Amendment proposed, to leave out from "That", to the end of the Question, and to add instead thereof:
this House, while welcoming a comprehensive Health Service, declines to give a Third Reading to a Bill which discourages voluntary effort and association; mutilates the structure of local government; dangerously increases Ministerial power and patronage; appropriates trust funds and benefactions in contempt of the wishes of donors and subscribers; and undermines the freedom and independence of the medical profession to the detriment of the nation.
When ancient ceremony interrupted our proceedings, Mr. Speaker, I was saying that the Minister deals the freedom of the general practitioner four blows. He prohibits the sale and purchase of practices, he does not allow the doctor to practise anywhere he wishes, he gives power to the tribunal to rob him of his livelihood without appeal to an independent court, and, lastly, there is that clement of salary which will now appear in the income of all practitioners. So much for the practitioner.
The enterprise of the specialist is curtailed in several ways by the Bill; for example, by the Minister's refusal to allow a specialist who is not in the Service to send his patients to a hospital, and by the Minister's power to take Over any clinic which a group of successful specialists may have established outside the service. There can be no doubt that the freedom and choice of doctor and patient are, in these ways, going to be limited. But I assume that, when hon. Members opposite vote this afternoon, they will say that these inevitable results are cheap at the price because they are going out for a great increase in administrative tidiness and because they do not believe that the freedom of choice was ever important over a wide area.
They might point to my own father's work as a surgeon in St. Bartholomew's Hospital. How many of the patients in the general wards, on whom he operated, had chosen him as their surgeon, or even knew his name before he first examined them? Without doubt, very few, and without doubt he performed those operations with as much care as any for which he received a hundred guineas. Why, then, all this fuss about the freedom of choice? So long as there is a qualified physician or surgeon available to every sick person, who really cares whether the patient has chosen that doctor or whether the doctor has agreed to treat the patient? So long as there are well-equipped beds somewhere in the region, who really cares where, exactly, those beds are, and how the hospital is managed or owned? So runs the argument for a Socialist medical service, and this Bill takes a very long stride in that direction. It is against this doctrine of utility medicine in utility hospitals that the doctors whom I have known would have protested so strongly.
There are, I think, two reasons why patients accept unknown doctors in hospitals. The first is that they have confidence in the hospital itself—perhaps some of their friends have been well treated there, perhaps they know someone who works there, or have themselves contributed to the hospital, and feel in partnership with its work. Perhaps, most likely, the general practitioner who has sent them to that hospital is a man in whom they trust. In this matter of confidence in a hospital, I draw no distinction between a voluntary and a municipal hospital except to note that confidence is most easily given to an institution which has a character of its own, and that the more remote is the management, the more difficult it is to build up a character of that kind.
The other reason for the confidence of patients in a particular hospital is that all doctors, whether they are general practitioners or specialists, have learned their medicine under the guidance of men who themselves have imbibed and are themselves embellishing the great tradition of undivided responsibility of the independent doctor to his patient. This tradition of single service has been taught to succeeding generations of medical students, along with their anatomy and their chemistry and all the rest of the medical curriculum. The Minister recognises the value of this tradition by the special and unsocialist treatment which he gives to the teaching hospitals. But how car. he expect these teaching hospitals, in the future, to be able to instil the same sense of duty when the students know that part of their income is to be State salary and that, throughout their careers, they will be affected by the favour or disfavour of the Minister or his nominees?
I know that there will always be some men who, once they have been given their salary and their post by a State-appointed Committee, will never again bother their heads about their paymaster.
Doctors less than other people. Such men will selflessly devote themselves to research and, perhaps, to a State Colonial service of the type mentioned by the hon. Member for Rochdale (Dr. Morgan) and to their patients. There will be some such men, we all wish there were more, but the fact is that that kind of men will always be the exception and not the rule. Therefore, I must ask again, Can a man serve two masters? I am quite certain that Lord Dawson of Penn would have said that the unselfish and unsparing work for which the British medical profession is well known has had its roots in this tradition of undivided responsibility by the independent doctor to his patient.
The hon. Member has mentioned that point several times and has invoked the ghost of a relative in order to reinforce his argument. In what way and in what part of the Bill does the Minister, or, indeed, any one of the boards under the Bill, interfere with the professional conduct of the doctor towards his patient?
I was saying that we shall find in the medical profession, as we find in the Church and other great professions, a number of men who are willing quite selflessly to devote themselves to the work of their lives, but the normal reaction of human beings is to keep one eye on the boss, whoever he is. There are always some people who will be good State servants, but the point that I wish to make is, that the quality of the profession depends upon the general run of doctors being brought up in this great tradition of undivided responsibility to the patients. In my judgment and, I am certain, in my relative's judgment, which I infinitely prefer to the Minister's, the high level of service which has been given to patients, whether or not they have wide choice of doctor, has been directly due to the standards of the medical profession. The ethics of a profession are hard to describe in words. Like liberty itself, they are precious values which are more easily recognised and denned when lost than when enjoyed. They are not just matters of honesty, or of accurately accounting for money spent and money earned. They are traditions of behaviour that saturate a man's conduct, as water goes through a lump of sugar. I ask again, How can a man serve two masters? What will it profit the Minister if he sets up this comprehensive and over-centralised health service, only to find doctors and nurses pay more attention to his regulations than to their patients?
There arc in this Bill some good things, which, I think, all thoughtful doctors will admit; but they do not justify this doctrinaire and un-English attack on what is most obviously in the interests of the patients themselves, namely, the quality and character of the doctors. The Amendment which has been moved from these Benches shows that the origin of these faults and omissions in the Bill is this Government's consuming passion for concentrating in their own hands power and responsibility that would be much better delegated down the line. In this case it should have been left with the medical profession, the local authorities, and the governing bodies of hospitals. The Minister had a chance—I think, a magnificent chance—to use the genius of the British race to reconcile the opposites of liberty and order. He has thrown away, and wastefully thrown away, our peculiar capacity to blend local and voluntary services with Government plans. He knows, as well as I know, that for many years the leaders of the medical profession have said that our hospital services, running on those two parallel lines, voluntary and municipal, were quite inadequate. The first person to suggest the remedy was Lord Dawson in his Committee of 1920; he correctly diagnosed the disease in our hospital system; but the treatment which he advocated was not this Socialist amputation, which is about to be performed by the totalitarian knife of the right hon. Gentleman, but the grafting of new services on the old, the keeping of what was good and, as quickly as it proved to be administratively wise to do so, the adding of still better services on to what we knew was working well before.
This Bill has a grand objective, but, as the hon. Member for Putney (Mr. Linstead) said, it sets up a second-rate instrument to achieve it, for all the way through it puts more emphasis on the control than on the character of the doctors, and it pays more attention to the finances, administration and ownership of the hospitals than to the care and recovery of the sick. This afternoon the House will pass an unsatisfactory Measure, but I believe that the time is not far distant when we shall have an opportunity to reverse the harsh and unimaginative provisions of this Bill, and to delegate, to those most capable of wielding them, the power and responsibility which the Minister, so arrogantly and so unjustifiably, takes to himself, and to himself alone.
Those of us who have had practical experience of the working of our existing health services have, inevitably, been impressed by the enormous diversity and the enormous number of the existing interests in these services, and I think that one of the great achievements of the Minister in framing this Bill has been that of cutting through them in a very determined way; which was, in fact, the only way to produce a really workable health service for this country. I have been a little bit disappointed, like the hon. Lady the Member for Liverpool Exchange (Mrs. Braddock), by the case the Opposition have put against this Bill. We have got here a vast, human Measure, with an enormous number of human problems—the care of the chronic sick, the provision of ambulance services, of specialist services in rural areas, of single bed wards and so on— yet almost all the discussion on these has come from this side of the House, and we have from the other, mainly, rather an arid, legalistic approach. When one comes to look at the picture which our opponents have painted, one finds that it is a picture of commercially-minded doctors and commercially-minded testators, and I am sure that that picture is, in fact, an unjust one. When we come to look at the reasoned Amendment which has been presented against this Motion for Third Reading, I think that that equally falls to the ground.
My hon. Friend the Parliamentary Secretary has himself dealt it some shrewd blows, but there are a few little extra coups I should like to administer. First, on the question of the discouragement of effort and association. The only kind of voluntary effort, as far as I can see, that goes is the signing of one's name at the bottom of a cheque, or the selling of flags. The need for real voluntary effort has never been greater. If those ladies, who complain about the getting rid of the voluntary hospitals really want to help them, let them organise themselves, and, once a week come along and do some domestic work in the hospitals. The real form of voluntary service which we want to have is work in those places, in the linen rooms and in the kitchens. Any one who has seen the conditions under which night nurses work, and, particularly, the food they receive, will know the enormous amount of voluntary effort that is still waiting to be done in our hospitals under the present organisation.
On the question of the mutilation of the structure of local government, if there is one thing on which hospital reformers of all political philosophies are agreed, it is that there should be one hospital system, and not two, and that it should be organised on a regional basis. The doctors themselves are pretty well united in not wishing for the hospital services to be run by the local authorities. There is a long history behind this view, but it is the doctors' view, and hon, and right hon. Gentlemen opposite would, in fact, return two thirds of the hospitals and two thirds of the consulting part of the medical profession from regional boards to local authorities, if they had their way. On the question of the undermining of the freedom of the medical profession, the hon. Member for Chippenham (Mr. Eccles) said the Bill makes the doctors serve two masters. Every doctor in practice has to strike a nice balance between his duty to the individual and his duty to the community. It is most obvious in the case of infectious disease, for example, and in cases where one has to see a patient who is involved in some matter which may require the police, and in unfortunate cases such as abortion. Every doctor already has to balance his duty to the individual with his duty to the community, and I am sure that he will continue to do so under the future organisation.
There is one danger, and I think that it is a real danger, which some of us have felt about this Bill, and that is that it gives to the doctors too much freedom. There is a danger that we may impose on ourselves a medical dictatorship, and a very bad thing that would be. The Minister has tried to combine the principles of industrial democracy with the principles of general democracy, and he has tried to get sufficient medical and sufficient lay representation on all the governing agencies of this scheme, so to make sure that the doctors have their say, but that the ultimate control rests with the people. It has been said that this is a skeleton, and, indeed, it is a skeleton, but its ultimate form will depend on the Regulations which the Minister makes.
I want to make some references to the proposed administration which I hope that the Minister will adopt, and which, in fact, applies to a great deal more than the medical services; which applies, I believe, to all major nationalised undertakings. First, I hope that all appointments in the new service, whether of specialists, general practitioners or to administrative posts, will all be publicly advertised. One of the disadvantages of the past has been the "hole and corner" filling of appointments—a doctor selling to a friend whom he happens to know, and who happens to be able to afford the right price for the practice. Then again, hospitals appoint, not necessarily the best person available, but the person who happens to live in the locality.
All that kind of thing has, I am afraid, been widespread in the past, and one of the hopes, which, I think, every young doctor has, is that there will be real equality of opportunity inside the new service. I hope also that there will be a maximum of mobility of doctors, so that if a doctor gets into the wrong job, or the wrong area, there will be every opportunity for him to move. That involves having superannuation schemes of the utmost flexibility. What I have said about appointments and mobility applies equally to all other health workers.
Concerning the pay of doctors and of other health workers, I hope that the Minister will be very stem on adequate objective criteria, in deciding levels of pay, and not have anyone to examine a doctor to see if he is a first, second or third grade general practitioner. The objective criteria which I have in mind are length of service, qualifications, special experience, and whether doctors have taken refresher courses; but nothing which would involve a situation where a doctor has to flatter and be in the position of having to please someone else in order to obtain extra income. That must be avoided at all costs.
May I pass now to the question of hospital administration? The essential difference between the voluntary and the municipal hospitals is not, I think, the way in which they have raised their money, but the way in which they are staffed. The municipal hospitals in the past have been staffed very largely on a hierarchial principle—the medical superintendent at the top, with £1,500 to £2,000 a year, two senior medical officers, four junior medical officers and eight very junior assistant medical officers; and the result is that, at each level, there is a number of disappointed doctors who cannot get to the top, and the top doctor is converted from a doctor into an administrator. This puts a premium on doctors becoming administrators instead of remaining physicians. In the voluntary hospitals, there has been a parallel structure, with three physicians or surgeons all equal, and assistant physicians, and the chances of promotion have been much greater. I hope that under the new scheme, as has been done in some municipal hospitals recently, we shall have the development of this parallel, rather than this hierarchial system.
I would like to say something about efficiency. Medical efficiency is, I am afraid, not all that it should be in many parts of the country. Medical qualifications are not very difficult to obtain, if one has the money and can stay the course. I wish that I could say that my profession was a very brilliant profession. It has many brilliant members, but I am afraid that, at the bottom, one-third of it is pretty low. One is concerned to know how the efficiency of the general practitioner can be improved—the general practitioner, in particular, because he is working in isolation. I believe that there is a possibility that a special form of inspection might help. It would have to be a very special form of inspection. A system which involves the reporting back on someone to someone else is most unpleasant. If one general practitioner were visited by another general practitioner, picked out for six months to do inspectoral work, and to report to no one except to the doctor he inspected, I believe that we should get an increased measure of efficiency, because he would be someone who could go round with the doctor for a day, and it is my own experience, that there is nothing else that teaches one more.
Finally, a word about red tape? In any medical organisation, whether it is a voluntary hospital, a municipal hospital or a clinic, there is bound to be a great deal of paper, because medical notes must be kept in great detail if the patients are to have proper treatment when they change from specialist to specialist, as they must change, and when special investigations are made. I hope that the Minister will do two things to help check the profligation of paper. The first of these is to provide adequate secretarial help for all doctors in the service. Their writing often cannot be read, and it is not worth writing if someone else cannot read what one has written. Secondly, I hope that the circulars, which must be issued, will be written in the King's English, and in large type, so that they are legible, short and useful, because if they are written in microscopic type in the old language, which I hope is disappearing from Civil Service use, they will not be read by doctors at the end of a busy day.
The B.M.A., at the moment, is considering whether the doctors shall negotiate on these proposals. I hope that they decide to negotiate, because it really will be a case of cutting off one's nose to spite one's face if they do not come in when this Bill becomes law.
The hon. Gentleman is wrong. The Minister has said that the conditions of service, salary and compensation must be done by negotiation in the proper trade union manner. Finally, I would say this is not a drab extension of commercialism, but a glorious adventure, and that is what the medical profession, and the nursing profession, and all those asociated with health work ought to feel. I am sure that when the organisation begins to exist that that is the spirit which will pervade it.
I should like to join with those other Members who have congratulated the Minister, at present absent from the House, upon the skill and great good humour with which he has piloted this Measure both in the Committee upstairs and in the various stages upon the Floor of the House. That is not to say that we do not think that he was unbending and unyielding on some very important parts of the Bill. The House will agree, irrespective of where hon. Members may sit, that the general aims and purposes behind this Bill are desirable, and" all Members, as far as I have heard their speeches on this Bill, accept those general aims and purposes. The differences are as to ways and means that have been taken. I find it very difficult to assess the full implication of this Bill from the Bill itself. Its structure alters substantially a great deal of the local government organisation of the country. Whether that is good or bad is a matter of opinion. The Bill centralises the health services, and if the matter stood there and there alone, I think one would be compelled to vote against the Third Reading, because in the modern State, if liberty is to be preserved, it must be maintained through the structure of local government and the independence of local government interests. In the formation and development of the modern State there is no other power sufficiently strong to deal with central government.
As the hon. Member for Barnet (Dr. Taylor) said, this Bill leaves its real operations to regulations. What are those regulations to be? We do not at the moment know, but we had some assurances from the Minister in Committee. When one looks at the structure of this Bill and finds various committees working with the Minister and appointed by the Minister—regional advisory boards, general hospital management committees and so on—it becomes very important to preserve as far as possible the voluntary effort, voluntary interest and voluntary responsibility. This voluntary interest and work is an important thing, and it will be important to watch how the Minister carries out his undertakings in the regulations. He intends that the hospital management committee shall have a great deal of power given to it—more power than was at first believed. The crucial point is that the hospital management committee, the local body, shall have handed to it a very important part of its functions under this Bill.
It is important that moneys that are donated to a hospital shall be used for the purposes of that hospital so far as that may be possible. Upon that point the Minister in the Committee, as I understood it, gave an assurance that it would be done under regulation provided that the donation did not go to the extent of undermining the scheme in his Bill. If that be so, this Bill depends really upon the nature of the regulations and with the spirit with which they are framed and carried out. I dislike many of the consequences of the Bill, and some of them I dislike entirely, and I do hope that the Minister will even yet think again, especially on such matters as the doctor's right of appeal to the courts, and that he will concede the point that has been made. He must direct his mind completely on this, and not think of it as a mistaken or misguided idea but as a very important point. I will leave that point at the moment, but I hope that he will reconsider it. I hope too, that the regulations will be so framed as to maintain in the new form and in the new structure the maximum amount of local interest and local responsibility. I hope that the objects of the Bill will be achieved by the work of all people called upon to put it into practice, so that it will be given a fair chance to work successfully and so that the liberty both of the medical profession and of local interest will be preserved.
We are now coming to the stage when we part with the Bill, which has filled the minds and occupied the attentions of many of us for a very long time. Those of us who quite early in the Coalition Government took part in the conversations in the days when Mr. Ernest Brown was at the Ministry of Health, and following that when the right hon. and learned Member for North Croydon (Mr. Willink) was Minister of Health, realised that there was an enormous problem to face in getting anything like a national service, because large numbers of interests were affected, including the local authorities, various sections of the medical profession, large numbers of voluntary agencies and, in addition, the modern hospitals. We realised it was a problem of great immensity. When this Bill passed its Second Reading and went to Committee, I was under the impression that there we were going into an operating theatre where we would see a great deal of surgical work performed, but the surgeon in charge did not give us very much chance. He did most of the operating himself. I think the Committee will agree that he did his job very well indeed. He was meeting all the forensic skill of the legal pundits and he met it with scintillating and dialectic brilliance. As one who disagreed with him at the beginning in some things and at the finish agreed with him in most, I think that if he did anything at all with outstanding success it was the way he applied the anaesthetic to the supporters on his own side, which anaesthetic when it was taken made a good many believe in things that they had opposed almost all their lives.
We have emerged from that stage, and we see the Bill as it is. I do not think it would be fair if we were to concentrate on those things which perhaps are not so important and are details which do not affect the benefits to be given under the Bill. There is a tendency for us to lose sight of what we gain by this Bill. No longer will the working class family have to wonder where it is to find the money for the doctor's bill. The insured workman was covered; now the insured workman's wife and family are covered. No longer will they have to delay getting medical attention because they cannot afford to pay for it. I wonder if Members generally realise the humiliating experience some patients have to undergo when the time arrives for them to go to a hospital. They do not see the doctor at first; they sec the almoner. That person does not do much almonery work but he is an assessment clerk who asks a lot of questions such as the patient's religion, and, if a woman, what her husband does, and so on. Finally, having given all the evidence possible against themselves, such people find themselves sentenced to pay so much per week while they are in hospital as a patient. Thus at a time when these people are getting less than their usual income, because illness has overtaken the family, they are called upon to meet heavier expenses. This Bill does meet that position, and because it does that it is a benefit which will enable us to compensate ourselves for some of the things in which we are interested. There is now the same door open for the working man as for the rich.
I must confess that on the Second Reading I was a critic, because I felt there was a danger in remoteness of control. I, and others, thought that a human service was being taken too far away from the people, but now they have been assured that management committees will have the measure of power that we felt was necessary. It is a dangerous thing for control to be vested in a centre 50 or more miles removed from the periphery. It is essential that the patient should be able to get in touch with the people on the spot, who are responsible for administration. A hospital is not merely a place to which a human being goes to be cured. The person is suffering while he is being cured, and mere mechanical efficiency is not enough. What is required is that while he is at the hospital he shall have as comfortable a life as possible, and decent food. One of the biggest problems of hospital administration, at present, is decent food. I have investigated this matter. Some time ago, the Ministry of Labour brought out a circular on this question. I have seen excellent food purchased and cooked, and I have been in the wards to see meals served up which were unappetising. The strange thing is that a dietician will tell you what calories, vitamins, and other things are required to make a balanced meal, but all that advice is wasted unless you can be assured that the vehicle of these qualities gets where you want it to get.
The problem of hospital catering is very important. My own authority are trying the experiment of appointing a special officer, whose sole job it will be to secure that the meal served to the patient is similar to that which he would get in ordinary life. People who are ill are living an artificial life. It is not simply that they are in pain, or are suffering, but that they arc robbed of life's dearest possession— activity, freedom, and the ability to come and go. Special consideration has to be given to sick people in consequence of that. If management committees were entirely dependent on a central authority, miles away, we should lack that detailed day to day human touch which is so essential to the patient. That is one of the things to which I hope the Minister will attend. One good thing I am pleased to see is the freedom with which people will now be able to get appliances which previously were denied to them. I refer, particularly, to surgical appliances. Imagine a woman with a caliper splint, or a child with a surgical boot. They are already penalised. Imagine someone wearing a spinal jacket costing £30 or £40. He is already penalised. This Bill will provide such surgical appliances, and I am very happy indeed about that.
Now I leave that side of the question, to deal with one or two matters in respect of which I think the Bill might be im- proved. I want to refer to the separation of the maternity services. I know the view is held that maternity is a normal part of a woman's life, that child-bearing is not a pathological condition, and that if reasonable arrangements are made for domiciliary midwifery that is all that matters. But the truth is that in present circumstances child-bearing is a social, as well as a medical, problem. I want to say nothing about the division of medical responsibility, where the woman, during her ante-natal period, will be treated at a clinic, under the care of the local health authority, and will go to hospital if she has to be subjected to a difficult Caesarean operation, or something of that description. But I would like to see in the Bill a power that gives to the local authority the right to secure maternity accommodation for the woman who is to have a normal confinement. In the Bill there is no provision for a local health authority to set up that type of accommodation. At present, owing to housing congestion, many homes are quite unsuitable for confinements. The mother has to be in bed for a time, and her confinement adds to the strain of the already congested household. So, I hoped that local authorities would have been empowered to provide maternity accommodation. There are many women who arc now hospital conscious, and who believe that confinement should take place outside their own home.
I find myself in disagreement with the Minister in not giving to the local health authorities responsibility for the ambulance service. My view is that that service is part of the hospital service, and that unless a hospital authority can have the security of transport for its patients it may be a bad thing for those patients. Within the last two weeks, I have received a letter from the medical director of a hospital, quoting two cases. A local authority, which was the supervisory authority under the Midwives Act, was doing its job within the limits of that Act. A midwife attended a case, and had difficulty in expelling the placents. She did her best, and, as she was allowed under the Act, called a doctor, but was unable to get one. The second case was one of uncontrolled haemorrhage, where no fewer than nine doctors were approached, but not one could come. Finally, in desperation, the midwife got in touch with a hospital, which was able at once to send an ambulance to the case, with blood transfusion appliances. The woman's life was saved. The point is that it was the speed with which the patient got to hospital that determined it.
Let me give an illustration of what may happen if, as under the Bill, the ambulance service remains under local government, with no close connection with the hospital authority. I know the argument that will be used. It will be said that, at the present time, a vast number of hospitals have not an ambulance service and are dependent upon local authorities. That, however, does not alter the fact that the purpose of this Bill is to make things better, and not to keep them as they are. This is what may happen. Let it be remembered that under the Bill a local health authority need not provide the ambulance service itself; it can farm out the job to a contractor.
A doctor may be called to a case. It may be in the middle of the night. The general practitioner has been attending a case of a perforated peptic ulcer or a strangulated hernia. This case is one for instant hospital treatment. Under the Bill, the doctor has to ring up the local authority, which in certain circumstances will have ambulance stations. If he asks for an ambulance at once, the answer may be, "You will have to take your turn, because the ambulances arc out." If the doctor then says, "But this is an urgent case and as a doctor I tell you that the ambulance is required at once," whoever is at the other end of the 'phone may say, "I have already got into trouble for giving priorities, because every doctor says the case is urgent and the ambulance is needed at once." The doctor then says, "There is a bed in the hospital, and as there is a bed waiting, surely you will give me priority?" The answer may be "No." Whose responsibility is that patient? Is the general practitioner still responsible? Is the local authority responsible? Is the hospital responsible? The hospital has undertaken to give a bed, the general practitioner is trying to get an ambulance, and the ambulance authority have their fleet of ambulances out already. I suggest that this is a weakness in the Bill. The ambulance service, as far as that type of work is concerned, ought to be connected with the hospital.
Let me invert the case and see what happens if the ambulance service is part of the hospital service. The doctor 'phones the hospital and says, "Have you a bed for this type of case?" In the receiving ward there is a doctor who knows what accommodation there is. He says, "Yes, of course." Incidentally, most hospitals have a reserve of beds for emergency cases. The general practitioner need do nothing else than give the name and address of the patient. The hospital authority sends an ambulance out at once, or if there is one on the road, instructs it to go. Even if all the hospital ambulances are out, there is still a second string, because the local authority must have some ambulance services in connection with the fire brigade service, and so on. I suggest that, in the interests of expedition and efficiency, the ambulance service ought to be a hospital service.
The local health authority is to be enabled to provide a domiciliary service which will include domestic help. I think that here there is another weakness in the Bill. Domestic help will be given in certain cases. Among those cases are illness, the presence of children under compulsory school age, mental cases, and so on. In Clause 78 there is a definition of illness. I think it would have been better if the definition of illness had been omitted. As soon as one defines things, the very fact that there is a definition excludes everything that is not defined. Because illness is defined in this way in the Bill, it may be possible for a woman who has had a minor injury which necessitates nursing care or medical attention to get a home help, but there may be a woman who is a helpless cripple and who, because she does not get any nursing help or medical attention, cannot have home help. There may be someone who has passed through the treatment stage and is blind, but according to the Bill, such a person cannot get home help. These are weaknesses which can very easily be remedied.
I think the hon. and learned Member for Carmarthen (Mr. Hopkin Morris) was right when he said that it is the regulations that will be important with reference to this Bill. I do not remember any other Bill which has so much depended on regulations. When we get those regulations in front of us, we shall see just how the Measure will work. At the moment we are able to visualise the machinery, but we are not able to visualise entirely how that machinery is to operate. It will not be until we get the regulations that we shall be able to do so. When those regulations are before us, I hope we shall be given an opportunity of making what suggestions we can to the Minister in regard to them, so as to ensure that in this new set-up we preserve the best of the past and bring in, in addition, all those improvements which the past has shown to be necessary. I wish to express my very great pleasure at being present at the Third Reading of a Bill in which I am intensely interested. There is no more important service. It has its economic side, it has its human side, for it is true to say that the wealth of a nation is in the health of its people.
By any test, this is a tremendous Measure; there can be no question about that. With all its faults it must go down in history as one of the outstanding ventures of this generation, designed to deal comprehensively and boldly in a field of national endeavour which is of the very utmost importance to the wellbeing of the nation. I think there is no one who can be satisfied with things as they are, or feel that at present we are making the best use of our most priceless asset, the personal wellbeing of the nation as individuals. For these reasons, and because we sincerely desire to see an ambitious scheme of coordination and expansion, brought into being, and because we are aware of the actualities and potentialities, those of us who feel bound to vote for the Amendment do so with a sense of very real regret that we cannot conscientiously support the Bill as it now is. We approve of the broad principles, but it is because we feel that the Bill contains certain defects which could quite easily have been eliminated, without detriment either to the principles or the administration, that we feel bound to take the action we are taking.
What are the defects? I can state them very shortly. I think there are four. First, not enough attention has been paid to the retention of local responsibility; secondly, the proposal to pool the hospital endowments seems to me to be entirely indefensible; thirdly, in spite of the assurances we have been given, I doubt whether the professional independence of the doctors has been adequately and satisfactorily safeguarded; and fourthly, like most Bills that come before us nowadays, this Bill leaves a tremendous power in the hands of the Minister to make or mar the Bill by his regulations. I will say a few words on each of those four defects. First, I confess that I am a confirmed decentraliser. I realise the immediate gain and the important advantages that arc to be obtained sometimes by a drastic measure of centralisation, and I realise also that we arc living in an age of highly geared organisation and that some greater degree of centralisation is inevitable. I hold however that the value of an alert, vigorous, sense of local responsibility and spirit of voluntary effort is so great as to be worth paying a big price for, in terms of administrative convenience and, if necessary, in hard cash, too. Surely, that spirit of local responsibility and voluntary enterprise is among the greatest contributions that our nation has made to the development of a form of democracy that works and gets results, and we should be very careful before we do anything to reduce the possibilities in that direction.
The principle we should adopt—it has been followed to some extent in the Bill although not far enough—is that if we have to eliminate one local institution we should try to create another local institution more fitted to the needs of the future. I hope that some of the regions will not be too big and I hope that complete mathematical equality in terms of population will not be the principle adopted, but that of associating areas which group themselves naturally together and have already in the past tended naturally to work together. I realise of course that that will not lead to regions of equal area throughout the country.
The proposed treatment of endowments may be expedient, but is it morally justified? There seems to me to be a most dangerous tendency today for the State to claim standards of conduct which if adopted by an individual would be condemned by most people as entirely deplorable. The State should set an absolutely impeccable standard of ethical conduct, particularly today when a Government arc in power who claim to be out to guide the nation into better ways. The third point is about the doctors. Throughout, the Bill seems to regard doctors with an attitude of suspicion, as Though they were a body of men who, given the opportunity, would abuse their position. [HON. MEMBERS: "No."] The record of our medical profession does not furnish anything which should give rise to that suspicion. We are told from time to time of a commercial attitude on their part. I suggest that what the doctors are anxious about is their professional independence more than their commercial independence.
Lastly is the question of the Minister's powers. Bill after Bill is brought before us containing the same feature. Every time we are assured, "You need not worry. We admit that the Minister has tremendous powers and that in the exercise of those powers he may make or mar the Bill; but don't worry. He won't use those powers, at any rate to mar the Bill." We do worry. We regard that answer as an insidious one and profoundly unsatisfactory. Far from allaying our doubts the answer is bound to stimulate our vigilance.
The Bill has great aims. Its introduction presented us with a marvellous opportunity. Many of us who are voting for the Amendment do not do so because we want to delay for one single day a great scheme of improvement in our health services, but because we think that, without the loss of any advantage, certain defects could so easily be removed from the Bill. We feel bound to put that view on record. If by any chance our views, do prevail, speaking personally, I am sure our attitude will be one of complete loyalty to whatever scheme is brought into force. We shall do our utmost to play our own parts as opportunity offers in making that scheme work.
It is more than 12 years since I first started to speak to groups of people concerning the need for a State medical service, and then I was only carrying on what other people had urged before my time. I am glad that at last legislation embodying the very principles for which we were then pressing is now being carried through Parliament. I hope that it will be a complete health service that will cover every citizen in the land, and will be very much in advance of anything that we have yet known. I was amazed at the hon. Member for Tiverton (Mr. Amory), after saying that the Bill would give us a marvellous opportunity of doing what we had wanted to do for many years, also saying that he was proposing to vote against it. According to the Amendment moved on behalf of the Opposition, the Opposition do not want a national health service. They want a vested interests health scheme. I am glad that our Minister will not accept it. For the first time we have a Government in this country recognising that the health of the people is the nation's greatest asset and that health is the concern of the whole nation. Therefore, the cost of the health services should rest, not upon the sick individuals but upon the nation. I know that there is much to be done before we can get our services coordinated and extended to meet the type of service that this Bill envisages, but that is the job of every one of us here, whether on the Government side or on the Opposition side. We have to do our utmost to bring about the development that is so necessary and that will meet the complete health needs of our people.
The Bill commends itself to me because it creates conditions for an advance, a further and bigger advance, in our health needs. Secondly, because it will relieve a great deal of anxiety and unnecessary suffering. From now on the economic obstacle will be removed which prevented many of our people calling the doctor when they needed one most urgently. It is delightful to know that everyone's need for medical service will be the criterion, and not their ability to pay. The third point which commends the Bill to me is that the doctors will be where they are most needed. They will be sorted out all over the country into areas that are un-doctored at the present time. The fourth point is that the Bill will bring about that which has been advocated since 1920—the provision of health centres. Doctors working together in health centres will benefit very much by each other's advice and experience and will be able to give a much better service because of that. But the doctors will also be able to give a much better service because, placed at their disposal in those centres, will be all the modern scientific aids to medicine which financial circumstances have prevented our doctors having for themselves in the past. Therefore, because of these advantages our doctors will be able for the first time to give of their best. Last but not least of my points in commendation of the Bill, is that it will enable many of our hospitals to reach a much higher standard of efficiency and will enable our future hospitals to be planned and built on a much more extensive scale.
While I welcome the Bill, I have one or two suggestions and criticisms which I hope will be constructive. The Parliamentary Secretary told us that we were not satisfied with all that there was in the Bill. I am happy to see that the provisions for health visitors and home nursing are compulsory so that the local authorities must provide them, but I am extremely disappointed that arrangements for the prevention of illness, arrangements for the care and after care of those who suffer illness, and the provision of domestic helps, which was mentioned by the hon. Member for South Tottenham (Mr. Messer), are still to be permissive. The Labour movement, especially the members of the working classes, have recognised the crying need for these services for a very long time now. They are now accepted as permissive measures, but we shall not be satisfied until they are compulsory on all local authorities. I hope that when he brings this scheme into operation, the Minister will press forward for reforms in these matters. I should have liked to see more detailed information about the preventive side of medicine in the Bill. Perhaps that will come in the regulations. We hope that it will. This is a health Bill and not a sickness Bill, and I hope that we shall keep that well in mind when issuing the regulations.
I want to make special reference in relation to milk to the Clause dealing with the bacteriological service. Tuberculosis is still a very great enemy of man, and I understand that the non-pulmonary type of T.B. is very high in children. This is carried by milk, and therefore I urge the great need for the compulsory pasteurisation of milk until we can complete our long-term policy of securing tuberculinfree milk right from the herds to the consumer's door.
Doctors have been very unevenly distributed in the past and this Bill authorises local committees to prevent doctors going to already over-doctored areas and to try to persuade them to go to the under-doctored areas. We are told that there is a real shortage of qualified doctors and
that in the early days of our national health service there will be difficulties in the change-over because of that shortage. I have had handed to me an article written in the "Lancet" of 29th June. I understand that this paper is considered to be a very sound and very honest journal. This article deals with the unemployment that is prevalent amongst doctors due to the fact that this Act will not come into operation until April 1st, 1948. The article explains it much more clearly than I could do, so i will read a small part of it to give the House an idea of what is happening in the medical profession today. It says:
The introduction of the Health Bill at any time might have caused some inconvenience especially to younger men not already holding a permanent appointment; and under ordinary conditions the mass demobilisation of doctors might have been associated with some little disturbance before each man found his niche in civilian life. Together, these circumstances have produced much greater difficulties. The experience of a leading medical agency is that, until the Bill was introduced, there was a steady demand for demobilised doctors alike as successors, partners and assistants; there was no difficulty in finding employment for demobilised men; and the number of unemployed doctors seemed not. to be substantially greater than at other times, allowing for the interval between demobilisation and establishment in a suitable post. The agency is satisfied, too, that, but for the Bill, the number of vacancies would have sufficed to supply nearly all demobilised doctors with the work they wanted. But with the introduction of the Bill the situation changed abruptly. With few exceptions those principals who would otherwise have retired decided to remain in practice for the time being; those who would have sought new partners held their hand; and those who might have taken assistants concluded that this was no time for an expansion that might yield no good return before the regime changed in two years' time. Now, with the supply of unemployed doctors greater perhaps than ever before, the demand is said to be less than at any time since this agency was established nearly a century ago.
Further down it states:
This state of unemployment is artificial, determined not by a superfluity of doctors in civilian practice—there are indeed too few— but by uncertainty and by economic considerations.
A great deal of work is required to organise and carry out this national health service. On Monday the Minister said that the Regional Boards would have to plan their hospital service long before the date of the operation of the scheme. Later, he said that he had power to help hospitals that were in difficulties during this
waiting period. I ask the Minister if he will help these doctors who will be in difficulties during this same period. I have been told that there are 500 doctors affected in this way. I appeal to the Minister to use these doctors now, even if it means sending them to different parts of the country to areas which are under-doctored and using them as panel doctors, because this will be some sort of preparation for the coming scheme. At any rate, this will make the general practitioner part of the Bill ready for the change-over. I want the national health service to be the very best possible, and I appeal to the Minister not to leave undone what can be done to make a success of the scheme.
I want to say right away that I am not speaking in political opposition to this Bill; I opposed the Coalition Bill strongly when it was suggested in 1944. My position is to reflect, as far as I can, the opinion of my profession. I want to point out that there is a practical difficulty about this Bill. How many doctors will be required if the Bill is to be put into operation? It has been estimated by good authority that at least three times as many doctors will be wanted as are now available. The present strength of the medical profession in actual practice is round about 52,000, and nearly the whole of that total of doctors are now members of the British Medical Association. The resolutions of that Association are surely important for the Minister to take into consideration as to the possibilities of operating this great service. The doctors are not attracted by the conditions imposed upon them. I submit that that is the tendency of all the discussions at the present time in the medical Press and at meetings, many of which I have attended; all of that feeling points to a great disinclination to accept service under this Bill. But the doctors will not "strike." That is a perfectly impossible and ludicrous suggestion. What they will say in the great majority of cases is, "We do not want to work under a State service, and we shall continue to work as we are now."
I want to make it quite clear that my objection is not political. I happen to be one of two hon. Members in this House who are also members of the honorary medical staff of a great teaching hospital, and I want to spend a minute in correcting some of the statements made today. I do not think it is at all true that access to the voluntary hospitals for consultation is by way of haphazard selection. It is nothing of the kind. It is the practice, and in some hospitals it has been suggested that it should be a compulsory practice, that no consultants on the honorary staff of the hospitals shall see patients unless they are sent up by a. general practitioner, and the great majority of cases that the consultants see at the great teaching hospitals are sent by the general practitioner. Surely that is a very useful practice. I would point out that the time spent in attention to patients by members of the consultative staff is roughly divided into two parts—one half is on private practice, and the other half is on hospital practice. The odd thing is that the very rich, who are supposed to pay those heavy private fees, and the very poor, see exactly the same doctors. That has been the usual method. It is quite wrong to suggest that the hospital system has failed to give a general service to all classes of the community except, possibly, the middle class.
A word about the observations made by the hon. Lady the Member for the Exchange Division of Liverpool (Mrs. Braddock). If I understood her aright, she said that the local authorities—meaning probably the big county councils of London and Liverpool—have been responsible for a very notable improvement in the status of the municipal hospitals under their control. I quite agree with that suggestion, but what we are doing now is destroying that, and I greatly regret it. The hon. Member for South Tottenham (Mr. Messer) made a very eloquent and justifiable plea for obtaining a less centralised approach to the new services than is designed by the Bill. The hon. Lady again gave a history, which I think was not entirely accurate, of the development of the two types of hospital. I suggest it would be useful if she would read a very authoritative history by the Chief Medical Officer of the London County Council, in which he pointed out that the divergence of the two types of hospital—what we call the municipal hospital and the voluntary hospital—began some 400 years ago, and diverged more and more as time went on. What is the final acid test of the efficiency of a hospital? I would suggest it is very largely the position of medical research. In four hundred years the two systems have developed side by side and the voluntary hospitals have done the research.
Will the hon. Member make it clear that he is aware of the fact that 400 years ago there was no such thing as a municipality as we know it? There were boroughs, not municipalities.
The municipal hospitals as we know them now are the direct descendants of the hospitals of that period which were Poor Law institutions, and it was the derating Act of 1929 which gave local authorities not only permission but encouragement to change their position from Poor Law infirmaries to a nearer approximation to voluntary hospitals. If my recollection serves me, at the present time something like half of the hospitals directed by local authorities remain, and are prepared to remain, under public assistance rules.
My main purpose in rising was to ask the Minister to re-examine his position. My hon. and learned Friend the Member for the Combined English Universities (Mr. H. Strauss), in the Debate on 23rd July, pointed out that the Minister had claimed that there were two primary purposes in his mind—
I accept the correction. There are two principles on which he is acting. Those two principles arc the abolition of purchase of practices and direction of doctors. Might I recall to Members that my right hon. and learned Friend the Member for North Croydon (Mr. Willink) in his White Paper in 1944, also claimed to reserve the power of direction of doctors? He was wise enough to consult the profession, and finally repudiated that power, but the power is not in any way repudiated by the present Minister. My hon. and learned Friend the Member for the Combined English Universities asked the Minister to have regard to a third principle, whether he called it primary or not. That third principle was to endeavour to obtain the wholehearted cooperation of those who are to work this Measure. He must know, any sensible person must know, that it is wholly impossible to make a success of a Measure which is resented by a large number of those who are to work it.
I wish to give some figures. I have said that there are 50,000 active practitioners at the present time, and that to work this scheme 150,000 will be required. How many of the 50,000 are actually available for, and will join, the service? I think that the Minister is not in a position to say that a 100 per cent. participation is possible. If he has any such idea he must be thinking of the views of medical officers of health; his contact must be not with practising doctors, but with officials who are a relatively small proportion of the whole body. I saw some figures a little while ago which showed that of the total number of doctors, about 4 per cent. are medical officers of health, and it is they who are behind the Minister. Of the total of the 50,000 practitioners I would venture to suggest that certainly not more than half are likely to join the service, and I believe the proportion will be very much less. But the Minister requires 150,000 doctors. He is in exactly the same dilemma as that which has overtaken the Education Act. That Act is now in the doldrums because there, too, 100,000 more teachers are wanted, and as the obtaining of that number is not in sight, it would seem probable that it will not be possible to work that Act when the appointed day comes. The Measure we are now discussing requires personnel on a similar scale. Is the Minister sure that he will get the required number by the appointed day in 1948?
I can give an example from a letter I received two days ago from a surgeon who was in this country during the time of the Coalition Government proposals in 1944. He is a very able surgeon in Australia. I wrote to him a few weeks ago and asked what the position was in Australia with regard to the medical service there. He wrote to me on 7th July stating that the position was that the Labour Government of Australia, very firmly established, introduced some four years ago what was essentially a State medical service. It was put upon the Statute Book, but the medical profession declined to work it, they would not join. Various efforts have been made by the Government of Australia to enforce a State medical service by indirect methods, and they have uniformly failed. That is the position of a firmly established Labour Government, which was opposed by a medical profession not nearly so widely representative or so well organised as in this country. I do not see how the Minister can obtain anything like the number of doctors who will be required to put this Bill into operation in anything like the time the Minister says, i.e., by 1948.
Unfortunately, I am old enough to remember the opposition of the medical profession in 1911, when the National Health Insurance Act was introduced. I happened to be in the forefront of that fight. The British Medical Association, in the opinion of many of us, rather let down the profession by accepting the terms of the Act. The immediate response in my hospital was the resignation from the B.M.A. of the whole of the honorary staff. That was at St. Mary's Hospital. I recall this history because the National Health Insurance Act started under a very great handicap in consequence of that opposition of the medical profession, and it has never been the success it might have been had there been greater circumspection in the approach to the profession. An even greater circumspection of approach is required now, and I am not sure that the approach of the Minister will bear any better fruit than did the approach in 1911.
It must be remembered that a general practitioner requires at least six years to qualify; a specialist requires ten years, and much of the success of this Bill depends upon the cooperation of the specialist section of the profession. There is no possibility of 100,000 additional doctors being trained in anything like the time for the appointed day under this Measure. It may be said, and I think it is probable, that the Minister will say, that I represent only the older members of the profession. I have taken the trouble to ascertain some of the facts. I have inquired at the Dominions Offices and I am told that they are overwhelmed by applications from demobilised young doctors to go away from this country. They are taking precisely the advice indicated in the reply of the Parliamentary Secretary to the Ministry of Health two years ago to the question, "What is a doctor to do who will not work the public service?" She replied that such a doctor could emigrate or retire. A large number of the younger doctors are emigrating; the figures are something like 100 in the case of South Africa, 150 to Australia and similar figures for Canada and New Zealand.
They always did. Has the hon. Member, who always makes the most astonishing and extravagant remarks in an undertone, any comparative figures of how many doctors emigrated before the last war and between the wars, to set beside those of today?
I can only say that the officials at the Dominions Offices represent these present applications as overwhelming.
I think it is very unfortunate that a political bias has been imported into the Bill; it has been described by several hon. Members opposite as being primarily and exclusively a Socialist Measure. We do not want politics in medicine. Doctors as a whole do not want it. I want to make two observations in this connection. I submit that the composition of the tribunal, which is the final court of appeal for a doctor who is in the public service and who is regarded as unfit for that service, is wholly political in its constitution. The appointment of the tribunal remains with the Minister. It will be set up by the Minister who is in power at the time and, therefore, it will be a political tribunal.
The hon. Gentleman really ought not to make statements which might be believed by members of the medical profession outside this House, particularly as he represents a university. It is laid down in the Schedule how the personnel of the tribunal shall be appointed. There is nothing political about it at all. It is a shame that statements of that kind should be made.
The chairman will be a politician and the tribunal will be appointed by the Executive. However, I will leave that point. I want to show how this political bias may act in practice. I have a letter before me from the
deputy superintendent of one of the largest L.C.C. hospitals in London, a hospital upon the staff of which I have served for a good many years as consultant. He writes:
I have been for seven years deputy superintendent in this hospital. I had a patient admitted to the hospital and referred to me a little time ago in my capacity as deputy superintendent and I found he was not a proper recipient of the service and that he ought to have been sent to a hospital for incurables because of the nature of his disorder. I decided to send him to such a hospital.
The sequel was that the patient wrote to a prominent Member of the Government who was also a prominent member of the L.C.C. He said words to this effect, "I have been a Labour supporter all my life. I have always voted Labour. I ask you to help me." The result was that the deputy superintendent was called before the superintendent, who said, "You have made us very uncomfortable by the action you have taken." My correspondent took the trouble to follow up the matter and he found that the patient had been admitted to another L.C.C. hospital. He had been examined by the staff of that hospital who had promptly sent him to a home for incurables which the other hospital had recommended.
It is said of some people that they cannot see the wood for the trees. In listening to the arguments of hon. Gentlemen opposite, it seems to me that that remark applies to them. They have been talking about the point of view of the doctor, the point of view of the voluntary hospitals and of the local authorities and so on, but the main purpose of this discussion is to consider the point of view of the patient. The primary purpose of this Measure is to bring a better medical service to the people of this country. I welcome this Bill because for the first time in the history of this country ordinary people will have free access to the best medical attention. I said that some people cannot see the wood for the trees. In my opinion the hon. Member for London University (Sir E. Graham-Little) could see neither the wood nor the trees. Some time ago the B.M.A. decided they would oppose the Bill. I wish the doctors of this country could have been present this afternoon to listen to the arguments advanced by the hon. Member for London University. If they then listened to the arguments from hon. Members on this side of the House they would look forward to the day when they can get out of the hands of people with the outlook of the hon. Gentleman, the day when our hospitals can be organised by people on this side of the House.
I want to deal with the dental aspect of the Bill. Before doing that, I wish to refer to a point which was raised by the hon. Member for Putney (Mr. Linstead). He advised these people who pay voluntary covenants to stop paying these covenants now. After hearing him I was rather surprised to hear the hon. and gallant Member for Horncastlc (Commander Maitland) say that he wished the Bill well. They cannot possibly have the matter both ways. I believe the mover of the Amendment, by his statement, is attempting to sabotage, not this Bill, but the hospitals of the country. There are one or two other points which I had hoped to raise but I have not sufficient time. However, I wish to say a few words about dentistry, as I took some part in the discussions of this aspect during the Committee stage. I should like to pay compliment to the leaders of the dental profession for the statesmanlike attitude they adopted in comparison with the attitude of the B.M.A. I think the dentists will help to work this Bill. They welcome it, although they disagree with some of the details. Speaking as a member of the dental profession, I would point out that for the first time dentists are given equal status with doctors in the treatment of disease in this country.
I do not want to bore the House with dental details but it is a rather important aspect of the Bill. Dentistry is a new profession, and the attitude of doctors and of the country as a whole towards dentistry has changed recently. A short time ago I was tracing the history of dentistry in the Armed Forces. During the South African war there was an outbreak ox gingivitis among the troops. An S.O.S. was sent home for dentists to fit dentures to the soldiers. The attitude of the Government was such that instead of sending dentists to South Africa they sent a consignment of mincing machines so that the hard tack could be minced and the men could eat it without teeth. During the 1914–1918 war, the attitude was a little better though even then it was left to doctors in the front line to extract teeth by cold steel. In the 1939–1945 war, and since then, the attitude has changed completely. During the last war the dental surgeon worked in equal partnership with the doctor. Many hon. Members have seen some of the patients who come as our guests here in the House from the East Grinstead Maxillo-facial Hospital. They include chaps who had their faces knocked about during the war, and we have seen the wonderful work which the dental surgeon is doing in collaboration with the doctor. It should be remembered, in connection with this great work which has been done by dental surgeons in the war, that these men have been members of the Armed Forces, working not for profit but as the servants of the State, and it is in that capacity that the best work of the dental profession was done in the Armed Forces.
In the past, when he have discussed dentistry, we have rather looked at it from the spectacular angle. I believe that the sight of the late Earl Grey was saved many years ago by the work of a dental surgeon in extracting a canine tooth, and that case caused some talk. During the war, we discussed the dropping of dentists, with their equipment, by parachute. Then, there is the work of the maxillo-facial units at East Grinstead and so on, but these things do not constitute the real task of dentists. That task is to provide dental treatment for the ordinary people of this country. This Bill is going to give the ordinary dentist a better chance than ever of treating the ordinary people in the country. In the past, dentistry was a service that could only be bought by the middle and wealthy classes—that is, preventive dentistry—and, for the first time, this Bill is going to place this service at the beck and call of the ordinary people.
There are one or two simple points on dental aspects of the Bill which I should like to mention. I am glad the Minister has recognised the priority classes—expectant mothers and young children—but I am disappointed that he has not included the adolescents as well. All the good work that will be done in treating young children will be ruined if adolescents are not treated as well, and I hope my right hon. Friend will bring pressure to bear on the Minister of Education to see that adolescents are brought into the priority classes as soon as possible. I also want to thank the Minister for the assurance which he gave me on the Committee stage that no health centre dentists will be asked to carry out a certain number of treatments each day. In the Armed Forces, dental surgeons, and doctors as well, were very annoyed that they had to return figures of the amount of work done each month or each week, and I am glad that the Minister has given an assurance that, under this Bill, it will not be necessary.
Thirdly, I welcome the health centres as a dental surgeon myself. In the past, dentists have not been like doctors, in so far as doctors have been able to go about in motor cars and meet people and other doctors, because the dentist was tied to his surgery and became completely isolated both from the people and other members of the profession. I believe that this Bill will increase their opportunities for working and consulting together, and I hope that, as a result, the standard of treatment will improve considerably. Also, I believe that one of the main problems so far as dentistry is concerned is that of education. The idea that a dentist is a good subject for funny postcards must disappear, and the only way in which it will disappear is by means of education. During the war, the Army produced a very fine film called "Our Teeth," which I hope will be shown to hon. Members of this House. As a result, dental centres have been able to show that film in the larger centres and it has given them an altogether better idea of dentistry. I think we should look at these health centres not as places for treating ill-health, but as places in which to educate people up to the value of good health, and where also we may educate them up to the value of good dental treatment.
Speaking as a Socialist, I look upon this Bill as a compromise. It does not give us all that we wanted. We wanted it to go much further, but the Minister has recognised that it is better to meet people half way and get their willing cooperation. I hope they will appreciate that compromise, because, if they do not, there may be a danger. This Bill is only a beginning, a skeleton. The flesh has still to be built around the bones—preventive medicine, industrial medicine, research and all the rest of it—but I wish the Minister of Health good health for the years ahead, for he has a big job before him and I have no doubt that he will do very well in it.
The remarkable thing about this Third Reading is that we have arrived at it so early in the proceedings of this House. If I remember rightly, the National Health Insurance Bill of 1912 took almost . as many weeks on the Floor of the House as we did days in Committee upstairs on this Bill. That is remarkable of a Bill so important in all its implications and so tremendous in its effects on all the people. The right hon. Gentleman cannot complain of an obstructive Opposition on this Bill. I wish to pay my tribute to my right hon. Friends on this side of the House—the right hon. and learned Member for South Croydon (Mr. Willink) and the right hon. and learned Member for Hillhead (Mr. J. S. C. Reid)—on the amount of time, energy, ability and intelligence which they have brought to bear on this Bill by concentrating a beam of light on its defects and thus enabling the public to see further into the Bill than otherwise would have been possible.
I would say this about Government supporters. In Committee they were all very quiet, as all good supporters of a Government are expected to be. There was not one Amendment initiated or moved from the Government Benches against this Bill which was carried to a Division. It is true we had a flicker of insurrection the other night from the hon. Member for Rochdale (Dr. Morgan), who spoke against his Government, but the flicker was extinguished before the Division, and he did not carry his convictions quite as far as we had anticipated. In regard to the Minister, I wish to say, with respect, as a Back Bencher paying tribute to one of the big men, that he has shown singular ability in the conduct of this Bill, great statesmanship and conciliation, and has been ably supported by his Parliamentary Secretary, who was perhaps rather more rigid in his mind, as all Parliamentary Secretaries ought to be, but who, at the same time, has shown a great knowledge of the Bill, upon which I congratulate him.
The Minister and his Parliamentary Secretary, between them, have achieved in this Measure a Socialist programme and deserve well of their party. Whether they will equally deserve well of the country remains to be seen, but, in achieving that Socialist programme and putting this scheme through, they are carrying out a great measure of nationalisation, which cannot be expected to enhance its value or commend it to this side of the House. After all, we were sent to this House to oppose such Measures, and that is what we have tried to do. This scheme will leave the House, along with the other schemes for the nationalisation of the Bank of England, of coal, of cotton purchase and civil aviation, in the streamlined pattern of legislation which was announced by and is so agreeable to the Chancellor of the Exchequer. But, unlike coal, this Bill deals with the lives, habits, predilections, tastes and idiosyncrasies of our people, and I venture to say, while wishing the Bill the utmost success, that this streamlined engine will carry a, heavy and diversified load and that it will never achieve the destination which the right hon. Gentleman himself wishes for it. without the utmost cooperation of all those involved.
I congratulate the Minister on personal grounds only on the fact that the Bill emerges with its structure intact. Central administration is there; hospitals are taken away from local authorities; all voluntary hospitals are taken over by the State, with their ancillary institutions and all their endowments—those general endowments and those special endowments intended for a specific object. Many authorities are virtually swept away in this Bill, so far as health matters are concerned. Dozens of local authorities in this country have been done away with in this connection, and urban districts, boroughs and rural areas have been taken over by larger authorities in this Bill. The doctors in the service become servants of the State. In future, no general practitioner will have the right of access to a single hospital in this country unless he is within the service. A general prac- titioner, who may have been principally concerned in building a hospital in a locality may now, in his later years, if he wishes to stay out of this Bill, have no right of access to that hospital.
The principle of the sale of goodwill is frowned upon by the right hon. Gentleman as an immoral act. For the first time in this country, the right of any body of people to settle in a given area is challenged and directed. Before this Bill leaves it, the House ought to know that the right hon. Gentleman cannot get away from the facts in spite of the explanations he has made. There is a body of people in this country who are going to have their livelihood curtailed and restricted in such a way that they will be precluded from earning a living in the places where they wish to earn it. That state of affairs has never existed in this country before. There is to be no appeal, except through the Minister. When, in a few weeks' time, this Bill becomes an Act, doctors, dentists and pharmaceutical chemists will come under its terms of service, although no real negotiations have taken place with the interests concerned under this Bill. I am sorry that the right hon. Gentleman has not seen fit to have such negotiations, because the Socialist Government of Australia, the Government of South Africa and the Socialist Government of New Zealand have all done this.
In conclusion, I wish to say that, even though on this side of the House we have, in principle, a number of objections to this Bill, I am going to appeal to the medical practitioners of this country to try and work the scheme. It is their duty to do that when this Bill becomes law. After all, when the giant octopus of the State catches hold of an industry or profession, it is very cold for those who remain outside; it is much better for them to come into it. All we can hope is that, in time, the swing and play of democratic opinion in this country will enable a Government to emerge which will redress many of the defects which are fundamental to this Bill and without which redress, in my judgment, it cannot be the realty workable Measure which we all wish it to be.
I am very glad to have this opportunity of adding my word of congratulation to the Minister on a very great Bill. It is great, I think, especially in its universal application because, when it becomes law, everybody who cares to will be able to take advantage of it without any qualification or waiting period. It will give, for the first time, the possibility of complete union between the preventive and curative services. As doctors, we discovered many years ago that prevention and cure cannot be separated. In the past, that fact has only partially been recognised in legislation. We have our dispensaries for the prevention of tuberculosis in which, very rightly, the main action is in regard to treatment. As the new health scheme develops, I hope that we shall see, not only some, but all, doctors closely associated with the preventive services because, as our health centres develop, all general practitioners will work in close association with the nurses, health visitors and clinics whose main function is prevention.
I wish to speak particularly about the relationship between the hospital management committees and the regional hospital boards, because I realise that one of the most important and most original parts of this Bill is in connection with the provision of our hospital services. For the first time, we are going to have a really unified hospital service through the union of the municipal and the voluntary hospital under the Minister. I hope that we shall get a complete marriage of these two services and that, in the new service, the best of each will be brought together, so that a really fine service can be obtained. I have had some experience of both services; I have been attached to a voluntary hospital ever since my student days, and for the last 16 years I have had experience in the administration of the London municipal hospitals. When such a hospital service is fully developed a specialised service can be provided. In London we have learned to use hospitals and hospital wards as they are most needed. Economy is another advantage. On the other hand, there is a great deal to be learned from the voluntary hospital— quick decisions, independence of thought, and power to experiment. Whether we get the best out of these two services in the new set-up depends very much on the relationship between the regional hospital boards and the hospital management committees.
In the Committee, some of us seemed to notice that the Minister was, to some extent, changing his outlook and was inclined to give more power to the hospital management committees and rather less to the regional hospital boards. In a few words, I want to warn him of the danger of this. Undoubtedly, he was right, as far as he went. More power should have been given to the hospital management committees. But I want to warn him that there are dangers. The use of beds, I feel, must not be left entirely to the hospital management committees. One of the advantages of regionalisation, on which all authorities are agreed, is that beds can be used to the greatest advantage. It may be that, in the case of an epidemic, beds in general hospitals may have to be used for infectious cases, temporarily. Then there is the question of bed bureaux. If a doctor wants a bed for a patient in a given hospital, and if he cannot obtain it, then only by some regional authority can that doctor be directed to another hospital where the necessary accommodation is available.
The conditions of staff must be unified. There must be no feeling amongst the staff involved that there is any unfairness between hospitals. To make that quite certain, there must be an appeal, not only for the doctors, but for all the staff, if necessary, against the decisions of the hospital management committees to some higher authority, which, I suggest, should be the regional hospital boards. Most important of all is the appointment of staff, because we are all inclined to prefer the devil we know to the devil we do not know, and it is so easy for a hospital to promote one of its officers to a higher post, rather than to use the services of, perhaps, a better officer from outside, of whom it knows nothing. So I do feel that, at any rate, as regards the higher appointments, these should not be left entirely to the hospital management committees, but that the regional hospital boards should be able to influence them.
Then there is the question of expenditure. It is suggested, rightly, that money should be given to the hospital management committees to spend as they desire, but I feel there should not simply be given a certain sum of money to each hospital to use as it likes; because not only is there the question of economy, which is important, not only must we see that each hospital management committee uses its money to the best advantage and does not waste it, but also, we must be quite sure that it keeps all its services up to par. I have had experience, in connection with L.C.C. hospitals, of officers who, thinking they were serving the council, rather cut down expenditure on necessary articles, such as food for the patients. Unless there is supervision by some higher authority, that may easily happen. Then there is the question of supplies. I am glad to see that, under Clause 63, there is to be the possibility of bulk purchase. But it is not only the purchase of supplies which is important, but the repair of articles. We in London have found it very useful, in connection with our many hospitals, to have a single institute—a workshop, I may call it—where the dental plates for the patients of all our hospitals are made. That could not be done economically and efficiently for a small unit of, say, 1,000 beds, which would be under the care of a hospital management committee.
In connection with statistics and research, I feel that a uniform method of recording will be very advantageous; so that the question may not be left to the whims of each individual hospital. I commend all these points to the Minister when he is making his regulations, for I do feel it would be dangerous to give too much power to the new hospital management committees, and so to run the risk of the development of another voluntary hospital system within the great scheme he has devised.
We are coming to the final stage of a Bill the importance of which has been recognised in all quarters of the House, and on which the hon. Member for Barking (Mr. Hastings) has been able, as have many hon. Members, to give us the benefit of his experience, both here and in the Committee upstairs. Many other hon. Members, like the hon. Member for South Tottenham (Mr. Messer), the hon. Member for Barnet (Dr. Taylor), and the hon. Lady the Member for the Exchange Division of Liverpool (Mrs. Braddock), have spoken from practical experience. I cannot claim to have had the same practical experience, but I think I know something of how professional men feel, and I have, at least, some knowledge of how this particular profession feels, because, with the exception of the hon. Gentleman the Member for London University (Sir E. Graham-Little), I number more doctors amongst my constituents than does any other Member of this House.
I think it was the hon. Member for Barnet, whose writings, I may say, I had the pleasure of reading before I had the pleasure of meeting him, who suggested that we had a legalistic approach. I hope that that is not, true in my case, although it is for the House to judge, and not for me; but I would say that it is demonstrably and obviously untrue of my right hon. and learned Friends the Members for North Croydon (Mr. Willink) and Hillhead (Mr. J. S. C. Reid), who certainly enriched our proceedings throughout by dealing with matters that were not purely law at all. A fine compliment was paid to the right hon. and learned Gentleman the Member for Hillhead without his knowledge, by a doctor who communicated with me, and who had read all the proceedings, and had assumed that the right hon. and learned Gentleman must be a doctor himself.
May one who regards this Bill as a Bill whose grave defects override its merits— though I admit it has merits—and who has been a persistent opponent, pay a tribute to the right hon. Gentleman the Minister of Health for the great vigour, suppleness and humour with which he has conducted this Bill, both on the Floor of the House and upstairs? He is entitled to claim a fine Parliamentary achievement.
As I have only a few moments, I will deal with only one aspect of this Measure, the question of the freedom and independence of the medical profession. There are many merits in the Bill, but, in my view, and in the view of innumerable friends I have in the medical profession, who do not by any means all share my politics, the threat to the freedom and independence of the medical profession outweighs all the merits of the Bill. I think that the real difference in approach between those who take the view, as hon. Members opposite sincerely do, that this is a great Measure of reform, and those who share my fears as to its threat to the future of medicine in this county—the great thing that separates us—is that they tend to forget that medicine is not only, or primarily, a science, but that it is also, above all, an art; and that on the happiness of the doctor-patient relationship the actual cure of the patient very often depends. I do not think that the medical members opposite will differ from me on that, though, no doubt, they will differ from me in thinking that that is threatened.
It is absolutely vital, not only that the patient should have a free choice of doctor, but that he should have absolute confidence that the medical man or woman whom he consults shall feel a deep duty to his patient and to his art but to no third party. The hon. Member for Barnet mentioned that he owes some duty to the community in matters that have relation to the criminal law. That is true; but broadly what I have said, I think, represents the facts. In the Measure which we are passing, it will be possible, without further recourse to this House, to transform the profession into that whole-time salaried service in which many hon. Members opposite sincerely believe. I believe that would be gravely injurious to the future of the medical art in this country. I believe that there can be no one who less resembles a civil servant than the man who is most fitted to be a good doctor and to make the greatest contribution to medicine.
This scheme will depend on attracting great numbers of men and women of the right quality. Let me say at once, that I agree entirely that there are always men and women who feel such a vocation to the art of medicine that they will practise it, and practise it well, perhaps, whatever the arrangements are; but there are a great number of others, not one wit less worthy for their efficiency and public spirit, in whom ambition is not an unworthy thing, and whose desire to reach the summit of a noble profession is not unworthy, and who enter the profession because it has always been characterised by an invaluable freedom and independence. I know medical people, whose friendship I have enjoyed, who have not started by buying a practice, but whose sense of adventure has led them to put up a plate and start practising. I know how they feel about what is now proposed, when they read Clauses 34 and 35 of the Bill and see what is involved; and it is no good telling them that their sense of freedom is not threatened. They can read in that series of threats the indi- cations of distrust, and the loss of freedom, and they feel that the profession will no longer be the profession which they entered and loved, and to whose traditions they are loyal; and they fear for its future.
One or two hon. Members have said: "Do we on this side of the House want to establish a comprehensive health service?" Let me answer quite frankly for myself: "Yes, if it is better than what we now have; no, if it is less good." I will explain exactly what I mean. I believe that the medical profession has always recognised that there are gaps and defects in the existing system and wished to cure them; and they believe that can be done in agreement with their profession, and without sacrificing their essential freedoms to plan their lives, to serve their art, and to do their duty to the patient. This Government scheme does not achieve that. It starts from the assumption that everything hitherto has been built up on the wrong lines, and that we must start again.
Those of us who were in the last Parliament—I am giving my genuine impression—will no doubt remember that there were many Members of the Socialist Party who questioned my right hon. Friend, the then Minister of Health, on his consultation of the doctors, and they made it quite clear that no national health service would be any good to them unless the doctors detested it. My view is that no national health service will benefit the public unless the doctors welcome it. It may be said that hon. and right hon. Members opposite share our desire for a national health service that is an improvement, and that not even Socialists could be mad enough to want a national health service for its own sake even if it were not an improvement. I wonder how many hon. Members opposite read "The New Statesman and Nation." I think that today I am one of the few original subscribers. On 19th January of this year a New Zealand correspondent wrote an article saying that we must not imagine that everything the Labour Government had done in New Zealand was good. They had had a number of successes, but had also had a number of failures. In the first paragraph he sets out the successful achievements. I want to read those words:
A universal medical scheme of dubious worth is in operation.
If I am to keep my promise I have only three minutes in which to speak. The last three speakers have been professional speakers. The only good point in favour of the hon. and learned Member for the English Universities (Mr. H. Strauss) is that we could hear him. Unfortunately, we could scarcely hear the last two professional gentlemen who spoke though sometimes we heard a distant rumbling. We have now come to the end of the Debates on this Bill and one hon. Gentleman said that there was a flicker of opposition on my part. I said before, and I say again, I have been in favour of the principles underlying this Bill for over four decades. I have advocated them in this House, and I have pledged myself to their translation into legislation. Because I differed on one particular point and, quite frankly, stood up for my principles to the extent that if necessary I was ready to go into the Lobby for them, badinage has been thrown at me by Members opposite, all of which I treat with contempt.
There has been much talk about professional opposition to this Bill, but in my opinion it will never take place. As I said before, I happen to be on both sides in this matter. I have heard the discussions in the sanctum sanctorum of the B.M.A. and I have heard the views on the workers' side from my association with the workers. The bulk of the doctors, if they could be rid of the political prejudice from the other side, would work this Bill as we would expect a great profession like ours to do. One thing which always strikes me is that doctors in their profession are so highly efficient that in political and sociological matters they are completely ignorant. There has been talk about State doctors being necessarily inefficient. Are the medical officers of health inefficient? Are the doctors employed in the fever hospitals inefficient? Are those in medical institutions inefficient? Are all those employed in tuberculosis and V.D. and in maternity and child welfare inefficient? I say that, before hon. Members come to this House and give a false impression to the country of the kind of profession this is and the efficiency with which the profession works these services, they should think twice and keep their minds from being steeped in political turpitude.
I gave a definite promise, Mr. Speaker, that whatever happened, should I rise early or late, I would stop at 10 minutes past three. I intend to stick to my promise. I would only say that I wish to congratulate the Minister, although I differ from him on many minor points. He has put this Bill through with astonishing efficiency, as must be recognised when one thinks of the long drawn out negotiations which the right hon. and learned Gentleman the Member for North Croydon (Mr. Willink) had with the British Medical Association, and when I consider the pile of documents, nearly as high as myself, which I and others had to read. My right hon. Friend has succeeded in unravelling it all, and in bringing forward this great Bill.
I am sure that hon. and right hon. Members opposite will have formed a clear view of the attitude of the party on whose behalf I speak, that when we say we wish this Bill well we mean that we hope the comprehensive health service to which we were pledged as much as the party opposite will not be retarded, or frustrated, by what we regard as the vices of this Bill. I think the Parliamentary Secretary was more than a little unfair when he described the attitude of the Conservative Party as being that all was well so long as voluntary hospitals were managed by voluntary bodies. He knows as well as anybody in this House, that all parties were committed to great and sweeping changes in the sphere of public health. As for the remarks which have just been made by the hon. Member for Rochdale (Dr. Morgan), about the quantity of paper he had to read during the period of the Coalition Government, it would be interesting, if one was free to disclose it, to consider how much of this Bill directly resulted from those dis- cussions, and has been unchanged since the Minister's arrival in office.
One thing that has surprised me about the Minister—and it is no doubt the attitude of an astute politician—is that there has not been one word of tribute to any work which has been done—I speak not for myself—before 5th August, 1945. When I went to the Ministry of Health in 1943 I discovered that work was going forward, and had been going forward for four years before 1943, on the instructions of two predecessors of mine, the right hon. Gentlemen who formerly sat for Ross and Cromarty, and for Leith. It takes years to build up such a scheme as this, yet the Minister—I hope unintentionally—has created the impression that this great scheme has been entirely developed in the period from August, 1945, to March, 1946.
Before I answer some of the observations made by the Parliamentary Secretary, there are one or two uncontroversial things I would like to say. First, there has been no reference during the Debate to the phrase, "the appointed day," which appears in many places in the Bill. The indication given by the Minister in Committee, as to the earliest date by which he hopes any part of this Bill can which was anticipated by earlier Govern-acceleration over the rate of progress come into operation, did not reflect any ments. No reference has been made to that date in the House since the Bill came back from Committee, but the date is, in fact, 1st April, 1948, which will be two years and nine months after the Minister went into office. I am sure that is a date at least a year, and probably two years, later than most hon. Members opposite thought that a National Health Service would come into operation. I make bold to say that, but for the very greatly increased difficulties which the Minister has placed upon the Department and upon local authorities by his scheme, the scheme could have come into operation at least nine months, and probably a year, earlier than it will do. We have also had no information as to how this Measure is to fit in, as a matter of time, with the National Insurance Bill. It is, obviously, most necessary that no money should be taken from the people on their stamps before there is a fair return to them in the shape of a National Health Service.
The second general point I want to mention, which has not been mentioned today, is in connection with mental health. It is one of the great features of this Bill that mental health is brought, as it always should have been, within the sphere of the general health service, but I would like to bring to the Minister's attention—and even if he does not comment on this, I am certain he will agree— the lamentable obscurity of the law with regard to mental health as it emerges from this Bill. This was a matter which even in the detailed consideration in Committee it was not possible to handle, but in three Clauses of the Bill—Clauses 49, 50 and 51—and in no fewer than 14 pages of Schedules of Amendments, the law with regard to mental health is reduced to a jungle as thick as any in Burma. I do not know how administrators in that field in the coming years will see their way through all the complications of the Statutory enactments with which they will have to deal. I hope the Minister will be able to make rapid progress in clearing up this field.
Another matter to which no reference has been made is the extent of the improvements which have been made in the Bill since it was given a Second Reading. Although on points of principle the Minister has not given way, I would like to pay a tribute to my Conservative colleagues, to those who represented the Liberal Nationals in the Committee, to the hon. and learned Member for Carmarthen (Mr. Hopkin Morris) and to the hon. Member for Cheltenham (Mr. Lipson), all of whom assisted in improving the Bill in a manner which, no doubt because they were under instructions, was not so frequently observable among hon. Members of the majority party.
It is worth while to mention four points on which substantial improvement has been made, I think I can fairly say, on our representations. First, the position of the Central Health Services Council has been very substantially improved. The Bill as introduced gave the Minister power to change the constitution of the council whenever he liked as a mere administrative measure. He now has to bring such changes before the House. The Minister brought in the Bill with power to suppress any part of the Council's advice. Now he must consult with them if he is minded not to publish any part of their advice. With regard to the standing Advisory Committees, we were delighted to obtain assurances from the Minister that there will be a Standing Advisory Committee on the hospital services and another on blood transfusion, in addition to the committees mentioned in the White Paper and to secure an amendment securing that these committees will have power to initiate advice, a provision which did not appear in the Bill.
Secondly, the position of the individual hospital has been immensely improved by the fact that it has been made a legal person with power to receive money and other property. That is an improvement in the Bill which will be of almost untold value. Instead of there being, as was the case in the Bill as originally drafted, no legal unit lower than, or closer to the people than, the Regional Hospital Board, there is now provision for the hospital to be a legal entity. Thirdly, the ridiculous remoteness of the Medical Practices Committee has been mitigated by the promise that it will be in substance the doctors of the district who will make the effective decisions as to the succession to practices. Fourthly, I feel sure that the Minister, whether he says it or not. is grateful to the Opposition for the suggestions we made as to the extreme hardship of Clause 35. These oppressive provisions have been very substantially improved.
The Parliamentary Secretary seemed to be surprised that hon. Members on this side of the House find it difficult to accept the principles of this Bill, and indeed, have felt compelled to put down a reasoned Amendment to the Government Motion. Perhaps what he heard from his hon. Friends on the other side made the position clearer to him. One hon. Lady who spoke described the Bill as a complete Socialist Measure, but she was outdone by the hon. and gallant Member for East Wolverhampton (Captain Baird). He said that what the hon. Lady thought was a complete Socialist Measure did not go nearly far enough and he wanted it to go very much further. It is perhaps the central feature in our objection to the Bill that it enables the most extraordinary things to be done.
We object to the Bill on five main grounds. In the time available to me I cannot do more than say a word about each of them. We object, because we believe the Bill discourages voluntary effort and association. We believe that this country has grown to its present stature and position in the world very largely because voluntary effort and association have been encouraged and not suppressed, as is being done by the Bill. How can that be contradicted when every voluntary hospital is being taken over by the State, when the Bill contains a provision which enables any future medical institution which may be set up to be taken over by the Minister? A world is being created in which there is no security for any medical curative institution of any kind whatever. This is a Bill which enables the right hon. Gentleman to take anything over as soon as it is established. How can voluntary effort and association be said to be otherwise than discouraged when money given this week for the benefit of a locality and for the benefit of a particular hospital, will, some time between now and 2nd April, 1948, become the property of the Minister of Health, to be put wherever he likes? How can we say that voluntary association is not being discouraged in the most lamentable way when we know what the Minister's proposals are, as indicated by the Bill, for those splendid voluntary institutions, the contributory schemes serving a number of hospitals?
How are people who have, very often at great cost to themselves and with considerable courage, entered into covenants for seven years, to be encouraged to do such things in the future when the Minister, advised no doubt that those covenants would lapse by reason of the appropriation by himself of the hospitals, puts into the Statute a provision that they shall remain effective for the benefit of himself? I agree wholeheartedly with what was said by my hon. Friend the Member for Tiverton (Mr. Amory) that this is objectionable not merely on administrative grounds—
—which the Minister controls and manages. Voluntary effort, sacrifice and association are all discouraged by the Bill.
With regard to local government, the Parliamentary Secretary denied that its structure was mutilated by the Bill. Could anything be a more serious mutilation of the structure of our local government than the complete removal of all responsibility for any form of hospital, or the separation, on a basis which has never been explained, of the hospital service from the clinic service? We have no idea whether the areas for hospitals will coincide with the areas for clinics, although their coincidence has been most strongly recommended by the hospital surveyors. Great regions are to be set up, local government of a new kind, not elected but appointed by the Minister, for areas which we do not know, defined on principles which have never yet been explained. I believe that the Minister does not yet know them himself. It is one of the most fundamental changes in local government that has ever been made. It is regionalisa-tion, in a Bill that gives no indication of the principles on which that region-alisation is to be brought into being. At first the Minister said that the setting up of these regions was a purely administrative matter for himself alone, and resisted any suggestion that the Orders setting up these regions should come before the House. At long last he agreed that there should be separate Orders, capable of being challenged in this House. It is typical of his attitude to local government that a service up to now democratically controlled should have been in his mind a simple administrative function of the Minister of Health, not subject to Parliamentary control at all.
The rigidity of this Bill in the sphere of local government is lamentable. That has been commented on earlier this week. No non-county borough is spared. Every one is to have its functions taken away, because that is tidy and simple and does not involve the Minister in argument. The situation in London is equally lamentable, but I will say nothing of that now. The structure of local government in London and all over the country is most gravely and unnecessarily prejudiced by the Minister's proposals.
The Minister prides himself on creating, to use his own words, an entirely new hospital service. Is this really the time, after what we have been through during the past six years, for the Government to take on themselves this extraordinary function, not only taking over the country's hospital services but creating something which the Minister describes as entirely new? Here again there is a frightening centralisation of power in the hands of the Minister. The Minister ought to be terrified of the power he is asking for himself in this Bill. I sometimes wonder if he realises that he is taking power to direct the administration and management of every place in which a citizen of this country can obtain hospital care. He is even taking power to direct the control and management of the teaching hospitals, both those that exist today, and those that in the future he chooses to designate as teaching hospitals. Every responsible controlling body throughout this hospital service is appointed directly or indirectly by the Minister. The Regional Board, the hospital management committees and the central practices committee are all appointed directly or indirectly by the Minister. So intent is the Minister upon complete centralisation that when one makes two modest suggestions, such as that the board of governors of a teaching hospital, all appointed by the Minister, might perhaps choose their own chairman, or that a hospital management committee, no doubt consisting of 20 or 30 persons, appointed by the Regional Hospital Board, might be allowed the favour of choosing three people from their locality whom they discover to be useful as co-opted members—-"no," says the Minister. Such small points as those he takes as invasions of his autocratic responsibility.
Let us consider the charitable funds of approximately £32 million, the figure suggested by the Minister in the Second Reading Debate. The Minister is taking upon himself in this Bill to administer, control and manage a fund of £32 million, given not simply for general hospital purposes, but, in almost every case, for the benefit of a particular locality. The Minister is taking upon himself the function of distributing that money over England or Wales exactly as he thinks fit, and he does not even propose to bring his scheme before this House. We see in this Bill a terrible example of excessive centralisation of authority in one man.
So far as the appropriation of voluntary funds is concerned, I wonder how many hon. Members, outside those who sat on the Standing Committee, have noticed the sad contrast there is between the provisions of the Bill as to the way in which hospital premises are to be used and funds belonging to teaching hospitals are to be used, and the provisions with regard to the funds of the ordinary voluntary hospitals. So far as hospital premises are concerned, they are to be used in such a way that their purposes, so far as practicable, are not prejudiced. So far as the teaching hospital endowments are.con-cerned, the objects of any such endowments are so far as practicable not to be prejudiced, but there is no limitation whatever on what the Minister of Health does with the £32 million belonging to the voluntary hospitals. We say that this is appropriating money, voluntarily given, in contempt of the wishes of the donors, and we disapprove of it most strongly.
Finally, I come to the medical profession. The hon. and gallant Member for East Wolverhampton made a suggestion, which we have heard very often in the course of these Debates, that anybody who talked about local authorities, doctors, specialists, hospitals, was not thinking about the patients. I am a little tired of that suggestion, because those who talk about these agencies, which are necessary instruments for the care of the community, are of course thinking about the patients. It is in order to see that the patient has effective, contented and instructed instruments that we talk about these matters. We feel that the proposals in this Bill make the medical profession less attractive to those whom we want to see serving in it; less attractive because less independent, less responsible to the patient, more controlled.
The Minister insists, apparently, on an immediate instalment of Socialist policy with regard to medical practitioners. We know the difficult position into which the party opposite got on 1st and 2nd May of this year when, the Parliamentary Secretary having admitted that a full salaried service was inconsistent with free choice of doctor and that free choice of doctor was the more important principle, the Lord Privy Seal came along the next day and said that the Labour Party stood by the policy of a full salaried service The party opposite is committed to two completely inconsistent principles: it is committed to free choice of doctor, it is committed to a full salaried service. For our part, we see in the Minister's quite unjustified insistence on a basic salary for every doctor the first instalment of what his Parliamentary Secretary himself admits is inconsistent with people choosing the doctor they want. There is pressure in many parts of the Bill —pressure direct and indirect—upon the medical profession to enter this service. There is a position of insecurity for all who come into the general service in the absence of any appeal from a tribunal, which is two-thirds lay and only one-third trained in the legal matters, to anyone except the Minister. Partnerships are threatened, partners are no longer to be free. It is one of the most astonishing things in this Bill that in future three men who have lost their fourth partner are not to be allowed to choose the man or woman with whom they want to work. He is to be selected. If there are more applicants than one, after the recommendation it may be, but not on the recommendation of the local doctors, their new partner will be selected for them by the Central Practices Committee.
On these most serious grounds—the attack on local government, the attack on voluntary effort and association, the excessive centralisation of power in the hands of the Minister, and the dangers which this Bill entails for the medical profession—we cannot do otherwise than vote for the Amendment.
I did not request that I should have a great deal of time in which to reply to the speeches of the Opposition today, because I believed that I would have a very light task. My task is even lighter than I thought it would be. The right hon. and learned Member for North Croydon (Mr. Willink) rejoices among his friends in a nickname which is very charming, and which does great credit to his qualities, but today it has indeed been a case of "Unhappy Harry," because he could not make up his mind which position he wanted to take up. On the one hand, he wanted to claim for himself and his predecessor that they were the real architects of the Health Bill. On the other hand, he has been roundly condemning it as a revolutionary Measure. I would like to have known which posi- tion he really wanted to take up. Does he really claim that the Measure which is now receiving its Third Reading, is the Measure to which he devoted so much energy? In fact, the right hon. and learned Gentleman has attacked each one of the main principles of the Measure, and in point of fact, the Measure which is now before the House, I rejoice to say, is entirely different from the one upon which he had laboured. Indeed, I tell the House that I am quite satisfied that even a Conservative House of Commons would have rejected the Measure which was in course of preparation. It was not only unpalatable; it was impracticable.
A great deal of criticism has been levelled today at what is described as the excessive Ministerial power which exists in the present Measure. But the right hon. and learned Gentleman, and hon. Members opposite, have not faced up to the implications of their own promise to introduce a universal health service as a part of a national insurance system. If we intend to enter into a contract with the citizens of the country, under which we collect from them a certain contribution, and in return for that contribution, we give a certain service, how are we to guarantee that that service is given, and that contract is carried out, if it is carried out through the agency of independent and self-motivating bodies? - But hon. Members opposite have never really faced up to the implications of their promise. Quite frankly, I do not believe that they ever intended to have a universal health service. They made lots of promises, but then we have heard promises from the party opposite for many years. The right hon. and learned Gentleman says that I am taking away from the hospital authority its rights of self-motivation. How am I to guarantee to the citizen in a particular part of the country that he will get the same service as a citizen in another part of the country, if the instrument to give him that service is an independent, autonomous, self-motivating body? In other words, the central principle of the Bill, under which the House places on the Minister the responsibility of these services, inevitably means that he must have agents. Every single instrument must be an agent, because when any instrument ceases to be an agent, the contract is broken.
Having established that principle, it is then necessary to provide that the central responsibility which the House places upon the Minister to provide a service, does not result in the service becoming too highly centralised in its administration. That is precisely what the scheme provides. It provides for the establishment of Regional Boards; it provides for management committees and for house committees. In fact, the scheme, right through, provides for measures of decentralisation, so that individuals in a locality can have as much influence as possible over the medical and hospital services.
Hon. Members opposite say, "In doing this you are in fact destroying the voluntary principle." That was answered by my hon. Friend the Member for Barnet (Dr. Taylor). The only voluntary part of the hospital service destroyed by this Bill is the necessity to sell flags and to collect money. In other words, this scheme emancipates voluntary workers from the indignity of having to collect money by private charity. Hon. Members opposite, as they represent the party of property, always imagine that the only voluntary act which has any sanctity behind it is the writing out of a cheque. The fact of the matter is that hon. Members behind me, in almost every branch of social service for the last 100 years, have a far better record of voluntary service.
Quite frankly, I think the whole country and the House were astonished when this Amendment was put down. Why is this Bill now being objected to on Third Reading? I tell the House this: The real reason behind the bitterness of hon. Members opposite- is because this is taking away from them one of their chief sources of social and political patronage. It is notorious in the world of medicine that doctors, first-class people, first-class surgeons, gynaecologists and general physicians have, from time to time, to desert the practice of their profession in order to seduce millionaires to provide money for teaching medicine. It is well known. As a matter of fact there are quite a number of people who sit in another place, in consequence of their benefactions. What is even more—
I was indeed, Sir. My point of Order was that the right hon. Gentleman has just said that a number of noble Lords in another place were there as a result of—I think he used the word— benefactions. Is not that at one and the same time a reflection upon the Crown, and a reflection upon Members of another place?
Unless, of course, the noble Lord now says that it is discreditable to be a benefactor. It is well established in the medical profession that one of the chief qualifications of some of the ornaments of the profession is the fact that they are able to attract money to the hospitals from rich individuals. I would like hon. Members to realise that the only aspect of the voluntary organisation which this scheme destroys, is one which is deeply repugnant to a civilised society, that is, that the care of its sick and the organisation of its health service should be dependent upon the benefactions of well-to-do persons. All the rest of the voluntary attributes of the existing service are preserved and enlarged. There will be more room for voluntary service in the new scheme than exists at the present time, and voluntary work will be much more efficient in the future because it will be emancipated from financial limitations. Indeed, I have been astonished by some of the arguments raised on the other side of the House today about covenants. Were not these covenants made in good faith? Were they not made for the purpose of conferring benefits upon a particular institution? These covenants resulted in the Chancellor of the Exchequer losing considerable sums of money. As a matter of fact, what have been called benefactions to the voluntary hospital system were, quite often, as I said on Second Reading, diversions of money from the Chancellor of the Exchequer to the purposes of private individuals.
I knew myself a rich man who wrote out a cheque for £30,000, and I, being an ingenuous and credulous person, congratulated him upon his generosity, but he said "Oh, no; £27,000 of this will be paid by Sir Kingsley Wood." It was, in fact, rather more, but there we are. He was a very rich man and he could divert £27,000 of our money. I should have thought myself that, these covenants having been entered into, it was perfectly reasonable for me to regard them as the assets of the hospitals, as they are, in fact. A contract is entered into. What do we do with it?
The right hon. and learned Gentleman does not know. If he does not know, I will explain to him once more, although I am rather weary of telling him. That money is not going to be used for the general maintenance of the hospitals, because we are going to provide that money ourselves.
The answer, as was stated by my hon. Friend the Member for Barking (Mr. Hastings) in what I thought was a most cogent speech, is that, in the hospital scheme of the future, a patient, instead of receiving incompetent treatment in a small local hospital, is taken to another hospital where he gets specialist treatment, and the endowment of that local hospital follows the patient, and becomes part of the endowment of the hospital management committee, whereas these foolish and superficial people opposite would keep the endowment to the bricks and mortar, and deny it to the patient.
Hon. Members opposite have said that they are very anxious, if the House of Commons adopts this Bill, that it should be carried out in a spirit of cooperation. Then they put this Amendment on the Order Paper against the Third Reading. What is the purpose of it? To incite the medical profession as much as possible. It is an astonishing thing to me that the leaders of the doctors have now identified themselves in a spirit of partisanship with the Conservative Party. That is, indeed, what has happened, because the spokesmen of some elements of the medical profession have now become the most reactionary politicians in Great Britain.
I deplore this. I deplore the medical profession, as a whole, being involved in these discussions and in this controversy. I believe that the medical pro- fession, as a whole, will work this scheme wholeheartedly. In fact, when a recent plebiscite was taken of the medical profession, they decided by a majority in favour of the abolition of the sale and purchase of practices. Now it has been suggested by the hon. Member for Chippenham (Mr. Eccles), who, as I said earlier in an interjection, invoked the ghost of a relative, that the ban on the sale and purchase of practices is an interference with the liberty of the doctor. It is a protection for the patient, and a protection for the profession. Why should a young doctor have to seek the assistance of a usurer before he can practise? Hon. Members opposite call that a "sense of adventure in medicine." It means that a young doctor who, for six years, has been qualifying and would never have gone through those six years at all unless he were a dedicated person anxious to practise his art of healing, can only begin to practise if he can borrow money. Why should he have to? Why should the medical profession be placed in the toils of usury on the excuse that, by doing so, one maintains a competitive spirit in medicine? What is wanted is not a competitive, but an emulative spirit.
The right hon. Gentleman must know that many of the doctors in this country did not start by buying a practice at all. It has always been open to them to put up their plate.
The answer is, of course, that those who can afford it, need not borrow, but we are not only concerned with them; we are concerned with those who cannot. If we are effectively to man the medical profession, it is necessary that we should derive our doctors from lower income groups than hitherto. Therefore, it is essential that we should start them off in a proper fashion. As I have said, the hon. Member for Chippenham quoted Lord Dawson of Penn, a most distinguished and revered name in the medical profession. But what did Lord Dawson of Penn say about the national health scheme? He said that what is required to be done is that the State shall provide to the medical profession an instrument, a machine and an apparatus of health which the profession shall freely exercise without let or hindrance. That is precisely what he said. In no part of this administration has the Minister of Health, or any other authority, the slightest control whatever over the professional conduct of the doctor. The Opposition said, "Ah, the doctors are going to become State servants." One would have thought—
I am sorry, but I cannot give way to the hon. Gentleman. I have given myself very little time; indeed, rather less than I really need. The suggestion is that there is some discredit in being a State servant. Yet, over and over again, eulogies have been poured out to distinguished State servants, both from the opposite and this side of the House.
; The right hon. Gentleman says that we do not want too many, but that is really a doctrinaire attitude. The fact is that the doctors under this scheme are not State servants at all. They are in contract with a body on which there is a half professional representation; they are, in fact, in contract with a body over which they themselves have considerable influence. They are not in contract with the Regional Boards or the Minister, but are in contract with an entirely different body.
It has been said in the course of Debate, and it was said in Committee, that the doctors resent the fact that they are not being properly protected. They will have more protection under this scheme than they have under the present one. At the moment, the doctors have only the appeal to the Minister of Health. Under this scheme they have appeals to the tribunal. They are the most protected profession in the country. But we know that some hon. Members got into their brains at the very start a number of a priori objections to this scheme, and from first to last they have been incapable of examining it and of understanding what it is. Their minds have been hopelessly prejudiced by headlines in some of the worst newspapers in Britain, and all through Second Reading and Third Reading we have had headlines thrown at us, all the time, without any examination at all of the principles contained in the scheme itself.
I have no time to describe some of the positive merits of the Bill. The Bill emerged from the Committee, as has been said, with its main structure unimpaired. It was intended to emerge from the Committee with its main structure unimpaired. However, I at once pay tribute to the Members of the Committee, on both sides, for having, in certain very important respects, improved the machinery of the Bill. I am a House of Commons man, and I have a great respect for House of Commons Committees. I believe that they are most valuable in fashioning and refashioning Bills, and we have had advantages from the Committee that considered this Bill as we have had from other Committees.
Now we have come to Third Reading, and what we hope now is to leave controversy behind us, and to get the cooperation of the great medical profession, and of all health workers in the country; because without that cooperation this scheme is bound to fail. The House of
Commons only passes Bills; but it is the men and women outside who can make them living realities. Now that we are reaching the conclusion, let me hope that the echoes of controversy will die down, and that what will reach our ears will not be the declamations of partisans, but the whispers and the piteous appeals of sick people all over the country, of the weak and distressed, who are reaching out their hands to this House of Commons to give them succour and assistance in their difficulties. I believe that, eventually, it will be that small voice that will be heard, and that will be most influential, and not the raucous declamations of controversialism.
|Division No. 272.||AYES.||[3.59 p.m.|
|Adams, Richard (Balham)||Corbel, Mrs. F. K. (Camb'well, N.W.)||Hamilton, Lieut.-Col. R|
|Adams, W. T. (Hammersmith, South)||Corlett, Dr. J.||Hardy, E. A.|
|Alexander, Rt. Hon. A. V.||Cove, W. G.||Harrison, J.|
|Allen, Scholefield (Crewe)||Crossman, R. H. S.||Hastings, Dr. Somerville|
|Alpass, J. H.||Daggar, G.||Haworth, J.|
|Attewell, H. C.||Dainies, P.||Henderson, A. (Kingswinford)|
|Attlee, Rt. Hon. C. R.||Dallon, Rt. Hon. H.||Henderson, Joseph (Ardwick)|
|Austin, H. L.||Davies, Edward (Burslem)||Herbison, Miss M.|
|Awbery, S. S.||Davies, Clement (Montgomery)||Hewitson, Capt. M.|
|Ayles, W. H.||Davies, Ernest (Enfield)||Hicks, G.|
|Ayrton Gould, Mrs. B.||Davies, Haydn (St. Pancras, S.W.)||Hobson, C. R.|
|Baird, Capt. J.||Deer, G.||Holman, P.|
|Balfour, A.||Delargy, Captain H. J.||Holmes, H. E. (Hemsworth)|
|Barstow, P. G.||Diamond, J.||Horabin, T. L.|
|Barton, C.||Debbie, W.||House, G.|
|Battley, J. R.||Dodds, N. N.||Hudson, J. H. (Ealing, W.)|
|Bechervaise, A. E.||Donovan, T.||Hughes, Hector Aberdeen, N.)|
|Benson, G.||Driberg, T. E. N.||Hughes, H. D. (W'lverh'pton, W.)|
|Bevan, Rt. Hon. A. (Ebbw Vale)||Dugdale, J. (W. Bromwich)||Hynd, H. (Hackney, C.)|
|Binns, J.||Durbin, E. F. M.||Irving, W. J.|
|Blackburn, A. R.||Ede, Rt. Hon. J. C.||Isaacs, Rt. Hon. G. A.|
|Blenkinsop, A.||Edelman, M.||Janner, B.|
|Bottomley, A. G.||Edwards, A. (Middlesbrough, E,)||Jeger, G. (Winchester)|
|Bowen, R.||Edwards, John (Blackburn)||Jeger, Dr. S. W. (St. Pancras, S.E.)|
|Bowles, F. G. (Nuneaton)||Edwards, N. (Caerphilly)||Jones, D. T. (Hartlepools)|
|Braddock, Mrs. E. M. (L'p'l, Exch'ge)||Edwards, W. J. (Whitechapel)||Jones, Elwyn (Paistow)|
|Braddock, T. (Mitcham)||Evans, John (Ogmore)||Jones, P. Asterley (Hitchin)|
|Bramall, E. A.||Evans, S. N. (Wednesbury)||Keenan, W.|
|Brook, D. (Halifax)||Fairhurst F.||Kendall, W. D.|
|Brooks, T. J. (Rotbwell)||Farthing, W. J.||Kenyon, C.|
|Brown, T. J. (Ince)||Fletcher, E. G. M. (Islington, E.)||Key, C. W.|
|Brawn, W. J. (Rugby)||Foster, W. (Wigan)||Kinghorn, Sqn.-Ldr. E.|
|Bruce, Maj. D. W. T.||Fraser, T. (Hamilton)||Kinley, J.|
|Burden, T. W.||Freeman, Maj. J. (Watford)||Kirby, B. V.|
|Byers, Frank F.||Ganley, Mrs. C. S.||Lawson, Rt. Hon. J. J.|
|Callaghan, James||George, Lady M. Lloyd (Anglesey)||Lee, F. (Hulme)|
|Chamberlain, R. A.||Gibson, C. W.||Lee, Miss J. (Cannock)|
|Champion. A. J.||Goodrich, H. E.||Leonard, W.|
|Chater, D.||Gordon-Walker, P. C.||Lever, N. H.|
|Chetwynd, Capt. G. R.||Greenwood, Rt. Hon. A. (Wakefield)||Levy, B. W.|
|Clitherow, Dr. R.||Greenwood, A. W. J. (Heywood)||Lewis, A. W. J. (Upton)|
|Cluse, W. S.||Grierson, E.||Lewis, J. (Bolton)|
|Cobb, F. A.||Griffiths, D. (Rother Valley)||Lindgren, G. S.|
|Cocks, F. S.||Griffiths, W. D. (Moss Side)||McAdam, W.|
|Collick, P.||Guest, Dr. L. Haden||McEntee, V. La T.|
|Collindridge, F.||Gunter, Capt, R. J.||McGhee, H. G.|
|Colman, Miss G. M.||Guy, W. H.||Mack, J. D.|
|Comyns, Dr. L.||Haire, Fit.-Lieut. J. (Wycombe)||Mackay, R. W. G. (Hull, N.W.)|
|Cooper, Wing-Comdr. G.||Hale, Leslie||McLeavy, F.|
|MacMillan, M. K. (Western Isles)||Perrins, W.||Strauss, G. R. (Lambeth, N.)|
|Macpherson T. (Romford)||Piratin, P.||Summerskill, Dr. Edith|
|Manwaring, W. H.||Platts-MilIs, J. F. F.||Swingler, S.|
|Mailalieu, J P W.||Popplewell, E.||Symonds, Maj. A. L.|
|Manning, C. (Camberwell, N.)||Porter, E. (Warrington)||Taylor, H. B. (Mansfield)|
|Manning, Mrs. L. (Epping)||Porter, G. (Leeds)||Taylor, R. J. (Morpeth)|
|Marquand H. A.||Price, M. Philips||Taylor, Dr. S. (Barnet)|
|Martin, J. H.||Pritt, D. N.||Thomas, Ivor (Keighley)|
|Mathers G.||Proctor, W. T.||Thomas, John R. (Dover)|
|Mayhew C P.||Pursey, Cmdr. H.||Thorneycroft, Harry (Clayton)|
|Messer, F.||Randall, H. E.||Thurtle, E.|
|Middleton, Mrs. L.||Ranger, J.||Tomlinson, Rt. Hon. G.|
|Mitchison, Maj. G. R.||Rees-Williams, D. R.||Turner-Samuels, M.|
|Monslow W.||Reeves, J.||Ungoed-Thomas, L.|
|Montague, F.||Reid, T. (Swindon)||Vernon, Maj. W. F.|
|Morgan, Dr. H. B.||Richards, R.||Viant, S. P.|
|Morris P. (Swansea, W.)||Ridealgh, Mrs. M.||Walkden, E.|
|Morris, Hopkin (Carmarthen)||Roberts, Emrys (Merioneth)||Wallace, H. W. (Walthamstow, E.)|
|Morrison, Rt. Hon. H. (Lewisham, E.)||Rogers, G. H. R.||Warbey, W. N.|
|Mort, D. L.||Scott-Elliot, W.||Weitzman, D.|
|Moyle, A.||Segal, Dr. S.||Wells, P. L. (Faversham)|
|Nally, W.||Shackleton, Wing-Cdr. E. A. A.||Wells, W. T. (Walsall)|
|Naylor T. E.||Silkin, Rt. Hon. L.||West, D. G.|
|Neal H. (Glaycross)||Silverman, S. S. (Nelson)||Whiteley, Rt. Hon. W.|
|Nichol, Mrs. M. E. (Bradford, N.)||Simmons, C. J.||Wigg, Colonel G. E.|
|Nicholls, H. R. (Stratford)||Skeffington, A. M.||Wilkins, W. A.|
|Noel-Buxton Lady||Skeffington-Lodge, T. C.||Willey, F. T. (Sunderland)|
|O'Brien, T.||Skinnard, F. W.||Williams, Rt. Hon. T. (Don Valley)|
|Oldfield, W. H.||Smith, C. (Colchester)||Wills, Mrs. E. A.|
|Oliver, G. H.||Smith, S. H. (Hull, S.W.)||Wilmet, Rt. Hon. J.|
|Orbach, M.||Smith, T. (Normanton)||Wise, Major F. J.|
|Paget, R. T.||Snow, Capt. J. W.||Woodburn, A.|
|Paling, Rt. Hon. Wilfred (Wentworth)||Sorensen, R. W.||Wyatt, Maj. W.|
|Palmer, A. M. F.||Soskice, Maj. Sir F.||Yates, V. F.|
|Pargiter, G. A.||Sparks, J. A.||Young, Sir R. (Newton)|
|Parker, J.||Stamford, W.||Zilliaous, K.|
|Parkin, B. T.||Steele, T.|
|Paton, Mrs. F. (Rushcliffe)||Stewart, Capt. Michael (Fulham, E.)||TELLERS FOR THE AYES:|
|Peart, Capt. T. F.||Stokes, R. R.||Mr. Pearson and Mr. Bing.|
|Agnew, Cmdr. P. G.||Galbraith, Cmdr. T. D.||Nield, B. (Chester)|
|Aitken, Hon. Max||Gammans, L. D.||Orr-Ewing, I. L.|
|Amory, D. Heathcoat||Gomme-Duncan, Col. A. G.||Peake, Rt. Hon. O.|
|Assheton, Rt. Hon. R.||Graham-Little, Sir E.||Pitman, I. J.|
|Astor, Hon. M.||Gridley, Sir A.||Ponsonby, Col C. E|
|Baxter, A. B.||Hare, Hn. J. H. (Woodb'ge)||Raikes, H, V.|
|Beamish Mai. T. V. H.||Harvey, Air-Comdre. A. V.||Rayner, Brig. R|
|Beechman N. A.||Haughton, S. G.||Reid, Rt. Hon. J. S. C. (Hillhead)|
|Bennett Sir P.||Headlam, Lieut.-Col. Rt. Hon. Sir C.||Renton, D.|
|Boles, Lt.-Col. D. C. (Wells)||Herbert, Sir A. P.||Roberts, H (Handsworth)|
|Boothby, R.||Hinchingbrooke, Viscount||Robinson, Wing-Comdr. Roland|
|Bossom, A. C.||Hollis, M. C.||Smithers, Sir W.|
|Bower, N.||Holmes, Sir J. Stanley (Harwich)||Spearman, A. C. M.|
|Boyd-Carpenter, J. A.||Howard, Hon. A.||Stanley, Rt. Hon. O.|
|Braithwaite, Lt. Comdr. J. G.||Hulbert, Wing-Cdr. N. J.||Strauss, H. G. (English Universities)|
|Butcher, H. W.||Hutchison, Lt.-Cm. Clark (E'b'rgh W.)||Stuart, Rt. Hon. J. (Moray)|
|Butler, Rt. Hon. R. A. (S'ffr'n W'ld'n)||Hutchison, Col. J. R. (Glasgow, C,)||Studholme, H. G.|
|Carson, E.||Jeffreys, General Sir G.||Sutcliffe, H.|
|Challen, C.||Kerr, Sir J. Graham||Taylor, C.S.(Eastbourne)|
|Channon, H.||Lancaster, Col. C. G.||Taylor, Vice-Adm. E. A. (P' dd t'n, S.)|
|Clarke, Col. R. S.||Legge-Bourke, Maj. E. A. H.||Teeling, William|
|Clifton-Brown, Lt.-Col. G.||Linstead, H. N.||Thorneycroft G. E. P. (Monmouth)|
|Conant, Maj. R. J. E.||Low, Brig. A. R. W.||Touche, G. C.|
|Crookshank, Capt. Rt. Hon. H. F. C.||Lucas-Tooth, Sir H.||Vane, W. M. F.|
|Crosthwaite-Eyre, Col. O. E.||McKie, J. H. (Galloway)||Walker-Smith, D.|
|Wakefield, sir W. W.|
|Crowder, Capt. John E.||Maclay, Hon. J. S.||Ward, Hon. G. R.|
|Darling, sir W. Y.||MacLeod, Capt. J.||Watt, Sir G. S. Harvie|
|Davidson, Viscountess||Maitland, Comdr. J. W.||Webbe, Sir H. (Abbey)|
|De la Bèere, R.||Manningham-Buller, R. E.||Wheatly, Colonel M. J.|
|Dodds-Parker, A. D.||Marlowe, A. A. H.||White, J. B. (Canterbury)|
|Donner, Sqn.-Ldr. P. W.||Marshall, D. (Bodmin)||Williams, C. (Torquay)|
|Dower, Lt.-Col. A. V. G. (Penrith)||Marshall, S. H. (Sutton)||Williams, Gerald (Tonbridge)|
|Drayson, Capt. G. B.||Medlicott, F.||Willink, Rt. Hon. H. U.|
|Eccles, D. M.||Mellor, Sir J.||Willoughby de Eresby, Lord|
|Eden, Rt. Hon. A.||Moore, Lt.-Col. Sir T.||Winterton, Rt. Hon. Earl|
|Fletcher W. (Bury)||Morris-Jones, Sir H.|
|Foster, J. G. (Northwich)||Morrison, Rt. Hn. W. S. (Cirencester)||TELLERS FOR THE NOES:|
|Gage, C.||Nicholson, G.||Mr. Buchan-Hepburn and|
|Sir Arthur Young.|
Bill read the Third time, and passed.