PUBLIC HEALTH (SCOTLAND) AMENDMENT BILL.
TUESDAY, 12th MAY, 1925.1439
The Committee consisted of the following Members:
Major Barnett (Chairman)
Adamson, Mr. William (Fife, W.)
*Advocate, The Lord (Carlisle)
Alexander, Sir William (Glasgow, Central)
Atholl, Duchess of (Kinross and W. Perth)
Baird, Sir John (Ayr Burghs)
*Balniel, Lord (Lonsdale)
Barr, Mr. (Motherwell)
Benn, Captain Wedgwood (Leith)
Berry, Sir George (Scottish Universities)
*Bethel, Mr. (Eccles)
Boothby, Mr. (Aberdeen, E.)
Broun-Lindsay, Major (Partick)
Brown, Mr. James (Ayrshire, S.)
Buchanan, Mr. (Gorbals)
Chapman Sir Samuel (Edinburgh, South)
Charteris Brigadier-General (Dumfries)
Cochrane, Commander (Fife, East)
Collins Sir Godfrey (Greenock)
Couper, Mr. J. B. (Maryhill)
Cowan, Mr. (Scottish Universities)
*Cowan, Sir Henry (Islington, North)
Craik Sir Henry (Scottish Universities)
*Crawfurd, Mr. (Walthamstow, West)
Crookshank, Colonel (Berwick and Haddington)
Dalkeith, Earl of (Roxburgh and Selkirk)
Elliot, Captain (Kelvingrove)
Fanshawe, Commander (Clackmannan and Western)
Ford, Mr. (Edinburgh, North)
Gilmour, Sir John (Pollok)
Graham, Mr. Duncan (Hamilton)
Graham, Mr. William (Edinburgh, Central)
Hamilton, Sir Robert (Orkney and Shetland)
Hardie, Mr. (Springburn)
Harvey, Mr. Charles Barclay- (Kincardine, Western)
Henderson, Mr. Thomas (Tradeston)
Henniker Hughan, Vice-Admiral Sir A. (Galloway)
Hope, Sir Harry (Forfar)
Horne, Sir Robert (Hillhead)
Hunter-Weston, Lieut.-Gen. Sir A. (Bute and North Ayrshire)
Hutchison, Mr. Clark (Midlothian and Peebles, North)
Hutchison, Sir Robert (Montrose)
Johnston, Mr. (Dundee)
Kennedy, Mr. Thomas (Kirkcaldy)
Kidd, Mr. (Linlithgow)
Kirkwood, Mr. (Dumbarton Burghs)
Livingstone, Mr. MacKenzie (Western Isles)
*Lucas-Tooth, Sir Hugh (Isle of Ely)
MacAndrew, Mr. (Kilmarnock)
Macdonald, Sir Murdoch (Inverness)
MacDonald, Mr. Robert (Cathcart)
MacIntyre, Mr. (Edinburgh, West)
Maclean, Mr. Neil (Govan)
Macpherson, Mr. (Ross and Cromarty)
Macquisten, Mr. (Argyllshire)
MacRobert, Mr. (Renfrew, East)
Maxton, Mr. (Bridgeton)
Mitchell, Mr. Rosslyn (Paisley)
Mitchell, Mr. Stephen (Lanark)
*Morrison, Mr. Robert (Tottenham, North)
Murnin, Mr. (Stirling and Falkirk)
*Palin, Mr. John (Newcastle, West)
*Richardson, Mr. Robert (Houghton-le-Spring)
Robertson, Mr. John (Bothwell)
Rose, Mr. (Aberdeen, North)
*Russell, Mr. (Tynemouth)
Scrymgeour, Mr. (Dundee)
Shaw, Lieut.-Colonel A. D. (Renfrew, W.)
Shiels, Dr. (Edinburgh, E.)
*Simms, Mr. (Down)
Sinclair, Major Sir Archibald (Caithness and Sutherland)
*Sinclair, Colonel (Belfast University)
Skelton, Mr. (Perth)
Smith, Mr. R. W. (Aberdeen, Central)
Solicitor-General for Scotland, The (Dumbarton)
Sprot, Sir Alexander (Lanark, N.)
*Steel, Major (Ashford)
Stephen, Mr. (Camlachie)
Stewart, Mr. James (St. Rollox)
Stuart, Mr. (Moray and Nairn)
Templeton, Mr. (Banff)
Thomson, Mr. Frederick (Aberdeen, S.)
*Warrender, Sir Victor (Grantham)
Watson, Mr. Maclean (Dunfermline)
Weir, Mr. McNeill (Clackmannan and Eastern)
Welsh, Mr. (Coatbridge)
Westwood, Mr. (Peebles and Southern)
Wheatley, Mr. (Shettleston)
*Windsor, Mr. (Bethnal Green, N. E.)
Wright, Mr. (Rutherglen)
* Added in respect of the Public Health (Scotland) Amendment Bill—12th May, 1925.
MR. COLOMB Committee Clerks.
MR. DENT Committee Clerks.1440 1441 STANDING COMMITTEE ON SCOTTISH BILLS. Tuesday, 12th May, 1925.
[Major BARNETT in the Chair.]
Mr. BUCHANAN: Before we begin the business, I would like to raise a point of order which, I think, has been raised once or twice before. Hitherto in my two years' experience as a Member of Parliament, the Members of the Scottish Standing Committee have had enough capacity and enough brains—I say this without intending any insult to the present occupant of the Chair—to produce one Scotsman who was capable of taking the Chair. It seems to me that there has been a change since the new Government came into office. In the business which comes before this Committee it would be better if the Chairman had a knowledge of the problems that we have to face from day to day in Scotland. I do not want to raise any anti-English feeling, but I wish to bring forward the point that in the last two or three Committees we have been making a departure from the practice that one who understands the problems of Scotland should preside over the Scottish Standing Committee. I would ask those who are responsible for calling us here, whether there is any particular reason why a Member from Scotland should not be allowed to take the Chair. I protest that when we are dealing with purely local problems, a man who understands those local problems ought to be asked to take the Chair. I want to protest personally against a Scotsman not being in the Chair.
The CHAIRMAN: I think the hon. Member for Gorbals (Mr. Buchanan)) is labouring under a misapprehension. The nationality of the Chairman is not an issue here, nor can it be a matter for this 1442 Committee. I will deal with the point of Order—I suppose it has been put as a point of Order. I happen to be an Ulster man, born in Kent, who can trace his descent from King Robert the Bruce of Scotland. My nationality is not an issue before this Committee, either on a point of Order or in any other way. The House of Commons in its wisdom has delegated to the Committee of Selection all these matters. The Committee of Selection has set up the Chairmen's Panel, and it is for the Chairmen's Panel to decide who shall be Chairman of any particular Committee, and I am sure I shall have the support of the hon. Member for Gorbals and of every other Member of the Committee in trying to carry on the work of the Committee in accordance with the rules of Order.
Mr. WESTWOOD: If it is correct that the Chairman can trace his ancestry right back to King Robert the Bruce, if he could go five stages further back, we should discover that he then belonged to Norway.CLAUSE 1.
The powers of a local authority under the Public Health (Scotland) Act, 1897, shall include and be deemed, as from the first day of March, nineteen hundred and twenty-four, to have included power to make such arrangements as they may think fit and as may be sanctioned by the Scottish Board of Health (in this Act referred to as "the Board") for providing medicines and treatment to persons who are suffering from diabetes and who, in the opinion of the local authority, require assistance in obtaining such medicines and treatment.
The CHAIRMAN: The first Amendment we have to consider is a manuscript Amendment in the name of the right hon. Member for West Fife (Mr. Adamson)—after the word "diabetes," to insert the words "or other diseases by an order of the Scottish Board of Health." I am afraid that Amendment does not come within the scope of this Bill. This is a Bill to authorise local authorities to make arrangements to provide medicines and treatment for persons suffering from diabetes, and other purposes connected therewith. The right hon. Gentleman informs me that when we were dealing with a similar Bill last Session, he was allowed by the Chairman to move an Amendment of this character. I have 1443 had the Bill looked up. It was one to extend the powers of local authorities under the Public Health (Scotland) Act, 1897, and it must be very obvious that that is a wide title, which would give power to make such an Amendment as is proposed by the right hon. Gentleman to-day. I must rule this Amendment out of order, because it does not come within the scope of a Bill designed to provide medicines and treatment for persons suffering from diabetes. The next Amendment stands in the name of the hon. Member for East Edinburgh (Dr. Shiels), who wishes, I understand, to move an alternative form of Amendment to that which is on the Paper, which is to add, at the end of the Clause: "The Board shall require the local authority to arrange that any medicines used for the treatment of such persons shall be supplied, according to an approved tariff, by persons, firms, or bodies corporate entitled to carry on the business of a chemist and druggist under the provisions of the Pharmacy Act, 1868, as amended by the Poisons and Pharmacy Act, 1908, who undertake that all medicines supplied by them to such persons shall be dispensed either by or under the direct supervision of a registered pharmacist except in cases where, with the sanction of the Board, circumstances make it necessary that the supply may be obtained from a medical practitioner." If there be no objection on the part of the Committee, I propose to allow the hon. Member to withdraw the Amendment on the Paper, and move the other Amendment in substitution.
Dr. DRUMMOND SHIELS: I beg to move, at the end of the Clause, to add the words
"The Board shall require the local authority to arrange that any medicines used for the treatment of such persons shall be supplied—
The SECRETARY for SCOTLAND (Sir John Gilmour): I would like, at the earliest moment, to try and make clear, as far as a layman may, my view of this, question. I am sure that the Committee has listened with interest and appreciation to the speech of the hon. Member for East Edinburgh (Dr. Shiels), who, speaking with a knowledge on this question as a medical man, deserves, of course, the very fullest consideration. What, I take it, we are concerned with, to-day in this Measure is, first of all, that it is a Bill to legalise the local authorities in the action which they have been voluntarily taking in the provision of insulin for those belonging to the poorest class of the country who cannot afford the cost themselves. I want to make it clear, in the second place, that this is a permissive Bill, and for that reason there are not included in it a large number of restrictions as to what these local authorities may do in their methods of dealing with this problem. I 1449 am sure, however, that what is in the minds of all the members of this Committee is, that whatever provision is made for the use of this drug for the attempted cure of a difficult disease, the steps which are taken should be safeguarded, and that those concerned should obtain the benefit of this treatment under circumstances as scientific as is possible, and also that they should obtain the benefits as cheaply as possible. I have considered this problem, and it seems to me that it would be a dangerous principle to admit that the issue of these drugs should be confined, at any rate in present circumstances, to chemists. I am, of course, prepared to agree that the actual composition of these drugs is a matter of scientific knowledge and ought to be conducted by those who are fully qualified to do it, but when you come to the question of the cost alone, as I understand it the Board of Health, working with the other great department of health in England, has been able to obtain this drug in bulk at much cheaper prices than the ordinary chemist has been to retail it to the ordinary individual. This is rather a fresh departure, and undoubtedly it is a matter of the greatest importance, and if, as I believe, the Department has been able, by arrangement, to obtain it at something like 2s., as against 2s. 8d., which was the possibility on the other hand, that is a consideration which is bound to weigh with all of us. Then, when one comes to the question of the care of the use of this drug by the public, I think it is clear that this treatment must originate, in the case practically of every patient, either in a hospital or at a clinic or under direct medical supervision. I listened with interest to the hon. Member, but there appeared to creep into his speech some kind of idea that the chemists were actually going to be the individuals who could be relied upon to advise and to supervise the use of this drug. I am bound to say I should enter conclusions at once with him on that point. I do not think it would be the province of the chemist. The province of the chemist, as I understand it, is to produce a drug and to sell it to the public in a proper form. An individual may often consult, as I have consulted, a chemist from time to time, but I have done it with my eyes open, and 1450 with the knowledge that he really did not take the full responsibility. But, really, what we come to in this matter is that the Government are very anxious to secure the greatest purity of this drug and all others, and there is a Bill before Parliament dealing with therapeutic substances, which will largely deal with that question. But I think it would be most regrettable that we should to-day, without greater experience than we have on this point, limit and hamper by such an Amendment as this dealing with these drugs. I am afraid, in these circumstances, the Government must resist the Amendment.
Dr. SHIELS: I hope I shall be allowed a word of reply.
The CHAIRMAN: The Amendment is lost. At the same time, by the courtesy of the Committee the hon. Member may be allowed to speak, if he restricts himself to two or three minutes.
Dr. SHIELS: I would point out that I rose to reply before the Question was put. The right hon. Gentleman has not. I think, made any serious objection to the principles which I have laid down. His principal argument was in regard to the matter of cheapness. He said local authorities could buy insulin in bulk, and thereby distribute it very much more cheaply. As long as that insulin, once obtained by local authorities in bulk, is given out by a qualified pharmacist, even in the employ of local authorities, I have no objection, and the Amendment specifically provides for that. Large local authorities like Glasgow and Edinburgh have such qualified pharmacists, but if you come to look at local authorities of smaller dimensions—smaller boroughs and county areas where there are no such qualified persons—in our opinion it would be very undesirable for local authorities to hand that dangerous drug out by the hands of unqualified people. In such a case we believe that if they are not able to employ a qualified pharmacist, it should be supplied through the local chemists. It is not so much a matter of the chemist in his commercial sense. The right hon. Gentleman stressed the word "chemist." It is the chemist as pharmacist, in the technical, and not in the commercial sense. That is the whole point of the Amendment. I have no 1451 desire that chemists in the commercial sense should supervise the buying and distributing of insulin. I think I made that perfectly clear. The National Health Insurance Act, which deals with the large bulk of the distribution of insulin, already has provisions in it similar to what I am proposing and it seems a very peculiar thing that we should have three methods of distribution of insulin, the National Health Insurance method, exactly as my Amendment, the Poor Law method, by qualified employés, and the third method of no system and no method at all. It is most unsatisfactory and shows for the first time a great want of co-ordination in such legislation. For these reasons I hope hon. Members will support my Amendment.
The CHAIRMAN: I must remind the hon. Member that the Amendment has been lost. He is only dealing, for the benefit of the Secretary for Scotland, with what would have been his reply if I had seen him rise, and, no doubt, his arguments will be present to the right hon. Gentleman's mind at a later stage.
Dr. SHIELS: If you rule that the Amendment is lost in spite of my having risen before the Question was put, there is no use in prolonging the funeral oration. But there may be another occasion on which I shall be able to bring the matter before the notice of a larger body of hon. Members.
Motion made, and Question proposed, "That the Clause stand part of the Bill."
Mr. W. ADAMSON: I do not rise for the purpose of opposing the Bill, but rather for the purpose of entering my protest against its limited character compared with the Bill of last year, which gave wider scope for the treatment of disease than the present one. I believe the Secretary for Scotland has limited it in the way he has done at the instigation of certain Members, and, it may be, of more than one local authority. I am well aware that in limiting the Bill he is following the lines he followed last year. At the same time, I believe his action then was taken because of the same influences, just as the action he has taken in limiting the Bill in the way he has done to-day. I think when we are considering legislation of this character, we should take 1452 the opportunity to give local authorities power to deal fully with the health of the people. The Amendment which you, Sir, in your judgment saw fit to rule out, had for its object the purpose of giving the local authorities wider powers for dealing with the health of the people. Why should our local authorities not have the opportunity of dealing with other diseases than diabetes, We may at any moment have as effective a cure for cancer as that for which we are making provision in the case of diabetes. In dealing with diseases of that character, promptness is the very essence of success. Unless provision be made similar to that which has been made for dealing with diabetes, valuable time and lives may be lost. Already we have had some experience of this. The Bill I sought to introduce last year was held up because of the opposition of the right hon. Gentleman to the inclusion of other diseases than diabetes. Somebody else, if a cure be found for cancer, may see fit to oppose the making of a similar provision to this, and valuable time will be lost, and, as a consequence, valuable lives as well. When we are dealing with the health of the people we are dealing with a question where our local authorities, subject to proper safeguards—and the Amendment which I handed in had what I considered proper safeguards attached to it, namely, that it would be by order of the Scottish Board of Health—should have the fullest power to deal with the health of the people. I want at this stage to register my protest against the limiting character of the Bill introduced by the right hon. Gentleman. I am not so very sure that it was not done with intent to prevent us from being able to move an extension of this Bill to other diseases. If it were so done, my protest is all the more justified.
Sir J. GILMOUR: Perhaps I may be allowed to say a few words in reply to what my right hon. Friend the Member for West Fife (Mr. W. Adamson) has just said. In the first place, I think I can claim that I have been completely consistent in my attitude on this matter. It is within the recollection of Members of the Scottish Committee that on a previous occasion I objected to the Bill introduced by the right hon. Gentleman 1453 and his party on the ground that I believed it was too wide. I objected to it then. I object to it now; not only because I have that opinion myself, but because I am fortified in that opinion by the support and opinion of the local authorities. After all, I think it is right to say that the local authorities are not averse to carrying out any scheme, if and when it has really been proved to be of benefit to the population over whom they have charge. When the right hon. Gentleman talks to us, either here or in the House, about the folly of shutting out the possibility of dealing with some yet-to-be-discovered remedy for cancer, let me say this to him: a remedy, which we all hope may be found some day for cancer, is going to be a thing of such gigantic proportions that it has got, first of all, to go through the experimental stage in which all well-informed medical opinion must be perfectly satisfied as to its efficacy before it is launched in any large measure upon the population. In the second place, if this remedy be found, it will be a matter of so great importance and such magnitude as to be a national as well as a local question. Just as in the question of tuberculosis, which it is impossible to 1454 believe would have reached the stage where it is, unless it had received from the State generally some measure of support, so it would be in the case of the relief of cancer. I do not for a single moment believe, if a remedy for cancer is ever found, and produced, that there will be the slightest difficulty or hesitation upon the part of whatever House of Commons is sitting at Westminster to give effect to the necessary legislation to carry it into being.
Question, "That the Clause stand part of the Bill," put, and agreed to.
Clauses 2 (Combination of local authorities) and 3 (Short title), ordered to stand part of the Bill.
Bill, without Amendment, ordered to be reported to the House.
Sir J. GILMOUR: I am sure that in expressing to the Chairman, on behalf of Scotland, our thanks for his presiding over this Committee, I am doing that on which all hon. Members will be agreed. [HON. MEMBERS: "Hear, hear!"]
Committee rose at Ten Minutes before Twelve o'Clock.
THE FOLLOWING MEMBERS ATTENDED THE COMMITTEE:—
Barnett, Major (Chairman)
Adamson, Mr. William
Advocate, The Lord
Berry, Sir George
Couper, Mr. J. B.
Cowan, Sir Henry
Craik, Sir Henry
Dalkeith, Earl of
Gilmour, Sir John
Harvey, Mr. Charles Barclay-
Henderson, Mr. Thomas
Henniker-Hughan, Vice-Admiral Sir A.
Kennedy, Mr. Thomas
Lucas-Tooth, Sir Hugh
Mitchell, Mr. Rosslyn
Palin, Mr. John
Richardson, Mr. Robert
Shaw, Lieut.-Colonel A. D.
Smith, Mr. R. W.
Solicitor-General for Scotland, The
Sprot, Sir Alexander
Thomson, Mr. Frederick