Orders of the Day — Public Health (Tuberculosis) Bill

Part of the debate – in the House of Commons at on 13 April 1921.

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Photo of Major Alexander Farquharson Major Alexander Farquharson , Leeds North

I have listened to the Debate with great interest, and I have been specially struck by the extraordinary amount of sentiment specially directed towards the condition of the tubercular person without really considering the merit of the treatment which this Bill wishes to provide. I welcome the Bill, which is necessary in filling up the gap left by the Act of 1920. That Act took sanatorium treatment from the Insurance Committees and it is now proposed to hand it over to county and county borough councils. This Bill solely deals with the question of institutional treatment for tuberculosis, nothing more And nothing less. As I read the finance of the Bill, something like £400,000 will be available for this purpose. In my view sanatorium treatment at present is nothing more or less than en experiment. Almost everything about medicine is experimental. The spending of large sums of money on institutional treatment is not in my opinion either wise or justified by the results of the past. It is only one of the whole gamut of methods of treatment. It is only one little stage of treatment which often comes in unfortunately when treatment of any kind is more or less useless. It is one little aspect of the whole question of treatment, and I do not think it has justified itself up to now. I do not think it warrants the huge and unlimited expenditure of money. Honestly, I regard the sanatorium as little more or less than one element of an educational agency which the Ministry of Health has at its command now. The Ministry of Health as an educational agency, to my mind, has a duty more important than merely creating bureaucrats to dispense large sums of money in this direction or that. One fault I have to find with institutional treatment is that it reaches a certain degree of what I might call passivity on the part of the patient himself. The After-Care Association encourage that passivity when often all that is wanted is to rouse the patient to the knowledge that he is his own keeper, that his health is in his own care, that by simple attention to hygienic rules he can not only give himself a higher and better and stronger life, but he can cease to be a burden upon his fellow men. The sanatorium as an educational agency to my mind has its value. The sanatorium as a treatment agency has merely its little part in the whole scheme of treatment.

Incidental reference has been made to the financial statistics of the Bill as they work out in relation to county councils, county borough councils, and the State; but there is one point with regard to this question of finance which impresses me as perhaps unique. This is a simple little Statute which ostensibly deals with the limited question of the treatment of phthisis which introduces the idea of a simple transference of what I might call the onus of the incidence of payment for benefit given. In the National Health Insurance Act the benefits derived by institutional treatment were paid for by the employers, by the State, and by the insured person himself. The onus of the incidence of that is by a stroke of the pen removed and placed upon the local ratepayer and the-income taxpayer. I do not think that is a precedent which should be followed. If financial readjustments like that are necessary, they should not appear as a side issue, or in some way oblique or in distant relationship to the Bill before us. Apart from the dislocation of finance in regard to the Bill, there is a dislocation of the personnel of National Insurance committees dealing with tubercular matters. The hon. Member (Mr. Ormsby-Gore) referred to the sad case of an official losing his job because of this dislocation. That is, unfortunately,' possible, but it cannot be avoided. It is part of the wreckage of the whole National Insurance scheme in regard to tuberculosis. No Act can compel a county borough council, which is now becoming the authority under the Act," to take over the personnel of the County Insurance Committee, with which it has nothing but a very indirect relationship. That is another point on which obviously the Bill will create difficulty.

It has been suggested that it should be made mandatory on county councils to co-opt members of insurance committees. An Amendment in that direction suggests to my mind a most unfortunate and iniquitous principle. That it should be permissive on the part of the county council is right and proper. People with certain statistical information with regard to the treatment of tuberculosis in institutions will be very useful, and I have no doubt they are, but to compel county councils to co-opt and give an equal voice in the deliberations of these committees to members of insurance committees is introducing an entirely vicious principle. I wish to support the Ministry in most heartily resenting that. Where the ratepayers elect their representatives they should have a vote but those who are not elected by the ratepayers to these bodies should be deprived of a vote on those vital matters. They might be given a vote on matters which do not concern expenditure or treatment; but to introduce an entirely new element into the representative character of local bodies will be disastrous in the extreme. In conclusion I maintain that the institutional treatment is entirely experimental, and that this Bill has one or two defects which ought to be remedied in Committee, but with these exceptions I welcome it as filling up a gap left by the Act of 1920.