Clause 2., — (Accommodation for and charges to paying patients.)

Orders of the Day — VOLUNTARY HOSPITALS (PAYING PATIENTS) BILL [Lords]. – in the House of Commons on 8th May 1936.

Alert me about debates like this

11.20 a.m.

Photo of Lieut-Colonel Sir Arnold Wilson Lieut-Colonel Sir Arnold Wilson , Hitchin

I beg to move, in page 2, line 7, after "may" insert, "with the consent of the Ministry of Health."

This Amendment raises a very important point which has not been considered either on the Second Reading of the Bill or in Standing Committee. The Bill was read a Second time without any hon. Member rising to debate it, and in Standing Committee it was passed without a Division after a few minutes conversation. So brief were the proceedings in Standing Committee that they have not been printed; they are only available in manuscript form. The Bill deals with voluntary hospitals and paying patients. There is a steady growth throughout England and Wales of paying patients' wards. There is a growing tendency in nearly all hospitals to admit paying patients consequent on the growth of municipal hospitals which are taking more and more of those who cannot afford to pay anything. The pressure upon hospitals to make both ends meet by taking in paying patients is increasing, and the Bill is an attempt to make it easier for them to do so in competition with State hospitals. But there is no reference anywhere in the Bill to the Ministry of Health. The Charity Commissioners alone are responsible.

Sixty years ago, when the nation was concerned with the proper distribution of educational trusts, they did not give the Charity Commissioners the duty of deciding how these trusts should be modified, they created a body called the Endowed School Commissioners, who went into every educational trust in England and made their report. The Charity Commissioners were to be no longer responsible for educational trusts; they were transferred to the Board of Education. It seems to me that the Ministry of Health should exercise a certain supervision and responsibility over the modification of trusts when they relate to the activities and scope of voluntary hospitals, and that they should have a voice in deciding whether a particular proposal is in. order or not. The Clause says: The committee of management may provide and maintain on such land from time to time belonging to them such new buildings or such existing buildings of the hospital or such parts of such new or existing buildings and such and so many beds therein and for such period as the Charity Commissioners may on the application 'of the committee of management—. Surely it is reasonable to ask that the Ministry of Health should come into these discussions. A transference of labour is going on in this country. Hospitals in Hertfordshire have three times as many patients as they had 10 years ago, owing to the great increase of industrial activities, and of motoring and other destructive activities. Industrial accidents are steadily increasing. A great proportion of them are now paying patients and very properly so, for there are employers' funds, workmen's compensation funds and other sources from which payments may be made to maintain the patient in hospital for the period of his treatment. How far an alteration is necessary and desirable in any one case should not be left to the Charity Commissioners. There are in the country for which I have the honour to be one of the five Members, eight different hospitals, each of them having somewhat different functions and each of them having its own independent arrangements, with no co-ordinating authority whatever.

I suggest that the time has come for the Ministry of Health to decide, after full consideration, whether paying patients of a particular type should be concentrated in a particular hospital, or whether there should be a redistribution of responsibilities. A Home Office Committee is at this moment sitting to deal with the treatment of people who receive injuries in industry. It would be out of order to discuss the activities of that Committee here, but it is quite clear that most of them would be the better for being treated in a particular hospital and not in any given general hospital. For those reasons—I will not detain the House by explaining further the importance of the Ministry of Health taking some responsibility under this Bill--I hope the House will favourably consider the Amendment.

11.28 a.m.

Photo of Sir Samuel Storey Sir Samuel Storey , Sunderland

I hope the House will not agree to this Amendment. This Bill has as its purpose the simplifying of the procedure by which hospitals with limited trusts can expand their usefulness to the community. I do not think there is any doubt whatever of the need for their doing so. If we accept this Amendment, not only will the hospitals have to go to the Charity Commissioners, but they will have to obtain the consent of the Ministry of Health, and I suggest to the House that that would only cause delay and confusion. l agree with my hon. and gallant Friend the Member for Hitchin (Sir A. Wilson) that the time is coming when there should be a co-ordinated hospital policy for the country, but I suggest that a Bill such as this to extend the powers of hospitals with limited trusts is not the time and occasion to start setting about that co-ordinated policy. I ask the House to reject the Amendment.

11.30 a.m.

Photo of Sir Percy Harris Sir Percy Harris , Bethnal Green South West

I notice that on this Bill neither of the representatives of the Ministry of Health has deigned to attend to give the House guidance. We have the ever-indefatigible Attorney-General, who I will not say is a poor substitute—for that would be a reflection on him—but the wrong substitute. This is not merely a legal matter, although of course there is the legal point of the relation of the charitable trusts to this particular reform. In my view the reform is in every way desirable, but I do not quite take the line that these changes have no relation to the co-ordination of hospital services.

We are very proud of our voluntary hospitals, which are a peculiar institution associated with this country. The Local Government Act made a great change in the whole hospital system, for it brought the old Poor Law institutions, as they used to be called, under the public health system. The hospital system is patchy, and, especially in and around London, there are very serious gaps. The voluntary hospitals are undoubtedly going through a very lean time, and I think that part of the object of this Bill is to fill the empty coffers of those hospitals. I have no objection to that, but if it will mean a shortage of free beds in certain areas, that will be a. very serious matter for many districts, especially newly-developed districts such as the district which my hon. Friend who moved the Amendment represents. All around London, in Middlesex, Kent, Essex and Surrey, new urban areas are growing up almost like mushrooms. The provision for voluntary hospitals is by no means complete, and there is at the same time a shortage of beds provided by public institutions.

The matter is not merely one for the Charity Commissioners to decide. It is a question of the organisation of health services throughout the country, and therefore I suggest that the Ministry of Health or the local authorities, which are the responsible authorities for providing the beds, should be brought in in some way or another. Whether the Charity Commissioners should have to consult the local authorities before com- ing to a decision or consult the Ministry of Health, I do not think is important. We ought to be sure that in making a reform which is desirable we do not risk a serious shortage in some areas of free beds for sick people when they need them.

Photo of Sir Samuel Storey Sir Samuel Storey , Sunderland

Is the hon. Baronet not aware that under this Bill there is a general safeguard that the available facilities for ordinary patients shall not be diminished? That seems to answer his point.

11.33 a.m.

Photo of Mr Rhys Davies Mr Rhys Davies , Westhoughton

I had the privilege of being a member of the Committee upstairs which dealt with this Bill, and I wish hon. Members who have spoken here had been in that Committee, for they would then have heard that we tried to put another point dealing with almost to the same problem they have raised today. We were forced to the very simple conclusion that if the Amendment which is now before us were carried, the Ministry of Health would have power over about six voluntary hospitals only. If we are to carry out this big suggestion, with which I agree in principle, I hardly think we should do it on this Bill and on this Bill alone. I think it will be agreed that it should be done on a bigger scale and ought to deal with the hospital problem as a whole.

May I point out that there are other Bills with which we have to deal to-day, and I hope the hon. Gentleman's enthusiasm for his Amendments will not lead him to prolong the discussion and prevent us from reaching the two other Bills. Were it not for my desire to reach the last of the three Bills, I would, in view of the fact that the Ministry of Health is not represented here, have moved the Adjournment of the House; but to do that at the moment would be to cut off my nose to spite my face.

To return to the Bill, may I say that hon. Members on these Benches are a little apprehensive about one thing which we debated upstairs, and I think it ought to be put on record to-day. Very briefly the position is this: Although the Bill only covers six hospitals, there is nothing in it to prevent those hospitals charging heavy fees to paying patients. We think that the Charity Commissioners ought to have the right to vary an Order under Clause 2, not only at the instance of the hospital committee, but on their own initiative. We have a feeling that in passing Clause 2 we shall extend the accommodation in these hospitals for part-paying patients, and that is all to the good, but our fear is that while we are doing that, we may at the same time limit the accommodation for those patients who cannot afford to pay anything at all. These are the things which influenced our minds in Committee. This is a private Member's Bill and the House of Commons is always rather generous in its treatment of private Members who want to secure small reforms. We have supported this Bill throughout, not because we did not think we could amend it—and indeed we sometimes think still that we ought to have pushed our Amendment to a Division in Committee—but because of the main principle involved. In the main the Bill will release those trusts which now bind these five or six hospitals, and that is a very desirable reform, and it is because of that principle of the Bill that we have not pressed certain Amendments.

11.37 a.m.

Photo of Mr Donald Somervell Mr Donald Somervell , Crewe

As reference has been made to the actions of my right hon. Friend the Minister and my hon. Friend the Parliamentary Secretary to the Ministry of Health, I would like to say that yesterday I considered this Bill and the Amendments which were then on the Order Paper. At that time, yesterday afternoon, the only Amendments on the Paper were two new Clauses, and the only point raised by the two new Clauses were legal points of construction. Therefore, so far as it was necessary for a Member of the Government to be present on this occasion to deal with the Amendments then on the Order Paper, it seemed that I was the proper person. The other Amendments which now appear on the Order Paper were put down some time last night. I think it is right that those facts should be stated. If Amendments affecting a Government Department are not put down until the evening before the Bill is coming on in the House, it is very difficult for those responsible for the Department to be in attendance.

11.38 a.m.

Photo of Lieut-Colonel Sir Arnold Wilson Lieut-Colonel Sir Arnold Wilson , Hitchin

It is true that I did not put down these Amendments until last night, but that was through no desire for obstruction and no feeling of contumacy, but simple; because the report of the proceedings in Committee had not reached me in printed form. Only after some trouble was I able to unearth it from the archives of the Library in manuscript. Upon reading it, I found that this point had been raised in Committee, but, I felt, inadequately, and as the report was not printed, it was not available to the public. The Bill was scarcely mentioned on Second Reading, and I felt that the Floor of the House was the proper place for these important points to be ventilated and discussed in order that the public and the appropriate Ministers might be aware of the very general feeling that all is not well with the voluntary hospital system and that they must sooner or later take their responsibility. There is a further Amendment dealing with consultation with county and borough councils, but as far as the Amendment about the Ministry of Health is concerned, and the consequential Amendments to it, I propose to withdraw them, with the permission of the House.

Amendment, by leave, withdrawn.

11.40 a.m.

Photo of Lieut-Colonel Sir Arnold Wilson Lieut-Colonel Sir Arnold Wilson , Hitchin

I beg to move, in page 2, line 26, after "to," to insert: the county or borough council in whose area the hospital is situated and This Amendment raises the point which has already been referred to by my hon. Friend the Member for South-West Bethnal Green (Sir P. Harris), and its object is to give the local authorities some say in the matter before the Charity Commissioners exercise their statutory duty in sanctioning a Scheme, or an alteration in the proportion of beds, or the provision of additional beds for paying patients. The arguments in favour of it are precisely the same as those already set forth in relation to the Ministry of Health, but they are in some respects more cogent in this case. The hon. Member for Westhoughton (Mr. Rhys Davies) is under a misapprehension when he thinks that only half-a-dozen hospitals will be involved. I anticipate that within a few:y ears we shall have perhaps three or four score hospitals who will come within the scope of the Clause. I hope we may; I hope to see great activity under this Clause. I think the Bill will have a far wider effect than the promoters themselves realise.

I submit that, in the interest of the hospitals and the Charity Commissioners, there should be some consultation with the county and borough councils. To go back to the question of educational trusts, which are more or less parallel, I would remind the House that in 1860 the Educational Trusts Commissioners and the Endowed School Commissioners were required by law to consult with the local authorities before reaching a final decision, and when these consultations were completed, the final reference was to the Charity Commissioners, whose powers were thereupon taken over by the Board of Education. It may be that the promoter will say that this Amendment would involve delay and difficulty, but I believe that consultation with the local authorities is always worth while, and that he would be well advised to accept this small Amendment.

11.43 a.m.

Photo of Sir Percy Harris Sir Percy Harris , Bethnal Green South West

I beg to second the Amendment.

I have already stated my reasons. This is really the right way to achieve our purpose, and it particularly applies to new areas where the local authorities have not yet been able properly to organise the means of making up deficiencies in accommodation by beds provided in a local authority's hospital, and where perhaps also, owing to insufficient local consciousness, it is not possible to raise funds to provide free beds for the ordinary patients. I do not think the Amendment will lead to needless delay. As a rule local authorities have the same pride and affection for the local voluntary hospitals as have the Governors and subscribers. I notice that my hon. Friend opposite shakes his head, but I think the sooner that friendly relationship is established, the better for all concerned. Here is a friendly gesture and the right kind of gesture, and I think that my hon. Friend would be well advised to accept the Amendment.

I am sorry that he has not the guidance of the appropriate Ministers, who are conspicuous by their absence, and it seems a sad thing that almost the whole burden of the House of Commons should be placed on the shoulders of the Attorney-General. The Solicitor-General, unfortunately, has been ill for some weeks, and I am very sorry for that. It is not fair, or right, or proper that the Government should put so much responsibility on the right hon. and learned Gentleman the Attorney-General. However, he is a man of wide knowledge and broad sympathies, and I hope that this time he will give us some guidance on this point.

11.46 a.m.

Photo of Sir Samuel Storey Sir Samuel Storey , Sunderland

I am afraid I cannot accept the Amendment on behalf of the promoters. I do not need to restate the arguments, but I think the Amendment is quite unnecessary. This Clause applies only to where there has been some material change of circumstances and the Charity Commissioners can step in and, on their own initiative, revoke or vary an Order. It is only right on such occasions that they should give the committee of management of the hospital the right to state their case. I think this Amendment is unnecessary, because, if hon. Members will look at the wording of the Clause, they will see that the Commissioners can also give this right "to any other persons appearing to the Commissioners to be concerned," and if the local authority were concerned, the Commissioners would have power under the Clause to hear them.

11.47 a.m.

Mr. DAVID ADAMS:

I am very glad to support the Amendment, which I think is in harmony with to-day's practice. Under the Local Government Act of 1929, it is obligatory upon local authorities and voluntary hospitals to confer when any changes are being effected with regard to the hospitals of one or the other. I happen to be chairman of a large health committee, and ever since the 1929 Act came into operation we have conferred with the voluntary hospitals of one sort and another.. For instance, when. the Newcastle Corporation desired to extend its hospital and to build a new block for children, we were compelled under the 1929 Act to confer with the Royal Victoria Infirmary, with the Babies Hospital, and with the Fleming Memorial Hospital, and if you are not to have overlapping, discontent, and uncertainty, which ought at all times to be avoided, in. short, if you are to have good will, there ought con- tinuously to be this conferring, or even standing committees set up upon which local authorities and voluntary hospitals would serve.

If that were not a good thing, why was this obligation placed on local authorities in the 1929 Local Government Act. So far as we are concerned, it has been exceedingly successful, and the best of good will prevails. There has been interchanges between one and the other of the hospitals, both voluntary and municipal, and by such co-operation the municipal hospitals are being brought up, where they are lower in status, to that of the best voluntary hospitals, and the voluntary hospitals, on the other hand, are being brought up to the higher standards of the municipal hospitals by association in this way. I think that to eliminate the local authority as is proposed, or at all events to weaken its authority under the 1929 Act, as would be the case if this Amendment were not assented to, would be a distinctly reactionary step.

11.50 a.m.

Photo of Mr Donald Somervell Mr Donald Somervell , Crewe

I wish, first of all, to thank the hon. baronet the Member for South-West Bethnal Green (Sir P. Harris) for his very kind references to myself. I am glad to say that I am bearing up, and I hope I do not show undue signs of wear and tear. This Amendment is, of course, a matter for the House itself. Everybody agrees with the desirability of co-operation and so on between local authorities and voluntary hospitals. On the other hand, I will put this point before those who are asking for this Amendment. They are asking for it at a very late stage. This Bill, like most private Bills, has very properly been the result of a great deal of discussion and negotiation with the various people, hospitals, and so on affected, and over a considerable period of time. I think every Member of the House is very grateful to my hon. friend and those who have worked with him in endeavouring to arrive at a common agreement and, finally, in getting a Measure which has commended itself to those concerned. It has been discussed in another place, it has had a Second Reading here, and it has had a Committee stage upstairs. It is not that I am saying that anybody might object to this Amendment. It is, as I have said, entirely a matter for the House. This Amendment is put forward as one of importance, and it may be that those who have put it forward and those who think it right will agree, now that the promoters have said that they would rather it was not accepted, particularly perhaps at this late stage of the Bill, when there is no further opportunity for discussions to go on, that it might not be wise to press the Amendment.

11.52 a.m.

Photo of Mr George Griffiths Mr George Griffiths , Hemsworth

I am interested in this Amendment, because I am informed that this Sub-section (4) will give the power to hospitals to readjust or amend their present powers so that people who at present are not forced to pay may have to pay if the Clause is carried without any local authority being enabled to make representations. I am informed that this matter affects not only London but the entire country, and I want to put a point of view from somewhere a little bit farther off than London. At my own pit, or rather the pit where I used to work, not my pit, we have contributed voluntarily during the last 10 years £70,000 to voluntary hospitals, which is al the rate of £7,000 a year, and what I am desirous of knowing is this: Supposing we have a man at that pit who has never been inside a voluntary hospital in his life and who may have been contributing for 30 years, and he meets with a serious accident. He has saved at bit of money, he may have a house, or he may have something in a co-operative society. Under this Clause, if he has a bit of a banking account., although he has been contributing for 30 years, week by week, the hospital committee can call upon him -to pay, and I am very desirous that that should not be the case.

I am desirous that, the local authority, of which I am a member, shall be enabled to make representations and to put their point of view before the hospital committee if that committee should desire to change its powers arid extend them, and the main point of view of the man who contributes week by week whether he has a full week's work or not. Many local authorities give contributions out of the rates, and those authorities who feel that they are too poverty-stricken to give a grant are looked upon by other authorities almost as blacklegs. I am desirous that those authorities shall be enabled to put their case before the Charity Commissioners so that protection should be given to our members who are continually paying to voluntary hospitals, who would not be able to keep open one day unless the workers were contributing towards their expenses

11.56 a.m.

Photo of Sir Samuel Storey Sir Samuel Storey , Sunderland

I think that I can give the hon. Member the assurance that he wants. There is nothing in the Bill which will affect the interests of working-men who subscribe their penny and twopence a week to voluntary hospitals. If there were, I should not be giving my support to it, for I have had too much to do with voluntary hospitals which raise a large part of their income from these small subscriptions. The Bill safeguards the right of these men absolutely. There is a general provision in the Bill that existing facilities shall not be affected, and that provides a complete safeguard. With regard to the Amendment, I ask the Committee to let us get on with the Bill. The promoters appreciate the need of consultation between local authorities and voluntary hospitals, but this Bill is not the place to bring that out. Under this Clause the Charity Commissioners have the power to ask any person who is interested to appear before them.

11.58 a.m.

Photo of Mr Wilfred Paling Mr Wilfred Paling , Wentworth

I want to protest against the novel defence set up by the Attorney-General. He said that this Amendment had been put down very late and that because of its lateness it might upset certain things, and asked us, therefore, not

to consider it. That is not a very good proposition to put before the House, and I hope that it will not be regarded as a precedent.

Photo of Mr Donald Somervell Mr Donald Somervell , Crewe

It is surely a proper course for the- Government to say on an Amendment that the people putting it forward are capable of explaining it, and that it is for the House to decide. The Government do not take one side or the other, but leave it in the hands of the House. There was nothing more than that in my remarks. My hon. Friend is free to say that he does not attach any importance to the fact that this point has been raised at a late stage, but I put that forward as a matter that the mover of the Amendment should consider.

11.59. a.m.

Photo of Lieut-Colonel Sir Arnold Wilson Lieut-Colonel Sir Arnold Wilson , Hitchin

The promoter of the Bill has made it clear that the consultation with local authorities, which is generally desired, is possible and would be arranged if necessary by the Charity Commissioners under the last two lines of the Clause. That being the case, I do not propose to press the Amendment, but I beg the House to realise that this Debate has served a useful purpose because it has made clear to the Charity Commissioners that there should be consultation in all cases with local authorities. I beg to ask leave to withdraw the Amendment.

HON. MEMBERS:

No.

Question put, "That those words be there inserted in the Bill."

The House divided: Ayes, 68; Noes, 75.

Division No. 170.]AYES.[12.1 p.m.
Adams, D. (Consett)Hall, G. H. (Aberdare)Muff. G.
Adamson, W. M.Hall, J. H. (Whitechapol)Paling, W.
Anderson, F. (Whitehaven)Harris, Sir P. A.Potts, J.
Attlee, Rt. Hon. C. R.Henderson, T. (Tradeston)Ritson, J.
Banfield, J. W.Hills, A. (Pontefract)Robinson, W. A. (St. Helens)
Barr, J.Hopkin, D.Rowson, G.
Batey, J.Jagger, J.Smith, Ben (Rotherhithe)
Benson, G.Jenkins, A. (Pontypool)Stewart, W. J. (H'ght'n-le-Sp'ng)
Brooke, W.Jenkins, Sir W. (Neath)Taylor, R. J. (Morpeth)
Burke, W. A.John, W.Thorne, W.
Cape, T.Jones, Morgan (Caerphilly)Thurtle, E.
Charleton, H. C.Kirby, B. V.Tinker, J. J.
Cocks, F. S.Lawson, J. J.Viant, S. P.
Daggar, G.Lee, F.Walker, J.
Davies, R. J. (Wcsthoughton)Leslie, J. R.Watkins, F. C.
Davies, S. O. (Merthyr)Lunn, W.Whiteley, W.
Day, H.McGhee, H. G.Williams, D. (Swansea, E.)
Dunn, E. (Rother Valley)MacLaren, A.Wilson, C. H. (Attercliffe)
Ede, J. C.MacNelll, Weir, L.Windsor, W. (Hull, C.)
Edwards, Sir C. (Bcdwellty)Mainwarlng, W. H.Woods, G. S. (Finsbury)
Gallacher, W,Marklew, E.
Green, W. H. (Deptford)Mathers, G.TELLERS FOR THE AYES.—
Griffiths, G. A. (Hemsworth)Messer, F.Lieut.-Colonel Sir Arnold Wilson
Grove:, T. E.Montague, F.and Sir Hush Seely.
NOES.
Anderson, Sir A. Garrett (C. of Ldn.)Grimston, R. V.Morris-Jones, Dr. J. H.
Aske, Sir R. W.Gunston, Capt. D. W.Morrison, G. A. (Scottish Univ's.)
Beaumont, Hon. R. E. B. (Portsm'h)Hamilton, Sir G. C.Neven-Spence, Maj. B. H. H.
Bernays, R. H.Hannah, I, C.Orr-Ewlng, I. L.
Bower, Comdr. R. T.Hannon, Sir P. J. H.Palmer, G E. H.
Brocklebank, C. E. R.Haslam, Sir J. (Bolton)Penny, Sir G.
Browne, A. C. (Belfast, W.)Heneage, Lieut. -Colonel A. P.Pownall, Sir Assheton
Bull, B. B.Holmes, J. S.Ramsay, Captain A. H. M.
Castlereagh, ViscountHope, Captain Hon. A. O. J.Reed, A C. (Exeter)
Chennon, H.Hudson, Capt. A. U. M. (Hack., N.)Remer, J. R.
Chapman, A. (Rutherglen)Hulbert, N. J.Sandeman, Sir N. S.
Chorlton, A. E. L.Jackson, Sir H.Savery, Servington
Cooke, J. D. (Hammersmith, S.)Keeling, E. H.Shaw, Major P. S. (Wavertree)
Crooke, J. S.Law, R. K. (Hull, S.W.)Somervell, Sir D. B. (Crewe)
Crossley, A. C.Leech, Dr. J. W.Somerville, A. A. (Windsor)
Cruddas, Col. B.Llewellln, Lleut.-Col. J. J.Southby, Comdr. A. R. J.
Denman, Hon. R, D.Lloyd, G. W.Strauss, H. G. (Norwich)
Drewe, C.Loftus, P. C.sutcliffe, H.
Fox, Sir G. W. G.McEwen, Capt. J. H. F.Turton, R H.
Fyfe, D. P. M.Macnamara, Capt. J. R. J.Ward, Lieut. -col. Sir A. L. (Hull)
Gardner, B. W.Magnay, T.Warrender Sir V.
Gledhill, G.Mannlngham-Buller, Sir M.Wickham, Lt.-Col. E. T. R.
Gluckstein, L. H.Margesson, Capt. Rt. Hon. H. D. R.Womersley, Sir W. J.
Goldie, N. B.Maxwell, S. A.
Goodman, Col. A. W.Mayhew, Lt.-Col, J.TELLERS FOR THE NOES—
Griffith, F. Kingsley (M'ddl'sbro, W.)Morris, O. T. (Cardiff, E.)Mr. Storey and Dr. Howitt.