is to say, the Board really has the power to direct doctors where they should go and work by a negative pressure process. That may be reasonable and may even be necessary so that people in scattered areas may get treatment, but it is a new proceeding altogether, and I hope at any rate there will be appeal machinery for cases which are likely to involve hardship.
  There are other functions of this Board which are far more startling. The Government now exercise the power of civil direction over men and women of military age. They can direct that anybody of that age shall be sent wherever their work is needed. It is proposed in the White Paper that the Central Medical Board should have this power of civil direction in time of peace, and not only in time of peace but over every single
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  entrant to the profession. This power of direction is to be exercised over every single entrant to the profession, and they are to have the power to say to a man in the early years of his career that he shall work full time for that service whether he intends to stay in it or not. These are very unusual powers, and I think it would be relevant to ask the Government whether they intend to apply similar powers to other sections of the community. Certainly if a body is to exercise powers of this kind it will have to have the confidence of the whole profession, and that means that a portion at any rate of its members should be elected by the profession. Before leaving this question I would say that these functions of the Central Medical Board are more controversial than all the rest of the White Paper put together. This is a new power that is being asked for, and it is looked upon with the very greatest suspicion in the profession. The first part may be necessary. There has always been great difficulty in getting men to go to parts of the country which are scattered and thinly populated, but I should have thought it possible to get men to work there not by compulsion but by the same means that have made the medical services of the Highlands and Islands of Scotland renowned for their proficiency.
  Leaving that question I come to the local provisions. The county and county borough councils, as your Lordships know, have been combined into a joint board. This Joint Board is to look after the hospitals, using that term in its very widest sense. What is left? There is left to the county and county borough councils only what may be called the small change of the medical services, sanitation and things of that kind. The life of the medical officer of health serving the county and county borough councils will be dried up. Interest will be taken out of it. I ask the Government if they have considered what will be the effect on this very important branch of the medical profession of desiccating it in this way of real interest. I think the difficulty could be got over if these men were used for part time service for the Joint Board. Then I would ask how is the voice of the profession to be heard locally. It is true there is to be a local health services council, but I think it will have no great power. If half a dozen members of that

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  council were allowed to serve on the Joint Board—not necessarily with voting powers, that is immaterial—they would bring the technical advice of the members of the profession to the Board and would greatly reinforce the medical officer of health. I regard that provision as the most important in the whole of the local arrangements which are designed to give the profession an opportunity of expressing its opinion.
  Now I come to the conditions under which the general practitioner will work. He will work in one of two ways. He will either work in what is called a separate general practice, in which case he will be paid a capitation fee, just as the panel doctor is paid at the present time, and the conditions of his life will be very similar to those that now exist, or he will go to work in a health centre, where six or ten doctors work in one building, in which case he will be paid a salary. I think there is very great reason to believe that the doctors who qualify after the war will prefer to go and work at health centres, because there they will not have to buy a practice, and very few men qualifying after the war will have the money with which to buy practices. Moreover, the Central Medical Board will be able to add momentum to this drift towards health centres. So I anticipate—I know that prophecy can be very dangerous—that in no distant time the great majority of the younger men in the profession will be working in these health centres, working on salary because that is the means of remuneration proposed for the health centres.
  You will then have this happening; a whole mass of the profession, the great majority of its members perhaps, removed from a life where their rewards were very strictly conditioned by their success in practice—their professional success that is—and transferred into a service where their rewards will bear very little relation to their success in their profession. I think we must at once say this. Many men will find themselves in a service in which there is no promotion as there is in the Civil Service, so that the one great incentive left is that of doing well a job which is worth doing. That undoubtedly will have great influence on many men, but I think it would be advisable to have some material stimulant to keep men on
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  their toes. Once this practice of remuneration by salary becomes fairly general such an incentive could easily take the form of letting the men have, in addition to their basic salary, a capitation fee; or, alternatively, they might be given extra remuneration for taking up some special branch of work in the health centre, such as child welfare or maternity work or things of that kind, for which they have fitted themselves and in which they have made themselves specially competent. But whatever is done, I feel that we must be very careful to sec that the profession in which in the past the general practitioner has been one of the hardest worked members does not become a service in which he does not work so hard.
  I would like to say this also about health centres. There are many forms of such centres. You will, as I say, get in them from six to ten doctors working together in one building, but I think that the form of health centre which is put forward in the White Paper is most unattractive. There is little, so far as I can see, except secretarial work and rooms that will be shared. I would like to see health centres set up where there is provision for forms of practice most appropriate to the general practitioner, such as child welfare and maternity work, where there would be a health visitor attached to the practitioner and lectures would be given on health. As I see it, in the future these centres will have three functions. First, there will be places where doctors work; secondly, there will be places where' healthy people are periodically examined so that the first signs of disease may be detected at the earliest possible moment; and thirdly, there will be community centres, like the Peckham Centre, where the people in the neighbourhood will find rest and recreation. I would only say this before I leave the subject of health centres. I believe that neither the profession as a whole, nor the public are yet prepared to welcome these centres, but I believe that they will provide opportunities for work for the practitioner which have never existed in the past, and that they will make for greater efficiency. It is because I believe that, that I think I ought to say so. I congratulate the Ministry of Health on the manner in which it has dealt with this issue, for resisting criticism and for going on with

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  this experiment out of which, I think, there is so much to be hoped for in the future.
  I come now to the consultant service, or rather to what is said about it in the White Maher. It is flat very Much. A page and a quarter out of fifty. It is, in my view, the most incomplete section of the Report. The contents of the one and a quarter pages are largely pious aspirations with hardly any detail at all. To bring out a plan for a comprehensive medical service, and to leave out of it any details about the consultant service is, it seems to me, very much like asking your Lordships to pronounce judgment on an aeroplane without being told what kind of engine is being put into it. I find it very hard to understand this lack of interest on the part of the Ministry in the consultant service. The hospital service is obviously the keystone of any medical service, and the efficiency of the hospital depends upon the consultants and specialists who staff it. It is common ground that there are not nearly enough consultants and specialists in England at the present time. And what are we doing to remedy this state of affairs? The Ministry seems to forget that it takes years to train a consultant. If we are to have any kind of service ten years hence it is necessary that the medical schools should begin training more consultants now. But how can you ask them to begin doing so when they do not know how many to train? We want to know how many there are at the present time, and where they work, so that we can realize how many there should be and where they are needed. In other words, what we need is a list of the consultants in England.
  But when at last the Ministry was persuaded to ask the Royal Colleges to prepare such a list, and when they had been making these preparations for many months, suddenly the Ministry began arguing with another organization which was the proper body to draw up that list. It is, perhaps, not unnatural that the Vice-Chancellors of the Universities throughout England who are Chairmen of the Committees drawing up these lists suspended their efforts for several months while the argument went on, in order to hear what the Ministry had finally decided. Even now when it is vital that the Deans of the medical schools should have in their hands the information provided by these lists at the very earliest
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  possible opportunity, we are told by the Minister in another place that these lists are only for his private eye—rather as if they might give information to the enemy. Now surely we must take this consultant service seriously, for it is the key to the whole thing. It and the general practitioner are the two arches on which the whole thing is built.
  I have said there are no details about this consultant service. That is not quite true. There is one clear and it is a disquieting one. It is that this whole service is to be put under the hospitals. If there are arguments that the general practitioner should be under a central body for remuneration and contract and things of that kind, surely the arguments are twice as strong for putting the consultants under a central body? Further, it is disastrous to have the profession split in this fashion, with the consultants tinder one body and the general practitioners under another. I should like to see the Central Medical Board in two sections, one for the general practitioner and the other for the consultant and specialist.
  Leaving the question of the consultant and coming, by a natural transition, to the hospitals, I look at the White Paper and I see that it is very friendly to the voluntary hospitals. Obituary notices generally are friendly. In spite of this, those who are in a position to advise me are very anxious about the future of the voluntary hospitals. They will lose at once half their income, which comes from patients' contributions. What will replace it? I think that that is the task on which friends of the voluntary hospitals have to concentrate. If it is not done, I see no future for the voluntary hospitals. I think that the danger to their immediate existence can very well be exaggerated, but I should be sorry to insure their future unless further safeguards are given to them.
  On these financial matters there are many of your Lordships who are far more competent than I am to express an opinion, but I should like, with your permission, to ask what will happen if these voluntary hospitals go under at the present time. There is a spirit of service which brings the very best out of men of our race when they are attached to great institutions, and it has been a very precious thing in the lives of the voluntary 'hospitals, sweetening many a long day's

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  work. But it is not of that that I wish to speak. The glory of the voluntary hospitals is that for many years the best brains of the profession have worked within their walls, adding to knowledge, and they have done so in an atmosphere of complete intellectual freedom, though that atmosphere has been sharpened by criticism, for no diagnosis is accepted in a great hospital until it has been mauled by half a dozen departments. Now turn for the moment to the municipal hospitals. In many of them, I believe, it is still necessary to ask for permission before you can send a medical contribution to a medical journal. There you have the two different ways of life, and I cannot but wonder whether the type of man who has made the good name of the voluntary hospitals will continue to come into the profession if our very professional thoughts are to be censored.
  There is something more that I should like to say about the hospitals. I think it is a practical point. Twenty-five years ago, I was appointed to the staff of a Poor Law institution in Paddington. I have seen that taken over by the London County Council and converted into a great municipal hospital. I have been happy in working there with medical superintendents of very exceptional ability, and I think we may say at once that the London County Council has done very good work in these institutions. But they cannot work miracles. To bring these institutions up to the standard of the great voluntary hospitals will be a matter of many years. We have a saying in medicine that if you cannot do good you should not do harm. I hope that you will not allow the voluntary hospitals to die through want until there is something equally efficient to take their place.
  Apart from financial worries, what have these hospitals to fear? They will be asked to accept certain conditions, such as the Rushcliffe rates for nurses and conditions of that kind. They all make for efficiency. They may press hardly on institutions which are in dire financial straits, but they should be accepted. There is one disquieting feature, however, to which I should like to call your Lordships' attention. Let me illustrate it by a purely fictitious position. Paddington has two hospitals—Paddington
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  Hospital, a great municipal hospital, and St. Mary's, a teaching hospital. Power is given to the Joint Board to say where any man or woman gets his or her hospital service of a particular kind, whether at St. Mary's or at Paddington. There will probably be only one thoracic centre, one head centre, and one department for venereal diseases in Paddington. Will the London County Council, which is the Joint Board in question, decide that these departments shall be in its own hospital, or, by a great act of altruism, station them at St. Mary's? I can only answer that the Minister will have a busy time in keeping the scales of justice even. It is an anxiety which must press on any one who has anything to do with hospital management.
  There is hardly an important statement in this White Paper which is not qualified by a "might" or a "may." Throughout the White Paper you will find that attitude. I am not at all certain whether that is not very adroit, but I am equally uncertain whether that is the quality which is most needed in setting forth the charter of a great profession. Aristotle believed that a physician had opportunities of studying human nature which are given to no one else. A philosopher, he said, should begin life as a physician, and a physician should end his life as a philosopher. Thinking men in my profession, reading the White Paper, are asking a question to which there is no immediate answer. They have seen in recent years much of the interest taken out of the life of the general practitioner. His patients, when they are very ill, are taken out of his hands and bundled into hospital. Responsibility is shifted from his shoulders to those of the consultant. Men who are worth their salt do not like parting with responsibility in this way.
  I am well aware of the many cogent reasons which have led to this state of affairs, but I believe that unless we find some way of bringing the ablest and the keenest general practitioners into our hospitals to work, the type of man entering medicine will deteriorate. The changes which are foreshadowed in the White Paper will add momentum to the tendency of which I have spoken. They seem to strike at the general practitioner as an individual; and, in John Stuart Mill's phrase, "The initiation of all wise and noble

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  things comes and must come from individuals; generally at first from some one individual." I keep asking myself—I cannot gel: it out of my head in reading the White Paper—what is the type of man who is going to enter medicine under this service in future? Because the medical student of to-day will make or mar the medical service of to-morrow. I beg to move.
  Amendment moved—
  At the end of the Motion insert: ("but regrets the absence at sufficient detail on many important matters, in particular on the consultant service, to enable the House to give a considered judgment":.—(Lord Moran)
  LORD NATHAN: My Lords, the personal distinction and the professional eminence of the noble Lord, Lord Moran, who has moved this Amendment, made it clear that it would be supported in a speech and by arguments of great impressiveness, and your Lordships have not been disappointed in that expectation. It was natural that the noble Lord should address himself to this subject largely from the standpoint of the profession which he adorns. I have no such qualification. I approach this subject from the standpoint of a layman whose experience of the problems which this White Paper confronts is limited to that of one who for a good many years past has been actively concerned in the management, as a member of the lay committee, of one of the great teaching hospitals—what is sometimes called Parliament's own hospital, the Westminster—and as chairman of one of the special hospitals. I therefore in no wise claim to be able to speak with that technical knowledge which the noble Lord possesses in so remarkable a degree. But I hope, as a layman basing myself on the experience of many years and standing in this place, to be able to reflect the views of those who sit upon these Benches, the views, as I believe, of the great mass of the public. And let me say at once that I do not think that there will be much in what I shall say in which there will be fundamental differences of opinion with the noble Lord who has just sat down or the noble Lord, Lord Woolton, who moved this Resolution.
  It is clear that the subject of this White Paper is one of quite unrivalled importance. Our health 'is our wealth. Without it there can be no social security, without
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  it there can be no full employment, without it there can be no national well-being; I think it was Francis Bacon who said that being without well-being would be a curse. It is because those who sit upon these Benches believe that the proposals contained in this White Paper will make a substantial contribution towards national well-being that we give it in general a warm approval. It must have been a matter of great satisfaction to the noble Lord, Lord Woolton, to be able to come before your Lordships with the proposals contained in this White Paper as the first fruits, so to speak, of the relatively short time that he has occupied the key position of Minister of Reconstruction. It must be a matter of equal satisfaction to your Lordships' House to have from the noble Lord an exposition so lucid and so sympathetic, and touching so many of the principal points which emerge from the consideration of this White Paper. I congratulate the noble Lord on being able to bring this White Paper before the House, and I think he would not disagree with me if I were to say that there were others too who spent much work during the months that are past over this White Paper whose names might not inaptly be mentioned—I am thinking of Sir William Jowitt, Mr. Ernest Brown and the present distinguished Minister of Health.
  The contents of this White Paper are in general outline, if not in detail, a compromise, but in the view that I submit to your Lordships' House they are the best possible compromise in the circumstances in which we find ourselves. They are not an ideal solution, they do not give even a wholly logical solution; they are clearly a compromise, political, professional and practical, but they are a good compromise. And I wish to say at this point that should, contrary to my anticipation, the noble Lord, Lord Moran, take this Amendment to a Division, then my noble friends would be found in the Lobby with the Government in support of this White Paper. I do not know if it has occurred to the noble Lord, Lord Woolton, or to other noble Lords, as it has to me, that the impact of these proposals on the public outside purely professional circles has been very small compared with the excitement of thirty years ago, when Mr. Lloyd George and the Government of which the noble and learned Viscount on the Woolsack and the noble Viscount,

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  Lord Samuel, were members—the only members I think in your Lordships' House to-day—
  VISCOUNT SAMUEL: Lord Crowe.
  LORD NATHAN: Of course Lord Crewe, whose absence we regret. I should be very sorry to omit the name of any still surviving member of that gallant band whose name should to-day be remembered. There was a tremendous surge of public feeling at that time. Something momentous and revolutionary almost was thought to be happening, and indeed was happening.
  LORD TEMPLEMORE: There was no war on.
  LORD NATHAN: There is no such excitement and enthusiasm to-day, and I ask myself what is the reason for it. I think to some extent the reason is that these proposals are themselves not new. The goal of a comprehensive medical service was set in those proposals of upwards of thirty years ago to which I have referred. But the lack of excitement to-day is really a tribute to the merit of those proposals, and it is a great and deserved tribute to one whose name has not been mentioned in this debate—to that great man, now a venerable figure, Mr. Lloyd George, to whom in my view the proposals of 1911 are the enduring and conspicuous monument. This excellent White Paper of 1944 is built upon tae foundations of the proposals of 1911. Even the panel system is to be found within the four corners of this White Paper, a modified panel system it is true, but still the panel system. This whole scheme is an extension, within the framework of a comprehensive social security, of the existing social insurance scheme. It is none the worse for that.
  It is of course, as I think Lord Moran pointed out, and certainly as Lord Woolton did, only a skeleton. The people are unable to tell exactly how this scheme is going to work out in practice. They ask themselves what facilities will in fact be available, what will the position be after this scheme has reached fruition compared with what it is now. They ask themselves, and justly, when will they be available. What difference, they say, is it going to make? I shall not refer to the position of the medical profession, for
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  Lord Moran has already dealt with that at length, but the question is being asked, not only by those in the profession but by the layman as well, "What will be the pay and position of doctors?" There is no very clear or precise statement in the White Paper on that. They ask themselves, "What is the future of the voluntary hospitals?" Lord Moran has dealt with that at some length too, and he has put some questions to Lord Wootton who also referred to this matter.
  What is the future of the voluntary hospitals? I speak as a Londoner. When the man in the street thinks or speaks of going to hospital, what does he think of? He is not thinking of a municipal hospital, he is thinking of Bart's, St. Mary's, St. Thomas's, or Westminster, hospitals of great repute and long history. Many of them are great teaching hospitals with a world reputation and a long tradition of professional freedom. Some of them, of course, are obviously too small, badly housed, poorly equipped. They ought either to go out of existence or he stepped-up, but that is because of their position and is independent of these proposals. The remarkable thing seems to me this, not that the municipal hospitals are not better than they are, but that they are as good as they are. After all, these municipal hospitals not only have no tradition but no history that extends beyond fifteen years, and they have scarcely had an opportunity in that short period to bring themselves into line with modern practice and tradition to the same extent as the great voluntary hospitals. It is true that London and certain other municipalities have established or stepped-up municipal hospitals of a first-class character in many important respects, but it is inevitable, for a long time to come at least, that the voluntary hospitals must play a vital part in the whole conception of hospital service.
  After all, these hospitals provide between one-third and one-half of all the available hospital accommodation. They comprise upwards of 75,000 beds. There is a strong case in logic for making them public; there is a strong case in practice for keeping them voluntary and, within limits, free; but there is no case at all on any grounds for keeping them voluntary and free, as the White Paper postulates, without securing that they will be able to continue to have the means of getting

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  the voluntary contributions that alone can enable them to be free. I do not quite understand the figure that Lord Woolton gave as regards the contribution from central funds. He said, as I understood him, that this would be a figure of £6,500,000 or so, compared with £5,300,000. The White Paper itself, on page 83, mentions a figure of £10,000,000, and that is the figure which has been contemplated in the discussions that have taken place among the hospitals in which, to some extent, I have myself been a participant. I feel that they are comparable figures. I think we are referring to the same matter. Perhaps when the noble Lord has an opportunity of referring to this matter again he will clear up what appears to be at first sight a discrepancy between the statement in the White Paper and the statement he made to your Lordships' House to-day.
  Be that as it may, whatever the precise figure may be, if the voluntary hospitals remain outside this scheme they must retain their characteristics and they must retain their monetary resources. It seems to me it must be one thing or the other. They must either he abolished or they must be retained It is almost wholly a financial question. They are to advise and help according to the White Paper; because of their standing, qualities, and, traditions which other hospitals lack, their co-operation in the scheme is absolutely essential. Indeed, the White Paper makes the voluntary hospitals what in fact they are—the keystone of the whole arch of this scheme of national medical service so far as hospitalisation is concerned. How are the voluntary hospitals to carry on, having regard to what the noble Lord has told us to-day? How are they to maintain their voluntary contributions when people who make no such extra contributions are entitled under the scheme to all hospital facilities just the same?
  It is a question whether hospitals free and paying can exist side by side unless arrangements are made under which contributors to the voluntary hospitals are given special facilities at these hospitals or at least allowed to choose a hospital. Voluntary hospitals cannot do without voluntary contributions, and these contributions will not be forthcoming unless contributors get something for their money. It would not be sufficient to fill the gap in my estimation if voluntary
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  hospitals have to depend solely on the good will and charity of the benevolent-minded who have so largely supported them in the past. Contributory schemes have become over a period a vital element in the maintenance of these hospitals.
  What I have referred to is one special instance of the gaps, the unanswered questions, if you like, the flesh that is not on the skeleton. They are rather important, and it is necessary, if public scepticism is to be allayed, that these doubts should be cleared up quickly. I have a feeling that in this matter the Government have not altogether clone themselves justice. They have never attempted to catch or reflect the new enthusiasm for reform even to the extent of the reforms which they are willing to accept. Instead of putting a good face on it, they are rather apt to put a bad face on it. People are therefore inclined to be a little sceptical. I am glad Lord Woolton had the courage to clear away one cause of scepticism to-day. It was a mistake, I am sure, that in speeches and in the White Paper, with perhaps some qualification, and in the small pamphlet without qualification, it should have been stated that the new health service in all branches will be free. That that should have gone forth to the public in an official statement made by the Government was not only inaccurate, but it was a statement that profoundly disquieted the public mind because people have not believed it. As the noble Lord has made clear to-day, the public are right. The service will not be free. It is an insurance scheme. People will have to make their own contributions to insurance as well as in their capacity as taxpayers and ratepayers. We must not talk about a free service. This is really a service under which all you need for yourself and your dependants you can get without paying any extra doctor's fees. It means a cheaper service, a fuller service, and that is a tremendous advance.
  Can it really be said at this point of time that this is yet a comprehensive service? Here again I think it is wise on the part of the Government and of all of us to be candid, for, after all, it is not a matter of intention, it is a matter of supply. Are the doctors, nurses, specialists, consultants, administrators, hospital beds, buildings, clinics, equipment, available or are they within sight? What methods are going to be adopted to

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  make them available and within what period of time is it calculated that that will be done? The White Paper, it is true, is frank in the two instances of teeth and eyes. I make the guess—I hope I shall be proved to be wrong—that before this service really gets under way as a comprehensive medical service along the lines adumbrated in this White Paper, at least ten years will have passed, and before the dental services are fully available perhaps twenty-five or thirty years. This is really a pretty long-distance programme. It is no worse for that, but let us recognize it for what it is. I should be sorry if the public should think that the services promised are going to be almost immediately available because I think that would be a mistake.
  Of course there are some who say this is not a good scheme because it is not 100 per cent. a State scheme, and others say it is not good because it is not zoo per cent. a private scheme. It is, as I say, a compromise, as it must be, and it is a good scheme because it is a compromise. I think it is rather a pity that the old distinction between fee patients and panel patients, and between the treatment of them, should continue. It will be for many people merely a fiction to say they have a choice of doctor and a guarantee of the best treatment. Logically there is a case for a complete public service with no distinction, but I agree that is neither politically nor practically possible. The proposals in the White Paper are to be formulated in the form of a Bill. It has to be passed by Parliament, it has to be worked by doctors, and so we have this mixed service, a public service for all who want it, patients and doctors, and a private service, outside and over and above the scheme, for those, patients and doctors, who want that. I am willing to accept this mixed service as a compromise on one important overriding condition—provided that the existence of the private service does not reduce the quality or restrict the facilities of the public service. If it is a fee-patients scheme the scheme will turn out to be a sham. We must not allow that to happen. The people at large are entitled to the best possible scheme. Indeed in the White Paper they have been promised it and we must see that they get it. The I.O.U. must be honoured.
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  This means public control to see that it is honoured, to see that the very large sums of public money involved are properly spent in the public interest. There must be sufficient public control to see that with expert aid and advice all the facilities promised are made available at the first possible practicable moment, to prevent the compromise between private and public doctoring from being a brake on the wheel; to prevent private practice from skimming the cream and leaving the public service under-nourished in personnel, equipment and facilities. And this is, first of all, a question of supply. The number and kind of doctors needed have to be recruited, trained, paid for and properly treated. Probably to prevent one treatment for fee patients and another for panel patients, doctors should not do both. They should choose between public and private practice. Mixed practice should not be permissible. It should be made worth while for the best of the doctors to enter a public service. But I will make a proviso to that suggestion, and it is that as regards those at present in the profession mixed service might be permitted, but a choice should be made compulsory by new entrants into the profession. We must have, as I have said, efficient and effective public control, but at the same time side by side with it we must have professional independence. To some extent no doubt the doctors' demand for independence is a political demand. It should not be listened to as such. But we must recognize that only doctors can decide about doctoring.
  It is also a question of administration. Is the administrative compromise efficient? There will be three authorities in each area: the general practitioners under Whitehall; Joint Regional Boards looking after hospitals and consultants; the local authority with responsibility for clinics and preventive services. It is obvious that there is a danger in divided control, but I think that the compromise which starts necessarily from the status quo and not from scratch, will work, but it will only work if certain conditions are fulfilled. First, there must be firm control from the centre. The Minister must have effective powers to enforce minimum standards of performance on all agencies. Then the doctors, while free professionally, must, administratively, be under orders, and powers should only be given to the large local authorities and joint

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  boards who can administer a uniform service over the widest possible area consonant with democratic control.
  I have great sympathy with what Lord Moran said in regard to this, question of the organs of control. Democratic control, although it is essential, should not be misconstrued to mean that the joint bodies and other agencies must be wholly representative in a political sense. There must, of course, be a representative majority but there must also be a strong, expert minority, a minority of members who know professionally about health. The views of doctors must be fully stated inside the Board's Committees. So must the needs of voluntary hospitals. I see no reason why representatives of the profession and of the hospitals should not be co-opted on to the joint Boards without in any way derogating from the principle of representative government. After all, on local authorities there are co-opted members. There are the aldermen and I should like to see co-opted members of the joint Board. I should also like to see voluntary hospitals co-opt members of the point Board as members of their lay committees in order that there might be a common knowledge and that they might get to know each other and their problems very much better.
  There is one other matter to which I must refer and it is the question of finance. Too much is being put on the local authorities. The Education Bill will add one-fifth to the over-all burden of rates and this White Paper will add one-fifth to the health costs which fall on rates. Other Bills will add more. The central Government are rather adopting the position that they leave a foundling on the door-step of the local authority and say to the local authority: "We refuse a great part of the responsibility. The rest of the responsibility of paying for this foundling is to be yours." This cannot go on. I am not asking that there should be reorganization of local government now. Though I think we cannot long postpone the reorganization of local government areas and functions, that will probably have to remain until after the war.
  But the reorganization of local government finance, of course, cannot be postponed indefinitely—cannot be postponed very long—without the whole structure of reconstruction collapsing. Unless ways
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  and means are found of enabling local authorities to bear their old and new burdens it will suddenly become necessary, to avoid breakdown, to transfer whole services bodily from local to national administration. After public assistance, health would be the next to go. Is this what the noble Lord, Lord Woolton, wants? Would it not be wrong that our administrative policy should be determined willy-nilly by failure to find the right financial reforms and find them in time? This is not a subject for this debate, though I think it might well be for another. The Government must consider all the alternatives—equalization of rates, revision of the rating system, modification of derating, uniform valuation, regional Income Taxes, higher rates of grants, and so on. It must, if it is to increase local burdens, find ways to increase local capacity to bear them. Whether it does or not vitally affects the future of this White Paper, of this sketch plan for a real national health service.
  I end as I began on a note of welcome and of caution. This is only a sketch plan; the details have to be filled in. Then the scheme has to be worked; it has to be administered; it has to be financed. It is a compromise, but the service must be provided—there can be no compromise about that. We have got to be frank. It is not a free scheme. It cannot be done in the twinkling of an eye. For purely physical reasons it will take years. But it will take the fewer years if we realize this and devote our energies to making the proposals into a scheme that will work. Perhaps if these proposals are seen and solved realistically, if the promises are performed as promptly as may be, perhaps then, just as for the past thirty years and even to-day people have talked of "drawing their Lloyd George," they will speak in the future of "drawing their Woolton," or perhaps it will be "drawing their Willink." This is a good scheme, a sound, workmanlike compromise on the right lines. It is a definite approach to the fulfilment of Sir William Beveridge's, Assumption B. It is a milestone on the way to making what was his assumption into a fact. It is a milestone, therefore, on the road to social security.
  VISCOUNT SAMUEL: My Lords, I shall ask the attention of your Lordships for only a very brief time. We all wish to hear the views of those who are able to

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  speak on the subject with personal knowledge of this question. I shall not attempt to engage in a comprehensive survey of the whole of the proposals in this most important White Paper, but it would be an omission if no one from these Benches were to rise and to give to these proposals a most cordial welcome. Like the noble Lord who has just spoken, my thoughts go back thirty years to the National Insurance Bill of 1911, which as he said owed so much to the initiative, to the resource and also to the combative capacity of Mr. Lloyd George. For what controversies he had to face. The whole medical profession was in arms against the Bill. It became a Party issue. We lost a number of by-elections because of the compulsory clauses of the National Insurance Bill When it came up for Third Reading in the House of Commons Mr. Bonar Law, then Leader of the Opposition, declared that if he came into power before the Bill was in full operation he would most certainly repeal it. Thirty years have gone by, and what a channe! Now there is no controversy with regard to this measure, which really in effect extends and completes the principles of the National Insurance Act of 1912. After too long a delay that pioneer measure is now succeeded by one which complements and completes it.
  This White Paper presents proposals which, as Sir William Beveridge has de-dared, are essential to hid own plan. We are glad to know that Sir William Beveridge has publicly expressed his concurrence, and his endorsement of the main principles of this White Paper. This proposal and the Education Bill are both of them to my mind large and important measures of constructive legislation and administration which reflect very great credit on the present Ministry, if I may respectfully say so. But I am obliged to add they are in very happy contrast to the procrastination and uncertainties in another province with which the noble Lord, Lord Woolton, perhaps to his regret, is now closely associated—namely, town and country planning, with special reference to land acquisition and land use, a matter not less important than these questions of health and education and perhaps even more urgent at this moment.
  This White Paper deals with one large part of what is the great political problem of our time. The nineteenth century
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  mainly had to deal with questions of constitutional reform and the establishment of lull self-government. Its attention was directed mainly to those matters and the great controversies were on those issues. This century is mainly considering the right province of the State, how far State action should extend in industry, commerce, environment, education, health. After much debate I think the country has come to the clear conclusion that they cannot be dealt with by any one formula, whether the formula of individualism or the formula of socialism, but must be dealt with by a combination of both. The conclusion is that a line is not to be set on any theoretical principle; it is not a straight line, but a wavy line. Nor is it to be a fixed line but one that shifts with the changing conditions of our society. One hundred years ago no public health system existed. Today we have one of great elaboration and this Bill will elaborate it much further. The principle is not either State or private enterprise, but in these various matters a combination of the two.
  Here we find, in the matters with which this White Paper deals, some difference of opinion and some doubt as to where the line precisely can be drawn between the State and the individual at two levels. One is the level of the local authority on the one hand, representing the State, and the voluntary hospitals and other voluntary organizations. As the noble Lord, Lord Nathan, has said, it is possible to have three methods of dealing with this question of voluntary hospitals. They can be superseded by the State and an entirely different system established; or they can be left in full vigour and efficiency; or, thirdly, they may be allowed to survive but maimed. They may be offered a choice between either being efficient or being free, but if they wish to be efficient they cannot be free and if they wish to be free they will not be allowed to be efficient. Nothing, of course, could be worse than the third alternative. As to whether the last is really the position in which hospitals will be is a matter on which experts must debate and we will listen and exercise our judgment afterwards. Various representations have been made to me on behalf of the hospitals to the effect that the financial proposals are quite inadequate, and the speech of the noble Lord, Lord Moran, to-day seemed rather to indicate that they have not been treated, I

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  will not say as generously, but as justly as they could demand.
  The other level at which this question of the State or the individual comes in is at the level of the individual patient and his own doctor. The White Paper states with the utmost clarity and emphasis that the principle of free choice of doctor by the patient must be maintained, and die noose Lord, Lord Woolton, has reasserted that to-day. And that principle surely is right, for doctoring is not only a mater of physiology, it is also a matter of psychology. You may have two doctors who have equal academic qualifications and equal technical skill, yet ore at them, because he is able to command the confidence of his patients, will be a successful doctor, while the other will be a less successful doctor. Of course, the principle ought, obviously, not to be carried too far as in the case of the character in the old play who said that he has so much confidence in his doctor that he would rather under his care than be cured by someone else. Even that degree of confidence might be justified, however, for a patient would be less likely to die if he had every confidence in the treatment which he was receiving. This right of free choice is assured by the White Paper, but is it ensured? Will it actually he open to the patient to have that free choice? There seems to be considerable doubt upon the point.
  We must listen to the course of this debate and await expressions of the views and the expert knowledge of those who are qualified to speak, and we must also await the result of the consultations that are to take place between representatives of the profession and the Ministry. I think we may all feel confident that such difficulties as may now be emphasized will, in due course, be overcome, that this excellent at White Paper, after, we hope, not too long an interval, will be translated into a Bill, and that the Bill will become an Act and greatly conduce to the health and, therefore, to the welfare of the people.
  VISCOUNT DAWSON OF PENN: My Lords, I interpret the Motion that the noble Lord, the Minister of Reconstruction, has invited the House to pass as being one of approval by your Lordships of the notion of a comprehensive medical service. A vote for it would not commit your Lordships to approval of the terms of the
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  White Paper, many of which are, undoubtedly, put forward for discussion and constructive criticism, and many of which are admittedly indeterminate and vague. Broadly speaking, I take it that the aim of the proposal is to ensure that the best measures for furthering health and curing disease will be at the disposal of every citizen. That, briefly, seems to me to summarize the purpose of the proposed comprehensive health service. I think it may be said that thus far this proposition is supported by a wide consensus of opinion both in the profession and amongst the public. Indeed, as my noble friend Lord Moran has said, such a comprehensive service has been advocated by the profession from the year 1920 onwards.
  I think it is fair to say that the White Paper is in itself a bold effort, reasonable in its unfolding, and, because of its good English, attractive reading. Some of the measures which it outlines, some of its proposals, give me pleasure. Others give me real concern and for this reason. When one reads what appears in the early pages of the Paper, where the principles are laid clown, those principles carry your approval, but you are shocked to find later on that in many instances the implementations of the proposals which are made do not conform to the principles contained in the early pages. In my judgment the, scheme tries to go too far; it cries to embrace too much. Lord Nathan said that in any case the ultimate scheme must have a long vista; that for many reasons which are well known it could not be completed for many years. Surely, then, the sensible plan is to take the foundations first. Begin with those as early as you like, and leave the superstructure to a later period to be erected in the light of accrued experience then, and not in the light of speculation now.
  I will give your Lordships one example to illustrate the divergency between the principles laid down and the implementation proposed. I will take the question of health centres. Having wisely said that health centres should be a matter of experiment, of cautious trial and error, the White Paper later on breaks out into a flamboyant passage, elaborating and extolling the particular application of the health centre of which we have less experience than any other—namely, utilizing it for the purposes of group practice. There is nothing new in group practice. It exists now. Whether it goes

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  to a health centre or not is not essential to its efficiency. I ask myself, therefore, why this enthusiasm, why this desire to push the health centre for the purposes of group practice? If you read the Paper you very soon realize that it is a way of insidiously introducing the principle of whole-time salaried service. I am not going to say that whole-time salaried service is not perfectly right for certain offices, certain departments of medicine. I think it is likely in the future, in any case, that doctors as a whole will probably draw a larger proportion of their earnings from salary than from fees. That, however, is a very different thing from saying that this new medical service has to bend the knee to a political ideology and be forced into a particular mould of thought, and that sooner or later it must be universally whole-time. Looking as far as possible into the future, I can see nothing but disaster for the best type of medicine if any service were universally whole-time.
  I now come to the mechanism of the administration. We quite see that when once a service becomes world-wide it is necessary for it to be under general Government control; no other arrangement is possible. We are met with the difficulty, however, that the medical profession is particularly difficult to regiment, not on account of the men but from the nature of their work. The White Paper faces this truth with admirable fairness, and I will quote to your Lordships what it says:
  "There is a certain danger in making personal health the subject of national service at all. It is the danger of over-organization, of letting the machine designed to ensure a better service itself stifle the chances of getting one."
  The difficulties there set forth are particularly illustrated in that part of practice which is concerned with the individual man, with what may be briefly called the doctor-patient relationship. Of all parts of the service none requires greater flexibility of administration if the planning of the service is to be satisfactory. The reason is a fundamental one. To whatever brand of politics a man belongs, it is a fact that man sick is individualistic, and will remain so to the end of time. The result is that the doctor who looks after him gets fashioned in the same mould; and individualism is resistent to restraint.
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  That has to be borne in mind when considering the administrative authority. If we take the administrative authority at the centre, under the Minister, we find that there are two bodies under the Minister, which have already been referred to. One is the Central Health Services Council, and the other is the Central Medical Board. The Health Services Council represents the vocational element. There is only one way in which it is possible to administer a large profession with all its technicalities, and that is to put at the right hand of every administrative body a vocational body with power to advise and guide its policy. We have to watch carefully to see that at every level, wherever there is an administrative body, such a vocational body at its right hand is a reality—not shorn of power, not just used for convenience to shelter Government Departments, but with real power.
  I apply that test in the case of the Central Health Services Council, and I find that at the very outset that principle is violated. The Health Services Council, which is to advise the Minister, should at least to the extent of half its members he freely elected by the profession, whereas at present, as the White Paper sets forth, it is to be nominated entirely by the Minister. That is a breach of the vocational principle at an important level of the administrative structure. The Consultative Council is consultative, but not executive. The Central Medical Board, on the other hand, is executive, and its dangers are peculiar to itself. There is no part of the structure which is more likely to suffer from the disease of bureaucratic control, which my noble friend opposite said that the Government wished to avoid. There is no body more in danger of becoming bureaucratic than that Central Medical Board. The fact that it has medical men upon it gives no guarantee that they will not ultimately become bureaucratic too, because it is a most insidious and progressive disease.
  I come now to another point. It is said in the White Paper that it is the desire and intention of the Government that the administration of the comprehensive service shall be kept free of the Civil Service structure. I applaud that, for anybody who has been connected with Government Departments knows only too well the insidious and potent influence of that extremely able body,

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  the Civil Service. Over and over again you see something which began by being independent being slowly drawn, year by year, within the spider's web. I think that one of the dangers and one of the criticisms of the administrative structure of this service is that it is put too near that dangerous area. It will be easy enough to start with an independent service, but I am not sure that it will be able to remain independent; and once you get medicine and its science and art under the control of the Civil Service, good-bye to the best that medicine can do! It may be very suitable for many other callings, but for medicine it will be fatal to efficiency.
  I turn next to the larger area of the hospital and allied services. The real foundation of all this scheme is the hospital and allied services. That is something which can be got on with quickly, and which should be got on with first, before we start speculations about whether we are going to have grouped practice in health centres. The only way in which the hospital and allied services can be got on with is by bringing the two sets of hospitals together, as has been advocated for years by my profession. So make your Organization that its members habitually sit around the same table and learn to know each other; and if they do I have very little doubt that they will evolve the course of the years a new ideal, a new type of hospital, which will be as good for that new era as the voluntary hospitals have been for the present age. It is by that kind of feeling that this new service will be built up, not by the dragooning which I will refer to at a later period, and to which my noble friend has already referred. That is the reason why we should not only begin promptly but should go gently and guardedly. It is really by getting people together in the hospital services that you will make the foundation of the whole movement. And if you do so my belief is that all the other things will be added unto you in time.
  These larger areas are not, I think, big enough. I know the Minister's difficulty. What is in the White Paper is surely a compromise which has had to be effected with the major local authorities. But the areas are not large enough. You must have an area large enough to embrace every type of hospital and clinic, interconnected one with another, working one
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  with the other—a regular scale upwards to a key hospital, wherever possible, at the top. The areas indicated in the White Paper, as I understand, would amount to nearly forty in number. That is too many. You could not get in every one of the forty areas a complete service. I hope by the time the Bill arrives we shall have got them down to a smaller number, and that they will have key hospitals at the top. Wherever possible those key hospitals should be teaching hospitals—the highest court of appeal. Each of these areas is to be governed by a joint authority, but your Lordships' attention has already been drawn to the fact that that joint authority has an exclusively local authority make-up. It is quite proper that the local authorities should have the main control of the joint authority. At the same time I entirely agree as to the inadequacy and foolishness of that arrangement. How can these laymen determine questions of policy confronting a learned profession which gets more technical every year? Assuredly they should have associated with them by the process of co-option a certain number of professional men at their meetings—not necessarily with a vote, but in order that the professional view may always be before the joint authority. There is ample precedent for that in other departments of government. As your Lordships have already heard, each of these joint authorities will have at its right hand a local health services council. That council will not merely consist of doctors, representatives of voluntary hospitals, and other ancillary services, but it will be necessary to make it quite clear that it is an obligation on the joint authority to listen to, and even ask for, advice before any major question is settled. And I have little doubt that that will be conceded.
  I pass next to voluntary hospitals. Voluntary hospitals do not need to stand upon sentiment. There is ample reason for surrounding them with sentiment, and they have the admiration and affection of a large part of the population of this country. But we do not place our claim for the voluntary hospitals merely upon sentiment. For many years to come the country could not do without them. They are the dominant part of the hospital service, and so they ought to be. Many of them have had centuries of existence, have gained a vast experience of administration, and have had under their roofs

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  the master minds of medicine in the past, who have left their mark upon them. It would be just crass folly to attempt this new comprehensive service without those hospitals. That is not in any way to derogate from the excellent work that some of the local authority hospitals have done in their fifteen years of existence. I think in the time they have done extremely well—not in all parts of the country; in some parts of the country they have done nothing at all. But that does not alter the fact that the voluntary hospitals are a necessity.
  Now if they are for the public interest I put it to your Lordships that they should be placed as free from financial anxiety as the local authority hospitals. We have to face up to this. From the moment this service starts you take all the ground from underneath the contributory scheme. I forget for the moment the figure that Sir William Beveridge gives but I think it is something like £10,000,000 a year which is obtained under the contributory scheme. The moment the new service is founded is it to be supposed under the conditions of the post-war world that the voluntary hospitals will receive the same amount of charity as they did before? I think it is almost inconceivable. I cannot see why there should be any hesitation in making them secure. And here we have an interesting parallel in the way in which the present Education Bill is proposing to treat the aided denominational schools. That Bill proposes to treat the aided denominational schools in the following way. It guarantees them payment of their whole running expenses and half their capital costs, which, added together, will actually provide them with 97 per cent. of the cost of running the schools, leaving them only 3 per cent. to find. And the reason for that is avowedly that the aided schools have performed great services in the past. They have great traditions, and they wish to preserve them, altogether apart from the fact that, very properly, they have to consider the particular religious convictions of those for whom they are run. The Education Bill thinks it worth while and right to secure the aided schools to the extent 1 have just stated, and if schools, if education, why not health, why not the voluntary hospitals?
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  Now I pass to the health centre. This idea had its origin in the year 1920 in a body of which I had the honour to be chairman. I may therefore say we do know what the health centre was meant to meet. It was looked upon as an outpost of the hospital system, a means whereby general practitioners could, where they had inadequate accommodation, go and have all the facilities of an institution on a small scale. Amongst other things there were to be, as my noble friend opposite said, means whereby preventive and curative medicine could be brought together in actual fact, where the communal clinics could meet, where the practitioners who went there could actually learn and see what the communal services were doing. In addition to that, it was supposed that there would be a certain number of beds. This is a place where the White Paper has forgotten something, and that is the provision of beds for general, practitioners. If you put general practice without beds that service assuredly deteriorate. The position is met at present by cottage hospitals, many of which have been modernized and where there is consultant advice available should the general practitioner need it; but there are parts of the country where there is a lack of beds, and the health centre was meant to fill that gap. As between separate practice and partnership—it may be of two or three or more—or again group practice, which represents a still larger grouping, all these three forms of practice should have equal rights of access to a health centre. It causes me disquiet when I read that part of the White Paper which goes out of its way to extol the health centre for group practice without thought of the single practice or the simple partnerships that exist now.
  Here and there, far too often, in my judgment, there peep up in the White Paper signs of what was described some years ago by the late Lord Hewart as "the new despotism." In reading the White Paper we have conceded to us that every administrative body will have at its right hand a vocational body to guide it, and then you come upon here and there sentences which practically give the Minister power to override the whole of them. One sees that with the health centres. I shall quote one ominous sentence. Having said that the health centre will be subject to the joint authority and its advisory committee, there follows this:

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  "… but will depend in the last resort upon the decision of the Minister in the light of his central policy on the general practitioner service and the new health centre experiment in the country as a whole."
  We know quite well that in that sentence lies a power for a Minister to override anything. If he happens to be a partisan for any particular form of health service—it may be for a whole-time salaried service for everybody—he has opportunities of stepping forward along the road before many people know what he is after.
  It may be that in the future the health service will extend in the direction of a whole-time State service and doctors may be paid like schoolmasters. That may be; but do not let us anticipate those days. One thing is quite clear: it would not do now. Any attempt to impose it would produce an unheaval inside the medical profession, and that is one of the things we want to avoid, for the success of this service depends without any doubt whatever on the good feeling, contentment, and satisfaction of the medical profession, and particularly the general practitioners. It is my belief that if a full-time State service were introduced at this moment your general practitioners would be a set of mediocrities without a spirit of adventure, without initiative, just a drab uniformity; and in no profession would that be more desperate than in medicine.
  I am coming nearer to the end. With regard to the freedom to pursue private practice, my fear is rather different from that of the noble Lord, Lord Nathan. The White Paper says it is in the power of any doctor to serve partly in private practice and partly in Government practice. I think I may say to the noble Lord that we have proved by our conduct in the past that we can do both and do them well, giving of our best to everybody in the community. I am not so sure when I read the White Paper—I should like to be put right—that private practice will not have a penalty attached to it. For instance, a patient will, on occasion, want to choose his own private doctor, may even want to go further and choose his own consultant. Supposing after that he wants to have hospital treatment. He should be able at any stage and at any level to join in the comprehensive medical service. After the passing of the 1870 Act, when everybody paid for elementary education, those who chose went on sending their sons to Eton or Winchester. Those
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  schools still existed, whereas once we set up this service there will only be one pattern of hospitals, and with only one pattern of hospitals there must be equal access to any patient, whether private patient or public patient. There is every advantage in the same doctors looking after all grades of patients. After all the world is their parish and they learn to give of their best no matter to what class their patients belong. I am very apprehensive that under this scheme private work will be much discouraged, as indeed Sir William Beveridge in his Report does discourage it. I think the danger is that those who feel they would get the best from a private doctor, and want to have a private doctor, may find that there will be not enough opportuntities for private practice to go on with anything like adequate success.
  Is this new service to be free and flexible? If so it must avoid the Civil Service pattern and we must be constantly watchful of that potent influence to prevent the medical profession being gradually brought under its sway. That is one of my greatest anxieties In another sense I have anxiety about the Central Medical Board. In the powers given to that Central Board there are some which are distasteful to me. I think in times of peace to direct a doctor where and how he is to practise is nothing but authoritarianism. It will never succeed. It you want to get a doctor to go to a part of the country where the conditions are difficult you will have to grant subsidies. I think we should be on our guard against the regimentation of the profession by the Civil Service. The Civil Service is there and we have to be careful that it does not convert us into a stereotyped uniformity. We have also to be on our guard against a universal whole-time service either now or by means of insidious instalments. We are agreed that we do need a comprehensive national service. We have already advocated it, but it must be free minded, it must be flexible and it must be professionally guided, because we want to preserve our great profession and to hand down its freedom and its great traditions to the generations which follow us.
  LORD LUKE: My Lords, I must apologize to the noble Lord, Lord Woolton, as I was not here when he began his speech but I do not think that I missed

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  very much of it. I should like, in the first place, to give a general welcome to the contents of the White Paper for it seems to me that the health service that is envisaged is an attempt to embrace all the branches connected with the treatment of sickness and to provide that treatment for the whole community. It is in that sense that I may allude once more to the appointment of the noble Lord, Lord Woolton, as an appointment to help reconstruction and, as he put it himself, the co-ordination of all the health services as they exist to-day. I am afraid that I must weary your Lordships for a short space of time once again on the aspect of the voluntary hospitals, but I promise that that is the only aspect of this question that I propose to speak about to-day. We have in the White Paper the Government's word for it that they welcome help and suggestions in settling the details of how the voluntary hospitals are to participate in the scheme and yet retain their independence. I think, if I may say so with all due respect to the noble Lord, Lord Moran, who moved the Amendment, it is the Minister's hope that the result of this debate will provide those very details for which Lord Moran has asked.
  I think that the Minister is not at all clear himself how this participation of the voluntary hospitals is to be effected. There is, without any doubt, a dilemma. As the noble Viscount, Lord Dawson, has already said, there can be no comprehensive scheme without the voluntary hospitals. On the other hand, the Government are anxious to give the voluntary hospitals the choice. They are voluntary in another sense of the word. They have the power to choose under the White Paper, and I am sure I speak for most voluntary hospitals when I say that they will welcome that choice of what they shall do. I am sure the voluntary hospitals have a general wish to assist the Government in framing their scheme, but on a closer study of the position I am not so sure that it does not mean Hobson's choice for the voluntary hospitals. They cannot stay outside without being accused of wrecking the Government scheme.
  If they participate, or even if they do not, their means of raising income is taken from them. The White Paper proposes that the health service is to be paid for partly by insurance contribution (but not, be it noted, by the hospitals' own
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  existing contribution scheme apparently), and also partly from central and local taxation. I agree very much with what Lord Nathan said that it is a very great disservice to the voluntary hospitals that it should have been said that this comprehensive treatment would be free. It is in no sense a free service, but that is the impression the public has gained. I realize quite well that if the voluntary hospitals remain voluntary it is not the concern of the Government where they receive the rest of their money. They will, of course, receive certain payments for their participation and they have to find their balance elsewhere. Some of them are lucky enough to have endowments, others again receive donations and payments by patients and contributory schemes make up the balance of their income. I think therefore it is rather difficult to reconcile the situation that faces the voluntary hospitals with the wish of the Government—and I quote their own words—"not to destroy or to diminish a system so well rooted in the good will of its supporters." I think that is the very thing they have done even though they have paid lip service to not doing it.
  Unless I am very much mistaken the results of the appeals of voluntary hospitals and other bodies that go to the public do not justify the contention that people are any less charitably minded than they were. I think the reverse is the case. It is very remarkable what has been collected. I am thinking particularly perhaps of flag days, from which there has been a very considerable increase of money for the hospitals and other objects, in spite of the fact that taxation has increased. But I think the effect of these proposals may begin to show fairly quickly. Contributory schemes have undoubtedly grown in size and in popularity, and the contributors feel that they are doing their own hospitals and themselves a good turn at one and the same time. If I may make a comparison, it is rather similar to the National Savings Movement. Much of the success of the Savings Movement has been due to the fact that people feel they are contributing to the cost of the war while the money is still theirs and may benefit them at some future date. These contributors have taken a very special pride in their own hospitals and I think they have a genuine anxiety I about the continuance of these schemes.

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  One question I should like to ask is, what is to happen to past contributions and the future treatment that contributors hope to receive? I hope it may be possible to continue such schemes within the framework of the insurance contribution that is referred to as one of the means of paying for the health service. I would suggest that it might be a sort of earmarked insurance, as it were.
  So much for finance, and perhaps the majority of the public hear more about the financial side of voluntary hospitals than anything else. I was very glad to hear the tribute paid by the noble Lord, Lord Moran, to the services rendered by the voluntary hospitals, for, that really has been their main object throughout their long history. They have a great tradition of service to patients, and they have acquired a very great fund of knowledge and of experience in the treatment of the sick. In the training of doctors and nurses they have accumulated a tradition of service, and we should not forget the great amount of voluntary work that has been put into these great institutions. The effect on the health of the nation must be incalculable and since it is incalculable is apt largely to be forgotten. The White Paper obviously has its doubts about the future of the voluntary hospitals. It is, as it were, written between the lines that if need be we shall go on. I regret that the voluntary hospitals, with all the experience they can offer to the national health service, are to have no representation on the bodies who will order the new scheme. They will act as advisory bodies on the local and central councils, no doubt, but on the Joint Board, which will possess the power, the hospitals will have no representation. I regret that very much. These Joint Beards will be a combination of local authorities, and they will consider first and foremost the local authority hospitals. I think it is only human nature that they should do that. The voluntary hospitals expected a full partnership, but they have not got it.
  In the health services of the country the voluntary hospitals are now the senior partners and they have been the senior partners for a very long time. They are to become the junior partners in the future. Their position will be reversed. Therefore I want to urge that there should be a central hospitals board analogous to the Central Medical Board, and that there
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  should be local hospital boards, so that both voluntary hospitals and local authority hospitals will be represented on the joint boards, because I think that is the only form of partnership that would be a success. If both types of hospital are made equal in status and in representation and are given equal powers, I believe the voluntary hospitals will most willingly give their great experience and make their contribution to the scheme.
  LORD GREVILLE: My Lords, at this late hour I propose to be extremely brief. In the admirable speech to which we have just listened the noble Lord, Lord Luke, referred to voluntary hospitals. I am pleased to know that he is following in the footsteps of his father and taking an interest in the voluntary hospitals. May I be allowed to say a few words as a layman who for some thirty years has been chairman of one of the London teaching hospitals? We welcome this scheme and are anxious to make it a success, but do not think anybody who has studied the medical side of this question can feel satisfied at present. Both the Minister of Health and the noble Lord, Lord Wool-ton, have laid great stress on the word "partnership." I have studied the White Paper as well as my poor brain will allow me but the more I read it the less I see of partnership. The voluntary hospitals which as I think anybody who knows anything about it must acknowledge have led medical science for hundreds of years, are now going to take a secondary place. I am not sure that we are not going to be put in a position of being made use of for just as long as it pleases the authorities and then they will say: "Thank you, we have learnt all we want to learn, good-bye." The noble Lord, Lord Woolton, seems to dissent but I am not at all sure.
  What I would specially ask is that this matter of partnership should be thoroughly discussed between the Ministry of Health and the voluntary hospitals, with the object of removing some of the apprehensions which we feel about the future of the voluntary hospitals. If we could be assured that this question is going to be thrashed out we should feel a great deal happier, because no voluntary hospital wishes to come under complete bureaucratic or political control. I see great danger there. We have learnt during the war how bureaucratic methods

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  can creep into voluntary hospitals. The number of forms we have to fill up, the returns we have to make, the mass of correspondence which Government Departments have thrown upon us, make us feel that if we get tangled in red tape we shall never get out of it.
  As regards financial proposals, as far as I can make out all voluntary sources of income such as the Hospital Savings Association will be completely swept away. We are told that we are going to be given lump sums—£10,000,000 has been mentioned—but we do not know how the money is going to be distributed. We do not know what is going to be given us for working expenses, for capital expenses and so on, but we do know that we shall lose very large sums of money. We do not know to what extent hospitals will be called on to pay for medical services. At the present moment we have a wonderful free service given by practising doctors and by consultants. If other hospitals run by local authorities are going to pay for their services, undeniably we shall be asked—certainly by junior members of the profession—to conform and pay. We should like to be assured that we shall receive help. Already our expenses have increased considerably. The
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  scheme put forward by Mr. Bevin on the domestic side is costing my own hospital £2,000 a year. We are paying for exactly the same service as we used to receive, a great deal more than we think it is worth. The financial side is really a very important one, and I entirely agree with what my noble friend Lord Dawson of Penn has said about it. I do not see why we should be called upon to render services that we shall not be paid for. That is a matter which I hope the Minister of Health will discuss with the Voluntary Hospitals Association and other bodies.
  I do not wish to detain your Lordships any longer at this late hour, but these are two things that are certainly troubling the lay side—one the question of partnership, and the other the finances of voluntary hospitals. It would be so easy for any body, for any local authority, that is not friendly to the voluntary system quietly to cut their throats in a financial way.
  LORD HORDER: My Lords, I beg to move that this debate be now adjourned.
  Moved, That the debate be now adjourned.—(Lord Horder.)
  On Question, Motion agreed to, and debate adjourned accordingly.
  House adjourned.