I beg to move, in page 4, line 27, at the end, to insert:
and shall be notified in the London Gazette and in such local papers as the Charity Commissioners may direct.
The principle underlying this Amendment was discussed not long ago on the Ribbon Development Act, and I think from what was said then that there is a strong case for giving the public at large information as to what is being done by hospitals and by the Charity Commissioners in this matter. I cannot conceive that there is a word that could be reasonably said against the proposal to require the Charity Commissioners and the hospital to make such public notification of their intention as would enable local authorities and private persons to prepare their case and to be heard in the event of any such scheme being the subject of an inquiry by the Charity Commissioners.
Far be it from me as a newspaper proprietor to do anything to discourage advertisements, but one of the few things I do not like is to have to charge advertisements to hospitals. I think this proposal would put an unnecessary expense upon hospitals, and I would ask the Mover of the Amendment not to press it.
The Bill to which I now ask the House to give a Third Reading passed its Second Reading not at a late hour, as the hon. and gallant Member for Hitchin (Sir A. Wilson) said, but at a very early hour, after an all-night sitting, and without discussion. It may, therefore, be for the convenience of the House if, very briefly, I explain what are its aims. The Bill is promoted by King Edward's Hospital Fund and by the British Hospitals' Association to enable hospitals with trust deeds settled long ago to meet the modern demand for pay beds, in which those who can afford to pay a moderate charge may receive the benefit of those modern methods of diagnosis and treatment which cannot be undertaken without the specialised equipment and staff of a general hospital, or can only be undertaken elsewhere at very great expense, if at all. Voluntary hospitals with modern trust deeds can and should provide for all who need hospital treatment, whatever their capacity to pay. As in the past, their first duty should be to treat free of cost the sick poor, but after that they should provide for those classes who cannot afford the greater charges which are made elsewhere and who, bat for the provision of pay beds, would hive to be treated in the ordinary wards. They should also provide for those other classes who can afford to pay charges proportionate to their means and who cannot obtain the treatment they need anywhere except in a modern general hospital.
But there are many hospitals with ancient trust deeds which cannot legally make such provision, even with money specially collected and given for the purpose, and on occasions when they have to give treatment which cannot be provided elsewhere they cannot legally charge for that treatment, even though the recipient may be able and willing to pay. Such a state of affairs is not fair to the hospital and is not fair to the people of the district which is served by it. This Bill, therefore, gives to the Charity Commissioners the power to remove such anomalies by allowing hospitals to provide pay beds if this is not done to the detriment of their first and primary duty, the treatment of the sick poor. No hon. Member need have any fear that in voting for this Bill he will endanger the treatment of the sick poor, for not only does the Bill provide full and adequate powers for the Charity Commissioners, but special safeguards have been inserted in it in another place at the instance of His Majesty's Government, to secure that there shall be no diversion to other purposes of property and funds acquired under the original trusts.
The Bill gives to the Charity Commissioners power to permit a hospital to provide a suitable proportion of pay beds for a specified period out of moneys specially collected for the purpose, and it does not permit the use of existing funds, land or buildings unless they cannot he used for the original purpose. In addition, the Charity Commissioners are given power to promote or vary an order if there has been a material change in the circumstances under which the order was granted; and there is a general safeguard that the existing available facilities for ordinary patients shall not be diminished. The Charity Commissioners may also require the committee of management of a hospital, in order to meet the needs of those who can afford to pay part if not the whole of the cost, to set aside a certain number of beds for their treatment, and the hospital is enabled to charge any deficit on that treatment to the general funds. In the order the Charity Commissioners can also lay down the scale of charges that the committee of management may make for maintenance and treatment by the resident staff of the hospital.
These are the main provisions of the Bill. The safeguards for the interests of the poor are, in my opinion, fully adequate, and I trust that the House will give the hospitals this additional power to enable them to extend their beneficent work. We all want to see an efficient hospital system available to all in this country, and most of us think that the voluntary hospitals can play their part in providing it. It is only by removing anomalies such as this Bill sets out to remove that we can enable the hospitals to play their full part. The treatment of the sick poor must always be their first care, and after that the treatment of those working men who, by their pennies and twopences and threepences per week, play such a. big part in providing the income of the voluntary hospitals, and who when they subscribe these sums pay very largely for their own treatment and that of their families. But after we have provided for those two classes we should also provide for those who can afford to pay in proportion to their means, so that every one in this country shall have the benefit of all the modern equipment, the specialised skill and training of the staffs of general hospitals. It is because I feel that this Bill will further extend this kind of work that I ask the House to give it a Third Reading.
I beg to second the Motion.
It is perhaps fitting that I should say -a word or two because I went through the Committee stage of this Bill. It is a private Member's Bill and every Member is entitled to think and vote as he likes. In the main some of us support this Bill because it releases for a certain purpose funds that are tied up by trusts. I think we shall have to reach a stage when all hospitals for the treatment of the sick must be free. I think, however, that there are some rich persons who, though they can afford to pay for hospital treatment, sometimes do not pay a penny piece. On the other hand there are cases where the sick poor are charged fees when they ought not to be charged at all. Consequently some day the hospital problem as a whole will have to come under the review of Parliament. This Bill will remove an anomaly. It deals with a very small problem and because of that I have taken the liberty of supporting it all along the line.
I wish to protest against the sparseness of the information given to the House by the Government Front Bench. When questions have been asked in the past we have been told that it is too early to give the information. To-day we have been told that it is too late to give it. I imagine that between the "too early" and "too late" the reason is that the Government have nothing whatever to say.
I do not want to raise unnecessary controversy. I am sure the hon. Gentleman appreciates the fact that our primary concern with this Bill is that it deals with charities. I am certainly not conscious of having been asked for any information which I have not given the House. If any hon. Member has asked me for information which I have not given him, I apologise to him.
It must be many years since any hon. Member has presented twin Bills to the House on a single Friday, with every prospect of seeing them both passed the same afternoon, and I should like to join with my hon. Friend the Member for Westhoughton (Mr. Rhys Davies) in congratulating the promoter on two exceedingly healthy twins. But there is one serious defect which I will mention. I regret that I could not mention it on the Report stage. Clause 5, Sub-section (3), authorises the Charity Commissioners to charge fees to the hospitals. There is no precedent for that, and to my mind it is very regrettable that the promoters should have allowed that Clause to slip in. Only last year on the Public Accounts Committee the whole question of fees was discussed. There are two kinds of fees, recording fees and other fees. Here are question and answers as given in evidence before that Committee:
Do you charge fees?—No.Why not?—Because no fees have ever been prescribed and no one has even succeeded in suggesting any scale of fees that would produce any revenue without killing the work of the Charity Commissioners.
You think if you charged fees you would kill your work?—If you charged certain fees you would.
Under the Act of 1869 the Treasury have power to prescribe the fees but they have never exercised the power.
You are doing work for the general body of the public, and, therefore, the general body of the public in the form of the taxpayer ought not to grumble if he has to pay?—Yes, I think that is very fairly put. The Geddes Commission went into that question of fees and they reported that we should be excepted."
That being the case, is it right that the Treasury or the Charity Commissioners should spatchcock into a Private Bill a precedent authorising the Charity Commissioners to charge hospitals for work done, a charge which they make in no other case for any charity?
My other point is that in reality the Charity Commissioners are not the proper body to deal with the matter. Sooner or later we must have a body like the Endowed Schools Commission, which will consider the questions with the experts and will not be in a position of having to do this in addition to a vast amount of routine work. I see from the Estimates Committee that there is only one Charity Commisioner who can do anything at all outside the office. How many of these officials are there who go about the country holding local interviews? There is ample justification for this Bill. There is also ample justification for a much fuller inquiry by the Ministry of Health into the future of charitable trusts with a view to creating some body which will, under the Ministry of Health, conduct an ad hoc inquiry into the position. I hope they will not use the machinery of the Charity Commissioners, which is by no means well adapted to it. With those remarks I wish the Bill a happy discharge.
I wish to give my blessing to the Bill and to tell the Attorney-General that I have no criticism. On the contrary, it is a great compliment that he should have thought this Bill important enough to devote his attention to it. We still object to the absence of representatives of the Ministry of Health, and I regret also the absence of the Charity Commissioner. The House of Commons has a representative on this very important organisation, the hon. and learned Member for Montgomery (Mr. C. Davies). He is very rarely called upon to do anything for us, but here is a job in which he might have usefully guided the House. We have an Ecclesiastical Commissioner, and. there he sits, with all his importance and authority, although this is not a Church matter. This is a good Bill and will be useful. We might have made it a better Bill if the Amendment which was put forward to strengthen the wording had been accepted. It would have worked better, and there would have been no injustice in Special Areas. The Bill does not pretend to do very much, but it will enable the hospitals to make their financial position stronger.
I wish to add my congratulations to those which have been expressed. As one who is interested in voluntary hospitals, I would also express my gratitude to those who have promoted the Bill in another place and have carried it through this House. The hon. and gallant Gentleman for Hitchin (Sir A. Wilson) must be very pleased with the twins which have; been promoted this morning. He has done his best to make the most of them, and with all the skill at his command. It has always seemed very unfortunate that many hospitals were not able to do their work to the extent of their scope, because they were not able to attend paying patients. That was not because they were not willing to take them, but because their constitutions do not allow them to do so. Hospitals do not desire to restrict their services, because they are the losers every time.
The financial benefits gained under this Bill will enable them to instal many new inventions that medical science is bringing to the notice of the public. The hospitals need those inventions. On the other hand, the great class of black-coated workers, especially the professional men, a large number of whom cannot afford the high fees charged in nursing homes, will be able to pay their four guineas or six guineas a week, which is the average charge for paying patients in these hospitals. The Bill will extend hospital services to a body of persons who may be just comfortably off but, when an emergency arises, such as a sudden operation, cannot afford to pay for treatment in a nursing home. They do not want to go into the ordinary wards with the poor people, and this Bill will make an intermediate course possible for them. I welcome the Bill whole heartedly and hope it will pass into law without undue delay. It has taken several months already. I believe it was introduced into the other place in July last. This is the final stage.
To me the most pleasing feature of this Bill is in its last line, where it is stated that it shall not apply to Scotland. I have no desire to prevent congratulations among English Members upon obtaining power to establish paying beds in voluntary hospitals, but those of us who know something of the great work of the voluntary hospitals must be disturbed to some extent by the way in which the power to establish paying beds is put forward in the Bill. The hon. Member who has just spoken attracted attention to the danger of creating class distinction and snobbery. People who are paying in these hospitals will be those who will get the greater consideration. Thousands of patients are waiting to be treated in these hospitals. I know that is so in respect of the greatest voluntary hospital in Great Britain, the Edinburgh Royal Infirmary, where 3,000 people are waiting to be treated. It will be a great dis-service to those people if any part of the accommodation in that great institution is set apart for paying patients. It will mean the establishment of two waiting lists, one of people to be treated free and the other, and smaller one, of people to be treated upon payment being made.
I hope that the passage of this Bill for England and Wales will not make the Government consider that they have any right to proceed with a similar Measure for the voluntary hospitals of Scotland. Those who are interested in the subject, and more particularly in the institution to which I have referred, which is the best, the biggest and longest established of these great voluntary institutions, know that the hospital is able to carry on its work by voluntary contributions. It receives more voluntary support than, perhaps, any two similar institutions in Great Britain. We shall strenuously fight against any idea of revoking the provisions of the charter of that institution and making it possible to establish paying beds there. I am hardly entitled to speak on the Bill, except in so far as any hon. Member has the right to speak on any subject. I am a Scottish Member, and I hope that there will be no endeavour to establish this sort of thing in Scotland.
The position is amply safeguarded. As the promoter has said, under the Bill the Commissioners are not going to allow paying patients to be taken instead of poor persons. The poor people will still be entitled to treatment.
I was only expressing my feeling with regard to what the result might be, and I do not think that anything that has been said by the promoters, or anything that is in the Bill itself, completely removes the fear that I have.
I am sure that, if any of us who have to do with voluntary hospitals, as almost all of us have, shared the apprehension expressed by the hon. Member for Linlithgow (Mr. Mathers), we should oppose the Bill, but I cannot believe that he really meant it when he said that greater consideration would be shown by voluntary hospitals to those who were prepared to pay. I cannot believe that of the Edinburgh Infirmary, and I am sure it is not the case in any of the hospitals that I know. They were all created, and they all exist, primarily to serve the sick poor, for whom they have done enormous work; and they have a further work to do in seeking out causes of disease and promoting health. They are doing great work in that direction.
We have been told that they are passing through a lean time and are in competition with the municipal hospitals, but I demur to both those statements. The hospitals are always short of cash, because they are doing a great and expanding work, but they are getting enormous voluntary support from the whole class who will be treated in the hospitals all over the country. I do not think that "a lean time" is the correct expression. They are being more and more useful as the community learns the importance of health, and the provision of health is getting more and more expensive. During the last 10 or 15 years there have come into being more and more departments which are like telescopes to look inside us and prevent disease before it begins. Those departments are very expensive, and that is why the balance sheet is difficult to balance; and, without help from all the patients, the hospitals would, of course, have broken down, and there would have been a great disturbance of the whole health service.
With regard to the question of cooperation, we are all agreed that it is most important that this fabric of protection against disease, this method of seeking out health, should be coordinated, but I demur to the word "competition". The hospitals that I know are in the very closest co-operation with the municipal hospitals, and I believe that the progress of the municipal hospitals has been promoted very effectively and with great success. Large numbers of patients are being treated in the municipal hospitals, but the voluntary hospitals are still very busy, and, as the hon. Member mentioned, there are long waiting lists. In try view, and in the view of those who give up their lives to organising this great charity, it will assist them to help the sick poor if this Bill is passed, as I hope it will be. I do not believe it will in any way enlarge the list of people who are asking for free treatment, but it will enable certain people, who at present cannot find a cheap room in which to be healed, to come forward and say they can pay £5, or £4, or whatever it may be. I believe that the Bill is a great step in the right direction. I fully agree that the hospitals must keep in touch with the Ministry of Health, as they are doing and will increasingly do. I very much hope that the House will pass the Bill.
I cannot allow this Bill to pass its Third Reading without joining in expressing the anxiety which apparently is in the minds of other Members of the House with regard to the possibility, at any rate, that it is going to lessen the opportunities of treatment for the sick poor by increasing the opportunities of treatment for those who can afford to pay. I am as conscious as any other Member of the tremendously good work that is done by the voluntary hospitals in the interests of the poor, but I am equally conscious that the major part of that work could not be done at all were it not for the sacrifices made by the poor. It is pretty well known, and to no one better than the governors of voluntary hospitals, that the major portion of the contributions towards the upkeep of these hospitals comes from those who cannot afford to pay the £4 or £6 a week which the hon. Member opposite mentioned as possible in the case of those for whom he is so anxious to provide additional accommodation at the hospitals. If those who can afford to pay £4 or £6 a week in the unfortunate event of their needing such treatment made their contributions to the funds of the hospitals in the same proportion as the working class who pay their pennies, twopences and threepences a week, there would be no need whatever to ask the House to pass a Bill of this description. We have asked time and again for an assurance, and an assurance in general terms has been given, that the Bill will not adversely affect those in whom I am particularly interested. We have been told that their interests are safeguarded, but, when I have asked for a specific reference to the portion of the Bill—
If the hon. Member will turn to Clause 4 of the Bill, he will see that its opening words are:
The Charity Commissioners shall not make an Order authorising any use or application of property or funds which, apart from the Order, would involve a breach of any trusts upon which the property or funds are held";
while paragraph (c) provides that the Charity Commissioners must be satisfied that
the authorisation will not diminish or restrict the accommodation for such persons as aforesaid which is provided in the hospital at the date of the application for the Order and which the committee of management would be able to continue to provide if the Order were not made.
That, I think, is quite definite.
It only allows existing buildings, land or property to be used for that purpose if they are not otherwise required. In any case the money has to be raised specially to provide for these paying beds. I can tell the hon. Member from my own experience that the effect of providing accommodation for paying patients at any hospital is not to decrease the number of beds available for ordinary patients, but to increase it. There are many people who cannot afford to pay large charges elsewhere, but who need treatment which hospitals alone can give, and who have to go into the ordinary wards. The effect of providing paying accommodation will be to set free beds in the ordinary wards.
I regret to say that this belated reference to a Clause in the Bill with which I had already familiarised myself by no means removes my apprehensions, nor do I think it will remove those of other Members. I do not wish to detain the House further, and therefore will leave the matter there. I only desire to make one other observation in conclusion. Before the House gives a Third Reading to the Bill, I should like to ask whether hon. Members have sufficiently considered the possibility that voluntary hospitals, after the passing of the Bill, may stand to lose, in a direction that has not been indicated, a large proportion of what they stand to gain financially from the Bill. Voluntary hospitals have to employ a great deal of wage labour, and it is an unfortunate circumstance, justified to some extent by the conditions under which their work is carried on, that in many instances that paid labour is not paid the same rate of remuneration that would be paid for the same kind of labour in the ordinary industrial market.
I am thinking, for instance, of such questions as those associated with the carrying on of laundry and other manual work, sometimes very great in volume, which is associated with hospitals. I had occasion recently to draw attention to the circumstance that voluntary hospitals in some cases were sheltering themselves behind the nature of the work they had and the comparative inadequacy of the funds provided for carrying on that work to pay very miserable wages indeed to some of their employes. A case came to my notice of a woman who made application to the public assistance committee of which I was a member. When the household income had to be considered it was discovered that of her two daughters, who provided the whole of the income, one aged 21 was receiving a wage of 12s. 6d. a week for work in a laundry and the other—
I do not share the misgivings of my hon. Friends that this is going to restrict the possibility of the accommodation of poor patients. As one who has spent a large part of his time as an officer of a hospital and who is now vice-chairman of one of the biggest and most important hospitals near London, I have sufficient experience to justify me in assuming that this is going to extend rather than restrict hospital accommodation. The great majority of hospitals can already do this. The Bill is going to affect only a very small minority of hospitals. If the misgivings to which we have been listening w ere justifiable, they would be in operation now. Most of the hospitals, especially in London, already have fee-paying patients, because they are not restricted by the trusts which were their foundation. Because I feel like that, I hope that we are not going to spend very much more time in preventing the Bill going through, but that the House will take the assurance of one who has some experience that this will not diminish the opportunities for the poorer patients getting treatment.
|Division No. 171.]||AYES.||[12.50 p.m.|
|Adams, D. (Consett)||Chapman, A. (Rutherglen)||Green, W. H. (Deptford)|
|Adams, D. M. (Poplar, S.)||Chater, D.||Griffith, F. Kingsley (M'ddl'sbro, W.)|
|Adams, S. V. T. (Leeds, W.)||Chorlton, A. E. L.||Grimston, R. V.|
|Adamson, W. M.||Clynes, Rt. Hon. J. R.||Groves, T. E.|
|Anderson, Sir A. Garrett (C. of Ldn.)||Cobb, Sir C. S.||Gunston, Capt. D. W.|
|Anderson, F. (Whitehaven)||Cocks, F. S.||Hamilton. Sir G. C.|
|Apsley, Lord||Cooke, J. D. (Hammersmith, S.)||Hannah, I. C.|
|Aske, Sir R. W.||Crooke, J. S.||Hannon, Sir P. J. H.|
|Attlee, Rt. Hon. C. R.||Crookshank, Capt. H. F. C.||Harris, Sir P. A.|
|Banfield, J. W.||Cross, R. H.||Harvey, G.|
|Barnes, A. J.||Crossley, A. C.||Haslam, Sir J. (Bolton)|
|Barr, J.||Cruddas, Col. B.||Heneage, Lleut.-Colonel A. P.|
|Batey, J.||Davies, R. J. (Westhoughton)||Herbert, Major J. A. (Monmouth)|
|Beaumont, Hon. R. E. B. (Portsm'h)||Denman, Hon. R. D.||Hills, A. (Pontefract)|
|Benson, G.||Donner, P. W.||Holmes, J. S.|
|Bossom, A. C.||Ede, J. C,||Hope, Captain Hon. A. O. J.|
|Boulton, W. W.||Edwards, Sir C. (Bedwellty)||Hopkin, D.|
|Broad, F. A.||Ellis, Sir G.||Hudson, Capt. A. U. M. (Hack., N.)|
|Brocklebank, C. E. R.||Findlay, Sir E.||Jackson, Sir H.|
|Browne, A. C. (Belfast, W.)||Fox, Sir G. w. G.||James, Wing-Commander A. W.|
|Bull, B. B.||Fyfe, D. P. M.||Jenkins, Sir W. (Neath)|
|Burke, W. A.||Gardner, B. W.||John, W.|
|Cape, T.||Gluckstein, L. H.||Keeling, E. H.|
|Castlereagn, Viscount||Goldie, N. B.||Law, R. K. (Hull, S.W)|
|Channon, H.||Goodman. Col. A. W||Lee, F|
|Leech, Dr. J. W.||Orr-Ewlng, I. L.||Somerville, A. A. (Windsor)|
|Leslie, J. R.||Palmer, G. E. H.||Southby, Comdr. A. R. J.|
|Llewellin, Lieut.-Col. J. J.||Peake, O.||Strauss, H. G. (Norwich)|
|Lloyd, G. W.||Penny, Sir G.||Sueter, Rear-Admiral Sir M. F.|
|Loftus, P. C.||Pilkington, M.||Sutcllffe, H.|
|Lovat-Fraser, J. A.||Potts, J.||Thomas, J. P. L. (Hereford)|
|Mabane, W. (Huddersfield)||Pownall, Sir Assheton||Thorne, W.|
|MacDonald, Rt. Hn. J. R. (Scot. U.)||Procter, Major H. A.||Thurtie, E.|
|McEwen, Capt. J. H. F.||Rankin, R.||Tinker, J. J.|
|McGhee, H. G.||Rathbone, J. R. (Bodmin)||Touche, G. C.|
|MacLaren, A.||Reed, A. C. (Exeter)||Viant, S. P.|
|Macnamara, Capt. J. R. J.||Reid, Sir D. D. (Down)||Wakefield, W. W.|
|MacNeill, Weir, L.||Reid, W. Allan (Derby)||Walker, J.|
|Makins, Brig.-Gen. E.||Remer, J. R.||Ward, Lieut.-Col. Sir A. L. (Hull)|
|Manningham-Buller, Sir M.||Rickards, G. W. (Skipton)||Warrender, Sir V.|
|Margesson, Capt. Rt. Hon. H. D. R.||Ritson, J.||Watkins, F. C.|
|Markham, S. F.||Robinson, W. A. (St. Helens)||Wells, S. R.|
|Maxwell, S. A.||Ropner, Colonel L,||Wickham, Lt.-Col. E. T. R.|
|Mayhew, Lt.-Col. J.||Russell, S. H. M. (Darwen)||Williams, D. (Swansea, E.)|
|Messer, F.||Salmon, Sir I.||Williams, H. G. (Croydon, S.)|
|Mills, Sir F. (Leyton, E.)||Sandeman, Sir N. S.||Wilson, Lt.-Col. Sir A. T. (Hitchin)|
|Moreing, A. C.||Savery, Servington||Wilson, C. H. (Attercliffe)|
|Morris, O. T. (Cardiff, E.)||Scott, Lord William||Womersley, Sir W. J.|
|Morris-Jones, Dr. J. H.||Seely, Sir H. M.||Woods, G. S. (Finsbury)|
|Muff, G.||Shaw, Major P. S. (Wavertree)|
|Neven-Spence, Maj. B. H. H.||Simon, Rt. Hon. Sir J. A.||TELLERS FOR THE AYES.—|
|Oliver, G. H||Somervell, Sir D. B. (Crewe)||Mr. Storey and Dr. Howitt.|
|Charleton, H. C.||Jagger, J.||Rowson, G.|
|Daggar, G.||Jenkins, A. (Pontypool)||Silverman, S. S.|
|Davles, S. O. (Merthyr)||Lawson, J. J.||Smith, Ben (Rotherhithe)|
|Dunn, E. (Rother Valley)||Mainwaring, W. H.||Taylor, R. J. (Morpeth)|
|Hall, G. H. (Aberdare)||Mathers, G,||Windsor, W. (Hull, C.)|
|Hall, J. H. (Whitechapel)||Montague, F.|
|Henderson, T, (Tradeston)||Paling, W.||TELLERS FOR THE NOES.—|
|Mr. Marklew and Mr. Frankel.|