asked the Minister of Health (1) what purpose has been achieved by issuing the White Paper on the health services, in view of the fact that he has now, in response to representations from the B.M.A., proposed an alternative structure fundamentally different from that outlined in the White Paper;
(2) why the proposed Salaried Medical Service operated from health centres and offering a new advance in medical practice, has been dropped at the request of the B.M.A.;
(3) what is the purpose of the experimental health centres contemplated in the alternative proposals to those contained in the White Paper, in view of the fact that they will provide accommodation from which doctors can conduct private practice more conveniently but on the same terms and lines as those practising from their homes.
The three Questions are all concerned with a wide subject and perhaps the hon. Lady will wait until she has heard the answer and see whether it covers her three Questions adequately.
On a point of Order. The right hon. and learned Gentleman said he would answer these three Questions together, with permission. Why did he ask the permission of the House, when he had the answers prepared in a combined form?
There seems to be much misunderstanding on this matter, and I welcome this opportunity of clearing it up. The proposals in the White Paper were for discussion before the Government decided on the terms of draft legislation. Discussion was invited with all the major professional and other organisations affected, and this discussion has been—and is still—taking place. In the course of it various possible modifications of the detailed proposals have been discussed by my right hon. Friend the Secretary of State for Scotland and myself with the several organisations; that is what the discussions were for. Soon my right hon. Friend and myself will consider with our colleagues some of these alternative methods of achieving the White Paper's objective, a comprehensive service of health for the nation. The Government will have then to decide whether these—or any of them—are desirable alternatives or not.
Before informing the Government of their views on these possible alternatives, the, various organisations — medical, dental, voluntary hospital, local authority —are considering, on reports from their representatives who took part in the talks, the matters which have been discussed. It is to some of those reports, no doubt, or to varying rumours about those reports, that recent references have been made.
When the views of the different organisations are available, the Government will decide upon the content of draft legislation for submission to the House, while discussion of much detail which may not need to be included in the Bill itself will go on. Until then the three stages of the procedure originally laid down—the White Paper, discussion of the White Paper and final preparation of draft legislation—are being adhered to, and the objects of this second stage have been those which were clearly set out in the introductory paragraphs of the White Paper.
Is it not a fact that before a White Paper is published full discussions have already taken place between the people who are interested, and that so far as this question is concerned the British Medical Association, and other medical organisations, had already thrashed out every question of principle with the Ministry?[HON. MEMBERS: "No."] The Minister said that only details are being altered, but is it not a fact that in this report, which has been published, and which is in the hands of every doctor in the country, and many lay people, too, every fundamental principle laid down in the White Paper has been altered?
The hon. Lady is under a complete misapprehension with regard to the function of a White Paper. A White Paper in such a case as this represents the outcome of discussions, but it also affords a new focus for discussion, particularly after the White Paper has been discussed in this House. The White Paper itself contemplated that there would be such discussions. The hon. Lady is under a further misapprehension, as I understand the facts, when she refers to the publication of this report. My information is that every copy of this report was marked "Not for Publication." She is under a third misapprehension when she refers to anything having been dropped. My answer makes it perfectly clear that the Government as a whole have not considered the outcome of these discussions.
In the course of discussions of this kind I should certainly not express an attitude to any particular proposals, which might embarrass the Government's ultimate decision on them. Discussions such as this give rise to alternatives and modifications for consideration by the Government.
Whether one approves the general system of issuing White Papers or not, is is not a perfectly proper and democratic method of operation, when a White Paper has been issued, to call into consultation all those who are likely to be affected; and would it not be quite absurd to issue a White Paper and then say that it cannot be amended in any form?
Is the Minister aware that statements have been made by members of the British Medical Association to the effect that their interpretation of their discussions with the Minister has led them to the conclusion that he has made certain concessions, or has agreed to put certain modifications before his colleagues in the Government? Is that correct?
My hon. Friend gave notice that she would raise this matter again on the Adjournment and I would like to know whether that will prevent the matter coming up again in the ordinary course in other circumstances.