Mr. Speaker, I move—

Mr. Speaker, as the House will remember, I supported this Bill at Second Reading because, as I said at the time, I agree with the principle of equal responsibility as well as equal rights between spouses, as, indeed, between men and women in every walk of life. The requirement which was laid down in this Bill for pro rata contributions for necessaries for the joint household seemed to me to be fair enough, as did the clause dealing with the joint and several responsibilities for liabilities incurred as far as necessaries for the joint household were concerned. As the hon. the Minister will remember, I also did not object to the removal of the proviso to section 3 of the Matrimonial Affairs Act of 1953, because I knew that this proviso had, over the years, led to considerable abuse and a great deal of litigation. Having said that, I want to remind the House that I said at Second Reading too that the Bill was vague and that it was full of uncertainties and ambiguities, and that, as it is presently worded, it too will lead to a great deal of litigation. For all those reasons I asked the hon. the Minister to consider sending the Bill to a Select Committee after Second Reading so that some of the uncertainties could be ironed out and so that some of the questionable features of the Bill could be obviated.

I also pointed out at Second Reading that the Bill is halfbaked in that it deals with only one of the ambiguities in our matrimonial law. It leaves untouched several very important aspects and deficiencies, such as the question of joint guardianship of children and the glaring disabilities which still remain for women married in community of property in South Africa, as well as other deficiencies. The Bill was passed at Second Reading without any objections and then, in the Committee Stage, an amendment was accepted which deleted the proviso to subsection (2) of the new section 3 as substituted by clause 1. The hon. the Minister, in giving his reasons for accepting the amendment which was moved by the hon. member for East London City, stated that he believed that it should really be left to the courts to decide how they should interpret this Bill, and that if anything, the proviso was a complicating factor. Therefore he agreed with the hon. member for East London City that the proviso should be deleted. Mr. Speaker, I wonder whether I could have a little quiet?

Order! Hon. members make such a noise that I cannot hear what the hon. member is saying. They must control themselves.

You are not missing much, Sir, but still … [Interjections.] The hon. member for East London City stated, when he moved that amendment, that the terms of any Act should be capable of easy interpretation by the legal advisers of the parties, who are so often called upon to settle matrimonial matters, without recourse to the expense of litigation. I agree with him; that is a perfectly valid reason. He also said he believed that the generalities phrase, namely “or any other relevant fact”, which was contained in the proviso which has now been removed, also created uncertainty. For those reasons he moved the amendment. I listened to his reasons and it seemed to me at the time that there was good reason, at least for not objecting to, even though one did not necessarily support, what the hon. member was doing and what the hon. the Minister was accepting. I did not oppose that amendment then, but I must now in all honesty say that I do not think that the one offset that a woman had against this statutory duty which is now being laid upon her for the first time, for a pro rata contribution to the necessaries of the joint household, should have been so lightly discarded. In other words, I believe that the offset to the claim which could be laid against her for not paying her pro rata proportion of the contributions to the cost of the necessaries, which was, more particularly as far as the woman was concerned, the rendering of services in the household, has in fact been too lightly discarded. I am sorry I was not quick-witted enough last night to have voiced these objections then, because I think I certainly would have voted against this clause at that stage, and I also think, in retrospect, that the removal of the generalities clause was a mistake, because although “any other relevant fact’’ might give rise to difficulties as far as legal interpretation is concerned and it might give difficulties to the courts, it does also give a discretion to the courts. That is the important point I want to make. The discretion of the court has now been removed and the court is bound by the bleak words of subsection (2) as it stands, viz.—

No other consideration can be taken into account by the court except the income. I hope I am wrong in my interpretation of this. I see the hon. the Minister is frowning at me; perhaps he just has a headache. However, if I am wrong, I know he will tell me so and I will be only too glad to be reassured, because I need reassuring on this Bill.

This is not a party political measure. As far as I am concerned a measure like this should always be left to the free vote of the House. I believe, as I have said before, that in this House far too few measures are dealt with on a non-party political basis. On matters like this, where political considerations per se are not in fact at issue, I think it is important that members should be left to use their own individual judgment. The Progressive Reform Party is not treating this as a party measure although it is very possible that hon. members on this side of the House will agree with what I say; some of them may not, of course.

As I have said, I do not think we should so lightly have discarded the one offset that a woman had as far as reckoning her pro rata contribution to the joint household is concerned. The value of her services is an important asset, because the very fact that she is bound down to her household duties as a wife and as a mother and has to, of necessity, spend many hours in the home attending to those duties, reduces her income-earning capacity.

Order! There is an hon. member at the back who is conversing so loudly that I can hear him even here. Hon. members must not converse so loudly.

Thank you, Mr. Speaker. As I have said too, on further reflection I do not think that the phrase “or any other relevant fact” should have been removed, because I would like to see some further discretion given to the courts. I would like to put to the hon. the Minister and to the House some of the misgivings which occurred to me, unfortunately, somewhat belatedly. Indeed, they occurred to me, as some members will know, almost immediately after we left the Chamber, because I discussed them with hon. members at that stage. I would like to appeal to the hon. the Minister to give these misgivings his earnest consideration so that some amendments could possibly be made in the Other Place. I hope the hon. the Minister will pay attention to a few examples that I am going to give him. I believe great difficulties are going to arise out of this Bill as it presently stands.

First of all, I think the courts should be given the right to take the services rendered in the home into consideration in assessing the financial responsibility to the joint household of the wife, particularly in the event of a dispute where the husband is claiming from the wife money which he says should have been expended as her pro rata share towards the necessaries of the household, and especially where a marriage is breaking up. As I said during the Second Reading, it is when a marriage has gone sour that the deficiencies of a Bill like this are revealed in all their starkness. As long as a marriage is going well and the husband and wife are working in amity, the law does not matter. Most women would in any case not have known that they had a right of recourse which existed in the proviso to section 3 of the Matrimonial Affairs Act if their marriage was going smoothly. However, they would soon have known of it if they had a smart lawyer acting for them in the case of a divorce. The lawyer would then have asked her whether she had been contributing to the household necessaries. If her answer had been in the affirmative, he would have told her that she had a right of recourse against her husband for the full amount of money she expended during the years in which the marriage has lasted.

We now come to this situation. It is now going to weigh very heavily on the woman in the case of a dispute, more particularly as now, it seems to me—and I may be wrong again in law—that the common law is superseded by statute. The common law of the husband’s duty to support the wife and family is, to some extent, superseded by the words in this legislation. In law there is no prescription between spouses as long as the marriage lasts and I believe prescription falls away only three years after divorce. I think that is correct as far as a marriage is concerned. I think we need some form of prescription introduced into this Bill, because I foresee that the abuse which existed under the proviso to section 3, which is now being removed, is going to reappear because of subsection (2); only this time the likelihood is that the abuses will all be exercised by the husband against the wife in the case of divorce or separation.

As I see it, the clause allows for retrospective claims against the wife for money which she should have contributed pro rata to the necessaries of the household and which she did not contribute and often did not contribute with her husband’s definite agreement, maybe even at his suggestion. Let me take a concrete case as an example. Where the husband’s income is R700 a month while the wife earns R300 a month. The husband might have said to the wife: “Look, don’t you worry about contributing to the joint household. I shall look after that. You keep your money, save some for emergencies, spend it on recreation for the family, e.g. for holidays and, my dear, then buy yourself a few little luxuries and extras. ’’ None of these need necessarily under these circumstances be considered household necessaries. If the day comes that the marriage is breaking up, the husband knows that his wife has not contributed pro rata. He has waived the claim, but if placed against this statute, I do not think it would stand good in a court of law. The husband then says: “Well, you have not contributed one cent to the joint household and now I am going to claim the total amount from you, the three-tenths which was your pro rata share of the cost of the household necessaries.” That is a very severe disability under which women who married out of community of property are going to suffer. Exactly the same dire effects can be felt by her estate after she dies, or, for that matter, her husband’s estate in respect of any moneys which she might have inherited from him. The hon. member for Pretoria Central told us about a sad case in his Second Reading speech. He told us about a man who died and whose wife then reclaimed moneys from the estate, in terms of the proviso that existed to section 3 of the Matrimonial Affairs Act. Will the hon. the Minister, or any reasonable or legal member here—if there is a reasonable legal member here—tell me whether or not the same cannot apply as far as the pro rata share that the woman is now, by law, bound to contribute to the joint necessaries. If she dies, I believe her estate is immediately subject to a claim by the husband or his heirs for money which she should have paid, but did not pay to the joint household. The same thing happens when her husband leaves her an inheritance, a portion of the estate. The remaining heirs may then claim against the estate saying that it should be greater by that amount which the wife has not contributed pro rata over the years. I may be wrong in law, but I need the reassurance of the hon. the Minister, because these misgivings have occurred to me since then.

I want some period of prescription introduced to prevent retrospective claims in life or after death. These cumulative claims can be crippling. They may be small in monthly amounts, but take those monthly amounts over a period of 15 or 20 years and the lump sum claimed against the wife, or an estate, can be a crippling amount. I do not believe that claims should be allowed to accrue and to become cumulative. The pro rata amounts should only be claimable during a certain period—a month, six months or a year if you like—during which time that income has either accrued or has been earned. Beyond that, I do not think it should be allowed to be cumulative. I think it is absolutely inequitable that reasonable expenditure, other than household necessaries, which might have been waived by an agreement between the parties, should not be taken into consideration by courts in assessing a claim made by a husband in the case of divorce or by an executor in the case of death. Mostly women will be affected by this although I know the law says spouses may claim—he or she. Since it is usually, but not always, the husband who supports and maintains the household, I think one will usually find that the claims will operate against the woman, or be to the disadvantage of the woman.

Finally, I want to mention the case of the ne’er-do-well husband, because again—and there are such …

Are there such husbands?

Are there such? Well, I would not say there are in this House, but there certainly are ne’er-do-well husbands. Take the case of a husband who marries a woman who has an income or who earns an income, and he decides that he is not going to bother to even look for a job. She is a very stupid woman to have married him in the first instance, but she may have been deceived. On the other hand, after marriage a husband may decide that since his wife has got an income, he will not bother to work, or even make any normal endeavour to find himself a job, or to maintain the household. The law specifically lays down that the pro rata contribution must be made according to income, and if no other circumstances are taken into consideration, it means that the wife is responsible for 100% of the costs of maintaining the household, unless she has a claim under the common law. This I do not know, but if this law supersedes the common law she will have no claim. I believe that there should be a qualifying clause that spouses should use their endeavours to maintain their particular part of the joint responsibility. As I have said, this is especially the case where husbands are concerned because wives are often precluded from looking for a job because of the priority of their household duties.

I am very uneasy about all the possible unpleasant consequences of this Bill, despite the fact that I am in agreement with the principle of equal rights, meaning equal responsibility, and the pro rata contributions due from each of the spouses. What I am asking the hon. the Minister to do is to take a long and objective look at the Bill before it goes to the Other Place to see if anything can be done about avoiding the complications which I have outlined here this afternoon, otherwise I foresee tremendous litigation as a result of the Bill, and I see tremendous disadvantages resulting from that litigation for women who have, after all, now given up a great deal in this Bill. There should be a quid pro quo of some protection for the woman who has given up a very considerable advantage which she enjoyed under the Matrimonial Affairs Act of 1953, and more particularly section 3 and its proviso.

That is the best speech you have ever made.

Is it the best speech I have ever made? I hope the hon. gentleman is going to vote for me when I call for a division.

It may be good, but not convincing.

A good speech has got to be convincing, surely. The hon. the Minister accepted a radical amendment at the Committee Stage and I believe that he accepted it too hastily; I believe that the Committee accepted it too hastily, and I believe that I accepted it too hastily. I therefore ask for a review of the situation. It can be retrieved, because the Bill has yet to go to the Other Place and some protection can be introduced in the Bill in the Senate which will overcome the difficulties which I have mentioned. It is not too late to correct the glaring inequities that a deeper study of the Bill has revealed, certainly as far as I am concerned. I would like to ask for an assurance from the Minister in this respect, otherwise I must record my objection in the normal way that one records objections in this House, and that is by voting against the Third Reading of the Bill. In so doing I hope …

You agreed to the Second Reading. You cannot do it.

Oh yes, I can, because there has been a radical amendment during the Committee Stage. I must inform the hon. member that if radical amendments are accepted during the Committee Stage, it has often happened that a party votes for a Bill at Third Reading when it has voted against it at the Second Reading stage, and vice versa. In my case it is vice versa. If the hon. member is a reasonable man—and there are a few reasonable men in this House—I hope that he will give the argument that I have used his objective consideration, because this is not a party political measure by any stretch of the imagination.

Mr. Speaker, the hon. member for Houghton, to whom I have listened with interest, during the course of her remarks cast a doubt—as I understood it—on whether there were any reasonable lawyers in the House. [Interjections.] I might remind her of a remark by the hon. Mr. Justice McCarthy—I think it was—who, I believe, was the only bachelor judge on the English Bench during his time. He is not there anymore. This judge, when counsel referred to “any reasonable woman”, asked counsel whether there was such a creature. [Interjections.] Mr. Speaker, I would not normally refer to the sex of the hon. member for Houghton, but she did take a dig at me. [Interjections.] I am the first to agree that it is extremely difficult in any legislation which tries to rectify the injustices of the 1953 legislation, to put that fault right and to cover every situation which might arise in the situation which then arises. I think one should go back to the beginning very briefly. It is generally agreed, and I think that the hon. member for Houghton also agrees, that the situation that we had under the 1953 legislation was undesirable. It was undesirable in the sense that, whilst it created a preference—if you like—to the female spouse, it certainly imposed an unwarranted hardship on the male spouse. Certainly, everybody who gave evidence before the Law Revision Committee, agreed that that was undesirable and that we should attempt to put it right.

That is also the view expressed in the leading word Husband and Wife by H. R. Hahlo. On page 169 the author says—

It is clear that the writer takes the view that that is an unfair state of affairs. Referring to the case law, he goes on to say (page 170)—

“Recourse between the spouses should follow the duty of support.” The duty of support, as I understand it—and it seems to be generally accepted—is that it should be pro rata according to the means of the parties. In common language the means of the parties means income—if one is not going to touch capital and it seems to be generally agreed that we should not touch capital. If I correctly stated the principle of the fault that existed in the previous legislation then this Bill, as amended, puts that right.

If possible, I believe that the hon. the Minister will accede to the request that has been made and that he will apply his mind to it as long as this is being piloted through the two Houses. One would expect him to do that, and I am sure he will. However, I doubt whether it is possible to draft a measure which deals with every situation that the hon. member for Houghton put forward as a possible difficulty. What motivated the hon. member for East London City in moving his amendment, was the fact—and I think I state the practice correctly—that far more—nine cases out of ten of divorce settlements—take place, not in a court of law, but in the Chambers of an attorney or counsel. The hon. member sought to make the task of counsel and attorney, who arrange most of these settlements, easier and less likely to be protracted by moving the amendment which he did.

The hon. member for Houghton has based her case principally on the example of the wife who has worked but who has not contributed pro rata her income to the purchase of necessaries for the household.

With the husband’s consent.

Yes, one assumes it would be with the husband’s consent. I doubt that she has not got a defence against a claim brought later in the marriage by the husband in respect of an arrangement to which he was a party. I would think that probably she has a defence. But if one wants to pin the arrangement on a pro rata contribution, then difficulties of this kind are going to arise and they are going to arise not only in respect of the woman who works; they will arise also in the converse case, where the income of the wife is greater than the income of the husband, or where the husband has no income at all because he is an invalid or something of that kind. So I do not think that the fact that there are some cases which may not fit comfortably into the wording of the Bill as it now stands warrants voting against the Bill at Third Reading and leaving the situation as it is at the present time, which we all accept is highly undesirable. I believe this is an improvement. That being so, this side of the House, the official Opposition, will not be voting against this measure at Third Reading.

I think the argument as to whether lawyers are reasonable or unreasonable has just been demonstrated. I think it has also been demonstrated that if one is a lawyer one can argue almost any cause. But I think in the present circumstances there is a slightly different approach that should be adopted. In the first place I want to concede that the 1953 position was undesirable. I do not think there is any argument about that, but I think the argument can be advanced with merit that when a situation is undesirable you do not substitute another undesirable situation for it. This I think is the real crux of the matter. I think it can be demonstrated that what is being done here is in fact to substitute another undesirable situation.

Sir, I want to concede another matter to the hon. member who has just spoken and that is that I think it is now easier to calculate what the liability is between the spouses than it was in terms of the proviso. I do not think there is any doubt about it because as it stands now it is only the income of the parties which is material in order to make the calculation. But the question which has to be asked is whether that is an equitable situation and in my view, with respect, if we go back to what the hon. member argued was the common law duty of support, the common law duty of support took into account the income but also the assets of the parties. With great respect, in the present circumstances the fact that one spouse is a millionaire or a millionairess becomes irrelevant in so far as that may consist of assets which are in fact not income-producing. Many people in fact invest their assets in order to obtain capital appreciation and not to obtain income. To me not to take the assets of the spouses into account is quite inequitable. Let me take a simple example. Let us assume for a moment the lady in the marriage has inherited a farm which is worth R1 million.

Port St. Johns.

Yes, let us assume that, and let us assume that that produces no income because she leaves it dormant. Her husband works and he has an income and yet the fact that she is sitting with very valuable assets, when eventually an assessment has to be made, is not a relevant fact in terms of this present Bill. This, to my mind, is not equity, and therefore I say we are merely substituting another undesirable situation for an existing undesirable situation. Let me give another example. Again I must take issue with the hon. member who has just spoken. With the Bill as it stands at the present moment, one could wait for 10 years and then say: “Now there is going to be an accounting.’’ It does not matter if the husband has been told by the wife that she does not want a specific thing, because then this would constitute a waiver and, as the hon. member who has just spoken knows, a waiver would constitute a donation and that donation could be revoked. This consequently does not make sense.

One is here creating a situation between husband and wife such that they may want an accounting 10 years later when they have perhaps become estranged or when other circumstances may have arisen. Neither is it any use saying there is prescription, because there is no prescription between husband and wife. One is therefore creating an unsatisfactory situation between husband and wife. Let me give another example. Let us assume for a moment that Mr. X decides he no longer likes his wife. He may decide to leave a will appointing Miss Y as the executrix and also making her the beneficiary under the will. Under these circumstances an accounting can be obtained over 10 or 20 years. With all due respect, it is madness to have that situation introduced into a relationship between husband and wife. If anything has demonstrated that the hon. member for Houghton was correct in initially asking to have this matter referred to a Select Committee, it is the present situation that has arisen, i.e. that one cannot now delete a proviso, stating that one can take all the relevant facts into account, without having studied all the implications of this measure. This is what worries me. One cannot decide this in the heat of the moment across the floor. With great respect, in these circumstances I think this matter needs further consideration. I support the argument of the hon. member who spoke before me, in the sense that one must try to reduce the costs of litigation and simplify matters, but one cannot make things so simple that one destroys the equities of the situation.

Mr. Speaker, we have had a fairly interesting discussion here this afternoon. I listened with special attention to the hon. member for Houghton. However, I think she was perhaps a little over-enthusiastic in her emphasis on the interests of the female sex. I do not believe that we are here concerned with a matter which affects only the interests of the woman. I think it affects the interests of both parties in marriage. It was also interesting for me to listen to the hon. member for Yeoville. I remember that he moved an amendment in the Committee Stage to the effect that the normal domestic duties of a husband or wife should not be taken into consideration in any calculation of joint compensation. Therefore it is interesting for me to see that this afternoon he tried to answer the argument of the hon. member for Houghton, namely that such services must indeed be taken into account. I would therefore like to suggest that those two members first obtain clarity between themselves about exactly what they want.

I now come to the clause as it reads at present. I do not think that the legislation which this Parliament must place in the Statute Book should only be fair. It must indeed be fair as far as possible, but in the last instance it must be practical and also suitable. For those of us who were lawyers in professional life—and are acquainted with the practice, not merely the theory—an Act must be such that it will not raise practical problems. If we now look at all the possible provisions which one could insert in this context, no matter how fair one wants to be towards all parties, one must be very careful to ensure that one is not going to create more problems in practice than those one is attempting to solve. Originally, the suggestion was that not only the incomes of the separate partners, but also assets which may have been used to procure domestic necessaries should be taken into account. However, the context in which these matters are to be considered, or exactly how the judge must decide on the weight to be attached to each element, has not been indicated. It is my opinion that the proviso, as it stood, would have created more problems in practice than it actually solved. I willingly concede to the hon. member for Houghton that, as the clause reads at present, viz. after the amendment which was accepted in the Committee Stage, it may very well occur in isolated cases, where only the respective incomes of the partners are considered, that full justice is not done. However, I want to repeat that were we to try and avoid those possible theoretical cases—which could also occur in practice—by means of further provisos, this could create more problems in practice than it would solve. I want to agree with her that possibly the question of prescription could be considered. This is a practical problem which may perhaps demand attention, but it would serve no purpose to refer the Bill to a Select Committee at this stage.

No, no!

I do not want to decide for the Minister in this connection. This whole matter has, however, already been considered by the S. A. Law Commission. I think that in the first instance, and also, perhaps, in the final instance, the lawyers concerned know more about these matters than I do or in any event than the hon. member for Yeoville does. Nevertheless they have come up with a recommendation which does not satisfy us either. I think that the simple formula which we decided on in the Committee Stage is the most practical formula at this stage, and, taking all circumstances into consideration, will work best in practice. The hon. the Minister has already said, in his reply during the Committee Stage, that he was inclined to accept the amendment moved by the hon. member for East London City. Let us return to practice. After all, the section which we are now amending has been in existence since 1953. If real cases really do occur in practice, cases which require a further amendment in this connection, then this will become clear in practice. I think it is unnecessary at this early stage to try and make provision in advance for all the hypothetical cases to which the hon. members for Houghton and Yeoville have referred, since by doing so we may create more problems in practice than we shall solve.

Mr. Speaker, although the hon. member for Houghton and I usually differ, I should like to assure her, that I listened with great appreciation to the arguments which she advanced, particularly those on behalf of women married out of community of property, with great appreciation. I want to assure her that I am the last person to want to do any injustice at all to married women as far as domestic necessaries are concerned. The hon. member has advanced one or two arguments which I shall indeed consider. I shall refer in a moment to the matters which ought to be considered. I should just like to say to begin with that we must never forget that we are only concerned here with domestic necessaries, a matter which clearly imposes obligations on both persons to a certain extent. What we must determine here is the degree of responsibility of each of the two persons. Must one consider the incomes of these people or their assets? The hon. member for Yeoville mentioned a specific problem and asked what happened to the assets. Should a woman who has inherited R1 million not contribute towards the domestic necessaries? In a marriage out of community of property the assets of each of the partners are in fact assets outside the marriage. This has nothing to do with the daily domestic necessaries. A person who has inherited, say, R1 million is perfectly entitled to say: “This is my R1 million. It has nothing to do with the joint household of my husband and myself.” The same applies to the husband. If a husband is rich and has separate assets outside this joint household, he is entitled to say: “My assets as such have nothing to do with household necessaries.” The income from those assets is another matter. One’s income is in fact important when it is a question of your obligation to keep up the joint household. Let us take the case of a woman who does not work at all. In terms of this legislation she accordingly has no obligation at all in respect of domestic necessaries. If she does not work at all and merely stays at home, as many women do, there can be no pro rata contribution as such in terms of this Bill. The more she earns, the greater is her responsibility in respect of domestic necessaries. The hon. member for Houghton must not forget that domestic necessaries are only those things which people need to keep up the household, for example, groceries and other goods which must be bought. If a woman has an income she must necessarily be held liable pro rata as regards her husband’s income for the goods which comprise household necessaries in a joint household.

Mr. Speaker, may I ask the hon. the Minister whether that would not depend on the circumstances of the household? If it was normal for the family to maintain a high standard of living, to go for expensive holidays and wear expensive clothes, would that not then form part of the whole set-up and therefore be considered household necessaries?

The household necessaries are calculated in accordance with the standard of living which the people maintain. This is quite correct. If the people maintain a very high standard of living, the things which are required to maintain that standard of living, are considered as domestic necessaries. However, the point I want to make is that if the woman has no income at all, she has no obligations in this respect. Then the person who does have an income is liable for this. If she is so unfortunate as to marry one of these old loafers who do not have an income—the hon. member referred to something of the sort—then that is a calculated risk which she takes when she marries. She cannot let her children go hungry because her husband is too worthless to work. She therefore carries the full responsibility of obtaining the household necessaries for the joint household. If she then no longer wants to live with her husband she must get rid of him. But while he is still there and while there is a question of a joint household, it is her full responsibility to contribute her share pro rata in respect of the household necessaries.

There are one or two other points which do trouble me. For instance, there is the question to which the hon. member for Houghton referred, namely for how long before the time must one be bound to carry that responsibility. Suppose the marriage were dissolved today, is it then expected that the husband can go back 20 or 30 years or even as long as the marriage has existed, and say to his wife: “During the whole time you earned R100 per month and never contributed a cent towards the household necessaries?” I think that the hon. member does have a point there. I shall give this matter my attention and see whether it will not be possible to set some realistic limit to this. This is the issue of prescription. She wants a certain amount of prescription and I think that in this respect she has perhaps put forward a good argument.

The other argument which she put forward concerns the supposition that a husband may come to an agreement with his wife and say: “Look, although you have a statutory pro rata obligation as regards the household accounts, my income is large enough. You may do what you wish with your money; I shall take the responsibility for household necessaries upon myself.” However, when the marriage is dissolved, he turns round and says: “I could not have taken that responsibility upon myself in any event, because this would have meant that you had given me a gift, something which could not be done. Furthermore, I could not have taken that responsibility because I cannot make an agreement which is not in terms of the provisions of the Act.” As far as I am concerned, this argument, too, is one which deserves consideration. I therefore undertake to consider that as well. I want to assure the hon. member for Houghton that I am most probably the last man in the House to want to make the world more difficult than it already is for women. The same of course also goes for men.

Looking at subsection (1) of the clause, one quite rightly notices that both parties must be liable jointly and severally against third parties. One cannot of course blame the shop-owner if he gives the woman too many domestic necessaries, because after all he cannot say what the woman’s pro rata share is. They must therefore be liable jointly and severally. The second principle which I feel is correct, is that the income must also be considered. I think that the argument of the hon. member for Umhlatuzana is quite correct in this respect, because it follows from the obligation with regard to the household that income is what makes the domestic accounts balance every month. The pro rata principle is therefore a sound principle.

There are two further points which were made by the hon. member, but personally I think that we should leave the matter as it stands. When there is a court case, the court can give the legislature an indication. As I said yesterday, the courts know exactly how a marriage works, what all the obligations involve and what stems from a marriage. If anything else is necessary in the legislation, anything which cannot be set right through the administration of justice, the courts will soon give the legislature an indication of this. The hon. member for Houghton must never forget that if the Appeal Court, for instance, should stipulate that it is ludicrous to try and issue a summons in respect of 20 or 30 years ago and that it should only be a reasonable period of time, then this would be a form of legislation. A statement like this would be binding, and in the future, household necessaries will only be able to be taken into consideration for a reasonable time. I am of the opinion that we should rather leave this a matter for the courts to decide. The courts must decide as to the period of time for which it can be calculated. We must only lay down for the courts the principles according to which calculations must be made. But in spite of the fact that this is my opinion, that we should allow the courts to do their work after we have done ours, I shall nevertheless submit these two points which the hon. member for Houghton has made and to which I have referred, to the legal advisers for further consideration and possibly for amendment in the Other Place.

I accept the assurance of the hon. the Minister.

Motion agreed to.

Bill read a Third Time.

Mr. Speaker, I move subject to Standing Order No. 56—

Agreed to.

Bill read a Third Time.

Mr. Chairman, I move the amendment printed in my name on the Order Paper, as follows—

Title:

Mr. Chairman, I move the amendment printed in my name on the Order Paper, as follows—

Amendment agreed to.

Title, as amended, agreed to.

Mr. Speaker, I move—

The question of control over private hospitals and unattached theatre units was investigated by a commission appointed by the State President, and the report of the Commission was tabled last year.

In the light of the commission’s recommendations, the Medical Schemes Act, 1967, was amended last year to provide, amongst other things, for a remuneration commission to determine fees which can serve as a basis on which the benefits to which members of medical schemes are entitled can be calculated.

As you will see from the commission’s report, control over the establishment and operation of private hospitals is at present being exercised to a greater or lesser extent by the provinces in terms of provincial ordinances. The commission found, amongst other things, that the provinces differ in their approach to standards, methods of inspection and registration procedures. The commission recommended that (a) the Department of Health should exercise control over the registration of private hospitals; (b) minimum standards should be laid down with which the institutions must comply; and (c) there should be consultation between the provinces and the department and the provinces should conduct the inspection of the institutions.

The report was referred to the provinces for comment. With one exception, the provinces agree that control over the establishment of such institutions should be centralized, but desire that the registration and inspection of these institutions should rest with the provinces. The province concerned, however, has undertaken to co-operate.

Section 133 of the Public Health Act, 1919, already provides to a limited extent for the making of regulations in respect of the registration and inspection of private hospitals and unattached theatre units. The field covered by the recommendations of the commission is mainly of an administrative nature and can best be covered by regulation. Consequently it has been decided to adapt section 133 in order to create the powers required for making the necessary regulations after consultation with the administrators of the provinces. In this way a flexible measure will be created in terms of which proper consultation can take place in order to provide the best measures and in terms of which administrative bottlenecks can be speedily eliminated.

Clause 1(a) contains an amendment to section 133(2). In terms of this provision, the Minister is authorized to make regulations, after consultation with the administrators, concerning the establishment and carrying on of private hospitals, the minimum standards of such institutions and the patients who may be accommodated therein.

In terms of the new section 133(2)(b), provision may be made in the regulations for refusal or for cancellation of registration by the Minister, or a person referred to in the regulations, on the grounds of unsatisfactory matters specified in the regulations. In terms of this provision, therefore, the Minister can lay down whether registration is to be handled by the Department of Health or by the provinces. Similarly, the requirements for registration and grounds for cancellation of registration must be laid down by regulation so that arbitrary action will not be possible.

Clause 1(b) contains an amendment to section 133(5) of the Public Health Act, 1919. This provision deals with unattached theatre units, which are usually linked to the practice of medical practitioners and are therefore not hospitals in the ordinary sense of the word. The patient remains there for a short while after very simple surgical treatment and is then discharged. The provision comprises the following:

1. (A) Section 133(5)(a) authorizes the Minister to make regulations, after consultation with the administrators, concerning—
   1. (i) the surgical activities which may be carried on in such institutions;
   2. (ii) the standards with which such institutions must comply, the records that must be kept and the qualifications of and number of nurses to be employed;
   3. (iii) as far as the registration is concerned, the fees to be paid, the registers to be kept, the certificates to be issued and the other requirements to be complied with;
   4. (iv) the refusal to register or cancellation of registration, similar to that in respect of private hospitals.
2. (B) Section 133(5)(b) provides that different standards may be prescribed for different categories of institutions in order to provide for the requirements of the various disciplines.

Section 133(6) contains penalty provisions and clause 2 contains the short title.

Mr. Speaker, this Bill in the main deals with the standards that will be required in respect of nursing homes and unattached theatres, and the regulations to enforce these standards. Why the hon. the Minister has decided to get advice from the Administrators of the various provinces rather than from the S.A. Medical and Dental Council, or the Medical Association or the Nursing Council, is something I hope he will explain when he replies. I feel that what is necessary is for the hon. the Minister not only to get advice from the Administrators of the various provinces, not only to get the best medical advice, and not only to get the best nursing advice he can get, but also to get the advice of the local authorities who, in the main, have been responsible to see that the regulations are at least being implemented properly, through their inspectorates.

What has happened over the years? If you will allow me, Mr. Speaker, I would like to deal with the increase in the number of beds that have become available in nursing homes, and the necessity to maintain these standards. It is my opinion that the province, which has the majority of the available beds, has not been able to keep pace with the supply of beds and with the increase in our population. We find, as the years go by, that more and more people find it more and more difficult to get into provincial hospitals.

However, what is sad is that there are in fact beds vacant in provincial hospitals which are not being used. Although these beds are available, patients cannot use them because there are insufficient nursing facilities for them. There is a shortage of nurses. There are two reasons for this. Firstly, we have not produced enough nurses, and, secondly, we find that nursing homes which have come into existence to make up for the shortage of beds available at provincial hospitals are giving nurses salaries far in excess of those which provincial hospitals are able to pay. The result of this is that nursing homes are usually completely full and have a full complement of nursing staff, while the provincial hospitals, which have been training the nurses to qualify fully, find themselves short of nursing staff.

What are we going to do about this? I would like to draw the hon. the Minister’s attention to the fact that while it is all very well to make regulations for the keeping of standards of nursing homes, it is necessary that we also consider the shortage of beds in provincial hospitals. The unattached hospitals have also come into being because of bed shortages and costs. Patients cannot afford to stay in nursing homes for more than a few days. The charges are absolutely ridiculous today, in my opinion. I do not know what the commission of inquiry has found, but in my own experience I find them exorbitant. Nursing homes will tell one that it costs a considerable amount of money to keep such institutions going. However, I would like to give an example of the difference in costs. One of my patients, a seriously ill man, was taken to a provincial hospital, where he was put into an intensive care ward. He was looked after for a week with the best possible treatment at the provincial hospital. He was given one blood transfusion after the other, as well as intravenous medication for the whole week. He was then put in a private room at the provincial hospital and his electrocardiograph was taken almost every day for three weeks. He had the very best attention from the provincial hospital, and his account at the end of that time, excluding, of course, his doctors’ fees, was R120, believe it or not.

Six weeks later the same patient had to undergo an operation for the condition that caused his emergency treatment. He was in a nursing home at this stage because the surgeon required this as the doctor could not operate in the provincial hospital. The surgeon’s fees were reasonable enough. It was not a very big operation and the patient was in the nursing home for five days. His account at the end of the five days for his keep there, was R522. We simply cannot allow these things to happen. Something has got to be done. Either the State has to subsidize the private hospitals to make it possible for the ordinary man in the street to enter a nursing home for treatment, or otherwise—and this is what I would say—we will have to find more staff for the provincial hospitals, so that we can use every bed that we have in order to give the man in the street a chance to go to a provincial hospital to get the excellent treatment that he can get there now. I am sure that if the hon. the Minister goes into this and he starts laying down the regulations that are required and keeps an eye on the costs at these nursing homes and hospitals, he will find that there are ways and means for the nursing homes to reduce some of their overheads. I am not an expert in this, but, I do not think that it is necessary to have all the elaborate furnishings that one finds in some of the nursing homes. On the other hand, in others one finds that people have been charged by private nursing homes on a level that is equal to a five-star hotel, while they have received one-star treatment. It is amazing, but sometimes one finds a man in a private room in a nursing home, who is very ill indeed, paying a minimum of R25 a day for the bare bed.

He cannot eat a thing, because he is too ill. He has a telephone in the room which he cannot use, because his hand is probably connected to an intravenous drip, but he is being charged for the food that he does not eat, charged for the telephone which he cannot use and charged for a bottle of tablets when he is only using two or three from the bottle. This is the sort of thing that we have got to stop.

Recently there has been some criticism of private nursing homes and there has been criticism of homes that are being used for the mentally ill. I am being very serious about this and I say to the hon. the Minister that he must try his very best to avoid criticism, particularly in respect of the mental homes. This hon. Minister and his department have seen fit to make use of a service that is provided for the mentally ill. These are equivalent to non-paying patients in a hospital, but they are given a service, which is sorely needed, and this is paid for by the State. There is criticism against these hospitals. I, myself, and members of my caucus have had the opportunity of visiting these hospitals, which are run by private enterprise, and I have been agreeably surprised by the high standard of treatment and the satisfactory standard of accommodation that is given to these people. I think that the criticism which is made about these hospitals is very often unwarranted and very often irresponsible, but I say to the hon. the Minister that to avoid criticism, he must see to it that every one of these hospitals is kept at a standard that is best for the patient. We do not want elaborate establishments; that is not necessary, but the cleanliness, accommodation, and the care that is given to the patient is important. I have no criticism against that now, but later on we are going to deal with another Bill which deals with this and I shall have more to say about it then. However, while we are talking about registration and standards, I want to press this point to the hon. the Minister.

The next question I want to ask the hon. the Minister is whether, when he talks about unattached hospitals and places where nursing is provided and where treatment is given, he includes such places as spas, the clinics where massages are given, etc. At the same time I want to know if the hon. the Minister is taking any steps to make sure that the establishments which provide sauna baths, etc., are inspected regularly. I understand that inspectors are appointed, but I want to know whether he receives regular returns and whether anything has been done to see that the standards are kept. It is important, because if one goes to these places, very high charges are made and it is most important for those people who go to these places that they are assured not only of good treatment, but that they are getting what they have paid for.

I said in the beginning that a large number of nursing homes are coming into being and that they are costing the entrepreneurs, who provide the beds, a great deal of money. I want to make sure that the plans which are drawn up for the erection of these nursing homes are carefully studied before building is allowed to take place on these institutions. I know of cases where vast alterations were made after building operations had started. I want to say to the hon. the Minister that he must make perfectly sure that the local authorities are brought into the picture and that their building inspectors make absolutely certain that the requirements of the hon. the Minister are seen on the plans before the first brick is laid; otherwise unnecessary costs are involved, there are delays and it is all recovered from the pocket of the ill person later on.

Having said this, I want to tell the hon. the Minister that we on this side of the House are going to support this Bill. We hope that those inspectors employed to carry out his instructions are efficient and that the standard of service that is at present provided, if not improved, is at least kept as it is at the moment.

Mr. Speaker, the hon. member for Rosettenville—whom I very much enjoy listening to—started his speech by asking why the hon. the Minister intimated in the Bill that he would draw up regulations after consultation with the Administrators. He wanted to know why he was not going to consult the Medical Council, the Nursing Council, etc. Basically, this affects the entire legislation. In section 84(1) of the Constitution of the Republic of South Africa, hospitalization is specifically entrusted to the provinces. It is the task of the provinces to provide a sufficient number of hospital beds. Private hospitals are therefore supplementary to provincial hospitals. It is in the Transvaal in particular that there is a shortage of hospital beds and as a result, private institutions play an important role there. There are various types of private institutions, such as industrial hospitals, which play a major role throughout the country, inter alia mine hospitals and other factory hospitals.

In addition there are the welfare institutions, most of which were originally established by the church in the homelands, and which are today run by the Department of Health on behalf of the Department of Bantu Administration, and then there are those which are being discussed here today, viz. the private hospitals. I say that these play a very major role in the Transvaal. It may be mentioned in this regard that the number of private beds in the Transvaal rose by 730 between 1971 and 1974. Sir, 730 beds is the equivalent of a very large hospital. Whereas previously the provinces carried out inspections of the private hospitals and had them under their control, since they had the experience and the staff to carry out the inspection, it is vital that the Minister should consult with the Administrators. You may ask: Why not simply leave it to the provinces to carry on with the task they have performed in the past? Sir, certain problems have arisen. The ordinances which controlled the various hospitals, the various private institutions, differed from province to province. In other words, there was a difference in grading in the various provinces and this gave rise to a great deal of confusion. Nor was there co-ordination between the various provinces as far as hospital inspection was concerned. There was no uniformity of treatment. This gave rise to a great deal of dissatisfaction and many problems. But, as the hon. the Minister has said, there has always been authorization, in terms of section 133 of the Health Act of 1919, for the State to take over these inspections. That authorization existed, but it was not used. But after the hon. the Minister has had appointed a commission of inquiry, the De Villiers Commission, this commission published an exceptional report which advanced reasons for the high cost of these private institutions. The hon. member for Rosettenville mentioned this. Fantastic amounts have been mentioned. Let me mention one example. A patient was debited with R1 800 for medicine, whereas medicine to the value of R300 only had been administered. The medicine account of another patient who was in a private hospital for one day amounted to R795. So one could go on. This was the finding of this commission. The commission also found—and this is one of the reasons why the Minister was forced to take upon himself powers to make these regulations—that there was no authorization for the State or the provinces to determine where a hospital may or may not be built. According to the findings of this commission it is not true, as the hon. member for Rosettenville said, that these private hospitals are always full. In fact, a great many of them are not full, and those which were not full tried to make ends meet by pushing up their fees, and this is a very major problem. Now the hon. the Minister is taking upon himself additional powers, powers which never existed in the previous legislation, powers to make regulations so that he too may lay down, for example, in which suburb a private hospital may be built, with the specific aim of not over-supplying certain areas with the result that the hospitals are empty, leading to exorbitant fees being charged in order to make ends meet. In my opinion this is a very necessary step which must be taken because I say we should accept that for many years—possibly for ever—these private hospitals are going to be providing a supplementary service, supplementary to that of the ordinary hospitals of the provinces.

The hon. the Minister dealt in detail with his control of the unattached operating theatre units. I think you will agree with me, Sir, that there has never been any control over them, that there must be standards and that in particular, limits should be set to the operations which may be performed there. One cannot perform a bigger operation than one’s facilities allow. That is why I think it is vital that this be done.

There is one other thing which this commission of inquiry recommended, viz. that an attempt be made to lay down the fees charged by these private institutions. In my opinion the Minister is wise not to try to take that power upon himself. I do not think one will be successful in that. But now we must bear in mind that last year, in terms of the Medical Schemes Act, a compensation commission was established for private hospitals, too, and private hospitals may also have their fees classified now. Then, too, the medical aid funds are prepared to pay their fees directly after negotiations and in accordance with the compensation commission. In my opinion this represents a major step. I hope and trust that the compensation commission will reach an understanding with these private hospitals. It seems to me that if the compensation commission is not 100% successful, it may be necessary in the future for the Minister also to take upon himself powers to make regulations concerning fragmentation, because the problem with these private hospitals is that accounts are built up in fragments. One pays for admission and one pays for the operating theatre and one pays for the bed and, as the hon. member said, one pays for the telephone, for your medicine—for everything separately. Thus the commission found that a typical account was made up as follows: Accommodation, R5,80 per day, theatre fees R67, theatre drugs R33, dispensary drugs R108 and ward drugs R132. Sir, the medicine one is given in the ward usually only amounts to a few aspirins, gripewater and that sort of thing. These are exceptionally expensive pills. I trust that the compensation commission for private hospitals will be successful in this regard. If not, we shall be obliged in future to give the Minister certain additional powers in this respect too.

Mr. Speaker, the amending Bill which is before us, arises, as the hon. the Minister has told this House, from the report of the Commission of Inquiry into Private Hospitals. When this report was first made public, it aroused a great deal of attention and received a great deal of attention also from the Press. This indicated that a great number of people were deeply concerned about what was happening in our private hospitals. So, in the first instance one says straight away that one welcomes the fact that this inquiry was undertaken, that the findings have been tabled and that as a result of these findings this Bill is now before the House. We believe that the control of registration and of standards is absolutely essential whenever any health service is being carried on, and accordingly we welcome the introduction of this Bill.

If one looks at some of the findings of this commission of inquiry, one notices the lack of co-ordination which was discovered and the recommendations which followed, inter alia, that the establishment of private hospitals be controlled. This is exactly what this Bill allows for now. It also recommended that the Department of Health control these establishments so that a uniform policy may be determined for the whole country, and that differences may be eliminated so that all may enjoy the same standard of treatment.

It is obviously impossible to have a uniform system right throughout the country. I assume that the change to the original Bill, which entails taking out the S.A. Medical and Dental Council and inserting each Administrator, is in order to bring about the maximum coordination and to have the best kind of control. I hope very much that this does not mean that, as has already been suggested, such organizations as the S.A. Medical Council will now be excluded from this control and of overseeing the private hospitals. It is a very difficult matter for a provincial administration to control the registration and the standards and the maintenance of those standards complete and absolute, because of the very real shortage of manpower which is in existence today in our country. The other findings, which I find very important, relate to the question of different standards. Each province had its own standards and methods of inspection, and therefore the Department of Health needs to keep an eye on all these aspects. These standards and inspection sometimes leave much to be desired. One does not have to go again over what has already been made public by the commission of inquiry, but it is good, if the public have a sense of protection as a result of this inquiry, because for a very long time there have been complaints, letters to newspapers, complaints to doctors regarding the varying standards of many of our private nursing homes. If as a result of this commission of inquiry, and because of the legislation which is before us, that is going to be remedied, then of course it is to be welcomed.

There is one matter which has been touched upon, particularly by the last speaker, and that is the control of fees charged by the private hospitals. One can understand the reluctance to accept the recommendation made by the commission of inquiry, but we in these benches hope that the hon. the Minister will continue to give this matter his attention, because the exorbitant fees that are being charged and the number of people who are penalized as a direct result, extends throughout South Africa. While a private enterprise system encourages people to get the best possible attention, even though it may be costly and people do have other choices, nevertheless there ought to be some sort of control over the amounts which are levied on persons when they enter private hospitals. Attention has already been drawn to the fact that many patients get all sorts of extras for which they either do not ask, or are simply attached to their accounts. In this age of television one can expect that not only will the operation be televised itself, with no fee being paid to the patient, but also that the patient will have to pay for the television set in his or her room!

There is one question which I have about the legislation which is now before us, and I would very much appreciate it if the hon. the Minister in his reply will enlighten us on this matter. In his opening remarks the hon. the Minister referred to the control of the patients which are accommodated in the nursing homes. I hope that the hon. member who has just sat down will realize that I have spent a great deal of my time talking about, in the main, White people who are being abused in various ways, the improvement of standards and the whole question of fees. In the whole question of health, one is of course concerned not with Whites or Blacks or Coloureds as such, but with people. In terms of the legislation which is before us, and in view of the controversies which have appeared in the Press over the last few weeks, we are wondering whether in clause 1(a), the final part which reads “of patients who may be accommodated therein”, is not simply looking at the number of patients that can be accommodated in each private nursing home or hospital, or is this going to be a rigid control of patients who may be allowed to go to private hospitals? It is a well-known fact that there are no private nursing homes, or very few—I certainly know of none, but I am open to correction—for patients other than White patients. We all know that in the “ontplooiing” of the policy of the Government, a number of Black patients also desire to have access to private nursing homes, and until such time as this comes about within the framework of the policy of the Government, it seems to us that people should be allowed to enter …

“International” nursing homes.

That is right, we should be allowed to have “international” private hospitals or nursing homes, provided they don’t dance on the property! All health legislation, as far as we on these benches are concerned, is non-political, unless they are made political by ideology. This is the only reservation we have, and we will be very grateful if the hon. the Minister will give us some reply as to what he meant when he said “en die pasiënte wat daarin gehuisves mag word”.

Mr. Speaker, the occasions are few on which one, or at any rate on which I, am able to agree with what the member for Pinelands has to say. Well, this afternoon has been such an occasion on which I want to agree with him to a certain extent, except in regard to the last part of his speech, in which, as is his custom, he tried to drag in a little Progressive politics in the sphere of hospitalization. To be specific, he suggested that there should be integration in the sphere of hospitalization at some stage. There is no doubt whatsoever that certain malpractices occur in private nursing homes in our country with disturbing frequency. Indeed, there is blatant exploitation of the public and this is occurring in times of distress and illness, and there are many victims who can testify to this. I think that more than one member of this House can also testify to this from bitter experience. However, there are also other nursing homes which are not quite so intent upon profit-mongering and which do in fact render a valuable service to the community. In many respects, these institutions maintain a high ethical code and do in fact meet a pressing need, a need which the provincial authorities are at present unable to meet because the necessary facilities and staff simply do not exist. These institutions are undoubtedly an asset to the community as we may infer from many appreciative letters which these institutions do in fact receive. Consequently I want to ask the Minister that the measures to be adopted under this legislation should not be such as to jeopardize the continued existence of private nursing homes as a whole. As I have already said, these institutions really do make a positive contribution towards indispensable and supplementary hospital care in South Africa. However, I want to refer to a report which appeared in Die Vaderland as long ago as 18 January 1972, in which the Director of Hospital Services in the Transvaal asked that where it was in the public interest, the provincial administration should have the right to refuse the granting of a licence for the construction of a private nursing home if necessary. He motivates his statement as follows (translation)—

That was said as long ago as 1972. It is therefore clear that there is a real deficiency in our health legislation which now needs to be rectified. It is undoubtedly true that there are cases of substantially higher salaries and other additional benefits, too, being paid to nursing staff and there is in fact a danger that the provincial hospitals will be emptied of staff as a result of their staff members going to private institutions. In practice, this state of affairs has resulted in an unnecessary increase in the cost of hospital services in the private sector. It is therefore a matter of urgency that this amendment be introduced in order that there may be proper control of the nursing homes and other places where surgical treatment is provided. This must be done so that the public may be protected against exploitation. It is necessary, too, that the standard of medical care, the instrumentarium, the minimum staff requirements, the accommodation facilities—in short, the total function of an institution—be properly controlled. Regular inspections should take place in order to ensure that those minimum requirements are complied with and that the standard can be made to correspond with the general standard at present maintained in provincial hospitals. This situation must be achieved by means of compulsory registration of private hospitals; and, as I have already said, inspections should take place regularly.

Owing to the motive of excessive profit-mongering at certain institutions, I, too, should like to see that even the fees for specific institutions are laid down, and perhaps fixed, too. Of course, in doing this, account should be taken of certain circumstances because there could be a world of difference between the cost structure in a place like Johannesburg, for example, and a place like Naboomspruit. Furthermore, I also want to point out that as far as the cost structure of some of these hospitals is concerned, it is not only the high salaries of some members of staff which play a major role, but also the administrative expenses of the hospitals, which are very high—I am tempted to say unnecessarily high. The fact that many of these hospitals also make use of so-called hospital consultants, people who certainly do not work for charity and who are extremely highly paid by these institutions, contributes towards disproportionately high administrative expenses.

However, there are innumerable examples—such as those mentioned here in the House this afternoon—of astronomical hospital accounts. Here is one I should like to mention. This particular patient was admitted to a hospital to undergo a medium operation. He spent 29 days there. At the end of his stay in hospital his account was as follows: Accommodation—R462; theatre fees—R126; theatre drugs—R86,82; ward drugs—R1 389,69, thus totalling R2 064,51, for a stay of less than one full month in hospital. We are simply no longer able to afford this kind of luxury today. Often, too, the accounts of these hospitals are not clearly specified, and any citizen of this country has the fullest right to be suspicious when he receives such accounts.

I shall quote another case, a case which provides even more grounds for suspicion. In this case a patient had to pay R9,60 for a single ampoule of terramycin. That was in 1972, whereas—after all the astronomical price increases that have taken place since then—100 mg ampoule of terramycin today costs 63 cents and the slightly stronger one—conttaining 200 mg—costs only R1,08. It is this kind of thing which the public is justifiably becoming impatient.

In spite of the fact that these conditions prevail at some of our nursing homes—conditions which we should like to see rectified in this new legislation—it is nevertheless true that the average fees for hospital accommodation are still lower in our country than in many other countries.

Some time ago, a report appeared in the Press which maintained that it was cheaper for a citizen of the USA to buy a return ticket to South Africa, undergo an operation here and on top of that to visit the Kruger National Park, than it would be for him to undergo the same operation in an American hospital. However, there are many other factors that play a role here, and consequently one cannot really draw this kind of comparison. Fortunately we are still living in a capitalist state, in which sound business initiative is maintained, and this applies to the sphere of private hospitalization as well. It is right that this should be so. We want it to be so. After all, we do not want to become a welfare state. However, this legislation only envisages the striking of a sound balance between public interest on the one hand, and the justified continued existence of private hospitals of good quality on the other.

In conclusion, I want to refer to part of the opening address to the 106th ordinary meeting of the South African Medical and Dental Council on 17 November 1975 in Bloemfontein by Prof. H. W. Snyman, President of the Council. In his speech he mentioned the over-visiting and over-treatment practised by some members of the medical profession which contributes equally to today’s high medical expenses. He had the following to say about this (translation)—

This statement is true in respect of hospital services in this country. The legislation before us must therefore be seen as an attempt to rectify an unhealthy situation in our national establishment and it therefore deserves the support of every right-thinking citizen of our country. Indeed, it should be possible for this medical asset to be used meaningfully by every citizen of our country. That is why the Government must ensure that disciplining and standardization of this indispensable service is effected in the best interests of every citizen of this country.

Mr. Speaker, the hon. member who has just sat down, the hon. member for Pietersburg, referred to the question of the registration of private nursing homes. I believe that as a result of this Bill there will be co-ordination in regard to conditions laid down for private nursing homes, that conditions will be made more stringent and that the provinces, which will be entrusted with the power to carry out inspections, will have their hands strengthened in this respect. The hon. member also referred to the question of nurses and the fact that in certain instances it would appear that private enterprise is depriving provincial hospitals of their nursing staff. It is interesting to note that in the report of the commission it is stated that the salaries and fringe benefits for nurses in provincial hospitals and private institutions compare favourably, but it is also pointed out—and this is significant—that private hospitals offer higher commencing salaries. This, I think, is one of the main factors depriving the provincial hospitals of their nursing staff which they have, in the main, been responsible for training, because the commission accepts that the provincial hospitals do, in fact, do the bulk of the training.

I shall come to the question of the exploitation of fees a little later. The hon. the Minister, in his opening remarks, indicated that this Bill in effect emanated from the recommendations of the commission which he had appointed and which, I believe, submitted a very comprehensive report with a minimum of delay. I would have been much happier this afternoon—and I believe I could have congratulated the hon. the Minister most sincerely—if the Bill we are considering was entitled: “To amend the Health Act of 1975.” I know that the hon. the Minister will remember that in 1972 Parliament appointed a Select Committee which was subsequently converted into a commission to consider the Health Bill of 1972. I am sorry that we are still amending the Public Health Act of 1919. I know that the commission has reported. In fact, I believe I am correct in saying that it reported early in 1973. As three years have elapsed since then, I believe it should be possible for the hon. the Minister to indicate in his reply when he expects the recommendations to be considered and the report published, and when he expects legislation to flow from that report. I concede readily that this is a most complex subject, but I believe the time has come for us to have a fully up-to-date, consolidated Health Bill.

The Commission of Inquiry into Private Hospitals accepted the fact, and was mindful of the premise that the duty of the State is to make provision for efficient health services. I believe that this Bill will help towards achieving this. The commission also agreed that the provincial hospitals were not, at present, geared to cope with all the needs, and accepted that it was a necessity to have private institutions functioning. The commission also agreed that there was a need for improvement and greater control, and I believe that the evidence substantiates this. I think that the control that has been exercised, probably by virtue of the fact that there has been a diversified set of regulations applicable to the various provinces, has not been as effective as it could have been. I believe, in the interests of the public at large, that we are entitled to strict and very stringent control measures to see that private nursing homes operate with the maximum of efficiency and provide the maximum of comfort for their patients at minimum expense wherever possible.

Let me mention one authentic case in Natal. At one private institution, according to substantiated information, the intensive care unit provided, was not always functional. There were two reasons for this. One reason was that there was not always the qualified medical staff in attendance to operate the intensive care unit which is normally called upon to be operational in times of emergencies. Secondly, the repair and service facilities existing were, to a large extent, inadequate and if major repairs were required or, in fact, if any repairs were required, it was necessary to call in people from outside to effect the repairs. I have seen signed letters from members of the nursing staff of this institution, in which they are prepared to say, virtually in the form of an affidavit, that the personnel management has no interest in the nurses or their welfare. However, I do not believe that situation applies in provincial hospitals. They also complain that these institutions—and this particular institution is a large one—ward equipment is inadequate. They also criticize the cleanliness in the serving of meals to patients. They say, too, that there are conditions that lead to a diminution in the patient/nurse relationship, something which is surely most vital in the treatment of disease. They refer even to the question of fresh linen not being available when it should be for the comfort and convenience of the patients. Another interesting point is that they claim that the food in itself is uninteresting, that incorrect diets are sent to the wards and that in one case a steel pot scourer was found in a patient’s meal served to him in his ward. I believe that these are all factors which a much stricter inspection service could minimize in the ordinary running of private nursing homes.

The question of fees has been mentioned, and I was glad to hear the hon. the Minister saying that the amendment to the Medical Schemes Act last year would, to a certain extent, ease this difficult situation. It is a difficult situation because, as has been mentioned by previous speakers, private nursing homes and hospitals do use fees, particularly fees charged for medicine, as a means of possible exploitation. The hon. member for Fauresmith referred to the fragmentation of fees. The commission itself specifically commented on that and stated that the fragmentation of fees system afforded private hospitals the opportunity of overcharging patients, of making unwarranted profits and of taking advantage of the ignorance of patients. These are not my words; these are the words of the commissioners themselves in the report which has been tabled. They stated too that in many instances the fragmentation of fees guaranteed the profitability of private hospitals, and that the sale of medicines was a most important source of income. I think that any form of exploitation on that basis is reprehensible and must be eliminated. I do not know whether the hon. the Minister, in his reply, will be able to indicate that the measures taken to amend the Medical Schemes Act last year are benefiting or will benefit the patient in this regard. One recommendation of the commission—I do not think the hon. the Minister referred to this—was that a comprehensive daily fee should be laid down which should include the cost of all ordinary medicines administered to patients, the cost of normal nursing and of sterile equipment. I visualize certain practical difficulties if this recommendation of the commission is accepted, but I would be interested to hear whether the hon. the Minister feels that this is a feasible suggestion.

If one studies the report, one notices that the hon. the Minister has complied with the suggestions and recommendations in schedule 1 of the report. However, has the hon. the Minister directed his attention to all the other aspects of the report, particularly to the findings of the commission in regard to doctors’ financial interests? I believe that this is an important aspect. I shall quote what the commission found and what it recommends, because I believe that this is a practice which, if left uncontrolled, can have a significant effect on the costs to the patient of private nursing-home services. The commission found (Report of the Commission of Inquiry into Private Hospitals, etc., paragraph 7.7.1, page 20)—

I think the commission made a very significant recommendation in this respect. It recommended (paragraph 7.8.1)—

I believe that over the years a system has developed which, while it renders a service, surplants to some extent the provincial services which are available to patients. This does result in a higher cost of medical treatment. I ask the hon. the Minister, in conclusion, whether he would care to express an opinion as to what steps he intends taking in regard to that particular recommendation.

Mr. Speaker, I do not really want to say a great deal in reply to the speech by the hon. member for Berea. I just want to make one remark before it slips my mind. It concerns the issue of the doctors. A group can manufacture a variety of pills and injections and sell them at a reasonable profit. We have no objection to that. Nor have we any objection to the wholesalers selling the same medicine at a reasonable profit. Remember, medicine is used for ill people and consequently money is being made out of illness. What I find strange is that as soon as a person has to go and lie on a bed in a hospital and someone wants to make a reasonable profit out of that, suddenly there is something terrible about it. If a doctor is involved, then it is diabolical. I cannot understand why a doctor should not also continue to have the right that he has at present, to invest in a private hospital or an operating theatre unit. The commission of inquiry found that in those very institutions where doctors were involved, the abuses which occurred were far fewer in number. Owing specifically to the doctor’s training and his ethical rules of conduct, it goes without saying that he will be far more careful to ensure that infringements will not take place. Consequently I am quite unable to agree with the findings of the commission or with the previous speaker that doctors should be forbidden to make money in a reasonable way. When I say this I am not thinking in terms of exorbitant profits.

I think there is a great deal of consensus among the various parties as regards this Bill. This Bill even has the doubtful honour of being supported by the Progressive Party, too. I think that there is also substantial consensus regarding the fact that we should not take too long to tell each other that we agree on the matter. Consequently I shall not be repetitive. I just want to say by way of summary that in my opinion there is a very great need for improved and uniform control of these private hospitals and other institutions. This, too, is the purpose of this Bill, and that is why we support it.

The public must be protected against poor medical services, and particularly exploitation. Of all forms of exploitation the exploitation of a person who is in distress owing to illness is undoubtedly one of the most contemptible. I have said that there is consensus, and therefore I do not want to repeat the whole story. However, I want to make a few remarks from another angle. With this in mind I want to make three basic statements. In the first place, as has already been said, this Bill is the result of the report of the Commission of Inquiry into Private Hospitals and Unattached Operating Theatre Units. I have the report here before me. In the second instance I want to say that one can support anything—and consequently a Bill, too—for two reasons. One can support it because of the principle it contains, viz. for what it states, and one can also support it for what it does not state. If, for example, one says that theft should be regarded as a crime, one will support this, but if it is not stated that a person should be publicly hanged for all cases of theft, then that too is a reason to support it. The first statement I want to make is that it is not always the letter of the law that is important. Very often the spirit in which it is implemented is of equal or even greater importance than the letter of the law. In view of these three statements I just want to consider for a moment the role played by the State, on the one hand, and the private sector on the other, in regard to the provision of health services, with particular reference to beds. In this regard I refer in particular to the control of private places for which this Bill provides. One could advance a number of arguments of one’s own, sound arguments, but because this Bill arises out of this report, I want to confine my arguments more specifically to this report. If we look at chapter III on page 2 of the mentioned report, we find under the heading “General Outline” and the subheading “Introduction” that—

The commission then states that health is the right of each individual in society. They go on to say that it is the duty of the State to make provision for health services. Thirdly they state—

I agree with that 100%. Certain other premises, too, are mentioned. The sixth point they mention is the following—

The seventh premise they mention, is the following—

I agree that they are entitled to a reasonable profit.

It is indicated in the report that the policy of the various provinces has not been uniform in the past. It is interesting to note what the policy of the Cape Province was. I quote (chapter IV, paragraph 1.1.2)—

The foregoing is that they have to comply with certain requirements. For example, they must be properly housed, they must comply with the Group Areas Act, etc. I quote further—

I quote further (paragraph 1.1.3)—

A number of reasons are then given. When we come to the Transvaal, we find that in the past they followed a different policy. I am very much in favour of control and a uniform policy. I wonder whether education, too, could not sometimes take a leaf out of the book of the Minister of Health in regard to uniformity in policy. I now come to the policy in the Transvaal. What I am now going to quote is a cardinal point as far as I am concerned. I know that I am perhaps quoting too extensively, but to me this is extremely important. Paragraph 1.1.9, dealing with the Transvaal, reads as follows—

This is the important point—

I send the patient whom I am treating to the hospital, but the superintendent, or the person appointed by him, has to examine the patient and decide whether the patient will be admitted. It sometimes happens that a medical practitioner who has a private practice, has a patient who is really sick and he decides that the patient has to be admitted to hospital. If the doctor should then tell the patient that he does not know whether there is room in the provincial hospital, the patient asks the doctor to phone. The doctor then states that he has in fact phoned, but that the doctor at the provincial hospital will first have to examine him in order to decide whether he may be admitted. In 99 out of a 100 cases my patients have then said that in that case they would prefer to be admitted to a private hospital, that they will pay the fees charged by a private hospital because they want to choose their own doctor so that he can tell him whether he is sick enough or not. After the doctor at the provincial hospital had made his decision, the following applies—

I can sum it up as it is summed up in the reports—

1. (1) that the hospital service is aimed in the first place at rendering service to a hospital patient (free or part-paying); and
2. (2) that, in view of a needy patient’s preferential treatment, the private patient should have recourse to “alternative accommodation”, that is, a private hospital, if available.

I maintain that in this specific case the provincial administration is forcing patients to go to private hospitals. In Oggendblad of 3 February this year I read that the Hendrik Verwoerd Hospital is now also closed to private patients except that 10% of the beds may be used for private patients. The patients are provided with a wonderful service there, and I have nothing against that. I think we can be grateful for what the State is doing. However I want to make the statement that the private hospitals have played a major role owing to the policy and actions of the provinces.

Why are private hospitals so expensive?

It is true that in the nature of the matter private hospitals are expensive.

They are extraordinarily expensive.

I note that at the moment the Groote Schuur Hospital is costing the province R36,55 per day per patient. The Tygerberg Hospital costs the province R42 per day per patient. The provincial hospital service of the Cape costs the province R160 million per annum. I have just obtained these data from the Administration. Whereas the expenditure amounts to R160 million per annum, the income is only R7 million, which is to be understood if they charged a maximum of R7,50 per day. The difference between R160 million and R7 million is paid by the State. I think that our comparisons of difference in tariffs is a little out of proportion. Someone said something about it costing a patient R500 to spend five days in a private hospital. My Volkswagen was at the garage for half a day and that cost R300! We must not lose our sense of perspective entirely.

The following is a quotation concerning the position in England, where in terms of the National Health Service a patient may be treated free of charge but nevertheless a certain percentage prefers private hospitals, for example—

The witness in question then goes on to say that this may still expand. In other words, it can be entirely free. It will not even be necessary to pay R7,50 per day. Nevertheless there is a percentage of people who are prepared to pay because they want certain facilities and I believe that they are fully entitled to them. There is another minor point which I want to quote although I see that I am speaking far too long. The hon. member for Fauresmith quoted the interesting statistic that from 31 March 1970 to 31 March 1974 the number of beds in Transvaal private hospitals increased by 773. A still more important point is that over the same period there was a drop of 134 beds in the Transvaal provincial hospitals. We must take due cognizance of this matter, because there are reasons for this and they are not the excessive fees of private hospitals.

The last point I want to deal with concerns the number of beds. I should like to view this matter in perspective. According to the statistics on page 44 of the report, there are 7 856 beds for Whites in Transvaal provincial hospitals as against 7 094 in private hospitals. In Natal there are 2 492 as against 1 718. The Free State, of course, is the exception. As the hon. member for Fauresmith said, they obey the constitution of the Republic. There are 2 026 beds in provincial hospitals as against 136 in private hospitals. The Cape has 6 160 beds in provincial hospitals and 5 072 in private hospitals. According to information I have received from the Cape Provincial Administration, it will cost the Cape about R100 million to provide the facilities offered in the private hospitals.

Will it cost R100 million per annum?

No, that is what it will cost the province now. A witness who gave evidence on behalf of the Transvaal—I do not want to quote this at length, but it appears in the report—stated that it would take the Transvaal at least 50 years to eliminate its backlog. When I think about the enormous population explosion, I have very serious doubts as to whether they will succeed in eliminating the backlog within 50 years.

I quoted from the report because in my opinion the report has to a certain extent been taken entirely out of context by hon. members, and most definitely by the newspapers and by members of the public. In my opinion it is absolutely scandalous when one gets an account for R1 500 or even R800 when in fact one should only have paid R300. Very vigorous steps must be taken against such phenomena. However, one should not on that basis decry the service rendered by the private sector We should be grateful that there are private hospitals. As a medical practitioner I am very grateful that I had a private hospital in my town to which I could send my patients. As a result it was unnecessary for them to go to private hospitals in Johannesburg because they were unable to get a bed in a provincial hospital.

Sir, this a short Bill with two clauses, one of which is the name. In other words, it therefore comprises only one clause. The principle of the Bill is the control of private hospitals and other unattached operating theatre units, etc. However the provision concerning the making of regulations is framed very widely. I could almost say that if we accept this legislation—and I support it 100%—we are virtually giving the Minister, in co-operation with the Administrators, carte blanche to make regulations to their hearts’ content, as they say in this report. I say that these regulations could break private hospitals. I do not think they will. That is why I say that it is not only the letter of a law which is important, but also the spirit, and to me this is often more important. I should greatly appreciate it—and here I agree with the hon. member for Pietersburg—if the Minister could set our minds at rest, because these people and the private hospitals are worried. These people can provide statements to prove that they have made a profit of 10% or 5% per annum, and perhaps paid a dividend once in a number of years because the Act obliges them to do so. In other years they plough it back into the hospital. These people would like to have the assurance from the Minister that this legislation will be implemented in such a way as not to break them.

Sir, I see the hon. Whip has come to sit next to me and I shall have to finish my speech. To conclude, I just want to repeat that I support the legislation on the basis of what is stated in it, but also on the basis of what is not stated in it, and one of the reasons why I support this legislation is the fact that it does not state that a doctor is not entitled to make a decent living.

Mr. Speaker, I have listened carefully to all the speeches that have been made this afternoon on a matter which the department considers to be very important and which has also become more urgent in recent years.

†I have listened with interest to the hon. member for Rosettenville, and I must say at the outset that the speech he delivered is typical of the way in which he approaches matters like these. In the first instance he spoke about the fact that we are now consulting the Administrators instead of the S. A. Medical Council on certain matters. But I think it should be clear to him that the S.A. Medical Council has to do with education, punishment and with standards; so, actually placing the S. A. Medical Council in that clause, means that, as we see things now and as matters have developed and health legislation has developed, it is an anachronism. We will of course consult the Medical Council where necessary, but otherwise I think the proper institution to be put in here is the Administrators, because they supply the hospitals and the facilities and they must at least be the bodies that should be consulted here. It is not a question of staff in the first place. The hon. member wanted fewer private hospitals. The idea is that the State can, by providing bigger institutions and by a more efficient use of manpower, money and facilities, eventually perhaps bring down its costs and the costs of health care. But we have not embarked on any policy specifically to diminish, by law, the activities of these people or to put them out of business. They have started and, as some of the hon. members have mentioned, they have done a good job. At a time when a province like the Transvaal did not have enough beds, they came to the fore and supplied those beds. Changes will happen, and these changes which have happened up to now call for some State interference in this matter. The charges being levied by these hospitals have come under the public eye, and we have cause for concern, because we have been inundated over the past few years by people who send us their accounts, so that we could see for ourselves the way these accounts are staggered in a very unfair way. And then there is also no uniformity. In one province a certain policy might be the policy of the day, while in another province it might be a different policy. The fees change and the prices of medicines change, and in the end the patient is dissatisfied. I can quote numerous cases where, looking at the account of a patient who stayed in hospital for two or three days, the Bill seems quite clearly exorbitant, and that did not even include the doctor’s fees.

The hon. member also spoke about health resorts and spas and that kind of institution and asked whether we were controlling them now or whether we envisaged controlling them under this measure. I must say that this Bill actually covers sick persons and the persons looking after them and all the other aspects that ought to be covered by a measure like this. It is a sick person and a nurse or a doctor caring for him, a qualified doctor, and there are many prescriptions that must be seen to. If these people comply with the law, then of course we have nothing against them, but I want to make it clear that this legislation does not envisage bringing these resorts, these spas and health centres, under the Act. We are not controlling them now. Still they are under the law, because if they do not act according to the law—and there are abuses and people complain—then we have to act. But we have had very good relations with many of these people, and many of them do good work. That is why I do not want at this stage to express myself about them, but—and this is a “but” which must be taken notice of—if we find that abuses occur, if we find that in these health spas and resorts people are being abused or are being taken for a ride, then I think it is the duty of the Department of Health to look into the matter. But we will bear it in mind, I can assure the hon. member, when next year we hope to come to this House with a consolidated Public Health Act. The present Act, and Act of 1919, is so old that one still has to read High Dutch.

*I come now to the hon. member for Fauresmith. The hon. member raised the same matters. I agree with him that there is a lack of uniformity. In fact, this was one of the reasons for the appointment of the commission. He also complained about accounts. He believed that these were exorbitant, and in some cases they were. The hon. member for Pietersburg made the same allegation. This is so. It is the kind of problem which the public brings to one’s notice and one has to try and satisfy the public to some extent by having the complaints thoroughly investigated.

†The hon. member for Pinelands made some quite flattering remarks at the start. He also dealt with a uniform system. He referred to the S. A. Medical Council and its functions, and referred to one small function that was now being taken away from it, the power to grant recognition. I have already answered that. The hon. member also spoke about the control of fees. A remuneration commission was provided for in the Act last year. That is a facet of the Act which also deals with medical schemes. We brought it in last year, in the Act dealing with medical health supplementary services. So, in future these people will also have a say, these owners. They are suppliers. The medical people are the other suppliers. The medical schemes and public are being supplied to. All these people will come together and have a remuneration commission as well as a judge. Who is there better than a judge to decide between right and wrong in the end? Everybody agrees on that. In any case, this is the way we envisage it for the future, and I think it is a very necessary aspect to bring in here. These people will have quite enough opportunities to put their case. However, we must opt for standardization to a certain extent, because in South Africa medical costs have soared sky-high. The Government is the whipping boy and feels the pressure being exerted on it from day to day.

The hon. member also spoke about the patients. In the clause we can, by implication, determine the type of patient. The only thing I can tell the hon. member in this regard is that we want to have the right to at least investigate the position so that a patient need not be kept in a nursing-home for eight or nine months, because the fees are high. The cost will then be exorbitant. We must have a right to say that a patient has been in an institution long enough. When people who are concerned about a patient come to us, we will be able to tell them that we now have the right to take that patient away from such an institution so that the costs do not accumulate indefinitely.

I have already referred to the hon. member for Pietersburg. He also spoke about complaints and the considerations which were in the minds of the commission.

*The hon. member for Pietersburg spoke of someone who had to pay a tremendous amount for one or two days. I received a complaint only yesterday, a complaint which was very clearly set out, from a patient who had been in a hospital for three days and whose account amounted to R2 064, excluding doctor’s fees. What is the State to do in a case such as this? Are we to check every item? One finds, for example, that a charge of 15 cents is levied for an injection which really costs 6 cents. On a long account this 9 cents profit becomes a tidy sum. We have been having problems of this kind for the past year. The high cost of medicine is not an aspect which I can deal with here, but I can mention, nevertheless, that it is often used by the hospitals as an excuse for their high fees. It is really the subject of another investigation, an investigation which is being conducted at my request by the Department of Commerce and Industry. Quite a number of people nominated by me are involved in this investigation.

Our legislation must create a sound balance between the people who provide services and the people who make use of the services. Speakers have said that they want the people who provide this service to be allowed a legitimate profit. This is quite correct. But on the other hand it is also our duty, by means of equitable legislation, and considering the practical circumstances, which are already known to us as a department, to protect the person who makes use of the service. Comparisons can be made here, after all, between the provincial hospitals and the private hospitals that we know. Where would a person want to go if he had to go to hospital tomorrow? To clinic A or to Groote Schuur’s intensive unit? The latter is a provincial hospital, and the former is private. So our people do in fact have a choice, but the choice must not be of such a nature that a man is forced out of the provincial hospital so that he is obliged to go the private hospital or institution.

This brings me to the doctors who have a private interest in private hospitals. Thirty years ago I personally had to struggle with a private hospital for some years because there was no one there. I want to tell hon. members that we must not only condemn in this connection. On the other hand we must be careful as well. There are medical practitioners, particularly in the Transvaal, who have almost been broken financially through wanting to help establish private hospitals because there were not enough beds in the provincial hospitals. These are aspects we have to consider. It has been said that it will take the Transvaal 50 years to provide in its provincial hospital requirements. I do not think it is as bad as that, but we have nevertheless found that doctors have to join private hospitals in order to have beds for their patients. I can tell hon. members that many of them are disappointed and would like to get out of it. As far as private doctors with shares in private hospitals are concerned, one also finds, as in the case of many other people, that their personal interests can come into conflict with their duties. It is a great pity that this accusation is already being made against doctors. As far as this is concerned, the State is not so antagonistic that it has prohibited this. The commission took a slanted view of this matter. For this reason I want to say today without fear or favour that it is not the policy of the Government that private doctors must have shares in hospitals.

†The hon. member for Berea mentioned the fact that nurses were not being trained at private hospitals. This is a very important aspect. The hon. member also mentioned the fact that the commission specifically gave attention to this aspect. As a result, private hospitals will have to look at this aspect in future, because at the moment they take away nurses and sisters, the qualified nursing personnel, of the general hospitals where they are trained. This is not right. If they go on in this manner, we will have to prescribe the type of nurses they should have, especially in the smaller types of hospitals which do not have all the facilities. If we do prescribe this, they must help us by training nurses. We have a specific need for trained nurses. We are lagging behind as far as this is concerned. I already dealt with the aspect of legislation the hon. member mentioned. Next year we will have a consolidated Public Health Act. The hon. member also mentioned technical matters, but I do not think it is necessary for me to reply to that at this stage. I agree with the hon. member as far as high costs are concerned. The hon. member also wanted to know why we turned to the Administrators for advice instead of to the remuneration commission or the Medical Council.

*The hon. member for Krugersdorp raised a matter to which I want to reply as well. The State has not yet committed itself to taking action against medical practitioners who have shares in private hospitals. What they are doing, therefore, is still quite legal. However, the State is to some extent concerned about this. We receive the complaint, for example, that patients are admitted to hospitals such as the Hendrik Verwoerd Hospital—it need not necessarily be this specific hospital; it can be Tygerberg as well—and that a private doctor subsequently tells the patient that he cannot remain there and that he has to go to a private hospital. If something of this nature happens, one gets suspicious, and then one’s suspicions sometimes prove to be founded on fact. If I find in a certain case, which I have had investigated, that a patient who might just as well have been treated in the Hendrik Verwoerd Hospital has practically been forced in a subtle way to go to a private institution where he will have to pay R1 500, this makes one think that this is a matter which ought to receive much more serious attention than it has ever received in the past. We must determine a fair profit for our private hospitals, and it will be determined, but then we must have uniformity throughout the country with regard to the determination of these fees. Our average public—not the public which is rich enough to go everywhere—is getting more and more worried every day about the escalation of medical costs. Hon. members must know that I am not only concerned in this matter as far as the hospitals are concerned, but also as far as the doctors are concerned, and as far as many other aspects are concerned, such as the cost of medicine, etc. I think we should take very balanced view, as has been taken by hon. members today, and we should regard the whole question of private hospitals and their regulation, not as just another matter to regulate and to regiment, but as an essential part of a kind of service which naturally extends all over the country and which is very delicate, particularly in the patient/doctor relationship. The State has a responsibility, particularly in view of the anti-inflation programme, to do its duty by ensuring that everyone gets his due, and to prevent a situation where some people get much more that their due.

Motion agreed to.

Bill read a Second Time.

Mr. Speaker, I move—

The South African Medical and Dental Council has made representations for these amendments. The required minimum qualifications for the registration of psychologists is a Master’s degree. The Professional Council for Psychologists has considered the practical training of graduates and is of the opinion that their practical training would be more effective if these persons were registered as interns with the South African Medical and Dental Council, and has made such a recommendation. To make provision for intern-psychologists, therefore, it is necessary to amend the Act.

Clause 1 contains a definition of “intern-psychologist”, and clauses 2, 3, 5, 6, 9, 10(a), 10(c) and 10(d) contain the necessary amendments to make provision for intern-psychologists. Sections 20 and 42(6) of the Act make provision for appeal to a court if a person is not satisfied with a decision of the council on his application for registration, or the removal of his name—these are disciplinary measures—from the register, or with a finding after an inquiry, or with a penalty imposed upon him. Sections 18 and 42(5) of Act 13 of 1928 created a right of application to a court which actually amounts to a review of the situation by the court. Since the court has a right of review in its own right, the department was of the opinion, with the drafting of the latest Act, the 1974 Act, that it would be in the interests of registered persons to create for them a right of appeal to the court instead. However, the department was not aware of the court’s attitude on the matter as reflected in the case Groenewald v The S.A. Medical Council, 1934 (T.P.D. 404), which subsequently came to the attention of the department. I should like to quote the following passage from the judgment—

Please note the following—

By way of illustration of the competence of the court to hear cases of this nature, I should like to quote the following passage from the judgment in the case Groenewald v the S.A. Medical Council 1934 (T.P.D. 404)—

The above-mentioned judgment was followed in other cases, for example McLoughlin v S.A. Medical and Dental Council, 1947(2) S.A. 377(W) and S.A. Medical and Dental Council v McLoughlin, 1948 (2) S.A. 355 (A). Since the court itself is therefore of the opinion that the council is the most suitable body to decide on matters of this nature and since the court is not prepared to change a decision of the council, the provisions in the Act serve no real purpose. On the contrary, if the provisions were to be retained, they could only lead to considerable financial expenditure which the council could hardly afford. Consequently the provisions are being deleted. The deletion of the provisions will not affect the right of the individual to apply to the court for review of a specific case. These amendments are embodied in clauses 7 and 8.

The Professional Councils for Optometry, Psychology and Medical Technology have recommended that provision be made in the Act for the registration of students in the respective professions. These recommendations have been accepted, but to prevent repeated amendments being effected, provision is being made for the council to be empowered to register students in all categories of supplementary health service professions. It is foreseen that registration will not be introduced immediately for students in all such professions—there are 28, i.e. physiotherapists, occupational therapists, radiotherapists, etc.—but that this will be done as it appears to be necessary and desirable. Provision for the registration of such students is being made in clauses 3, 5 and 10(b).

The Chiropodists Association (S.A. branch) have drawn attention to the fact that there are apparently persons who are not registrable, who are using abbreviations of a qualification such as M.C.H.S., which is apparently the same as that of a registrable qualification. In this way confusion is caused concerning the recognition of such a qualification. These are registered persons in the supplementary health service professions with the right to use those qualifications, but the unregistered persons also append these initials to their name. In view of this the professional council concerned has recommended that section 40 be amended to prevent such practices. This amendment is embodied in clause 7.

Mr. Speaker, this is a Bill of two parts. In the first part we deal with the registration of psychologists and intern-psychologists. We agree that psychologists and intern-psychologists should be registered and we agree with the other provisions dealing with the psychologists and the intern-psychologists. The Hon. the Minister has not stated in the Bill at what stage a psychologist student can be considered an intern-psychologist, and I would like to know from him whether he becomes an intern-psychologist after he has obtained a B.A. degree in psychology or whether he has to take an honours degree and an M.A. degree before he is considered to be an intern-psychologist. This is a matter which the hon. the Minister can easily clear up for us this afternoon.

The second part of the Bill is the one which perturbs us and which perturbs me in particular. The Act has been in existence for barely one year. It is an Act which was passed in 1974. This means that during this period the Medical Council would possibly only have sat once or at the most twice to deal with cases that have been reported to them and which needed investigation and in which they could possibly pass sentence on the person to whom the complaint relates. The Minister presents us with a Bill in which clause 4 removes the right of the person to have his name included in the register, and gives the Medical Council the right to remove his name from the register after it has been included. I want to refresh the memory of the members who are in the House this evening and I want to read to them what section 20 of the Act provides:

1. (1) Any person aggrieved by the council’s decision—
   1. (a) to refuse to register him or to enter in the appropriate register any qualification, additional qualification, speciality or particular which he desires, and maintains to be entitled, to have so entered in terms of the provisions of this act; or
   2. (b) to remove from the register his name or any qualification, additional qualification, speciality or particular which he maintains to be entitled to have entered in the register in terms of the provisions of this Act, may, after notice to the council and within a period of two months after the date of such decision, appeal to the provincial or local division of the Supreme Court of South Africa having jurisdiction in the area in which the appellant normally resides, against such decision.
2. (2) The court may dismiss such appeal or, if it is of the opinion that the council has not acted in accordance with the provisions of this Act, may make an order reversing or modifying the council’s decision or may remit the matter to the council for further consideration or make such other order, including an order as to costs, as it may deem appropriate.

This section does not deal at all with the conduct of the practitioner. It deals with the registration of the qualification. I may feel that I am entitled to have a qualification included in the register and the council may think otherwise. I think I should have the right of appeal against such a decision.

It is a protective device for the for the profession.

It probably is; it protects the profession. It must be remembered that in this case there is no consideration whatsoever of a man’s conduct, and I feel that it is wrong that the practitioner should be deprived of access to the courts. We then come to clause 8, which deals with a different matter, viz. the deletion of section 42(6) of the Act which provides—

Here we have to take into consideration the matter which the hon. the Minister has brought up. He mentioned the findings in the Groenewald case. It was the judge’s decision that the findings of the council should stand. I understand there has recently been another case, and I understand that in this case, which is a matter of misconduct as well, judgment has been reserved. If there is doubt at all, then I feel that the practitioner should have the right to be able to go to court and ask for his case to be heard again. What is going to happen in the future? Doctors are even going to be afraid of making a decision as to what they may charge. I have a notice in front of me which has recently been issued to dentists. I suppose the hon. the Minister has seen this. It has been sent out by the Dental Association of South Africa (Cape Western branch). It reads—

It must be remembered that fees is one of the matters that can be dealt with by the council—

If I come to an arrangement with a patient and I tell the patient that an operation is going to cost RX and he agrees to pay RX and I charge RX, he can still go to the council and the council may then say that the fees are excessive and I can be punished for that although I have come to an agreement. That is the sort of case where I think the practitioner should have the right to appeal against a decision of the council. Where there are blatant transgressions of the ethics of the doctor, the transgressor himself will not go to the courts. It must be remembered that in the case of important transgressions a man is struck off the roll and may be deprived for some reason or another of the right to practise as a medical practitioner. For instance, he may have been found guilty of procuring an abortion, and he may be charged with culpable homicide. Not only does he lose his right to continue to practise as a medical practitioner, but he has to appear in court again to be punished. He suffers two punishments. He may not only lose the right to practise, but he may also be sent to prison as well or be heavily fined or both. Surely when a man gets such a severe sentence it is desirable that there should be some other body to which he may appeal. He may appeal for leniency, but his peers may find that nothing can be done other than what is stipulated in their law of ethics. I consider that the man should be given another chance and that his case should be heard again. If he is guilty the Appeal Court will not make him less guilty, but they may modify the sentence and that is all I am appealing for.

I feel that in this and in other cases the access to the courts must remain a cornerstone of our society. [Interjections.] If we are going to deprive any person of his right of access to the court, we will be discriminating against one particular group of persons. Why should we not allow all people who have committed a crime, or have been said to have committed a crime, or have been found guilty of having committed a crime, to have their case, not only reviewed—not only reviewed automatically—but also to have a chance to go and plead before a court? For that reason we on this side of the House, feel so strongly on this Bill—we feel that these two clauses are so important—that we cannot accept the Bill as it stands at the moment. Remember I have said at the beginning that we want to see the registration of psychologists. However, in this Bill this is only a minor matter compared to the grave matter of depriving a man of his right of access to the courts, and perhaps depriving him of earning a living in the future and also of the right to ask for the punishment imposed to be reduced or to be seen in a different light.

Mr. Speaker, the hon. member for Rosettenville had a good opportunity here to put a good case to this House. The first aspect was the important one—in my opinion it was very important—and it deals with the training of psychologists. I will refer to this again later. Unfortunately the hon. member gave very little attention to this. His argument mainly concerned what he thought would be unfair measures. I just want to say that as doctors, the hon. member, and the rest of us here, have the greatest respect for the South African Medical Council. The function of the S.A. Medical Council was—as stipulated by the Act—to set up a code by which the medical profession should operate. This includes, amongst other things, the behaviour of doctors, their ethical code, as well as approved tariffs. The hon. member mentioned with justification, an example of a doctor whose tariffs were too high. Now, however, I want to ask the hon. member whether he knows of any doctor whose name has been struck off the roll by the S.A. Medical Council because his tariffs were too high? The Council has its disciplinary measures. Doctors are reprimanded and warned. They are told how they ought to practise their profession.

The other aspect which the hon. member for Rosettenville mentioned here chiefly concerned the inclusion or exclusion of a medical practitioner’s name from the roll.

Surely, the medical roll must be kept by the Council in order that it may decide whether a person’s qualifications justify the inclusion of his name on the roll. The Medical Council decides whether the name of a person may be enrolled on a specific register whereby he is allowed to practise only a certain part of the medical profession. Now, however, the hon. member for Rosettenville asks to have recourse to the courts. Already that is something judges do not want to do. They do not want to decide whether a person’s qualifications justify the inclusion of his name on the medical roll. Nor do judges want to decide whether a medical practitioner’s name is to be struck off the roll as a result of some offence he has committed. We had the same argument with the Opposition when the Publications Act was placed before this House. Just as the judiciary does not want to judge a medical practitioner, it does not want to judge the moral standards of the population either, and that is why we amended the Publications Act abolishing the right to appeal to the courts. The case in question is basically the same. A judge does not want to pass judgment on whether the name of the medical practitioner should be on the roll or not. Irrespective of his registration or his ability, a medical practitioner—if he can prove mala fides in the actions of the Medical Council—can have recourse to the bench via another channel, viz through criminal law. This can happen in cases where a medical practitioner can prove that he was wrongly dealt with, for example when documents have been forged, or something of the sort. Therefore there are in fact ways open to him, but the courts do not want to be concerned with matters in regard to which they cannot maintain a certain standard.

The hon. member for Cradock will elaborate on this. I want to go on to speak about what, in my opinion, is the most important part of this entire piece of legislation. This concerns the study and registration of psychologists.

At present we are living in a world in which the rate of development is unequalled. Although the rate of development of technology and the tempo of our lives have accelerated, man has remained basically unchanged. Unfortunately he is not always able to keep up with that process. We are all aware of frustrations in all areas. Man’s spiritual development has not been able to keep up with technological development. Man has been unable to keep up with the pace of life, and this has given rise to frustrations. In America, for example, we have the phenomenon that everyone in a high position has his own personal psychologist, who must assist him and give him advice. They find this absolutely essential.

The actual reason why I appreciate the introduction of this legislation is the fact that it is especially important for the younger generation, for the children of today. In every province it is considered almost essential that a psychologist be attached to every department of education. These psychologists must be there to help solve the problems with which the family, the parent, cannot deal due to the accelerated development to which I referred.

Now we have the problem of the poor child who is left in the midst of the pressure of life and in the midst of a material civilization with which he is unable to cope and in which he cannot develop his personality. In my opinion this is a very positive direction. It also indicates the direction in which we should move in the future. The time will come when each school will need its own psychologist to help solve the problems which arise among children. This legislation, however—if I interpret it correctly—provides that would-be intern-psychologists must possess at least a B.A. Honours degree. In order to be allowed to register as a psychologist, however, the Act requires that applicants be in possession of at least a Master’s degree in psychology. Mr. Speaker, we cannot pay too much attention to the physical and mental problems of the youth, especially the school-going youth, because we and civilization are chiefly responsible for psychic deviations among the youth as a result of divorce, broken marriages, broken homes, alcohol abuse and all those evils of our society. The school will have to help in this regard, and in future the school will need the psychologists’ assistance more and more. I should like to wish to the Society of Psychologists all of the best in their task for the future and express the hope that it will be essential for everyone to conform to the demands of society.

I should like to say a few words about clause 7. In my opinion one should not try to be what one is not, and I am therefore pleased that it is included in the legislation that one may not credit oneself with a title or qualifications which will give the public the impression that one does indeed have the qualifications concerned. Finally, I should just like to refer to psychological training. I am doing this especially for my hon. friend who so often talks about Bantu and other population groups which do not have the right to attend free universities. Here I want to refer to the survey carried out by the University of the North concerning a psychological deviation which was found amongst Bantu in the Groothoek Hospital. I am referring to this matter especially for the benefit of the hon. member for Pinelands. In the course of this study the researchers came across the Malopo syndrome. I quote from an article about this syndrome (translation)—

Is that Alex Boraine?

What I should like to illustrate here, is that this study was made by the Black people of the University of the North on a scientific basis amongst their own people. If that university and the faculty of psychology had not existed, this investigation would have to be made by another university. However, people can never be examined more successfully than by their own people. This is what I wanted to illustrate to the hon. member over there.

I think that the hon. member for Rosettenville was a little too concerned. On the other hand I have complete confidence in the Medical Council and in the judiciary, and I also have complete confidence that this legislation will not impair anybody’s rights.

[Interjections.] Mr. Speaker, if I could have just a moment of quiet I should like to express my thanks to the hon. member who has just sat down for his psychology lecture, which he aimed at me in particular. I want to say how grateful I am for the treatment he has suggested, and I hope his fees are not too high. Perhaps he can talk to me about this afterwards. I would be very happy if he and his colleagues could come to me, because I would like to prescribe some treatment for them as well.

We in these benches have no quarrel with the greater part of the Bill before us. We are also very much in agreement with a great deal of what the previous speaker said. The whole profession of psychology, clinical psychology in particular, has become very important, and some of the gentlemen I have talked to, agree that this legislation is necessary and is to be welcomed. However, we must express in the strongest terms our opposition to clause 4 of this Bill. The hon. member for Rosettenville has already spoken at some length about this. When we look at the history of clause 4, we find that in the original Act of 1927 or 1928 there was no right of appeal to the Supreme Court whatsoever. There was, however, the right of review. This, I understand, was based on the very well-known British Act, which is supposed to be one of the best in the world, and there too there was no right of appeal. There was simply a right of review, if I understand the matter properly. However, in the 1974 Act this was altered to include the right of appeal, and the hon. member for Rosettenville has already quoted section 20, and I am very glad he did so. I say this because it is of the utmost importance to understand what has taken place in regard to the deletion of section 20 to which clause 4 refers. I cannot understand, however, how it is that only a year ago this Government, in its wisdom, decided to include not only the right of review, but also the right of appeal to the Supreme Court.

It seems to me that this was an absolutely correct decision. Now this decision has been reversed and not only is the right of appeal removed, but also the right of review. I am perfectly aware that under any other circumstances this right of review is afforded a doctor who is to be struck off the register or a doctor whose qualifications are held in doubt by the Medical Council. However, the decision to delete this provision after less than a year, staggers the imagination, and one wonders whether the hon. the Minister has sought the opinion and advice of the law societies, whether he has talked at length with the Medical Council and obtained their views about the deletion of this right of appeal. I have talked to some of the representatives serving on the Medical Council, and they themselves are very worried indeed. They do not want to see this Bill go through in its present form, and accordingly I hope very much that the hon. the Minister will change his mind once again and allow this appeal to the Supreme Court to stand. I am firmly of the opinion that we should have not only the right of review, but also the right of appeal written into the Act. Reference may be made to the fact that very few appeals have been lodged since 1974. It is true, but this is of no consequence, because the period of time has been so short. The hon. member for Rosettenville, who speaks with the experience of a practitioner, has outlined the effect that a severe decision against a doctor can have on that doctor. One realizes that he can forfeit his career, his livelihood and that he can also be very severely punished in a court of law. It therefore seems to me unreasonable in the extreme that this right of appeal, which has been in the Act since 1974, should now be removed.

When one bears in mind that, when we discussed the 1974 Act in this House, several of us raised the question of the composition of the Medical Council and that, despite our objection, the council was truncated and is now in terms of numbers dominated by Government nominees, I think this deletion becomes even more ominous. Only on 6 February this year there was a case before the Supreme Court. It is a matter of judgment, which may be right or wrong, but it is at least open to question, and there are many in the medical profession who believe that, were it not for that right of appeal, an injustice would have been done. Even if only one wrong decision is taken by the Medical Council, a decision that is subsequently reversed by the Supreme Court on appeal, it seems to me to be reasonable that, just as every citizen has the right of appeal to the Supreme Court, so the medical profession should not be denied this right either. I hope very much that the hon. the Minister, having listened to the strong objections of the official Opposition and ourselves, will reverse this decision and will not allow the Second Reading of this Bill to take place under the present circumstances. Because we feel that we are in general agreement on so many of the other sections of this Bill, I wish to move as an amendment—

Mr. Speaker, of course I am not in the least surprised that the Progressive Party, through the hon. member for Pinelands, has stated its opposition to this specific principle in the Bill. What I do find surprising, however, is the fact that he tried to use this opportunity to cast suspicion on the composition of the Medical Council. I think it is a despicable deed to come here and say …

Order! The hon. member must withdraw the word “despicable”.

I withdraw it, Mr. Speaker. I think it is a disgrace that the hon. member sees fit to say, with reference to the composition of the Medical Council, which was approved in this House last year, that “this deletion now becomes ominous”. What he meant to imply by that is very clear to us. That is why I think it is a disgrace that he made this allegation here.

As the hon. the Minister has already indicated, this provision found its way into the principal Act through an oversight because the people who drafted this legislation at the time had not taken cognizance of the fact that the Supreme Court had, over the past 30 to 40 years, repeatedly expressed itself opposed to the principle of interference in a finding of the Medical Council. The hon. the Minister referred to several judgments and, as far as I know, not a single judgment of the Supreme Court has yet been at variance with these. The judges have continuously adopted the standpoint that they are not in a position to judge on matters such as ethical norms, ethics, and so on, matters which are more properly the province of a professional council such as the Medical Council. I think the fundamental standpoint adopted here by the court is a very sensible one, and I am saying this for a number of good reasons. A professional council, such as the Medical Council, is constituted, in contrast to the suspicions of the hon. member for Pinelands, from people of high repute who are themselves members of the profession, people who compel esteem and respect in that profession, who have been members of that profession for many years, who have a feeling for the finer nuances of ethics and specific norms, who have had experience of these things, and who are able to express a far better judgment on them than a court. I am saying this with all due respect to the courts. These are people who enjoy the esteem and respect of their colleagues. They judge these matters according to merit, and take cognizance of the finer nuances of the general ethical norms which apply in the profession. They base their decision on that.

The assessment of facts which point to the contravention of specific ethical standards and norms is therefore best left in the hands of people who are conversant with those ethical norms and standards, people who have gained a respected standing in the profession owing to their scrupulous maintenance of those very ethical norms and standards. To allege that the proposed deletion of this provision infringes on the rights of medical practitioners really does not hold good, because a right of review does still exist. These people are still able to go to court and have recourse to the fact that there was, for example, a gross violation of procedure and of rules in that inquiry, that there were signs of prejudice or of mala fides, etc. They are still able to have recourse to the court on those grounds in terms of common law. But on the merits of the case the court has already expressed its opinion, and it is not prepared to find otherwise than the professional council has already done.

Actually we are dealing here, with the provision as it stands in the existing Act, with a paradoxical situation, which ought to be terminated for the sake of the medical practitioners whom it is supposed to serve. The hon. the Minister referred to these judgments. On the one hand we have the position that the court refuses to express an opinion on the merits of a specific case while on the other this measure creates an expectation among medical practitioners that a possibility exists that they may nevertheless be able to succeed. But in terms of these court decisions no such possibility exists and the medical practitioner is caused a lot of distress and unnecessary costs. In my opinion there are three very good reasons for the removal of the section concerned from the principal Act. In view of repeated decisions of the Supreme Court, this provision, as I have already said, holds out no advantage to the medical practitioner. It offers him no remedy, because the court will not decide otherwise than the Medical Council has already done. In the second place this section in the Act creates expectations in the medical practitioner which cannot be fulfilled. And in the third place it must be borne in mind that cases of appeal to the Supreme Court not only have major financial implications for the medical practitioner but it is said that the Medical Council has to spend a few thousand rand in every appeal case, while it has already been determined in advance that the action cannot succeed. Therefore I find it strange that both the Opposition parties should oppose this legislation.

Mr. Speaker, the hon. member for Cradock does not surprise me. He has merely repeated the point of view which his Minister enunciated in his Second Reading speech. But what I find a little difficult to understand is the fact that in order to quote examples it was necessary for the Minister to go back nearly 40 years, to 1934 and then to 1947 and 1948. It would appear that there have not been many cases which necessitate or justify the removal of this particular section from the original Act. Reference has been made to the Act No. 13 of 1928. I have the original copy here. It looks like a collector’s piece, and as far as I am concerned, it is. In section 18, page 10 of the original Act of 1928, the side-line says “Appeal to the court against refusal to register or removal from register”. This was entrenched in 1928. If we go to the new Medical, Dental and Supplementary Services Act, No. 56 of 1974, section 20, we see “Appeal against refusal to register, or removal from the register”. So for 48 years the right of appeal to the courts has existed. It would seem that the right has never been abused. On the contrary, where members of the profession have felt definitely aggrieved they have had that right. We on this side of the House, the official Opposition, believe that it is not fair to take that right away after its having been entrenched in legislation for 48 years.

Then there is a question I should like to address to the Minister. From 1928 to 1974 the three professions which operated under Act 13 of 1928, were the medical, dental and pharmaceutical professions. The provision still exists in section 24 of the Pharmacy Act, No. 53 of 1974. Is it the intention of the Minister, if that Act is to be amended in the near future in other respects, that this provision will also be taken out of the Pharmacy Act of 1974? If so, I believe he will be depriving another section of a similar profession of rights which they have enjoyed. I can speak with a certain amount of personal experience, having served on the S.A. Pharmacy Board during the period that we operated under Act 13 of 1928, and unless my memory is at fault, I have no recollection, although we dealt with cases that had been referred to the board, where professional pharmacists had contravened the law, and though we also dealt with cases which arose from contraventions of the ethical rules, of a single case during my tenure of office of 10 years which went on appeal on that basis, although the right to appeal existed.

Reference has been made to the fact that the Medical Council is now a smaller council although its composition has in my opinion been slightly circumscribed. Is the Minister fully satisfied that the two voluntary associations which operate under the umbrella of the Medical Council, i.e. the Medical Association and the Dental Association, wholeheartedly support the repeal of this section? My information from individuals is that they are deeply concerned and that this is in effect an intrusion in the right of freedom which they have enjoyed for 48 years, the freedom to approach the courts.

There is one further aspect to which I wish to refer. As I understand the Bill—and I would like the Minister to confirm this—the provision of appeal would only apply in so far as medical practitioners, dentists and psychologists are concerned, and not for all the other supplementary services which operate under this Act. If that is correct—and I believe it to be correct—it would not mean that the Medical Council would be flooded with a large number of appeals from members who operate under the supplementary services covered by this Act.

I now want to come to another aspect of the Bill. The Bill provides for the registration of certain interns and students. I should like to refer the House to a quotation from the Commission of Inquiry into Scientology, its summary of recommendations, and I draw the attention of the House to the fact that all the findings and recommendations of the commission are unanimous, according to the report (RP.55 of 1973). I refer to the chapter “Recommendations”, on page 231, where it says—

As I understand the situation, the Act of 1974 took certain steps in that direction while this Bill puts the position of intern-psychologists beyond doubt. I want to quote from a book entitled The Hidden Story of Scientology. On the flyleaf appear the words “Issued by the Board of Directors”. The following appears there, and I think this has significance to the subject under discussion—

Then I wish to refer briefly to Dianetics, The Modern Science of Mental Health, published by the founder of Scientology, L. Ron Hubbard, in which he says (page 167)—

And then there is a contradictory sentence on page 168 which I believe should be quoted. It is—

And the final sentence of the chapter reads as follows (page 169)—

I do not wish to comment on that. I find some of it a little difficult to understand. Yet I feel it should be placed on record because I believe that Parliament has taken a wise step in clarifying the position in so far as psychologists are concerned.

Mr. Speaker, I shall not delay proceedings very long. Before the hon. the Minister replies, I merely want to make one final appeal in connection with the clauses which deal with the repeal of the right to appeal to the courts. I do not regard these provisions as motivated by any sinister purpose. I sincerely believe, however, that it is unwise to remove the right of appeal, particularly because of the fact that in both cases the right of appeal is very wide and very broad. It gives the person the right to appeal if he is aggrieved—“as hy veronreg voel”. It is a far different story to the right of review which is an inherent provision of our law but which is confined to the question of irregularity or mala fides. It is an entirely different approach to that of the wide provisions of appeal provided for in both sections. Despite the fact that the hon. the Minister has referred to two cases where judges stated, some 40 years ago in one case and some 30 years ago in the other, that they would not like to interfere with the standard of ethics that a particular profession feels should prevail in the profession, I do not see any good reason why the right of a man to be heard before the courts should be taken away from him. The question of review has always been a difficult procedure for anyone who is before some forum, whether it be a quasi-judicial forum or any other forum, where he is limited only to the right of review. There are no automatic reviews, as may have been suggested—that only takes place in respect of certain penalties which flow from certain judgments in the magistrates’ courts. If a fine of a certain amount of money or a sentence of a certain period of imprisonment is imposed, the case automatically goes for review to a judge and is considered by a judge-in-chambers without representation from the accused.

It is just an automatic right of review in order to give further protection. This is an entirely different situation. Judgment here is passed by a body of men who are not acquainted with the law. They are not a court, they are not even a quasi-judicial forum, but they are established in a profession in order to maintain a certain standard of ethics. As this happens to be one of the age-old traditions of this profession and other professions of a similar nature, for years—as has been pointed out—the right of appeal was provided so that the matter could come before a forum which is absolute and completely impartial, a reputation which our courts enjoy. That is why I believe it would be unwise for the hon. the Minister to proceed with this action. I would like him to disabuse his mind of the thought that this side of the House reads anything else into the appeal provisions of the Act other than that in our opinion it is unwise and completely unjust to deprive a member of a profession of this right of appeal, not only because of the fact that it has been an element of law for over 50 years, but more particularly because that is one of the rights of natural justice to which any member of the public should be entitled. On those grounds I appeal to the hon. the Minister to give some further consideration to the plea put forward by this side of the House. Our opening speaker indicated at the outset that we shall oppose the passage of the Bill for those reasons, and despite the fact that an amendment was moved to the same effect, that is the purpose of this side of the House, as evidenced in the viewpoint presented by our opening speaker and others who have supported him.

Mr. Speaker, in the first place I would like to answer the hon. member for Rosettenville. He asked me about the position of the intern psychologist. As soon as a person obtains an MA degree in psychology, he becomes an intern psychologist. However, after we had had consultations with the S.A. Medical and Dental Board and with the Psychology Board, we decided to retain people as students as soon as they obtained a BA degree. After a student of psychology obtains a BA degree, he can go to a hospital and do an honours degree, after which he can qualify as a student psychologist. This confirms them in a specific profession. We want to have the intern psychologist, and eventually the psychologist, as part of the multi-disciplined profession of medical science.

There is also the question of the right of appeal. It seems to me we have no bones to pick about the general principles of this Bill which consists of quite a number of clauses. By now discussing one clause in detail, we would actually be doing the work we are supposed to do at the Committee Stage. Nevertheless, I think I should make a few remarks on it. The hon. members for Rosettenville, Pinelands, Berea and Jeppe were opposed to taking away the rights of the medical profession. I contend that we are not taking away any rights. We are only setting the records straight in a realistic way so that we do not have any confusion in our courts of law in time to come, and certainly not in the minds of the people who have the common law right to appeal for a review. As far as review is concerned, I would like to quote from a book called The Civil Practice of the Superior Courts of South Africa by Herbstein and Van Winsen. I have already quoted many cases, but I still have many more I could quote. However, I do not want to waste the time of the House. If hon. members so desire, I shall quote those other cases. My present quote, however, is from page 586—

I should also like to quote from another case I shall not specifically name—

This refers to a review of the procedure, the way in which the case has been conducted. I continue—

According to law this body has certain specific legal functions. I quote further—

I do not want to repeat my Second Reading speech again. I told hon. members why we erred, not one but two years ago, in providing for an appeal in section 20 and 42, an appeal which is causing confusion at this very moment. I want to quote two or three more instances—

I am not only going back to 1904; I can go up to 1948 and later on, and yet there are not many cases. I read on—

Therefore, it is only mala fides, grossly improper conduct, etc., by the examining body which will eventually cause the court, when reviewing a case, to decide that throughout the procedures, things have gone wrong. Therefore, it is my conclusion—and I am supported in this by each and every one of our law advisers who completely concur with the opinion of the Chief State Law Adviser—that unless it is the intention to curtail the inherent right of review of the court or to extend such right in a particular case, a creation of special machinery for the right of review by the court will be entirely tautological. But that is what those hon. members want. Our courts guard their right of review under the common law jealously, as is evident in a large number of decisions. Even in cases where it is affected by statutory law, the courts have taken up the attitude that the word “review” must be understood in its widest and what may be called “popular” sense. It is seen as conferring a wide exercise of supervision and a great scope of authority.

*On the basis of advice I have received from all my legal advisers and on the basis of the numerous Acts of the past, I have come to the conclusion that it is only right to eliminate this uncertainty which is going to give rise to heavy expenditure. If a person were to think that he had the right to appeal with regard to the question as to whether he was good enough to be a medical practitioner, would a judge be able to decide that matter? Over the years the judges have decided that they were not sufficiently well equipped to do so. To this end a statutory council, comprised of some of our most prominent people, has been appointed. All that can be ascertained when a case goes on review, is whether the matter has been dealt with correctly. The same applies in the case of disciplinary measures, which have been laid down very specifically. It is not for us to determine what disciplinary action should be taken; it is for the council to decide. Therefore, when it comes to the deletion of a person’s name, his refusal to register or the fact that disciplinary action is being taken against him, it is a matter for the statutory council to decide, because according to common law, such a person can still turn to the courts.

†I do not think that under these circumstances I can accede to the request to delete clauses 4 and 8.

Question put: That all the words after “That” stand part of the Question,

Upon which the House divided:

Ayes—102: Albertyn, J. T.; Badenhorst, P. J.; Ballot, G. C.; Barnard, S. P.; Bodenstein, P.; Botha, G. F.; Botha, J. C. G.; Botha, L. J.; Botha, M. C.; Botha, P. W.; Botha, S. P.; Botma, M. C.; Brandt, J. W.; Clase, P. J.; Coetsee, H. J.; Coetzee, S. F.; Cronje, P.; De Beer, S. J.; De Jager, A. M. van A.; De Klerk, F. W.; De Villiers, D. J.; De Villiers, J. D.; Du Plessis, B. J.; Du Plessis, G. F. C; Du Plessis, G. C.; Du Plessis, P. T. C.; Du Toit, J. P.; Engelbrecht, J. J.; Greeff, J. W.; Greyling, J. C.; Grobler, M. S. F.; Hartzenberg, F.; Hayward, S. A. S.; Hefer, W. J.; Herman, F.; Hoon, J. H.; Horn, J. W. L.; Janson, J.; Koornhof, P. G. J.; Kotzé, G. J.; Kotzé, S. F.; Kotzé, W. D.; Krijnauw, P. H. J.; Kruger, J. T.; Le Roux, F. J. (Brakpan); Le Roux, F. J. (Hercules); Le Roux, J. P. C.; Ligthelm, N. W.; Lloyd, J. J.; Louw, E.; Malan, G. F.; Malan, J. J.; Malan, W. C.; Marais, P. S.; McLachlan, R.; Meyer, P. H.; Morrison, G. de V.; Nothnagel, A. E.; Palm, P. D.; Potgieter, J. E.; Potgieter, S. P.; Raubenheimer, A. J.; Reyneke, J. P. A.; Rossouw, W. J. C.; Roux, P. C.; Schlebusch, A. L.; Schoeman, H.; Schoeman, J. C. B.; Scott, D. B.; Simkin, C. H. W.; Snyman, W. J.; Steyn, D. W.; Swanepoel, K. D.; Swiegers, J. G.; Terblanche, G. P. D.; Treurnicht, A. P.; Treurnicht, N. F.; Ungerer, J. H. B.; Uys, C.; Van den Berg, J. C.; Van der Merwe, H. D. K.; Van der Merwe, P. S.; Van der Merwe, S. W.; Van der Spuy, S. J. H.; Van der Walt, H. J. D.; Van der Watt, L.; Van Rensburg, H. M. J.; Van Tonder, J. A.; Van Wyk, A. C.; Van Zyl, J. J. B.; Venter, A. A.; Viljoen, P. J. van B.; Vilonel, J. J.; Vlok, A. J.; Volker, V. A.; Vorster, B. J.; Vosloo, W. L.; Wentzel, J. J. G.

Tellers: J. M. Henning, A. van Breda, C. V. van der Merwe and W. L. van der Merwe.

Noes—36: Bartlett, G. S.; Basson, J. D. du P.; Baxter, D. D.; Boraine, A. L.; Deacon, W. H. D.; De Villiers, R. M.; Eglin, C. W.; Enthoven (’t Hooft), R. E.) Fisher, E. L.; Graaff, De V.; Hourquebie, R. G. L.; Hughes, T. G.; Jacobs, G. F.; Kingwill, W. G.; McIntosh, G. B. D.; Miller, H.; Mills, G. W.; Murray, L. G.; Oldfield, G. N.; Olivier, N. J. J.; Page, B. W. B.; Pyper, P. A.; Raw, W. V.; Schwarz, H. H.; Slabbert, F. van Z.; Streicher, D. M.; Sutton, W. M.; Van den Heever, S. A.; Van Eck, H. J.; Van Hoogstraten, H. A.; Van Rensburg, H. E. J.; Von Keyserlingk, C. C.; Webber, W. T.; Wood, L. F.

Tellers: D. J. Dalling and R. J. Lorimer.

Question affirmed and amendment dropped.

Bill accordingly read a Second Time.

Mr. Speaker, I move—

The Hazardous Substances Act, 1973, will come into operation later this year when all the regulations in terms of the Act will be ready for promulgation.

Electronic products are being controlled in terms of the Public Health Amendment Act, 1971, but will be controlled in terms of the Hazardous Substances Act, 1973, when it comes into operation.

In the light of experience gained with the control over electronic products, it has become apparent that several minor amendments to the Hazardous Substances Act, 1973, are necessary to enable effective control to be exercised over such products.

The components of many electronic products are imported into the Republic and are assembled in the Republic. In addition obsolete equipment and equipment which has been written off are bought and reassembled for sale. It is therefore necessary to control such assembly for the safety of the operators of such equipment and the relevant patients. Section 29(1)(a) empowers the Minister to make regulations authorizing, regulating, restricting or prohibiting inter alia the manufacture of hazardous substances. However, the definition of the word “manufacture” does not include assembly, and to ensure that assembly can be controlled as well, it is necessary to amend the definition of “manufacture”. This amendment is included in clause 1(c). Clauses 1(a) and (b) contain only consequential amendments.

Except for the provision in section 29(1)(f), which empowers the Minister to make regulations providing for the keeping of records and the submission of statistics and reports relating inter alia to the sale of grouped hazardous substances, the Act does not provide for control over the sale or lease of electronic products as it does in section 3(1)(a) in respect of the sale of Group I substances. For the safety of the operators of such equipment and the patients, it is important that such products should not be offered for sale or lease unless the department is satisfied that the particular model will create no significant risk of injury to any person and has furnished written notice of its approval. In view of the foregoing it is considered necessary that sections 3(1)(b) and 3(2) should be amended to include control over the sale and lease of such products. This amendment is contained in clause 2.

Section 3(1)(b) and (c) provides that no person shall use, operate or apply any Group III hazardous substance unless it is registered under section 4(b), or install or keep installed any such substance on any premises unless such premises are registered in terms of section 4(c).

In terms of the regulations published under the Public Health Amendment Act, 1971, licences may be issued in respect of electronic products and the premises on which they have been or are to be installed. A great number of licences for products as well as premises have already been issued in terms of the regulations. A considerable amount of administrative work will therefore be created if it becomes necessary to replace the licences, issued in terms of the regulations, with certificates of registration required by the Act, and this will also be confusing to the holders of licences. Furthermore, there are large stocks of different forms which would become obsolete and would have to be reprinted. It has therefore been decided to amend the Act to provide for the issuing of licences in respect of Group III hazardous substances, and the premises on which they are installed, instead of the registration thereof. The relevant amendments are contained in clauses 2, 3, 4, 5 and 6.

Clause 2 introduces a new subsection 3(3). This was an omission in the principal Act, and since section 3 contains several prohibitions, the insertion of subsection 3(3) is necessary.

Mr. Speaker, I rise merely to express my approval of this Bill and to tell the Minister that we shall support it. There does appear to be an urgent necessity these days for great care in the handling and the manufacture of electronic substances. In my opinion a register as well as a licence should be required for all people to handle and store these substances. Their premises should also be registered. My great fear is that if registration is done away with, we might find that many electronic substances, which are not found by manufacturers to be of value in the manufacture of other electronic substances, may accumulate and cause damage. I think it would be very wrong if electronic substances which are no longer in use were allowed to lie about in unregistered premises, and for that reason I think it would be wise of the hon. the Minister perhaps to retain the registration of premises and factories, especially premises which will house unused electronic substances. I wish to conclude by saying that we on this side of the House will support this Bill.

Mr. Speaker, when the original legislation was serving before this House in 1973, we foresaw that we were entering a new field. Already at that stage we decided that this Act would necessarily have to be amended. We are living in a time in which the development in the electronic field and the development of chemicals are taking place at an immense rate. We calculate that approximately 400 new kinds of chemicals are manufactured every year. Therefore the basic legislation in this connection is even more essential. In time this legislation will however have to be adapted. As an example I would like to point out that researchers in America have discovered certain dangers, not only with respect to certain toxic substances, but also with respect to the ordinary colouring agents used in food. Only a few days ago one of the food manufacturers in South Africa withdrew such a colouring agent as a result of the fact that it had been discovered in America that it contained carcinogenic properties.

Dangerous substances are already being controlled in South Africa by various laws. Firstly we have the Medical, Dental and Pharmacy Act as well as the Drugs Control Act, the Food, Drugs and Disinfectants Act as well as the Atomic Energy Act. The legislation which is now being amended in this House refers, however, to substances which are not controlled by the other legislation. In other words, these are poisonous substances which are normally used in commerce and industry. Because there is a great lack of knowledge on the part of the public and some dealers, especially in recent times in connection with electronic apparatus, it has become absolutely essential to exercise better control and to apply this legislation more effectively. Many dealers are also very careless in their handling of this apparatus and many of the people assembling this electronic apparatus, have very little knowledge of it. Therefore I want to express my gratitude that the Bureau of Standards has laid down very strict measures and restrictions in regulations, for example, in respect of television sets. I think however that the Minister and the department foresaw that this matter should enjoy the attention of the department on a far wider level. The Act, as it read previously, concerned the manufacture of the apparatus, but assembly has always been an aspect circumvented by the dealers, and we are very grateful that, by means of this amendment, that matter will now be rectified.

Business suspended at 18h30 and resumed at 20h15.

Evening Sitting

I rise to support the Hazardous Substances Amendment Bill and I shall be very brief. There is nothing contentious in this Bill as I read it. I would simply like to say that we note with pleasure that the Hazardous Substances Act of 1973 will come into operation later this year, when according to the hon. the Minister’s speech, regulations will be ready for promulgation. It seems that the amendments in the Bill before us make good sense. One is particularly aware of the rapid development in nuclear medicine. If one visits some of the major hospitals in our country, one sees the incredible development in the use of technology and machines, and therefore it is to be welcomed that we have extra safeguards. While I am on my feet, let me say how good it is to know, also, that there are protection officers available wherever these machines are in use so as to protect the personnel.

The last point I should like to make is that when one looks at this Bill and realizes the enormous administrative work that could have been necessitated and was avoided by the way in which the Bill has been framed, the framers of this Bill, the department, are to be congratulated for moving away from so much bureaucracy and for ensuring that what is done, is to the best advantage of all concerned. We support the Bill.

Mr. Speaker, I agree with the hon. member for Rosettenville in supporting this Bill. I will not be as brief as the previous hon. member who has just sat down, because while he may have interpreted the intention of the Bill perfectly accurately, I would refer him to the draft regulations. If he studies those regulations very carefully, I think he will agree with me that there are certain aspects in regard to the administration of the control of hazardous substances which deserve the serious attention of this House. The hon. the Minister, in his brief introductory remarks, referred to the fact that every year there are 400 new chemicals. I should like to point out that the original Act, which this Bill seeks to amend, was promulgated in 1973, three years ago. During that time there have been at least 1 200 new chemicals introduced into the South African market. I would be the first to concede that many of these chemicals or medicines have been taken care of by the Medicines Control and Related Substances Act of 1965, but there are others which I believe fall into the category of hazardous substances which are, as it were, floating around waiting for this Bill to be given effect to. I know that regulations were promulgated for consideration and comment last June, and comment has been received but no final regulations have been published.

On a point of order, are hon. members entitled to stand talking in the gangways?

The hon. member may proceed.

We in this House are being asked to accept an amending Bill to an Act which as yet has not been given effect to, and I believe this House has some responsibility at least to consider the intent and content of the draft regulations. I propose briefly to refer to some of these draft regulations because it seems to me that people are not aware of their complexity or of their import.

This amending Bill seeks to regulate the sale or letting or hazardous substances and to provide for the control, by the issue of licences, of such substances and for the control of any premises on which they are installed. I cannot quarrel with any of those particular intentions, but if we consider the draft regulations we find that there will be four groups of hazardous substances and that in Group I there will be two categories, A and B, and in Category A there will be 13 substances including, in certain instances, their preparations. Any product registered with the Department of Agricultural Technical Services in terms of the Act of 1947 will fall into Category B.

I have said that the regulations and conditions laid down are extremely complicated. May I briefly refer to just one such condition? This is one of the conditions required of substances to be included in Category B: “Any product registered under Act 36 of 1947 where the active technical substance of the product—(a) produces death within 14 days in half or more than half of a group of 10 or more laboratory white rats, each with a mass of between 200 and 300 grammes at a single dose of 50 kg or less per kg of body mass when orally administered.” But that is not all. It then goes on to subject the same number of white mice or white rats of the same mass to exposure to a gas continuously for a certain period. I submit that that is an extremely complex condition to apply.

Coming to Group II we find that Group II in the draft regulations contains 10 categories which range from bleaches and disinfectants to aerosol containers. When one reads the regulations in connection with Group II substances, one is forced to the conclusion that this is perhaps bureaucracy running wild. There are conditions in which products must be labelled. Let me briefly refer to the conditions according to which a product must be indicated on a label. The label is referred to as “the area of principal display panel”. In the case of a rectangular container the conditions refer to the product obtained by multiplying the height by the width of the side that includes the principal display panel, and in the case of a cylindrical container, to 40% of the product obtained by multiplying the circumference by the height of the container. Sir, I find that rather complicated, and I confess that I claim a reasonable intelligence.

When one comes to the issue of licences to people who will handle or sell such products, one finds on page 4 of the regulations that—

I believe in all seriousness that it is the function of Parliament to examine legislation objectively, and if such stipulations flow from legislation, I believe Parliament should consider it carefully.

I have tried to explain briefly and to indicate the need there is for safety, but I believe that safety must be coupled with simplicity. I believe it is unwise to expect compliance with complicated regulations and Acts when a large proportion of the population who have to sell or handle and/or use these hazardous substances may not have the education and ability …

Mr. Speaker, on a point of order: May the hon. member deal with the regulations in terms of the existing Act while the Bill actually concerns the amendment of a few other sections?

The hon. member may proceed.

Those to whom I have referred cannot possibly be expected to understand these complicated legal requirements. Therefore my suggestion is to the designers of the varied 12 different designations which have been submitted in the draft regulations that they should concentrate on simplicity and recognize the fact that people will not have the ability to absorb these complicated designs. The hon. the Minister should seek a speedy finalization of these regulations so that both the Act and the Bill to which we lend our support are able to be implemented in the interest of the safety of the public of South Africa.

Mr. Speaker, I cannot deal with the complications which are so incomprehensible to the hon. member at this moment as far as the regulations are concerned because they are not contained in the contemplated amendment to the Act. The hon. member is talking about things which may flow from the Act … [Interjections.] … and he is talking about things which he wants to sound complicated. He refers to a lot of regulations on which I never touched during my Second Reading speech. The regulations are being drafted at the moment to be promulgated in terms of the legislation. The hon. member has perhaps brought a matter to our attention which needs our consideration. I should like to know whether the hon. member is supporting the Bill.

I said so.

That is all I wanted to know. [Interjections.] I grant him his little gymnastic display of his knowledge of the regulations. I have no objection to that …

He taught you a lesson.

If he supports the legislation, then I have nothing more to say. We shall look into the matters which he has discussed. Why should we not? [Interjections.]

Order!

I do not think that it is necessary at this stage to go in such depth into matters of that nature unless of course it is aimed at getting some attention in this very sociable atmosphere.

I have looked around and I do not seem to find any hon. member who is in disagreement with the legislation and I thank the hon. members for that. I shall look into the matters they have raised. As far as the exercising of control is concerned, the hon. member for Rosettenville mentioned the question of registering and licensing the premises affected. I think that, by licensing these premises, control will be exercised on the keeping of the substances there. I do not think the hon. member need worry about that.

Mr. Speaker, may I ask the hon. the Minister whether he is aware that the regulations which he says are not relevant, were published for comment with a view to their implementation in terms of the Act?

Regulations which are published for comment are still sub judice as far as this Parliament is concerned.

Is the hon. the Minister of the opinion that if he publishes regulations and invites interested people to comment, hon. members of this House are prohibited from commenting?

Comment is invited in the ordinary course of events. I did not question the right of the hon. member to comment. However, I think this is not the appropriate occasion for him to go into matters of that kind. After all, he supports the Bill. But if he goes into matters in that way, he is actually now wasting his time.

Why?

No, it is easy for him to follow the ordinary course of events and submit his objections, if there are any, in the flowery language he uses. He should submit his objections to the department who will look into them. The regulations to which he objects are not now part of this legislation.

Motion agreed to.

Bill read a Second Time.

Mr. Speaker, I move—

The Dental Mechanicians Board has addressed representations for the amendment of this Act. Section 17 of the Act requires that no person may conduct a dental laboratory except under the continuous supervision of a dental mechanician and that no person, other than a dental mechanician or a dentist, may supervise a laboratory. In addition the section requires any person who conducts a laboratory to report this fact to the board.

The board has decided to further the standard of work by dental mechanician contractors by introducing a diploma course for dental mechanicians to enable them to obtain a master dental mechanician’s certificate of competency. The idea is that in future only persons who are in possession of such a certificate will be allowed to practise as a dental mechanician contractor, or to supervise a laboratory for dental work. I am of the opinion that this decision of the board should be welcomed. An amendment in this regard is embodied in clause 1(a) and (b).

The board is experiencing an enormous number of problems in exercising effective control over the conducting of laboratories and the combating of unlawful practices. Since it is only necessary at present to inform the board that a person is conducting a laboratory, the board has no authority to prescribe any standards which should be applied in the laboratory. The lack of a minimum standard is disadvantageous to the worker as well as the patient. When a dental mechanician is guilty of unlawful practices, the board is at present only able to take action against such a person, and the possibility exists that the laboratory which he is conducting will not be affected by it, and that the conducting of the laboratory may be continued.

In view of the above a new section 17A is being inserted by clause 2 which provides that—

1. (a) all laboratories shall be registered with the board;
2. (b) the board shall keep registers for the laboratories and the persons conducting them;
3. (c) application for registration shall be made to the board;
4. (d) the board may not register a laboratory if the requirements that are laid down are not being complied with;
5. (e) the board may, under specified circumstances, cancel the registration of a laboratory; and
6. (f) the board is being empowered to exempt a laboratory from registration.

The conditions for the registration of a laboratory are the absolute minimum which it is in fact possible to lay down. As far as the laboratory itself is concerned, the board will prescribe minimum standards which have to be complied with. As has already been mentioned it will in future be a requirement that dental mechanicians conducting a laboratory shall be in possession of a master dental mechanician’s certificate of competency. Until such time as dental mechanicians who intend conducting a laboratory qualify for the certificate, however, the requirement that such a person shall have not less than three years practical experience shall apply. Since a dental mechanician cannot deal directly with the public it is, in addition, only reasonable to require that a person who conducts a laboratory shall render services to at least one dentist.

As a result of the insertion of section 17A it is also necessary to amend sections 19(1)(a) and 30. These sections deal with penalties and forfeiture and the amendments are embodied in clauses 3 and 4.

Clause 5 contains additional powers of the board to make regulations with the approval of the Minister which are essential to give effect to the objects of clause 2.

Mr. Speaker, we on this side of the House will support the Bill. I want to remind the hon. the Minister however that up to a few years ago it was possible for a dental mechanic to make a very good set of dentures at a very, very reasonable price. For the ordinary man in the street it was a great saving to be able to go to a dental mechanic to have his dentures made. The dental mechanics did not interfere with the work of the dentist, in that their jobs consisted solely of providing the dentures. They did not do extractions, fillings, prosthetics and all the rest of it.

I find that this Bill is necessary. I do not think that the work of the dental mechanician is going to be hindered in any way because, from what I have found, they are being very reasonably remunerated for the work they do. Those of us who have to visit dentists every now and again, know how well they are being remunerated, because the dentist passes the charges on to the unhappy person who has a bad tooth.

However, there are one or two provisions in this Bill which are not quite clear to those of us who have studied this Bill. I do not know whether or not the Dental Board has already made provisions for a course permitting a dental mechanic to become a master mechanician. There is nothing in the Bill that says that these courses are to be held at a technical college or university. As far as I know, no standard of education is laid down. So, I do not know whether it is necessary for a person to have a matriculation certificate before he can become a master mechanician. Up to now it has not been necessary. The hon. the Minister must, of course, make these things clear for the benefit both of the present dental mechanics and of the young people who intend going into this profession. The hon. the Minister has established a board and the board has the power to provide for examinations, and so forth. I do not know whether a particular educational qualification has been laid down in respect of these dental classes.

There is one other thing I would like to know from the hon. the Minister. I should like him to confirm that those dental mechanics who are at present employed individually by dentists or in laboratories or who have small laboratories of their own, will be allowed to continue to practise once this Bill has gone through. I think provision is made for this by the proposed new subsection (2) as contained in clause 1 of the Bill, but I would like confirmation of this from the hon. the Minister. Many dental mechanics have already expressed their doubts as to their future, and I should like the hon. the Minister to allay their anxiety. Once again I should like to tell the hon. the Minister that we shall support the Bill.

Mr. Speaker, I am amazed at the hon. member for Rosettenville. He belongs to a profession that is very closely associated with the dental profession. Yet tonight I think he displayed a great lack of confidence in a profession that is very closely linked to his own. He said that a few years ago dental technicians could make dentures for the public at a much more reasonable price than the dentist.

Do you want a closed shop?

Mr. Speaker, the hon. member for Durban Point does not need a closed shop; he needs a shop in the zoo. The hon. member for Rosettenville knows the anatomy of the mouth very well, or should know it.

Is that why you put your foot in yours?

You have such a big mouth that you could put both feet in yours. We are busy with an important Bill and thus I am surprised at the statement of the hon. member for Rosettenville. The dentists in South Africa will be shocked by his statement that in years gone by, the dental mechanician could provide very good dentures for the public at a very reasonable price. Is he not aware of all the quacks? Does he not know why this measure was first introduced in this House years ago? Is he not aware of the damage to tissue and malignancies that can be caused by these quacks? Is he not aware of all the reasons why this measure was originally introduced?

*South Africa is experiencing an acute shortage of dentists. Today I am in the position where, speaking figuratively, I have to extract teeth of United Party members. I want to repeat: There is an acute shortage of dentists in South Africa as well as in the whole world. I had the privilege of visiting one of the largest universities in the United Kingdom, that of Liverpool, last year. In days gone by, the dentist had all the time in the world and also all the knowledge and skill to make dentures himself. However, in the present time and as a result of the shortage of dentists, the dentist has neither the opportunity nor the time to make dentures. What is of importance is that the dental student is taught the basic principles with respect to the manufacture of proper dentures. This is done in our universities as well as overseas. This is a very important aspect. Both from an aesthetic and health point of view, dentures are of enormous importance. Let me say that, if it were allowed in South Africa that people such as these quacks, who did not have the necessary training or the necessary background, could make dentures, there would have been people in this House tonight whom I would not like to look see sitting here. Aesthetically speaking, it is a very important aspect. The health aspect is also important.

By means of this legislation it will in future be possible to exercise greater control in this respect. This legislation will serve as a stimulant for the dental mechanician. Let there be no doubt about this: We have dental mechanicians here of whom we can be very proud. They need protection so that they can establish laboratories of a high standard, laboratories in which the dentist may have confidence. There is a very sound relationship between dentists and dental mechanicians today. It is being ensured that the remuneration which dental mechanicians receive, is sound and that they are not forced to work at an unreasonable tariff. This Bill therefore promotes their own profession. I want to congratulate the hon. the Minister on it. I think that this is of very great importance. I regret that the hon. member for Rosettenville, whom I get along with quite well as far as medical matters are concerned could have made such an irresponsible statement.

The dentist has the required background. The hon. member should be aware of this, because I think we attended the same university. Unfortunately there was no other medical faculty in the Republic in those days. Otherwise they would never have got me into that red haunt. The hon. member had to study the same subjects as I did for the first four years in order to obtain his degree. What the hon. member knows about anatomy—from head to toe—the dentist also knows. The hon. member must not have any doubt about this. This is a noble profession, a profession which needs the assistance of the dental mechanician. In this legislation the opportunity is now being created for us to work together in service of South Africa in the sphere of dentistry.

Mr. Speaker, the hon. member for Rustenburg seems to have been very upset. It seems that the hon. member for Rosettenville touched on a raw nerve. However, the hon. member for Rustenburg obviously knows what he is talking about when he talks about dentistry, but this cannot be said about universities. As a dentist by former profession he says that there is a great shortage of dentists. I am tempted to suggest that he should relieve the shortage by going back to practice.

As far as this Bill is concerned, my comment will be very brief. We support the Second Reading of the Bill. I would like to make just one observation. This is something which was pointed out to me by a dentist. I am not sure whether the hon. the Minister will accept this, but nevertheless I suggest that it might be better to describe this not as the “Dental Mechanicians Amendment Bill”, but as the “Dental Technicians Amendment Bill”. This is a very minor point, but I would nevertheless like to bring it to the attention of the hon. the Minister.

Mr. Speaker, I thank the official Opposition as well as the secondary Opposition for supporting the Second Reading of this Bill. I do not think there is anything I should comment on. Perhaps I should reassure the hon. member for Rosettenville that as far as the requirements for the diploma for master technicians are concerned, this is described in clause 5. The examinations will be taken at a technical college. The dental technician now in charge of a shop, so to speak, will be allowed to go on. The hon. member will find the stipulations in the new section 17A. There it can be seen that a dental technician without the necessary qualifications must work at least three years under a dentist or a dental mechanician contractor.

*I thank the hon. member for Rustenburg for his emphasis on the necessity for control in this matter. This is a problem which was brought to our attention by the Dental Council. The problem was taken up by us and we therefore drew up this Bill. I am pleased to see that it enjoys the general support of the Opposition and of the whole House. It is most important that the work which is under discussion here is done under proper supervision, that it is registered and that we ensure that the public receives the best service from the best people.

†I would like to assure the hon. member for Pinelands that I shall not make a mistake this time. He mentioned changing the name of the Bill. I shall not reply immediately, because I shall have to have a look at this. If we can sort things out, I might consider his proposal or, retain the old name. I hope the hon. member will realize that it is not very easy for me to reply in the affirmative to his question immediately.

Motion agreed to.

Bill read a Second Time.

Mr. Speaker, I move—

Provision is made in section 11 of the principal Act that that Act shall also apply in South West Africa. As you know, provision is also made in the Act for abortion on the grounds of unlawful carnal intercourse with a female idiot or imbecile. In terms of the definition, “unlawful carnal intercourse’’ means rape, incest and unlawful carnal intercourse with a female idiot or imbecile in contravention of section 15 of the Immorality Act, No. 23 of 1957. The Attorney-General of Windhoek has invited attention to the fact that Act 23 of 1957 does not apply in South West Africa, but that section 2 of proclamation 28 of 1921 (S.W.A.) is in force in regard to unlawful carnal intercourse. As a result of the fact that no reference is made to the aforementioned proclamation in the Act, no provision exists in South West Africa for abortion on the grounds of unlawful carnal intercourse with a female idiot or imbecile. This Bill is designed to remedy this shortcoming.

Mr. Speaker, we on this side of the House support the Bill. We think it is necessary.

Mr. Speaker, we too support the Bill.

Motion agreed to.

Bill read a Second Time.

Mr. Speaker, I move—

Since the amendment of the Drugs Control Act in 1974 it has become necessary to effect a few changes in order to eliminate administrative problems. Several laws administered by the Department of Health require inspectors to be appointed, and that such inspectors be provided with an identification document signed by the Secretary to the department. To prevent a person who is appointed as an inspector under several laws from having to carry a variety of identification documents, the department has devised a single identification document in which all information relating to the legislation in terms of which a person is appointed as an inspector is furnished.

The Act in question, however, requires the identification document of the inspector to be signed by the Registrar of Drugs. This means that a person who is appointed as inspector under more than one Act will have to carry at least two identification documents. To prevent this the amendment in clause 1 is being proposed.

The Act provides that the Secretary for Health shall perform certain functions. When drafting the Act the scope of these functions were not yet known. It was also necessary, for control over the implementation over the Act, to place all the powers in the hands of the Secretary. The Act has now been implemented, and the scope of the functions is of such a nature that it has now become necessary to delegate these to subordinate officers. However, the Act does not make provision for delegation of functions. Hence the amendment in clause 2 of the Bill.

In paragraph 23 of subsection 35 (1) provision is made for the Minister to make regulations in regard to the acquisition, keeping and use of Scheduled substances by the masters of ships or by the officer in charge of any aircraft. The only other persons who may deal in Scheduled substances are registered pharmacists, medical practitioners, dentists and veterinarians. However, it has become apparent that there are organizations which visit remote areas—I am thinking here of mountain climbing expeditions, and geological survey expeditions, for example—where there are no professional persons available to supply Scheduled substances, if necessary. Consequently the provision in subsection 3(a) is being proposed to meet this need. Up to now there have been no powers in terms of which the destruction of old substances, or substances, the holders of which have broken, and which have thus become unfit for use, can be arranged. There are old medicines lying around everywhere. This deficiency is being eliminated in subsection 3(b). Clause 4 contains the short title of the Bill.

Mr. Speaker, we on the official Opposition benches support this amending Bill. It is a four-clause Bill involving changes to the Medicines and Related Substances Control Act of 1965, relating to the control and strict policing of the Act by inspectors. The Bill itself seeks to regulate the authorizing of inspectors. We have no problems with that. The Bill furthermore provides for the delegation of powers—I will refer to that later—and confers wider powers by regulation. It broadens the scope and the keeping of scheduled drugs, at a time such as the present when I am sure that the hon. the Minister of Health and his department, as well as the Department of Police and all those who are involved in the rehabilitation of drug dependents, must be deeply concerned at the recent theft of more than a million mandrax tablets. These tablets are a scheduled drug and are, in terms of the provisions of the Act, to be kept under strict supervision. Yet a million of them have been stolen. Arrests have been made and the case is now sub judice. I do not want to allocate any blame to the hon. the Minister and his department, because I feel they have been using their powers adequately in so far as the appointment of inspectors is concerned. In most instances they have appointed pharmacists who, by their training and specialized knowledge, are competent to do the work and are reported to be making a very good job of it. I have no difficulty with the amendment in clause 1 which substitutes “Secretary” for “registrar” as far as the authorization of inspectors is concerned. What is worth noting as far as inspectors are concerned, is that during 1975 over 1 500 inspections have been carried out by the inspectors under the hon. the Ministers department, involving nearly 400 doctors, 35 dentists and over 1 100 pharmacists. What is, however, disturbing and what we cannot disregard, is the fact that as early as March last year the Cape Western branch of the Pharmaceutical Society found it necessary to send out what they indicated to be an important circular. It is brief, and I would like to read it—

This circular was sent to all the members of the Cape Western branch of the Pharmaceutical Society as well as to Boland members. They comprize over 500 pharmacists. Reports that I have received indicate that pharmacists are frightened that their pharmacies might be burgled not for the cash in the safe or the till, but for the mandrax tablets that might be found. Under these circumstances, I believe it is only fair to appeal to the hon. the Minister to use the considerable influence I know he has. I know that mandrax tablets are scheduled under schedule 6 and that the conditions are stringent. I do not want to go into great detail, but a prescription is required and it limits the number of tablets which can be supplied. There are no repeats on that prescription and it remains valid only for a limited time. The manufacturer himself has to keep a register of the tablets which he has, and he has to balance it every quarter. However, that has not solved the problem. There has been a suggestion that there should be more stringent measures, and I honestly believe that the only measure which will stop and prevent the ready demand which exists in the grey world of the hippies and drug dependents, would be for the hon. the Minister to urge that mandrax tablets should be banned. That would mean that they would be placed either in schedule 8 or schedule 9. If they were placed in schedule 7—I have heard this as a suggestion—it would simply mean that all the conditions to which I have referred would be complied with, but the pharmacist or the doctor who supplies the tablets, would also have to keep a register which he would have to balance. That however would not overcome the activities of a determined thief. It would not overcome the very real problem of forged prescriptions when prescription pads are being stolen from doctors’ consulting rooms and forged prescriptions are being tendered to pharmacists, who are not always in the position to identify a forged prescription. I believe that the only effective step to deal with this particular problem is to ask the hon. the Minister if he would use his influence. I know that the procedure is that the consideration of this matter would be handled by the Medicines Control Council. The hon. the Minister, however, is concerned with the citizens of our country and his influence could be considerable should he decide to use it in this respect.

My information is that general practitioners themselves are disturbed at the abuse which is taking place, the constant desire of the public to engage in some sort of traffic in prescriptions from the doctors’ consulting rooms themselves. The doctors themselves are placed in a difficult position. I understand that hospitals are not using mandrax tablets at the moment. One State medical officer in a high position, suggested that in his opinion control would be effective if a licence were issued to a specific manufacturer, virtually giving him a monopoly to manufacture these or other tablets of methaqualone under special licence and stringent control. I believe that that will be an intrusion on the freedom of private enter-prize, and therefore do not believe that it will be a solution to the particular problem. I also believe that no manufacturer should be allowed to enrich himself at the expense of the community when there is evidence that a medicine is being grossly abused, as is the case with mandrax, because the normal dose of these tablets to provide a normal person with a good night’s sleep, is one tablet, but in the hippy world is seems that a dose of four to six tablets together with a dagga zoll or a shot of liquor, produces an instant high. It is this that people are seeking when they steal mandrax tablets.

I want to refer to clause 3 of the Bill, which deals with the regulations. I submit that the amendment, as it stands at the moment, slightly broadens the scope of the Act, and I hope that the hon. the Minister will consider favourably in the Committee Stage an amendment which we on this side of the House will table and which will specify more specifically the intention of this particular amendment. I can see a need for that. The Minister has given examples, which I cannot refute indicating that there is a need that there should be some form of exemption. The Act limits the sale and supply and use of most scheduled substances to medical practioners, to dentists, to pharmacists and to veterinary surgeons, except under section 22(A)(12) of the Medicines and Allied Substances Control Act, and I realize that there is already provision for registered nurses and persons of that category to handle these drugs. An anomaly arises in the present position. We have general practitioners, dentists and pharmacists who are entitled to handle these preparations and if they contravene the stringent provisions—the records show that very few of them do—they are punished twice. If, however, the individuals to whom the hon. the Minister refers in this amendment, contravene the requirements of the Act and the regulations, they will be punished in the courts. I have a case here of a pharmacist, one of the few who sold scheduled drugs. He was found guilty in court on two counts and fined R50 on each count. The Pharmacy Board considered his case and his sentence was erasure from the register of pharmacists. The control of these drugs by registered persons is being fully assured, but I would like the assurance of the hon. the Minister that when it is necessary for scheduled drugs to be issued to persons who are not registered, the strictest precautions and conditions should be laid down to ensure that there is no possibility of abuse.

Mr. Speaker, I understand the arguments of the hon. member for Berea and I am in complete agreement with him. We have come to know him in this House as an advocate of the control of medicines and the elimination of the abuse of drugs, of the smoking of dagga, and of all the other substances to which persons become addicted. However, I think the hon. member for Berea went a little too far by devoting a major part of his speech to the Scheduled substances and the availability of Scheduled substances, while the amendment in clause 3(e) deals with Scheduled substances which have become unfit for use, and not with the availability of such substances. That is the reason why the regulation is being amended. I want to give the amendment my whole-hearted support, but I also want to add that we should not think only of the Scheduled substances which have become unfit for use and which are harmful to human beings, but also of the many other substances, tablets and medicines which have become unfit for use owing to the passage of time and which are also dangerous. I once walked into a pharmacy and saw a large box, approximately a cubic metre in capacity, standing there, filled to the top with bottles, pills and medicines of all descriptions. I asked the pharmacist what he was going to do with it and he said that he would put it down round the back of the shop so that the garbage collectors could throw it on the municipal dump. In that case the department will have to lay down certain procedures which will have to apply to pharmacists and subsequently even to us and to our families. One finds numerous bottles of medicine, pills and other substances which have become unfit for use. On the bottles there is usually an expiry date. But how many people ever read that date? How many know that they should remove the bottles from the medicine cabinet when the date has expired? We should also give consideration in future to the destruction of all substances, not only Scheduled substances, which have become unfit for use according to an established procedure.

Mr. Speaker, I have listened to the various speakers who discussed this subject, and I am very grateful that the Opposition supports the amendment of the Act.

†The hon. member for Berea raised the matter of mandrax and mentioned that this was becoming a dangerous drug which is finding its way all over the country, especially amongst people whom he classified as “hippies” and “dope-pedlars”. They sell this drug underhand in a clandestine way, and get big prices for it. Meanwhile we have had the case where a million of these tablets disappeared, and I can assure you …

Two rand a tablet on the black market.

I can assure hon. members that this matter has been brought to the attention of the Medicine Control Council and that they are giving their attention to it. They are also giving attention to the fact that mandrax, which is a dangerous drug, falls under schedule 6—it could perhaps be brought under schedule 7, but the hon. member indicated that he had reservations about it. We could perhaps think of banishing it altogether like dexamphetamine, but that is a matter which we shall look into. As it is, we are at the moment investigating this scourge. The measures that we are taking as far as the control of scheduled drugs are concerned, is a matter which is receiving continuous attention. It depends on abuses which are found from time to time.

The hon. member also referred to clause 3. It appears as if he has an amendment up his sleeve. I will have a look at that amendment, because I have come to know the hon. member as an hon. member who always makes a contribution. I am accordingly prepared to look at his amendment.

*The hon. member for Brentwood simply reaffirmed what all of us think about the various preparations and Scheduled substances. In particular he pointed out that some substances eventually become unfit for use and lie about all over the house—pills, pills and even more pills. Eventually no one knows what they are for, because there are no labels on their containers any more. Regulations are now being made which will lay down specific methods as to how these preparations should be destroyed. It is right that we should exercise better control over these dangerous preparations.

Mr. Speaker, I wonder whether the hon. the Minister has considered drawing up some regulation for the complete destruction of disposable syringes. I am very perturbed at what is happening at the moment in many doctors’ consulting rooms. The syringes are used once and the used syringes are then thrown into a bucket or into a waste-bin of some kind or other. They are then collected in the ordinary waste-disposal bins. I know that these syringes are then collected in the …

Order! The hon. member cannot make a speech now.

I am going to ask a question. I am merely elaborating on it a bit. Is the hon. the Minister considering making some regulation to ensure that doctors are obliged to destroy the syringes before disposal?

We will consider that. It touches the whole question of plastic containers which contain dangerous substances.

Motion agreed to.

Bill read a Second Time.

Mr. Speaker, I move—

1. (a) To make provision for the registration as chiropractors of persons who at the time of commencement of the principal Act were studying, but neglected to have their names enlisted.
2. (b) The granting of authority to make rules prescribing the conditions under which a registered person may practise, and the fees which such person may charge, and indicating the penalties for contravention of such rules.
3. (c) To make the Act applicable in South West Africa.

The Act requires inter alia that all South African citizens, who were studying at the commencement of the Act, apply within six months after such commencement for enlistment as students. It has come to the notice of the department that there are South African citizens who were studying at the commencement of the Act, and who did not apply for enlistment. The department did endeavour as far as possible to make enquiries concerning these cases, and it appears that these persons were not aware of the legal requirements. Because these persons were abroad during their studies, it cannot reasonably be expected that they should have been conscious of the requirements.

In order to protect the vested interests of the aforementioned persons, the requirement that they must apply for registration within six months of the commencement of the principal Act, is withdrawn in the new paragraph (aA) in clause 1(b), in order to give them the opportunity to have their names enlisted.

The Executive Council of South West Africa has made representations that the Chiropractors Act, 1971, should also be made applicable in South West Africa. Apart from these representations, the Medical, Dental and Supplementary Health Services Professions Act, 1974, is also applicable in the Territory and, as you are aware, a chiropractor will expose himself to prosecution in terms of the last-mentioned Act if he should practise in South West Africa. It is therefore necessary to safeguard these persons against legal proceedings. Since the principal Act is only applicable in the Republic, and since the enlistment of practitioners is limited to six months after the commencement of the Principal Act, it is necessary to create similar provisions in respect of South West Africa. The provisions are included in paragraphs (aB) and (aC) of clause 1(b), and in clauses 1(c), 1(f) and 5. Clause 1(d) contains only a consequential amendment.

During the Second Reading of the principal Act, the former Minister of Health pointed out in his speech, that the profession must put its house in order. The society concerned has gone as far as possible in the circumstances. Under the present provisions the society is unable to make further progress and has made representations for the creation of powers to control the practices of practitioners. In this regard I wish to point to a single unacceptable practice, viz. advertisements appearing in popular magazines where a minority of practitioners advertise their practices. Such actions are viewed in all recognized professions as unethical conduct.

The Government agrees with the Society’s request and consequently provision is made in clause 2 for the promulgation of rules to—

1. (a) prescribe conditions subject to which a practitioner may practise; and
2. (b) prescribe the fees that such a practitioner may charge.

Provisions is made for penalties for the contravention of the rules.

Clauses 3 and 4 embody amendments to bring the Act in line with the Medical, Dental and Supplementary Health Service Professions Act, 1974.

Mr. Speaker, we in the official Opposition benches, support this amending Bill. I wish to place on record my appreciation of the hon. the Minister of Health and his department for the sympathetic approach that they have taken to this question of chiropractors. This is a matter which has enjoyed the intermittent attention of this House for the past 15 years. That is as far as my memory goes back in respect of my experience in this House.

I can remember that in 1961 a member on those benches moved a private member’s Bill. It was left to an open vote, but unfortunately, in terms of the rules of the House, the Bill lapsed and nothing further was heard of it at that time. In 1962 the matter was reintroduced as a private member’s motion, also by a member on that side of the House. Again, the motion lapsed, but the then Minister of Health, Dr. Albert Hertzog, appointed a commission of inquiry. We became used to things moving slowly in that era, Mr. Speaker, and this commission of inquiry was no exception. It was appointed in 1962 and it reported nine years afterwards, in 1971. We then had what to me was an unusual experience in this House in that a Bill was introduced to this House by a Minister of Health, the same Bill being subsequently withdrawn and another Bill on chiropractic, differing from the first Bill, being introduced during the same session.

The first Bill introduced almost a total ban on chiropractic and it brought an outcry, not only from the 120 odd chiropractors, but also from the public of South Africa, many of whom had a sincere admiration for the efforts of the chiropractor.

The second Bill granted the chiropractors a reprieve to a certain extent, but it operated almost, I would say, like the law of diminishing supply, because it limited the practise of chiropractic to those chiropractors entitled to practise at that time. It simply meant that, as Anno Domini took its toll, the number of chiropractors would diminish, and eventually those left would be in the happy position of having a very pleasant monopoly under which they would be able to operate quite legally.

We then had the amending Act, No. 96 of 1972, which broadened the scope to a small extent. However, the present Bill would not be before this House tonight if the House had accepted the advice of the United Party in 1971. [Interjections.] I am going to quote from Hansard. On 2 April 1971, under the heading Chiropractors Bill (Instruction), Mr. M. L. Mitchell said (Hansard, Vol. 33, col. 4167)—

Where is he now? [Interjections.]

Mr. M. L. Mitchell, my friend, is adding lustre to the legal profession, and if you can ever compete with him in fame you will be doing very well.

He has given up with you guys.

You were still playing marbles then.

I am not going to be diverted from my purpose, which is to indicate that this instruction was lost, and that there are still people sitting in the green benches opposite, who voted against the instruction and who subsequently came to members on this side of the House and said: “Good show. I wish they would do just that. ’’ This exemplifies a typical attitude: What the United Party suggests to the Government, they usually adopt within five years. [Interjections.]

Mr. Speaker, I do not want to mix politics with chiropractic, but I want to make one prophecy: The Government will accept our federal plan too. [Interjections.]

What does the long title of this Bill state? The Act is being amended “To provide for the making of rules for the practice of chiropractic.” It contains the very intention of the instruction that was turned down. However, we welcome this Bill, and once again I thank the hon. the Minister because I think he has been extremely co-operative. I do, however, want to suggest that he review the situation because when chiropractors were not recognized, they enjoyed certain facilities and recognition by medical schemes. Now that they are recognized by statute, I believe the time has come—not only in the interests of the chiropractors, but also in the interests of the people who derive genuine benefits from their services—for them to enjoy some privileges under the Medical Schemes Act. I commend that thought to the hon. the Minister because I believe that here again, with his influence, he would be able to investigate the position and if necessary, take action in that regard. I conclude by reiterating that we on this side of the House support the Bill.

Mr. Speaker, I can understand the elation experienced by the hon. member for Berea in alleging that we are only now adopting the proposal made by them as far back as 1971. It is so seldom that those people suggest anything which is acceptable that I can understand their elation if they suggest something in a period of five years which this Government is able to accept.

When the principal Act was first discussed, it was a fairly emotional discussion. I can remember, too, that there were serious differences between the two sides of the House about the provisions of the principal Act. In particular, there were members on that side who advocated that this profession should not disappear but that full recognition should be given to it. In order to get the discussion on the amending Bill in perspective, it is useful to refer briefly to what the commission of inquiry recommended at the time. The basic objection to the profession of chiropractors was that they had a basic philosophy which was not in accordance with scientific findings. The objection was that they tried to reduce diseased conditions to subluxation of a dorsal vertebra. This is in fact a philosophy for which no scientific proof exists. A second objection that was raised against these people at the time was that their training left much to be desired. From the commission’s report we learned that several witnesses had testified that these people were poorly trained and that in fact they received very little or no clinical training. A third objection was that some of these people tried to create the impression that they could treat all diseased conditions, with few or no exceptions, by means of their manipulative procedures. We were unable to accept that. The commission of inquiry recommended at the time (chapter 16, page 20) (translation)—

1. 1. That no statutory recognition be given to chiropractic as a profession in the Republic of South Africa.
2. 2. That those who are already practising chiropractic in the Republic of South Africa be allowed sufficient time, say until 1970, either to obtain medical qualifications or to obtain qualifications which would enable them to comply with the requirements laid down for registration as physiotherapists.

The Government felt at the time that it would be unfair to prohibit these people at once from practising their occupation, or even to impose a time restriction, and it was felt that it would be better to guarantee the livelihood of these people and that those who were active in the occupation should be allowed to continue in their profession until their death. This concession was made with a purpose and one is disappointed to have to learn from the hon. the Minister this evening that these people have not set their house in order yet. We hoped that with this sword hanging over their heads, the chiropractors would realize that they would have to improve their training standards, that they would have to define a very clear field for themselves and that they would have to accept that what they are able to provide is really a supplementary medical service and not a full medical service, as many of them would like to give out. It is gratifying, however, that the chiropractors are now going to have the right to lay down certain ethical norms. This is a good beginning. We trust that it will be the beginning of a further campaign and that they will in fact set their house in order, so that it will be possible for the legislation which is before us this evening and the legislation which was passed in 1971 to be withdrawn completely in course of time in order to allow these people to carry on their occupation to the benefit of all. After all, the standpoint of the Government at the time was that these people had a limited contribution to make. We just want them to realize that limitation. They cannot cure all diseased conditions but in certain fields their manipulative therapeutical procedures can nevertheless be beneficial. The only thing is that they have to confine themselves to those fields. I trust that those people, too, will see this legislation in that light and that they will be given an opportunity to comply with these standards.

Mr. Speaker, when the hon. the Minister introduced the Second Reading of the Bill, he mentioned that it was comprised of three sections. However, one cannot view this Bill without making some reference—as has already been done—to the principal Act of 1971. This Bill at first sight probably comes as a disappointment to those people who are in the chiropractors profession. I say that because the Bill goes only about one-tenth of the way that I think it ought to go. However, it does make some improvement and it does make a very considerable concession. It seems to me almost illogical that action was taken against this group which did not bar them, therefore acknowledging that they were not dangerous, but nevertheless cutting off the supply for the future and restricting them very considerably. The first concession that this Bill makes is to be welcomed in that it enables those young men who have been studying overseas in order to further their training, and who were not registered in time, to escape being penalized. For that I think the department is to be congratulated because I think they have done the right thing. They have not penalized people who, through no fault of their own, were not registered in time. It is a pity that we did not, at this time, also make it possible for those who are studying this profession at the present time to escape being penalized when they have completed their training, in two, three, four or five years’ time. However, the fact that this concession has been made does, I think, open a door to the future, and if this is the attitude of the hon. the Minister and the department, I think it is now up to the chiropractic profession to make the best possible use of this so that in future other amending Acts can come into being to enable the chiropractors to practise freely, as they do in every State of the USA;

Of course there must be control and there must be standards, and the chiropractors—at least the ones I know and have talked to—are the first to acknowledge that this should be so. Therefore it is to be welcomed that their association can make rules. I believe that if it is true—and I am sure the hon. the Minister is right, otherwise he would not have mentioned it—that some of the small minority of chiropractors are still advertising their practice, of course that is unethical. However, I believe that in the main the majority of the chiropractors themselves do not approve of this, so it is up to them to put that right, as I believe that they will.

When I first read the Bill, it seemed to me as though those who would not be able to practise in South Africa, would at least be able to practise in South West Africa. I am grateful for the hon. the Minister’s explanation which makes it clear that here again this is being done so that chiropractors will be able to practise there and will not be penalized.

Very early on this afternoon, when we began with the first of these many medical Bills, I mentioned that we in these benches believed that health matters are, in most instances, above party politics. One remembers last year the debate on the Abortion Bill when the same attitude was adopted in regard to the granting of a free vote. It seems to me that this the subject of chiropractors is far removed from the arena of politics. This measure is concerned with the health of individuals. I hope we shall approach the subject in the same way because I am convinced that there are hon. members on that side of the House and hon. members on these benches who have had first-hand experience of considerable help from chiropractors. However, we know this is a controversial issue. We know that doctors are divided. I know personally of many doctors who have suggested to their patients that they get the help and treatment they themselves cannot give. They asked, their patients, however, please not to quote them. We know that there are people in high places and from all walks of life who have received help, and I am very grateful that this Bill is before the House. We support the Bill and hope that this is the first step towards a much more enlightened approach to this profession.

Mr. Speaker, I shall only take up a few minutes of the time of this House. There is something which I should like to rectify. I am reacting to what the hon. member for Berea said, namely that this side of the House were rather balky about chiropractors and that it is in fact the United Party that accepts responsibility for the fact that we are able to come here with these amendments tonight. But in the same breath the hon. member admits that the initiative for giving these people this opportunity came from this side of the House. It was this side of the House which through a private member, presented their original Bill.

But you rejected it.

It was also this side of the House which moved a motion to the same effect. In other words, the initiative actually came from this side of the House originally. I am pleased that we are now able to work together because I do not think there ought to be any difference of opinion about this matter. The hon. member for Pinelands, too, has just congratulated the hon. Minister on this step which has been taken. There will be some of us who have negative evidence. There will also be some of us who can present positive evidence in regard to the work of chiropractors. Some medical practitioners’ mistakes are six feet under the ground. Some of our teachers have had failures. A girl once told me that the reason for her going off the rails had been because a teacher had made a certain remark about her in class. So there will be failures but success stories as well. I just want to express the very sincere hope this evening that the chiropractors will put their house in order and will do it in such a way that they will in future be able to provide a service to people who are suffering pain.

Mr. Speaker, the hon. member for Hercules made a very reasonable plea for a sympathetic approach to the problems of the chiropractors. I want to thank him for this and say that I am confident that if this matter should be before the House again in future, and the rights and future of this group again be discussed, we will be able to depend on the support of the hon. member and of many other hon. members. I am referring to hon. members who give their support to the chiropractors outside their party-political affiliation.

I want to react to a few of the statements made by the hon. member for Cradock. I feel that, to a certain extent, he might not have furnished this House with the correct information or, to put it differently, the picture as he presented it to this House, was not entirely correct. The hon. member said that the approach or philosophy of chiropractors was that they can cure all diseases merely by manipulating the vertebrae.

I did not say that; the commission said it.

The hon. member is now saying that he quoted the commission. But that point of view is not entirely correct, because the chiropractors are aware of the fact—the necessary proof for this has already been produced—that there are many diseases which can be cured in a positive manner by manipulating the vertebrae. I would, however, like to add to this that the responsible and leading members of that discipline will readily concede that they are not able to cure all diseases on that basis. I think that one should be reasonable and in one’s approach to the problems of chiropractors one must accept that over the years they have proved in hundreds of cases and, in many countries of the world as well as in South Africa, that they have solved medical problems which could not be solved in any other way. One must therefore accept that chiropractors have provided the population of South Africa with valuable, indispensable, medical service.

The second point which I should like to comment upon, is the hon. member for Cradock’s quotation from the report that the training of chiropractors is faulty. There may be cases where this was true, but the information I have …

Have you read the report?

Yes I have read the report. The information I have is that the training which is provided in the U.S.A. for example conforms to the highest possible standards. I know that the organization has already announced that they are prepared and willing to put their own house in order. They will therefore do everything in their power to comply on the highest level with all the requirements which are set for them in respect of their organization. They are prepared to lay down the highest ethical laws and standards for their members. They have also shown their willingness in this respect. The hon. member also said that if the chiropractors were prepared to accept that they must provide a supplementary medical service, he—this is the impression I got—would be sympathetic to the organization and the people who provide that service.

That is quite correct.

This is interesting, and to me it is a gratifying sign if this is in fact the case, because I believe and trust that the chiropractors themselves want nothing more than to provide a supplementary service. They want to help people who cannot be helped medically. They want to do this by performing the service they render. There is proof that they can provide successful service in cases where other medical disciplines are unable to do so.

Order! I want to point out to the hon. member that I have not imposed any restraints on hon. members. Other hon. members, too, spoke outside the context of the Bill. Consequently I do not want to adopt a different approach to the hon. member. I should appreciate it, however, if he would nevertheless bear in mind that the Bill, in fact, has a limited scope only.

Mr. Speaker, I accept your ruling. I am merely replying to and commenting on important points made by other hon. members. In any event I shall dispose of the matter quickly.

The hon. member also said that the Government accepts the principle that these people are providing a valuable service. I think that this is enlightening and very important. If the Government accepts that these people are providing a valuable service, it seems to me as though it would be in the interests of South Africa and all its people who need medical assistance, if we looked at the interests of this group again in the near future.

I have a comment to make on the extension of the legislation to include the territory of South West Africa. Has a survey been made of the number of South Africans abroad who are at present studying to be chiropractors, people who are under the impression that when they qualify, they will be able to go to South West Africa and practise as chiropractors there? It is true that a large number of people studied abroad or are still studying there and are under the impression that they will be able to practise their profession in South West Africa, since that the 1971 legislation does not apply to South West Africa. The same problem which, during the consideration of the 1971 legislation, was experienced by chiropractors studying abroad with the aim of subsequently practising in South Africa, will now be experienced by chiropractors who want to establish themselves in South West Africa after completion of their studies abroad. I want to make an urgent appeal to the hon. Minister to give attention to the dilemma in which these people will find themselves. I want to request that when these people approach the hon. Minister and his department individually for the consideration of their particular difficult circumstances, they will be accommodated. They are studying in the U.S.A. at present. When they began studying a year ago, they were under the impression that they would be able to practise their profession in South West Africa, but now the legislation is being extended to apply to South West Africa as well. They will therefore experience the same problems as were experienced by people when the legislation was introduced some time ago to control conditions in South Africa. I want to make an urgent appeal to the hon. the Minister to take their problems into consideration when they return and make representations to him.

Mr. Speaker, in the first place I want to refer to the appeal made by the hon. member for Bryanston. If he had read the Bill, he would have seen that we have made specific provision for those cases of persons who will be returning to South West Africa. They may re-apply. I therefore want to advise him to read the Bill, about which he has just spoken with such great knowledge. If he does this, it will reassure him. The fact that chiropractors had a place in South Africa in the past and that somehow or other they were able to do people who were not healthy some good, was already admitted in 1971. If the hon. member would only read the 1971 debates, he will discover that we discussed the merits of chiropractors and their position in South Africa at that time already. The result was the legislation which was then introduced. It is true, however, as the hon. member for Cradock said, that the basic philosophy of these people was not entirely consistent with scientific principles. In South Africa we have the South African Medical Research Council, which exercises control over the training of people who learn about human diseases and the treatment of these diseases in a skilful way, and it was true that amongst the chiropractors there were several people who, to tell the candid truth, could be regarded as nothing but quacks. This was also admitted by hon. members on the other side, and therefore it was necessary that there should be regulation and control of these people. In the first place we accepted the responsibility of giving this component of the group of people who make it their task to care for people’s diseases, namely the chiropractors, a place in the sun, but according to certain rules. These rules were laid down, and the result of this was the 1971 Act. But this was not enough. They were told: “You must put your house in order”. Certain requirements were stated to them. We did our best to have an association established for them. They were told: “You require a code of ethics if you want the respect of society. You need certain aspects of training. There are certain obligations you have to discharge”. We protected this group by indemnifying them in 1974 in the Medical, Dental and Pharmacy Act, on condition that they appeared on a list which we considered to be the list of chiropractors who really conformed, in other words those who did their work in a scientific or more or less scientific way, to what their association prescribed for them. We protected this profession, so that it would not be deprived of a livelihood. But this was not sufficient. Other requirements were laid down. This profession cannot go on like this for ever. People come from all over and say they are chiropractors. They have certificates, but there is no proof that they have studied to be chiropractors. Do you know, Sir, that some of these certificates are blatantly sold?

However, we accepted that there are colleges in the U.S.A. at which these people study and we decided that if these people are really interested in practising in South Africa, they would be given an ample period of six months in which to register. This applied to students as well as to those who were already practising here and who were recognized as chiropractors by their association, which established a certain standard. Now it seems that there were some who did not know of this, and it also seems that the Act was not made applicable to South West Africa, and that these people would be liable to prosecution under the Medical, Dental and Supplementary Health Service Professions Act. All these matters are being rectified by means of this legislation. We have now opened the door for those who did not register in a bona fide manner, so that they can once again prove their bona fides, and so that the State will be able to determine whether they should be placed on the list so that they can practise. Hon. members will all agree that we must have rules and regulations. We cannot play around with people’s health. We are a country which considers itself to be a civilized country, and therefore these people must be subject to some or other form of regulation. That is why we cannot simply allow these people to be admitted. The period of six months is once again introduced by means of this amendment Bill. Once again they are being given six months. Those who were practising in South West Africa, are being given three months. Those who are being admitted as students, are being given one month. At the same time we are now making it possible for these people to draw up a code of ethics and rules. They now have the opportunity to make rules and regulations to bring themselves within the cadre of an organized, scientific association. We would prefer them to put their house in even better order, and establish some or other form of course for themselves in a scientific way, so that they can study in a scientific manner. It should not be impossible for any intelligent group of people to do this and then to come to us and say that they want to become a supplementary health service profession. If they do this, it is possible for them to be registered under the Medical Council. Then they are protected, and it will be possible for them to create an association or council which will enjoy full protection. Now I ask hon. members: Why do these people not want to do this? Why have they not done so up to now? It is because there are no rules and regulations. Everyone does as he likes. There are some who do a lot of good, but there are others who are absolute quacks. It is the duty of the State to protect the public against this.

I am very pleased that hon. members support this legislation in general, and I want to thank them for their support in this regard.

Motion agreed to.

Bill read a Second Time.

Mr. Speaker, I move—

Clause 1 contains an amendment of section 29(1)(a) of the Act. Reference to the Criminal Procedure Act, 1973, is being deleted. As you will recall, the two Acts in question were at the time introduced simultaneously, but the Criminal Procedure Bill was not proceeded with at the time and consequently reference to it has to be deleted.

In terms of the said provision a curator ad litem shall in the form prescribed by regulation apply to a judge in chambers to make a recommendation to the State President for the discharge of a patient. It serves no purpose to prescribe the form by law since it has to be adapted from time to time to changed circumstances and has to be promulgated anew by regulation every time. Consequently the requirement in respect of the application in a prescribed form is being amended to written application. There will still be a form, but it will not be a prescribed form.

Clause 2 contains the insertion of a new section which places a prohibition on any person who, without the authority in writing of the Secretary for Health, sketches or photographs or causes to be sketched or photographed any institution, portion of an institution, patient or group of patients, whether within or outside any institution, or who publishes or causes such sketch or photograph to be published. This prohibition does not apply to a member of the Newspaper Press Union of South Africa.

In addition the provision places a prohibition on the publication of any false information concerning the detention, treatment, behaviour or experience in an institution of any patient, or concerning the administration of any institution, knowing the information to be false, or without taking reasonable steps to verify such information. The onus of proving that reasonable steps were taken to verify such information rests on the accused. A contravention of the provisions is an offence and the accused is liable on conviction to a fine not exceeding R1 000 or to imprisonment for a period not exceeding one year, or to both. This measure is similar to the provisions of section 44(e) and (f) of the Prisons Act, No. 8 of 1959, with the exception, inter alia, of the exemption of a member of the Newspaper Press Union of South Africa relating to the publication of photographs or sketches. You will ask me why this exemption is being made. The reply is simple. The Press in South Africa has always acted in a very responsible manner with regard to everything relating to mental patients. Up to now the Press has respected the privacy of patients and, as is proper, has dealt with any matters concerning these patients with the greatest circumspection, for it is fully appreciated that we are dealing with a group of unfortunate people who cannot protect themselves and who have to be cared for by society. Where it was found to be necessary, the Press has not hesitated to express criticism. However, the Press has never, as far as I am aware, published a report without contacting the department or myself in advance to verify the facts. I should like to avail myself of this opportunity to convey my appreciation to the Press in South Africa for its highly ethical conduct in this regard, and for the way in which this entire matter is being handled.

We are not afraid of criticism. On the contrary, constructive criticism is welcome. It serves to expand the service in South Africa, to make our population aware of the needs of these patients, and to improve the facilities for these patients. But I reject the mendacious and slanderous articles on mentally ill patients which are being published by certain organizations which are doing this for their own obscure motives. I should like to give a few examples of these publications. Recently the Society for Safety in Mental Healing, which was established by the Church of Scientology, and the Committee for Ethics in Mental Healing, published and caused to be published an article on a patient in the Komani Hospital. The publication contained such serious allegations that the documents were referred to the Attorney-General for such action as he may see fit. The case is now sub judice, and therefore I cannot elaborate on it any further.

In the editions of Scope of 14 and 21 November 1975, two articles appeared on Horace Morgan dealing with his experiences in institutions for mental patients in South Africa. The articles are teeming with untruths, half-truths and even falsehoods. In the second paragraph of the first article the following appears—

I want to pause to consider the following passage—

His hospital file indicates—I do not want to make confidential information public now—that he was treated for his mental illness from the first day he was admitted, and subsequently also received treatment for physical ailments until the day on which he was discharged. In fact, if it had not been for the efforts made by the hospital staff, Mr. Morgan would even now not have found himself united with his family. Before he was discharged the hospital helped him to find work, and even after he was discharged, the hospital staff still helped to care for him. I do not reproach Mr. Morgan for furnishing information to the periodical, for his alleged statements were typical of the pathosis from which he was suffering. Such a condition is best described in the following paragraphs—

What the article omitted to add, however, was that such a pathosis causes the person to have a distorted image of reality, for example the allegation that he was strangled, or that strangulation was used to discipline patients. A possible explanation for his allegation is that he developed an abscess in his oesophagus, i.e. his gullet, in January 1938. According to his record he was still in a catatonic coma in February, 1938, and tube-feeding had to be applied. A catatonic coma is when the body remains in a particular position from which one cannot move it. The person is as stiff as a ramrod. It is possible that it is as a result of this that the distorted idea arose in his mind that he had been strangled, for in 1939, after an attack of enteric fever, he did speak for a short while. Subsequently the following report was written about his mental condition—

Although I do not take it amiss of Mr. Morgan, I definitely take it amiss of the publishers of the article. If the article was meant to reflect the mental condition of a patient, it may perhaps be condoned, but that was definitely not the intention, as is evident from the following foreword to the second article. By the way, hon. members should note that the words “lunatic asylums” re-occur frequently—

If they had taken only the slightest trouble the publishers of the article could have verified the facts with the department, but they did not do so, for if they had had the information at their disposal, the article would not have been sensational. I am of the opinion that the periodical acted in an absolutely irresponsible manner, not only towards Mr. Morgan, but also towards the State which is responsible for the service. The ostensible purpose of the article was to cast suspicion on and disparage the service to patients, and for that reason the distorted memories of an ex-patient were used, and for that reason emphasis was placed on the long period of detention of the patient, on assaults on the patient, and on the expression “lunatic asylum”.

But that is not all. I should also like to draw your attention to the periodic publications of Freedom, the mouth-piece of the Church of Scientology. In October 1974 an article under the headline: “Sterkfontein—Visit reveals sex and violence”, was published. The November 1974 edition contained an article under the banner headline: “Wes-Koppies—Shock report”. In December 1974 this was followed by an article under the headline: “Qualified nursing assistant exposes savage truth of treatment in our mental hospitals: The death of John Brown”. Another article in the same edition was to the following effect: “Unnatural sex practices in mental hospitals”. I am not going to deal with these articles in detail, since you have yourselves apparently received unsolicited copies of the publications concerned.

In its fight against psychiatry the organization in question does not hesitate to use any conceivable means of opposing the profession. The organization does not hesitate to publish the most gruesome tales of horror to justify its standpoint. Articles are being published about political opponents in foreign countries who are being detained in mental institutions, and of mental patients who are being used as guinea pigs for medical science. The inferences which are to be drawn are that these are the practices which are being followed in such institutions, in other words: “We are not publishing anything about South African institutions, but draw your own conclusions”. No consideration whatsoever is given to the facts that (a) the mental health service is financed by the public of South Africa, by you, (b) that it is a service by the Government, (c) that the service has to be accounted for to this Parliament, (d) that the staff are subject to professional control by the Medical and Nursing Councils and (e) that our courts are responsible for supervising the protection of patients. Recklessly the attacks are being continued, without taking into consideration that the patients are being cared for with dedication by a small group of medical practitioners, nurses and male nurses, just as long as the object of opposing psychiatry can be achieved.

In view of the department’s experiences with this organization, the Secretary for Health issued instructions last year to the effect that no officer may furnish any information to the organization or its satellites. The Secretary had my full support in this regard from the outset.

However, slanderous and untruthful attacks on the psychiatric service rendered by the State, and on the medical and nursing professions rendering that service, and the resultant disparagement of the service as such, can no longer be allowed. What is more, I would be shamefully neglecting my duty if I did not take the necessary steps to protect Parliament and our courts against indirect accusations of dereliction of duty, as if we were, through our connivance, allowing the deeds mentioned in the articles to take place.

I want to assure the public that we do not detain one patient any longer than is absolutely necessary. Apart from the statutory provisions the reason is simple—we simply do not have the space to detain such people unnecessarily. Nor are people being bundled into institutions indiscriminately. On the contrary. All documents relating to the case have to be submitted to a magistrate who then has to issue a detention order, and subsequently all documents relating to the case have to be submitted to the Attorney-General, who has to submit it to a judge in chambers to confirm the detention of a person. Apart from the above-mentioned procedure, any patient or any near relation of a patient is at liberty to apply to the courts to investigate the detention of the patient, and as far as I know, such an application has never been made to any court. However, I may be wrong.

The Act makes ample provision for the protection of patients against assault. Assault includes physical assault as well as immorality. Although a charge of assault against a staff member may damage the image of the department, I can give the assurance that the department does not hesitate to report an alleged case of assault to the Police immediately for the necessary steps and does not hesitate to take disciplinary action itself against such a person. We had such a case last year. Even the slightest suggestion of a complaint is thoroughly investigated, because the department is aware that patients cannot protect themselves, and have to rely for protection on the Government. Disciplinary action against a staff member means discharge and the removal of his name from the register of the council with which he is registered.

Apart from the above, there is still the hospital board of every hospital which consists of private persons from the community, even members of the House of Assembly. The board of each hospital has to visit such a hospital at least once every two months, and every patient has the right at such an opportunity to make representations to the board. Patients are not disciplined or punished. Such actions would amount to assault. Sedatives are administered to a patient if his behaviour justifies such action.

In the entire history of South Africa it has never happened that a political opponent of the Government, whatever Government happened to be in power, was certified to be mentally ill and detained as such, and any vestige of a suggestion of this nature is utterly rejected. Articles of this nature suggest that we as a Government are neglecting our duty in that we are, through our connivance, allowing improper deeds to take place in our institutions. It is probably not general knowledge that members of Parliament periodically visit these hospitals in groups, and during such a visit members have always been at liberty to speak to any patient or to any member of the staff in order to investigate the situation in the hospital. Apart from that I am aware that members in whose electoral divisions hospitals are situated display a lively interest in the hospitals, and immediately take up any complaint they receive with me. Even members in whose electoral division there are no hospitals, correspond or discuss hospital matters with me periodically.

However, I am not the only supervision over the institutions. Institutions are inspected daily by matrons, and officials from the head office of the department pay regular visits to the institutions to look after the conditions of the patients. In view of what I have said I reject any suggestion of dereliction of duty on the part of the authorities. If these had only been suggestions of dereliction of duty, we could still have accepted it. As far as the staff is concerned, however, we are dealing with a group of dedicated officers who discharge their duties scrupulously. These people are performing a labour of love, for as may well be realized, it is not always an easy task to care for patients of this nature year in and year out. I am no longer prepared to see these officials being slandered with lies and distortions and their lives being made unpleasant in many other ways. These officials deserve the gratitude of the community, not calumny and abuse. Nor am I prepared any longer to see the privacy of the patients being invaded by these articles and the patients subjected to such slander and defamation. The patients cannot protect themselves, and it is our task as Government to do so. The measures place no prohibition on the publishing of correct information, and even information which is less correct, if there is proof that it was bona fide deduction. On the contrary, if information of any nature concerning any malpractice is correct, it must immediately be made public for the protection of patients, and the Government as well as the department will welcome the disclosure of such information.

Mr. Speaker, I think this is perhaps the most important Bill we have dealt with this evening. The Bill deals, in the main, with people who are unable to look after themselves. I, for one, resent those sensation-seeking articles about the mentally ill that appear from time to time.

This Bill only has two clauses. One clause facilitates approach to a judge in chambers to alter a decision on a State-detained patient. It is no longer necessary to fill in complicated forms and there is no longer any obstruction. The patient, through the curator ad litem, can be looked after and his case can be heard by simply going to a judge in chambers and presenting in writing the reasons for a reassessment of the case. I do not think anybody will want to argue with that, and I do not think anybody will oppose it.

The second part of the Bill deals with the protection of the mentally deranged hospital patients. I am sure everybody in this House will agree with me when I say that the time has come for the legislators of this country to do their level best to protect these unfortunate people. We must protect them in such a way that their privacy is not interfered with. It does not really matter whether the patient is suffering from a mental illness or any other illness, I feel that he has the right to privacy. His illness or condition should not be bandied about willy-nilly in the Press. The person who is not in a mental hospital can protect himself, but the patient who is in a mental hospital needs us to protect him. For that reason we on this side of the House will support the Bill. What has been happening has been happening not in the distant past, but in the recent past.

This Bill would never have had to come to Parliament had it not been for what was written in some of the publications which have been bandied about in this country during the last few years. I would not want to see anybody in my family—if I was unfortunate enough to have a relative or friend in a mental home—having his condition described in a pamphlet that is handed out on street comers. I do not want to see pictures of persons who are mentally deranged or subject to epileptic fits; I do not want to see photographs being taken of such persons during a fit, nor do I want to see those photographs printed in such publications. I do not want to see pictures of the senile dementia patients. I do not want to see pictures appearing of patients who are suffering from deep melancholia. It is bad enough for these people to be in hospitals, but it is far worse to have their conditions irresponsibly displayed in the type of publication that is now being distributed. What is it all for? What good is it doing? Members on this side of the House have had an opportunity of visiting mental hospitals run by the State. We visited those in Pretoria, those in Cape Town and those that are now housed in their thousands in former mine compounds. These compounds have been transformed into mental hospitals, and the transformation that has taken place during the past few years has to be seen to be believed. I have been impressed by the work these private individuals have done for the patients. It must be remembered that these patients go there after being referred by psychiatrists from one of the State hospitals. There they are looked after. In this regard I want to say that in a publication, which I have before me, these institutions are called human warehouses, and it is said that the people who run them are making millions out of madness.

Nobody runs a private institution for any illness without a profit motive. They cannot be expected to do otherwise. I can assure this House that millions are not being made out of madness. These are brave people, who have undertaken this work and they deserve every credit. The adviser to this company is one of our former psychiatrists. He has taken a great interest, an intense interest, in the patients of these hospitals. How some of these patients, who arrived there as mental wrecks, are today taking an interest in their surroundings and are able to do work that keeps them occupied during the day, is something to see. One of the great things one can do for these people, is to keep them occupied. It is important to keep these people busy. It is difficult enough to treat patients who are merely mentally deranged, but it is much more difficult to treat and look after hundreds of patients who are not only demented, but who are, in addition, blind or deaf or dumb. That is a task to undertake! When one sees this sort of thing being done, with some success at least, one has to take one’s hat off to the people who are undertaking this task.

The Department of Health may have some faults. They do many things which I do not like. However, they deserve to be complimented on this particular task which they are undertaking. I believe that, in a year or two, these places that are being run privately, will be show-pieces for the whole world. Those colleagues of mine who have accompanied me on these visits, were absolutely amazed to see what was really being done. However, they were being castigated for their work by these pamphlets and so-called newspapers. The distortions that are being placed in them, the irresponsibility with which they are published, makes me support this effort of the Minister to control these irresponsibilities more effectively.

I am not going to go into details concerning the treatment these people are being given. I am satisfied that they are receiving the best treatment possible under the circumstances. I have already seen various criticisms to the effect that many of these patients have to sleep on coir mats on the floor. Why is that done? Some people think it is because of a shortage of beds, but that is not the reason for it. You cannot put an epileptic in a bed, unless you have somebody looking after him all the time. It is far safer for the patient to be on the floor. That is the reason for it. There is also another reason. Many of these patients refuse to lie in beds; they want to lie on the floor. They are used to lying on coir mats.

I have also seen criticisms about the food these patients are given. I went into the kitchen and I saw the food being prepared. It is ample, wholesome and scientifically prepared. I never saw anybody in that home—and there are thousands of patients there—who looked as if they were starving. They were all very well fed indeed. The medical treatment is first rate throughout. They do not have all the amenities we would like them to have, but I think that all that will come in time.

Before the House adjourns, I want to add that this department has nothing to be ashamed of as far as their treatment—I say “their” because it is their business to provide it—of the mentally ill in this country is concerned.