Mr. Chairman, the principle of this Bill was accepted at Second Reading and it will be our endeavour to improve the various clauses wherever we can. In my Second Reading speech I indicated to the hon. the Minister that in our opinion it is necessary to improve the Bill by including a definition of “industry”, because in the title and various clauses of the Bill we have the specific phrase “secondary industry”. I believe that in a Bill about industry it is important that we should define the very essence of the Bill that we are discussing. Therefore, with your permission, I move the following amendment, which appears on the Order Paper in the name of the hon. member for Pietermaritzburg South—

Order! I am afraid that I am not able to accept the amendment as it is in conflict with a principle of the Bill as read a Second Time.

Clause agreed to.

Clause 2:

Mr. Chairman, as far as we in these benches are concerned, we do not believe that the economy of South Africa can be segregated on ethnic grounds. We believe that if there is a need for a Government agency to promote the needs of a certain socio-economic group in private enterprise, this could well be considered, but not on ethnic grounds. We believe that to segregate these Government agencies and to have legislation for the different ethnic groups is not acceptable and therefore we are not in favour of this clause.

Clause agreed to.

Clause 3:

Mr. Chairman, again we believe that if we are to improve the essential purpose of the Bill, we should omit the word “secondary” in this clause. Accordingly I move as an amendment—

Order! For the same reason I am not prepared to accept this amendment.

Clause agreed to (Progressive Reform Party dissenting).

Clause 4:

Mr. Chairman, in accordance with your ruling on clause 3, I shall not move the amendment standing in the name of the hon. member for Pietermaritzburg South.

Mr. Chairman, we in these benches feel that there could be a certain re-think in respect of clause 4. It is apparent that we are dealing with a Bill that falls under the aegis of the hon. the Minister of Economic Affairs …

Are you speaking on clause 4?

I am speaking on clause 4. This Bill falls under the aegis of the hon. the Minister of Economic Affairs. However, we wonder why the Minister of Indian Affairs has not been given anything to say in connection with the affairs of the Indian people. Surely, this Bill has to do with the Indian Industrial Development Corporation and we feel that the Minister of Indian Affairs should have some measure of say in what is to be done with the future and development of the Indian people, economically or otherwise. Furthermore, we also feel that the body which was established by the Government, viz. the S.A. Indian Council, should have something to do with the objectives of the Bill that is before us. I quote from clause 4(a)—

1. (a) promote or assist in the promotion of the establishment of undertakings for conducting secondary industrial operations in the Republic;

While that is so, we feel that this could be greatly improved by the following amendment, which I now move—

We feel that this would be a step in the right direction as this would not merely limit the promotion of the establishment of undertakings to the secondary industrial field, but would also allow for discussion to take place between the two Ministers I have mentioned and the S.A. Indian Council, who could give valuable advice to both Ministers. I am sure that in effect this is advice that they need when one examines what particular industries or industrial operations are worthy of consideration for assistance by this council. I urgently ask the hon. the Minister to consider this amendment.

Order! I regret that I am unable to accept the amendment moved by the hon. member for Umhlanga, as it is in conflict with a principle of the Bill as read a Second Time.

Mr. Chairman, I want to raise two points in regard to clause 4. In the first place the Government has on many occasions given the Indian community the assurance that what has been done for the Coloured community will also be done for the Indian community. One of the main operative reasons for this development corporation is to assist in the promotion of the establishment of undertakings. Why, in the light of the Government’s undertakings, is the instrument which has been created for the promotion of the Indians’ position less than that which has been created for the promotion of the Coloureds’ position? If one looks at the two communities, the vast majority of the Indian community and the vast majority of the Coloured community are on exactly the same socio-economic level. We strongly believe that the instrument for promoting the interests of the Coloureds and the Indians should be identical, in line with the Government’s undertakings.

I should like to refer to paragraph (f) of clause 4 which refers to guarantees. If one gives guarantees, it is considered in banking circles the same as giving a loan. Perhaps one of the most important factors in this regard, because the capital is very small and the lending ability of the corporation is very small, is the attitude of the hon. the Minister with regard to giving guarantees for undertakings. Does he envisage this as being used to guarantee long-term or short-term capital or does he see it as being used in support of bank overdrafts? How does he view the issuing of guarantees in terms of this clause?

Mr. Chairman, the hon. member surprises me, because those hon. members opposed the Second Reading, in other words the principle of the legislation, and voted against it. The argument the hon. member is now advancing is in direct contrast with the standpoint they adopted during the Second Reading. They now want us to extend the scope and the sphere of operation of the legislation. Only they will understand how they find it possible to endorse a certain standpoint on one day and a different one the next. Or perhaps the hon. member was not in the House when the legislation was being discussed. If so, I want to suggest that the group sitting over there consult with each other in regard to the standpoint they have to adopt here in the House because the question whether such an instrument should, on principle, exist at all was opposed by them.

In order to make a little propaganda for himself and his group the hon. member now wants to know why we are giving the Indians poorer treatment than the Coloureds. In terms of the legislation relating to Indians, the scope of the aid being proposed here … [Interjections.] If the hon. Whip opposite would be silent for a while, perhaps I could convince the hon. member. The legislation which makes provision for Coloured development affords more aid in other spheres. If only the hon. member had looked up the basic facts, viz. if he had read the motivation for the legislation I submitted to the hon. House, he would have found that the crux of the argument lies in the fact that the various population groups have progressed at different levels, in the first place, and in different lines of development. I went even further and provided the quantitative reasons and indicated what percentage of the Indian population was active in the commercial and service sectors. Hon. members on this side of the House took the matter still further and indicated to what extent the Indian population were already active in industry. I argued, and I now want to repeat the argument, that the need for aid, whether through technical training, skills or of a financial nature, so as to be able to diversify the share of the Indian population in the economic life of the country to enable them to make their maximum contribution to our economic development in the primary, tertiary and secondary spheres, must at this stage take place for the most part in the secondary sphere. I further indicated that if it became clear in time that there was an over-emphasis on their participation in secondary industry, I would come back to the House. I really cannot understand how the hon. member can argue as he does, because there should not be the slightest doubt that the initial motivation submitted to my department by the Indian Council and the Executive Committee emphasized this very aspect, viz. that there was a need among the young men and women of this population group who were completing their studies for us to direct our efforts towards opening other doors for them in the industrial sector, more specifically in secondary industry, rather than moving into spheres which were already overcrowded. Secondly, it is, after all, a well-known fact that the development requirements of the different population groups are different.

Surely it is clear that as far as the Brown people are concerned, at the time of the establishment of the Coloured Development Corporation 15 years ago, there was a need to help develop the Coloured population in all sectors of the economy, specifically in commerce, too, because their participation, even in commerce, was very limited. I have given the figure in respect of those who have since entered commerce, namely 1 600 in the greater Western Cape. That is why there is a difference with regard to the aims we wish to achieve by means of the legislation. In explanation I could just say to the hon. member for Umhlanga that I do not like what is implicit in his argument, viz. to ask where the Minister of Indian Affairs is and whether he has anything to say in connection with the legislation. After all, we cannot argue both ways. During the second reading the hon. members argued that I was dividing the economy. Members on my side and I argued that if that were true and hon. members could argue on those lines, they would possibly be able to argue theoretically that that was in fact the case if the IDC fell under the Minister of Indian Affairs. The whole argument was specifically that there were special requirements in this regard, economically speaking, as far as the Indian population was concerned. Because they form part of the economy as a whole, we have created an instrument for their special needs falling under the department responsible for the overall economic policy. I should just like to place that on record.

Mr. Chairman, I want to react to what the hon. the Minister said and say that we in these benches do not object to a Government agency being formed to assist a socioeconomic group in obtaining a position in the private enterprise. However, we object that it is being done on an ethnically divided basis. This is our objection to it. I am afraid that the hon. the Minister has still not answered the question which I put to him. It is generally accepted that the majority of the Coloured population and the majority of the Indian population are on the same socio-economic level. [Interjections.] That is where we differ then. We cannot understand, despite what the hon. the Minister said, why the Indians should have a lesser instrument for promoting their entry into the private sector than is the case with the Coloured population.

The other point which I would like the hon. the Minister to reply to concerns the issue of guarantees. We have here a corporation with a capital of R3 million. It can borrow a further R1½ million. It is unlimited in regard to the guarantees it can issue. It could issue R1 000 million in guarantees, to use an example. What I would like to know from the hon. the Minister is: What is his attitude towards the corporation issuing guarantees? What does the hon. the Minister envisage the guarantees will be issued for? Does he see them being issued to back up bank overdrafts and long-term loans in the private sector?

How does he actually see the guarantees being used?

Mr. Chairman, I rise merely on a point of explanation. I want to point out to the hon. the Minister that I was in no way trying to suggest that the hon. the Minister of Indian Affairs should be present in this House. I was merely suggesting that the hon. the Minister of Indian Affairs could possibly be consulted from time to time. This is in terms of my amendment which you, Sir, have ruled to be inadmissible. I did not intend in any way to criticize his absence from the House.

Mr. Chairman, I accept and understand the explanation of the hon. member. I would just like to refer him to clauses 11 and 13 of the Bill where he would see that in that particular case I have to consult my colleague, the hon. the Minister of Indian Affairs, in relation to the appointments of members to the board. He, in turn, will again consult with the Executive Committee of the Indian Council. I would like to suggest that the legislation we are considering now was initiated when I was the Minister of Indian Affairs. I hasten to assure the hon. member that there is continuous consultation between my colleague and myself as far as the economic development of the Indian people is concerned. There is, quite obviously, no necessity to put that provision in the Bill. As far as I am concerned, that consultation will take place automatically.

The hon. member for Randburg argues from the assumption that the economic development of the Indian people is horizontally and otherwise on the same level as that of the Coloured people. Once one accepts that premise, one can well argue in the way in which the hon. member argued. But I want to submit that I have advanced very important reasons and arguments to indicate that as far as the Indian people are concerned, they have largely participated in the commercial sector of the economy. They themselves feel that there has been an over-concentration on participation by the Indian people in this particular sector as well as in the service industries. The need that has been identified by the Indian people in respect of the Indian people themselves, and in which I concur, is that their need lies particularly in the direction of assistance to enable them to make a greater contribution in the secondary industry sector. If the hon. member would refer to the decision that was taken initially, when this was first mooted, then he would see that the request of the council itself was for assistance in the secondary industrial field.

It is quite obvious therefore that there are various stages and levels of development between population groups. In this particular case, there is a case to be made out at this point in time for assistance in industry and not in commerce. I would therefore suggest that all we have to do is to meet that particular need which has been identified. If it should in time occur that there is a need in other directions then I would be the first person to come back to seek those powers to assist them.

Clause agreed to.

Clause 5:

Mr. Chairman, in view of your previous ruling under clause 3, I withdraw the amendment standing in the name of the hon. member for Pietermaritzburg South.

It is not necessary for the hon. member to withdraw the amendment. He need merely not move the amendment.

On a point of clarification, I wish to refer to page 4, lines 40 to 43, where it is stated that “the corporation shall not be required to provide an unduly large proportion of the capital that may be necessary for such establishment or development”. Is the Minister thinking of share capital here, or is he thinking about share capital and loan capital?

I am thinking of both, i.e. equity and also loan capital. What is inherent in this clause is that the particular applicant must have some resources of his own which can be augmented by the corporation.

Clause agreed to.

Clause 11:

Mr. Chairman, I wish to address the Committee on clause 11(2)(a). During the Second Reading the hon. the Minister indicated his preparedness to accept Indians on this board of directors. He also indicated this to me when clause 4 was under discussion a short while ago. Indians in their own right have a full understanding of the requirements in respect of the promotion of undertakings in all fields of commerce and industry, which are undertaken by their particular group. We feel that it is human nature to sometimes ask for more than we expect. While it is only human to reach for the maximum, to ask for the optimum, I hope that I shall at least arrive at a happy and acceptable compromise by moving the amendment standing on the Order Paper, as follows—

I trust that the hon. the Minister will see the wisdom of this amendment and will agree with our submission.

Mr. Chairman, it will be recalled that in the Second Reading I fully motivated the desirability of having Indians on the board. I shall not go into the broad detail as I did in the Second Reading, but the hon. the Minister will recall that at that stage I even went a bit further by suggesting that the board should consist only of Indians or, alternatively, of a majority of Indians. In response to that, the hon. the Minister said he would be prepared to appoint Indians to the very first board of this corporation.

I shall support the amendment moved by the hon. member for Umhlanga but, as I have said, I would go even further if the hon. the Minister would be prepared to have more than half the members of the board as Indians. In the circumstances we support the amendment as it now stands on the Order Paper.

Mr. Chairman, I have no objections whatsoever to the sentiments expressed in the amendment. In fact, I have indicated that, on the first board to be appointed, the Indian people will be represented, as the hon. member for Walmer quite correctly indicated. I have no objection in principle to accepting the amendment.

However, it does tie one down to some extent. I have considered asking the hon. member to withdraw the amendment on an assurance I shall be prepared to give him that I shall appoint at least four Indians, if they are available. However, on second thoughts, if it would satisfy hon. members, I shall be prepared to accept the amendment in any event. I am quite sure we shall be able to find four to five Indians—depending on the number of members on the board—to be appointed. Therefore, Sir, I am prepared to accept the amendment.

Mr. Chairman, may I express the appreciation of hon. members on these benches to the hon. Minister for his gracious acceptance of this amendment. We are very pleased and gratified by it.

Amendment agreed to.

Clause, as amended, agreed to.

Clause 16:

Mr. Chairman, clause 16 deals with the share capital of the proposed Indian Industrial Development Corporation. It deals with the manner in which the shares shall be held and how they shall be purchased. We indicated in the Second Reading debate that we believed that the Bill as such unnecessarily fragmented the economy. Clause 16(8)(b) reads—

Again the clause refers specifically to “an Indian”. We believe that this is too restrictive and too narrow and that, if the Bill is to serve the economy as a whole, this paragraph could well be deleted. Accordingly I move the amendment standing in the name of Mr. W. T. Webber on the Order Paper, as follows—

Mr. Chairman, clause 16 presents certain problems to me because this corporation is supposed to be a Government agency to promote a certain section of the population. However, this clause provides that Indians can become shareholders and later on provision is made that the board may declare dividends. One gets the impression that it could become a profit-making concern. There could arise conflicting interests in this Government agency, which is there to promote the interests of a certain socio-economic group, in that certain directors might just want to make the biggest profits possible. I would appreciate the hon. the Minister explaining to me whether he sees a conflict of interests in this and if he does, how he thinks it can be sorted out.

While we are talking about this matter there is the further aspect of taxation. Will this corporation be subject to taxation?

Yes.

It will be subject to taxation, as against the Coloured Development Corporation.

It is like the IDC, which is also subject to taxation.

Mr. Chairman, this corporation, as you know, was asked for by the Indian people. Therefore we have no problem with this particular clause in terms of which the shares will be allocated to the State or to an Indian. In the circumstances we oppose the amendment moved by the hon. member for Cape Town Gardens, although the hon. member for Cape Town Gardens is only being consequential, because this follows on the rejection of the Second Reading of this Bill. In our case we accepted the Bill for the reasons given. We therefore support the clause as it stands.

Mr. Chairman, I do not believe that because there is a provision in this Bill to the effect that the B shares may be sold to the Indian people, presupposes or entails that we are dividing the economy or the country. I have consistently tried to explain that the Bill is intended as an instrument to assist a particular group of the South African population because they have special needs to participate in that sector of the economy in which their participation has been little or totally lacking up till now. Therefore I believe it would be wrong, if I am correct that that need exists, that the shares may be held by other groups. Then I believe the point which the hon. member for Walmer and the hon. member for Randburg are making can have substance, namely that they could exploit the very people that we are trying to assist. Therefore I would suggest to the hon. member that he should accept my own point of view—and after all, I am in charge of economic affairs and of this Bill—that this Bill cannot be interpreted as dividing the economy and that the accent of this Bill is that there are special needs of a particular group of our population which needs attention, and that the Bill is the instrument to take care of those particular and specified needs of that particular group, namely the Indians. Therefore I cannot accept this amendment.

I immediately suggest that what we would like to see happen eventually is that this corporation, as happens in the case of the IDC, must initiate and assist the development of the Indian people in industry. It can do that by providing loans, guaranteeing loans and by taking up equities in companies, but the funds of this corporation must eventually become a revolving fund. As the loans are paid back, the money must be re-allocated to other projects in that particular field. If equity is taken in a business, and it is eventually making a profit and it is on its feet, then my own approach is that they must sell those shares to the Indian people and take the proceeds of the sale of those shares to initiate other development. That is the approach which I would like to see in this case.

Mr. Chairman, the problem which I still have is that in the case of the IDC they perhaps sell off the shares in subsidiaries, but they never sell shares in the IDC as such. Here we are envisaging a situation where shares in the Indian Development Corporation could possibly be sold off. I see a potential conflict of interest at that stage where there are certain shareholders being the State whose interest is to promote the economic needs of a certain socio-economic group and there are also other interests, namely the Indian shareholders, whose interests are to make as much profit as possible. I see in this a potential conflict of interests at some future stage. Does the hon. the Minister agree with me or not?

Mr. Chairman, I do not agree with the hon. member. I indicated during the Second Reading that I would eventually like to hand over this corporation to the Indian people, to be run by themselves, entirely on their own. That could best be done if those shares have been sold to them.

Amendment negatived (Official Opposition and Progressive Reform Party dissenting).

Clause agreed to.

Clause 21:

Mr. Chairman, I move the amendment standing in the name of the hon. member for Pietermaritzburg South, as follows—

Mr. Chairman, this clause deals with the accounts and audit of the Indian Industrial Development Corporation. During Second Reading we indicated that we believe that the moneys that are being made available to this corporation do, after all, come from public funds. Therefore, it is only right and proper that the audit should be carried out by the Auditor-General, and not by an individual professional auditor or auditors, people for whom, as we indicated, we have the highest regard.

Mr. Chairman, the Auditor-General, as far as I know, suffers from a shortage of staff. Therefore, I cannot see why his already overburdened staff should be loaded with more work than they have at the moment.

The Auditor-General should act as the watchdog over public funds!

Mr. Chairman, I shall come to the watchdog in a moment. If one looks at the Coloured Development Corporation Bill, one will find that it contains a provision similar to this one, namely that a registered accountant from a private practice is appointed. As far as we know, this works very satisfactorily in the case of the Coloured Development Corporation. Whilst the hon. member for Cape Town Gardens is talking about the watchdog, I want to point out to him that this clause which provides for the appointment of a registered accountant and auditor, is concerned with professional people from private enterprise. We in these benches would like to encourage private enterprise, and that is why we would like the hon. the Minister to retain this clause as it is. We therefore oppose the amendment moved by the hon. member.

Mr. Chairman, unfortunately I cannot accept that amendment. I think the hon. member knows that we have already discussed this particular facet, i.e. that of auditing the accounts of State corporations, ad nauseam. The fact remains that the Auditor-General does not audit the accounts of any State corporation because he does not have the power to do so.

In the case of control boards, the accounts of which are subject to audit by the Auditor-General, the Auditor-General, for the reasons mentioned by the hon. member for Walmer, does not even have the staff at his disposal to have those accounts audited by his own staff, and therefore that work is not done by his staff. It is in fact done by private auditors, but by contract. It is true that the auditing of accounts of Government departments have to be done by the Auditor-General, but in terms of the Exchequer and Audit Act it is not possible for the Auditor-General to entrust the auditing of the accounts of Government departments to private auditors. Two things are implicit in this. In the first place there is the fact that a situation may arise of the Auditor-General not having the staff at his disposal to do that work, and secondly, the private auditor, by virtue of his professional discipline and in terms of the Act under which he operates, is fully capable of providing all the safeguards required for proper auditing.

Question put: That the words stand part of the Clause,

Upon which the Committee divided:

Ayes—106: Aronson, 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, 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.; De Wet, M. W.; Du Plessis, B. J.; Du Plessis, G. F. C.; Du Plessis, G. C.; Du Plessis, P. T. C.; Du Toit, J. P.; Greeff, J. W.; Greyling, J. C.; Grobler, W. S. J.; Hartzenberg, F.; Hayward, S. A. S.; Hefer, W. J.; Henning, J. M.; Herman, F.; Heunis, J. C.; Hickman, T.; Hoon, J. M.; Hom, J. W. L.; Janson, J.; Janson, T. N. H.; Koornhof, P. G. J.; Kotzé, G. J.; Kotzé, S. F.; Kotzé, P. H. J.; Langley, T.; Le Roux, F. J. (Brakpan); Le Roux, F. J. (Hercules); Le Roux, Z. P.; Ligthelm, C. J.; Lloyd, J. J.; Louw, E.; Malan, G. F.; Malan, J. J.; Malan, W. C.; Marais, P. S.; Maree, G. de K.; Meyer, P. H.; Morrison, G. de V.; Muller, S. L.; Nel, D. J. L.; Niemann, J. J.; Nothnagel, A. E.; Palm, P. D.; Potgieter, S. P.; Raubenheimer, A. J.; Reyneke, J. P. A.; Rossouw, W. J. C.; Roux, P. C.; Schlebusch, A. L.; Schoeman, H.; Scott, D. B.; Simkin, C. H. W.; Smit, H. H.; Snyman, W. J.; Steyn, D. W.; Streicher, D. M.; Swanepoel, K. D.; Terblanche, G. P. D.; Treurnicht, A. P.; Uys, C.; Van den Berg, J. C.; Van den Heever, S. A.; Van der Merwe, H. D. K.; Van der Merwe, S. W.; Van der Merwe, W. L.; Van der Spuy, S. J. H.; Van der Walt, A. T.; Van der Walt, H. J. D.; Van der Watt, L.; Van Heerden, R. F.; 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.; Vlok, A. J.; Volker, V. A.; Vosloo, W. L.; Wiley, J. W. E.

Tellers: J. P. C. le Roux, N. F. Treurnicht, A. van Breda and C. V. van der Merwe. NOES—37: Bartlett, G. S.; Basson, J. D. du P.; Baxter, D. D.; Bell, H. G. H.; Boraine, A. L.; Cadman, R. M.; Dalling, D. J.; De Villiers, I. F. A.; De Villiers, J. L; De Villiers, R. M.; Eglin, C. W.; Enthoven’t Hooft, R. E.; Graaff, De V.; Hourquebie, R. G. L.; Jacobs, G. F.; Kingwill, W. G.;. Lorimer, R. J.; McIntosh, G. B. D.; Miller, H.; Mills, G. W.; Murray, L. G.; Oldfield, G. N.; Olivier, N. J. J.; Page, B. W. B.; Pitman, S. A.; Pyper, P. A.; Raw, W. V.; Slabbert, F. van Z.; Suzman, H.; Van Coller, C. A.; Van Eck, H. J.; Van Hoogstraten, H. A.; Van Rensburg, H. E. J.; Von Keyserlingk, C. C.; Wood, L. F.

Tellers: E. L. Fisher and W. M. Sutton.

Question affirmed and amendment dropped.

Clause agreed to.

Clause 22:

Mr. Chairman, clause 22 of the Bill deals with the information to be furnished by the Minister to Parliament and the shareholders. It does ensure, as is common practice in private enterprise, that the shareholders and those responsible can be kept informed by means of a completely audited set of accounts as soon as possible after the end of the financial year. I believe that while the clause makes this provision, it does not go far enough. If we are going to emulate private enterprise, I move the amendment printed in the name of the hon. member for Pietermaritzburg South, with the deletion of “four months” and the substitution therefore of “six months”—

I should like the hon. the Minister to accept this as it will ensure that Parliament and the public are speedily informed about the finances of the corporation.

I accept the amendment.

Amendment agreed to.

Clause, as amended, agreed to.

House Resumed:

Bill reported with amendments.

Mr. Speaker, I move—

From the outset the demands made on the Medicines Control Council for the proper implementation of the Medicines Control Act were exceptionally heavy. With the registration of any medicine the following facets inter alia, receive attention—analytical control, formulation, specifications and stability, manufacturing methods, physiological availability, animal experiments, dosing, toxicity, side-effects, clinical experiments and scheduling. This wide-ranging task is covered by six expert committees which perform this service on a part-time basis. Members of the council serve as chairmen of the committees.

The chairmen of the committees are expected to examine all the scientific documentation accompanying an application for the registration of a preparation and to prepare comprehensive reports from the comments and recommendations of their committee members for submission to the council. This task has assumed such proportions that the council has already been compelled to divide the work of one committee among two sub-groups, and virtually appoint two chairmen for the purpose. Similar problems are developing with other committees. The work-load has assumed such proportions that members have already raised objections and expressed misgivings, that a few highly esteemed committee members have already resigned and that council members have even indicated that if assistance is not forthcoming they will not be able to proceed with the task. Consequently the amendment in clause 1 is being proposed to increase the number of members on the council from 11 to 15, in an effort to alleviate the work-load of serving members.

Section 47 of the Mental Health Act provides that the period of service of the members of a hospital board shall be three years. As you know, the membership of a hospital board consists of persons from the community. Last year I appointed members of this House and the Other Place as members of hospital boards. I want to thank the members for the good work they are doing and for the interest they are displaying in mental health. As a result of the present provision the period of office of such members will expire on dates other than those which apply to members who had already been appointed. This could create administrative problems and consequently the amendment is being proposed in clause 2 to ensure that the period of office of all members expires on the same date.

Section 77(1)(o) provides for the making of regulations on the payment of fees and other expenses incurred in connection with the detention and maintenance of any person in a State institution. At present no provision exists for the payment of fees by any person for the treatment of patients. Last year it was decided, inter alia, that private patients may be admitted to State hospitals. The treatment of patients also takes place on an out-patient basis. Up to now the treatment has been completely free. The opinion is held that if a patient is able to make a financial contribution to his treatment as an out-patient as well, this should be made possible, and consequently the amendment of the relevant provision is being proposed in clause 3.

†Clauses 4, 5, 6, 7 and 8 deal with amendments to the Homeopaths, Naturopaths, Osteopaths and Herbalists Act, 1974. This Act is not applicable in the territory of South West Africa. Section 36 of the Medical, Dental and Supplementary Health Service Professions Act, 1974, the provisions of which are applicable in South West Africa, prohibits the practice of a profession which is not controlled in terms of that Act, with the result that a homeopath may not practise his profession in that territory. The Executive Committee of South West Africa has therefore made representations for the amendment of the homeopaths legislation so that the legislation may also be applied in South West Africa in order to enable homeopaths in the territory to practise their profession. Amendments to this effect are embodied in clauses 4, 6, 7 and 8.

Clause 5 makes provision for the deletion from the list of practitioners of the name of a practitioner who commits an indecent act with a patient. Should a practitioner commit an act with a minor girl, the name of such a practitioner could, under the present provisions, only be deleted on the third offence. I am of opinion that the name of such a person must be deleted on the first offence in order to safeguard the public against such unscrupulous practitioners.

Section 22 of the Pharmacy Act, 1974, empowers a body corporate registered as such with the S.A. Pharmacy Board at the date of commencement of the Act, to carry on business as a retail pharmacist in the Republic. No provision exists for the registration of new bodies corporate after the date of commencement of the Act to carry on business as retail pharmacists. Representations have been received from the Pharmacy Board that provision be made in the Act that pharmacists should, like most other professions, be given the opportunity to decide whether they wish to practise their retail pharmacies either as bodies corporate or as individuals under sole proprietorships or partnerships. The representations of the board are embodied in clause 9.

Section 22(1)(b)(iv) was designed to prevent bodies corporate, operating as retail pharmacists at the date of commencement of the Act, from acquiring further interests in retail pharmacies. This section provides that the board may cancel the registration of a body corporate if it disposes of the whole or any part of its interest in the retail pharmacy business in respect of which it is registered to a person other than a registered pharmacist. This sanction has not deterred bodies corporate from purchasing pharmacies owned by other bodies corporate and accepting that the registration of the selling company will be cancelled, or from purchasing pharmacies from pharmacists or from opening new pharmacies. In the circumstances any body corporate may extend its ownership of retail pharmacies without restraint and there are indications that some commercial and other organizations intend to expand in the retail pharmacy sphere. Such a development will be entirely contrary to the intention embodied in section 22(1)(b)(iv) and to prevent this, the new section 22A in clause 10 is proposed.

Section 49(1)(m) of the Act provides that regulations may be made regarding the training and registration of pharmaceutical technicians. It became apparent that the term “technician” could not appropriately be applied to the category of auxiliary personnel needed in the health services, and the board made representations that the provisions of the said section be amended so that auxiliary personnel, who would not require the standard of education and training that would normally be associated with a technician, could be included. The amendment of section 49(1)(m)(i), (ii), and (iii) in clause 11 is therefore proposed.

*The South African Medical and Dental Council has reconsidered the training of medical practitioners and decided to reduce the training period to five years, followed by a year of student-internship and a year of internship. To give effect to the resolutions of the council it is necessary to furnish a definition of the concept of “student-intern”, to make provision for the registration of student-interns, to provide that student-interns may perform certain of the duties of a medical practitioner and to make provision for the training of student-interns. Consequently the amendment of sections 1, 18, 36 and 61 is being proposed in clauses 12, 13, 16 and 18, respectively, to make provision for this.

As section 32 of the Act reads at present it contains an anomaly which lends itself very easily to erroneous interpretation, and the amendment in clause 14 is merely intended to clarify the matter.

In section 36 of the Act provision is made for the limited registration of medical practitioners, dentists and psychologists. A similar need exists in respect of the supplementary health service professions. The standard of certain overseas qualifications is not always acceptable, but if it is made possible for the possessor thereof to work for a period under supervision in the Republic, the possessor of such qualifications may in time acquire full registration. In this way it is possible to utilize such persons from abroad in the service of our country. Clause 15 makes provision for this matter.

Section 52 provides that a medical practitioner may, under certain circumstances, dispense medicines personally. Attention has been drawn to the fact that in the rural areas, where there is a tremendous shortage of medical practitioners and where no pharmacies exist, the time of the medical practitioner is occupied to such an extent with the dispensing of medicine that he does not have enough time at his disposal to give attention to his patients. To eliminate this problem the amendment in clause 17 is being proposed.

The council has, at the request of the Professional Council for Health Inspectors, made representations that provision be made for the practical training of health inspectors and the insertion of paragraph (viii) in section 61(1)(1) is being proposed in clause 18(b) to make provision for this.

The council received representations from universities that the council should give consideration to making the provisions of section 51, in terms of which the council may hold an inquiry into the state of health of a medical practitioner, applicable to students as well in order to take precautions well in time to prevent a medically unfit person from qualifying as a medical practitioner. The council has no jurisdiction over the enrolment of students at universities, and registration as student with the council is not a prerequisite for enrolment as a student at a university. Consequently such a provision would be almost valueless. It is appreciated however that the council does have a need for an authority to remove the name of a student and therefore provision to this end is being made in clause 18(a). The council and the universities should get together to thrash out the implementation of the provision in practice and to adapt the rules of the universities for admission of students accordingly.

In section 48 a professional council is being empowered to investigate complaints against supplementary health service staff. Section 48(3) provides that certain sections which are applicable to medical practitioners, dentists and psychologists should mutatis mutandis be applicable in respect of such inquiries as well.

Section 61(1)(r)(i), however, only empowers regulations to be made on inquiries held by the S.A. Medical and Dental Council in terms of section 41, and no provision exists that inquiries of such a nature may be regulated by a professional council by way of regulation. The amendment of the abovementioned paragraph is being proposed in clause 18(d) to supply this deficiency.

Mr. Speaker, the hon. the Minister has given us a very fair review of this Bill and an explanation of the necessity of the various changes that are to come about through this Bill. We on this side of the House will support the Second Reading. The amendments make up a rather mixed bag and several different Acts, hardly related to one another other than that they deal with health matters, are affected by this Bill. These include the Mental Health Act; the Homeopaths, Naturopaths, Osteopaths and Herbalists Act; the Pharmacy Act; the Medical, Dental and Supplementary Health Service Professions Act; the Medicines and Related Substances Control Act and so on. This, in essence, then, is really a Committee Stage Bill. There is no thread running through this Bill on the strength of which one can speak of the principle of this Bill. Therefore we on this side of the House shall deal with the various clauses as we core to them. I can tell the hon. the Minister that I do not think there are any clauses in this Bill that we shall oppose. We shall ask the hon. the Minister to explain the difficulties which, as we see them, may arise through the amendments before us.

Firstly I want to say to the hon. the Minister that, we shall support those provisions relating to appointments to boards. I think that what he has told us in this connection is perfectly correct. We shall also support the registration of members of affected professions and we shall certainly support those provisions which deal with ethical standards and standards of proficiency. I was quite amazed to learn that the standards that have existed up till now, as far as the ethics of the para-medical and the supporting health services are concerned, have been relatively low. How easy it has been for say a osteopath or homeopath to abuse his position. Before he could be dealt with in the past and struck off the roll as a member of that profession, he could commit an offence three times. That is quite amazing. Therefore I am so pleased that the hon. the Minister has come with this amendment to tighten up this rather grievous state of affairs that existed in the past.

The provisions dealing with pharmacists are aimed at preventing non-pharmacists from controlling or holding shares in a pharmacy. This brings the pharmaceutical profession in line with associated medical professions and with other professions as well. I am pleased that we have now reached the stage where a pharmacist cannot take a non-pharmacist as partner in his pharmacy—that is the essence of the amendment. Doctors cannot take non-doctors as partners and lawyers are similarly restricted. I am pleased that we have now reached the stage where it has been recognized by the hon. the Minister that the pharmacists should be brought into line with the provisions, which apply at the moment and, I hope, will continue to apply, to the effect that members of these professions cannot take, as partners, people who do not belong to the same profession.

The clauses dealing with the difficulties experienced by medical practitioners who have dispensing practices, may quite easily satisfy the doctors, but we must also think of the safety of the patient. I want to make it perfectly clear that I am not at all keen on opening up the doors in these professions to people who are not proficient and not properly trained. People who do dispensing work, and especially those who in terms of this Bill will now be permitted to do that work, must be skilled. The fact that a girl, who has passed Std. 8 and who is an enrolled nurse, will now be permitted to dispense those medicines listed in the first four schedules, may seem quite innocuous at the moment, but my good friend, the hon. member for Berea, has been good enough to provide me with the schedules concerned. I am certain that the hon. the Minister and his colleagues on that side of the House have no idea how very extensive the lists of medicines are that are contained in these four schedules.

I do not want to challenge the hon. the Minister to tell me what they are. I did not know what they were, and I am sure none of my colleagues know what they are. To expect a girl with a Std. 8 level of education and to expect a doctor who is going to give the job to the girl who has passed Std. 8 to accept the onus of dispensing these 10 or 12 columns of medicines, is expecting an awful lot. In this respect we must be very careful about what we are doing here, and I would say to the hon. the Minister that although we are going to agree to this, I want him to keep a careful eye on the effects of this legislation. I know of the difficulties that have arisen in country practices. I know quite well that where there is no pharmacist for five or six miles, and even greater distances sometimes, it is very difficult for the doctor to have to go back each time to his surgery to do the dispensing there, and then to have to go back to the farm or other remote place where he has seen the patient. It is very difficult, but as I said earlier, we want skilled people to do this type of work, and in fact all work associated with health matters. I do not really want to be a party now to opening up the doors for the less skilled. However, I am prepared to meet the exigencies as they now exist and I am quite realistic in this matter. Therefore I say to the hon. the Minister: Let us try it and see what happens. But at the same time I want him to be careful and to be sure that no accident takes place, because it is quite easy for accidents to happen.

Having said that, there are one or two other points I would like to bring to the attention of the hon. the Minister at this stage. In the Committee Stage I am going to ask the hon. the Minister to explain what the position is, or what he contemplates the position will be in the matter of treating private patients in mental hospitals. At the moment, if I am correct, I understand that in the State institutions there are no private patients. There are voluntary patients and those who are looked after by the State who have been committed there by the State. If my knowledge is correct, then only State physiatrists, doctors associated with the hospitals, are allowed to attend to those patients. I also understand, and I may be wrong in this respect, that even in those places where there is an out-patients’ department for voluntary patients to come and see a psychiatrist, the patient is seen by a State medical officer. With this amendment which is being introduced this afternoon, will it be possible for a man to be treated in a State institution as a private patient and to have his own private psychiatrist attending him at that hospital, either as an in-patient or as an out-patient, and will the private psychiatrist then be entitled to charge a fee for attending such a patient.

This is an important matter with which we have to deal and I think we may find that as the years proceed, we will find a greater and greater demand for accommodation at State institutions, because I know how terribly expensive it has become for a private patient to be admitted and looked after in a private mental institution and to be looked after by a private psychiatrist. The ordinary man in the street cannot afford this sort of thing, but if there is an opportunity for that person, especially in the towns where there is an institution, of being attended to by a private psychiatrist with a reduction in the cost of keep and hospitalization, it will be a great thing for the patient and it will relieve the pressure on the institution doctors. They will be able to devote more time to those patients who are housed there. I do not know how the hon. the Minister feels about this. When he replies to the Second Reading, he can perhaps explain the matter to us.

Another matter which I would like the hon. the Minister to clarify, is the question of what is to become of persons who have been practising for 20 years or more in some of the associated medical or para-medical professions. I think, for instance, about opticians. We all know opticians who have their shops, who have been selling glasses, who have been testing eyes, for 20 years or more. Now they are faced with a very great difficulty. Some of these people are already in their 60s. They are now faced with either going out of business—in many cases after 30 years or more—or having to start studying to write exams so that they can retain the right to practise as opticians. These are not optometrists. They do not profess to be fully qualified people. I wonder if the hon. the Minister is not able to stretch a point here and to allow these people to continue in their practice. It is only a small group, really. They are phasing out. They are phasing out because of age and not because they want to give up their professions. I am hoping that the hon. the Minister will be able to do something for these people in order to allow them to continue in their practices. I have never known of any cases really where they have done any harm. They supply a pair of spectacles after carrying out the various tests, and I believe that some of them, through experience, have been able to know what eye conditions require specialist treatment. They have no hesitation in sending such patients to the specialists. I wonder if something cannot be done for them. Perhaps the hon. the Minister has something in mind.

What I have just said, is probably in conflict with what I said previously about opening up the doors to the unskilled. However, I believe that this is a different category of persons altogether. These are not persons just entering this profession. These are people with a great deal of responsibility, experience and I am hoping that they will not be put into the same category as those not really fully trained people whom I have already referred to, those who are doing dispensing and so forth.

Relating to the appointment of members of boards, I also have a point that I want to raise. I know that the hon. the Minister will understand when I say this to him. I have been looking at the appointments to hospital boards and other boards, and I wonder why—he does not find place for more English-speaking people on those boards. I have no complaint about the work done by the people who have been appointed to those boards. I have no complaint about that at all. In the main, these people are really diligent and capable. They apply themselves well to their work. They take a pride in the work they are doing. However, at the same time I think that the hon. the Minister must consider the fact that there are a very large number of people who are English-speaking and who would also like to be given an opportunity of serving on the various boards. I want to ask the hon. the Minister to have a look at the Gazette sometime and to go through the list of names. The hon. the Minister should do that, and I say, in all sincerity, that he will be amazed to find how few English names there are on these lists. I think the time has come for the hon. the Minister to give a lead in this matter and to start asking some of the English-speaking people to take the responsibility as well and serve on these boards. They will grab the opportunity, and I am sure they will do just as well as those people who are doing it at the moment.

Do not ask for crumbs; ask for a fair deal.

I am not going to have an argument, because I know that the hon. the Minister is very sympathetic about it But sometimes it just happens that from the group of people that are available very few English-speaking persons are chosen. I know that it especially happens in the country areas. In the larger centres where there are people who speak the other tongue, they should also be given the chance to serve.

With these few remarks I want to conclude. The hon. member for Berea will enlarge on those matters dealing with pharmacists. I want to say again that we will not hinder the passing of this Bill except that during the Committee Stage we will deal with one or two matters which I think need clarifying.

Mr. Speaker, I should like to thank the hon. the Minister for his clear statement of the aims of the Bill. My party will support the Bill. I just want to make a few remarks and put a series of questions to the hon. the Minister in respect of some of the clauses.

It is clear that there were deficiencies in the sections now being amended. The amendment Bill is now rectifying these deficiencies. I should like to know why these deficiencies were permitted to occur in the first place. Various improvements are being effected by the Bill. These improvements will be welcomed by the profession, too, and will result in a better service to the public.

In the first place, I want to put a question in respect of clause 5, which inserts the words “commit any indecent act with any patient” into section 5(1). I should like to ask the hon. the Minister whether it would not be advisable to provide a definition—not necessarily in the legislation, but perhaps by way of regulations—of “indecent act”. This would furnish guidance, both to the profession and to those patients who may be the victims of such acts.

I also want to refer briefly to clause 9, which deals with the Pharmacy Act. I want to ask the hon. the Minister whether the effect of the amendments could not perhaps result in encroachment upon the principle of free enterprise as far as pharmacists are concerned. The position is that pharmacists are people who sell commodities to the public, and if the control measures applying to the commercial activities of pharmacists be taken so far, this could perhaps result in a degree of encroachment upon the principle of free enterprise.

The next clause I want to discuss is clause 15. Mention has already been made this afternoon of supplementary health professions. As regards the provision made in the clause for the temporary registration of supplementary health service professions and the activities of those involved therein, I want to put the following question to the hon. the Minister: What provision is being made to protect the public against any harm they may suffer as a result of this? In other words, what recourse do the public have if they should suffer harm due to services rendered by one of these supplementary professions?

The last clause to which I want to refer concerns those areas where a pharmaceutical service is not available and where a pharmaceutical service is provided by the staff of a medical practitioner. I do not associate myself with the argument advanced by the previous speaker, namely that one cannot depend on the reliability or ability of a qualified nurse. A qualified nurse is a person who is concerned every day with the life and health of people. As a result one can accept that a qualified nurse is a person with a sense of responsibility and is a person who will not neglect her duties, but will carry them out successfully and faithfully. The argument I want to advance is that the problems or misgivings voiced here could quite probably be eliminated if provision were made on some basis for supplementary or additional training of nurses entrusted with this task and responsibility. Whereas I have no misgivings as to the sense of responsibility or the ability of qualified nurses, I want to suggest that where such nurses have to perform these additional duties and services, the hon. the Minister should consider giving attention to a course of some kind which would afford such a nurse additional knowledge, ability and qualifications so as to inspire confidence in the public in this respect as well.

Mr. Speaker, I gratefully note that the two hon. Opposition spokesmen who have just made speeches support this Bill in principle and in substance. Naturally—as the hon. member for Rosettenville rightly observed—there is no continuous principle in this Bill and one must, of necessity, confine oneself to a few clauses. I want to comment, however, on only one facet of the Bill which the hon. member for Rosettenville dealt with here when he spoke of the inherent dangers in the situation, namely that medical practitioners’ receptionists with inadequate qualifications would now have to bear the responsibility of making certain medicines available to the public, on the responsibility of the medical practitioner concerned, of course. The hon. member made a great song and dance about the dangers and the long list of such medicines. It is a fact, however, that not many of those medicines are to be found on the shelves of medical practitioners who administer their own medicines to patients. In practice we normally find that a medical practitioner has a few remedies on his shelf and that he familiarizes his staff with the relevant dangers and instructs them in the use of those preparations. I do not think there are any real dangers involved, although I agree with him in principle because one does not want unqualified persons to handle dangerous preparations. The simple fact, however, is that in practice, particularly in remote areas, one finds that the medical practitioner or the hospital has no other choice but to make use of the services of these people. I do not think, however, that the dangers the hon. member envisages are are serious as he supposes.

The hon. member for Bryanston spoke here of the spirit of free enterprise which would be damped by the implementation of clause 19. There can be no question whatsoever of an absolute spirit of free enterprise in any profession. Whenever a profession enjoys the protection of the law, there are also certain things the profession must do in return, not only for its own sake, but also for the common good.

During the 1974 Parliamentary session, a long-cherished ideal of the Pharmaceutical Society was eventually realized when the Pharmacy Act was accepted in the House. In the Act effect was given to the idea that pharmacists have a right as, a professional group, control their own affairs and effect was also given to the professional status of pharmacists. The Act also gave effect to the profession’s desire for self-determination. The Act made, inter alia, the following provision: A Pharmacy Board was established and this exercised control over interests peculiar to pharmacists. Secondly, protection was afforded to the pharmaceutical profession against unfair competition by lay organizations or by novice business institutions in the sale of medicines. Thirdly, section 23 of the Pharmacy Act, in particular established the sound principle that retail pharmacies could only be owned and run by people qualified and competent in the pharmaceutical profession.

In motivation of the principles laid down in the legislation at that time, I might mention that owing to their professional training, pharmacists are best equipped for the preparation and sale of medicines. Secondly, owing to their professional status and their importance in the whole chain of health services which have been established on a sound basis in our country, it is only fair that the pharmacist should look after his own affairs and make his own decisions about the profession’s ethical norms and codes of conduct.

As soon as novice outsiders have a say in the running of the pharmaceutical practice, the right to self-determination is prejudiced. Improper pressure and influence may be exerted—in fact this has occurred—by lay members of the managements of such pharmacies and by lay shareholders of such pharmaceutical undertakings. Improper pressure upon, and the influencing of, professionally trained people have also occurred. This has brought many a pharmacist into conflict with his ethical norms and his codes of conduct because of his attempts to adhere to his codes of conduct and promote the interests of his shareholders and directors at one and the same time. The laymen who are not actively involved in the profession, and who have not been trained in the profession’s traditions and practices, cannot fully understand or properly apply the finer nuances of pharmaceutical ethics. Consequently laymen cannot be allowed to exercise control and authority in this regard either, in a profession in which high standards of training, ethics and codes of conduct are an absolute requisite.

In the second reading speech of the hon. the Minister of Health when the principal Act was being considered in 1974, he indicated that the position of pharmacists would be closely observed and that he would not hesitate to introduce legislation if that profession did not also play its part in putting its house in order. In fact, he felt so strongly about it that he mentioned in his speech that he was holding a sword of Damocles over the profession in an attempt to urge them to put their house in order.

It has now come to light that attempts are increasingly being made to disrupt and frustrate the whole spirit and drift of that legislation, particularly in regard to the protection of the profession against infiltration by lay members. It is apparent that various wholesale chemists, who should actually be occupying themselves with the preparation and manufacture of medicines and with research, are beginning to concentrate on the establishment of retail pharmacies. These wholesale concerns are not under the exclusive control of trained and qualified pharmacists. Many of the shareholders and directors of these companies are lay members who concentrate on the profit motive. This is entirely contrary to the aims of section 22 of the principal Act, in particular, and completely thwarts the object of that provision.

Consequently clause 9 of the Bill under discussion aims, inter alia, at removing this shocking condition and this anomaly. In future, therefore, unless all their shareholders and directors are pharmacists, wholesale pharmacies will not be allowed to run retail businesses. To that end, pharmacists are now also being empowered to organize themselves into companies which have to be in the exclusive possession and under the control of such people. Clause 9 re-emphasizes and perpetuates the exclusiveness and professional status of the pharmaceutical profession, an ideal this profession has been endeavouring to achieve for many years.

It must be remembered that during the debate which took place with the introduction of that Bill, an appeal was repeatedly made to the pharmaceutical profession to put its house in order in regard to the sale of articles which are not normally and traditionally the province of pharmacists. It was emphasized repeatedly that when their professional status is assured and they are protected against unfair competition from laymen, they must voluntarily discipline themselves and adapt their commercial practices to the new concept of professional pharmaceutical conduct. Moreover, the sale of goods other than the normal articles traditionally sold by pharmacists, was to cease immediately. The Pharmaceutical Society adopted an official standpoint on this principle and, in fact, actively assisted in activating its members and encouraging them to relinquish this practice. A pharmacy is not a place where cars, refrigerators, stoves etc. should be sold. In a pharmacy one expects to find medicines, cosmetics, baby foods and related items. In fact, in that debate the Minister also made an earnest appeal to the pharmacists of our country to take steps to do away with this anomaly.

My own observations have shown me that the pharmacists of South Africa reacted to this appeal almost dramatically. It was my observation that a complete metamorphosis took place virtually overnight, and it was again a pleasure to walk into the majority of the pharmacies and see these people engaged in what they were trained for and to see that the articles which they were selling in their establishments, had some bearing on their profession as pharmacists.

Unfortunately, as in any society, there are also some stubborn elements, people who rebel against appeals to abandon such practices. I think that some attention will soon be focused on those people and I think they ought to heed the repeated warnings that if they do not want to abide by the wishes of the majority of their colleagues and confine themselves to selling what pharmacists traditionally sell, they must expect action to be taken against them, even if this had to be done by way of legislation. In this regard it is also the bounden duty of the Pharmaceutical Society to give urgent attention to this matter once again to bring these stubborn colleagues of theirs to a better understanding of the situation.

The Government cannot be a party to a situation in which a particular profession enjoys legislative protection, with all the advantages inherent in such a situation, whilst allowing certain members of that profession to exploit the situation and refuse to abide by the undertaking of the majority of their colleagues, thus gaining an unfair advantage from their competition with their colleagues. Legislative protection requires a quid pro quo. These people enjoy the protection the Act affords them and therefore they, too, can be expected to make certain sacrifices in this regard.

I briefly want to refer to clauses 12, 13, 16 and 18 which now give effect to a completely new concept in the training of medical practitioners. This concept has arisen as a result of the adaptation of our medical school syllabuses to modern demands. Here I am referring to the expression “student intern” which is being embodied in legislation for the first time. In clause 12 provision is being made for the registration of the student intern. The creation of the concept “student intern” is a very important development in the field of medical student training. Hon. members are probably aware—in fact, the hon. the Minister has referred to this—that the period of academic training of medical students has been shortened from 6 tot 5 years. At the end of their 5th year their formal academic training is concluded and the 6th year is used for the practical training of the student in the hospital wards, operating theatres and outpatient departments of our hospitals.

This is a step forward which can only lead to the more purposeful and effective training of our medical students. In the past few years, one has unfortunately and involuntarily begun to get the impression that our medical schools are placing increasing emphasis on the academic training of our medical students. In the training programme the emphasis has, more often than not, fallen on the specialist instead of on the general practitioner. It is therefore gratifying to note that this new concept shows signs of this tendency being reversed and of attention once more being given to the practical training of a medical practitioner so that he can, first and foremost, take his rightful place in general practice. The general practitioner can and must still be regarded as the backbone of the medical profession. We are grateful for the attempt by our medical universities, in this regard, to train more practically orientated medical practitioners. It is therefore gratifying to note that this specific concept is now also being laid down in legislation.

Mr. Speaker, the hon. member for Cradock has, in my opinion, always shown that he has an awareness of, and a sympathy for some of the problems which have beset retail pharmacy in particular and the pharmaceutical profession in general. He referred to the famous sword of Damocles speech made by the hon. the Minister in 1974. I can assure him that the clang of the impending fall of that sword has echoed and re-echoed through the halls of pharmacy. I know that there are many people in the profession who took very seriously the remarks made by the hon. the Minister at that time, and that the statutory body, the S.A. Pharmacy Board, and the voluntary body, the Pharmaceutical Society of South Africa, have sought conscientiously and sincerely to try to overcome some of the commercialized aspects of pharmacy and to make our profession more the profession which both the hon. member for Cradock and I feel it should be.

I should like to refer to the hon. member for Bryanston who raised the question of the free enterprise system. While he addressed his inquiry to the hon. the Minister, I feel I should like to place on record certain of my own thoughts on the matter. I do not believe that there is any intrusion into the free enterprise system as far as the terms of this particular Bill are concerned. I say this advisedly, firstly because it has to do with the pharmaceutical profession which, as a professional body, it is bringing into line with the medical profession and the legal profession in that it gives them the right to work together as professional people but does not allow lay-people to be associated with the profession for gain. If the hon. member for Bryanston is suggesting that it would perhaps interfere with the free enterprise system in so far as prices are concerned, I know that there are some people, who in my opinion are not sufficiently aware of, or informed about the situation, who believe that this Bill might result in an increase of price in regard to professional services in pharmacy. I think it should be placed on record that, so far as medicines normally ordered on prescription are concerned, viz. what are referred to as ethical medicines, the pharmacist himself has no power to fix prices in that field. Those prices are fixed by the manufacturers of the medicines concerned and, although I am open to correction, I understand that these manufacturers are under fairly strict surveillance by the Price Controller. As regards the medicines that fall within the ambit of the dispensing schedule, I believe there is constant negotiation between the Pharmaceutical Society, the Department of Health and the Price Controller and that, before any changes are effected, it is an obligation on the S.A. Pharmacy Board to approve of those prices. Therefore I do not believe that any complaint in that respect is valid. One point I would like to put is that, as far as the pharmacists are concerned, many of them are operating under the Medical Schemes Act at the present moment in that they are supplying medicines in terms of the dispensing tariff laid down and accepted. They are therefore not in the advantageous position of other professions who, if they feel that the remuneration they receive is not adequate, opt out and then formulate higher tariffs, which means that they can charge more and receive more remuneration. However, if the pharmacist does not charge the standard price for the medicines he dispenses, he would not be paid through the organization which administers the payment for the medical schemes.

The hon. member for Rosettenville referred to this Bill as a Committee Stage Bill. I agree with him wholeheartedly, but I do believe that two principles are involved and that, in the practice of these two principles, there could be two different effects. I feel that, under those circumstances, I have a duty to put that point of view to the hon. the Minister. As far as clauses 9 and 10 are concerned, they have been dealt with by the previous speakers and are in connection with bodies corporate. I must say that, as I see it, these clauses place the intention of the principle of the Act accepted in 1974 beyond doubt. They are acceptable to the pharmaceutical endeavour in general. I can assure the hon. the Minister that the pharmacists themselves will continue to bear in mind his plea in his “sword of Damocles” speech and they will continue to try to raise the ethical standards of pharmacy as a profession.

Clauses 9 and 10, I must say, give me a certain amount of satisfaction, because I am aware that for the last 40 years the pharmaceutical profession has sought to receive the legal protection which I believe has been satisfactorily embodied in the amending Bill today and which is found in terms of the long title of the Act itself, the Pharmacy Act of 1974, because it says, inter alia, “to provide for the control of the practice of the pharmaceutical profession”. I believe that these amendments do just that. They close a loophole which existed in so far as retail pharmacy is concerned and they do not prohibit the free enterprise system in so far as the manufacturing or wholesale sections of pharmaceutical endeavour are concerned.

I feel that to a certain extent the practice of pharmacy at this particular moment in time is slightly inhibited because of an uncertainty, which could well be attributed to the fact that a commission, constituted by the Minister of Economic Affairs, is sitting at this moment. This commission, on the pharmaceutical industry, has been sitting since September 1975 and as far as I know there has been no report. I think that a question mark hangs over the profession as to whether there could be any significant repercussions in the various facets of the profession as a result of the recommendations which might flow from this particular report particularly in so far as the economic aspect is concerned.

I would like to refer briefly to clause 11, which is the regulations clause. As previous speakers have said, it deals with the question of pharmaceutical technicians and it makes provision for regulations to be framed in consultation with the S.A. Pharmacy Board, as well as making provision for other pharmaceutical auxiliary personnel. I have made inquiries and although the provision for pharmacy technicians has existed, as far as I know, for some considerable time in the Act, there is no register and there are no pharmaceutical technicians registered whatsoever. I appreciate that the sphere of activity of a pharmaceutical technician would not in any way assist with regard to the problem which the hon. the Minister has in regard to the creation of this particular form of personnel. I am disturbed, however, because the hon. the Minister made it clear in his speech, that they, i.e. “other pharmaceutical auxiliary personnel” will have a lower standard of education and a shorter period of training. This does imply to me that the door will be opened to a lower grade of people who will be able to perform some function which otherwise might be reserved for pharmacists themselves. I shall come back to that a little later.

The other aspect also has to deal with the question of the inroads or intrusion by other people into the preserves of a qualified pharmacist, and we find that in clause 17 of the Bill. This of course is an amendment to the Medical, Dental and Supplementary Health Services Act, but it does have a very significant effect and implication in so far as pharmacy is concerned. My colleague, the hon. member for Rosettenville, made reference to it and said it was not our intention to oppose the Bill. If the hon. the Minister will be accepting some of our carefully considered amendments, there will be no possibility of our even having to consider the possibility of opposition. However, there are certain aspects that I want to put before the hon. the Minister. I would like in the first instance to quote the side note to clause 17 in the Bill so as to clarify the position. It reads—

I do not want to read the whole clause but, to paraphrase, in effect, it gives the Secretary for Health, if he is of the opinion that the consulting room of a doctor is not within a reasonable distance of a pharmacy, the right to grant authority to a person who is registered or who is enrolled as a nurse to supply any person under the direction of the doctor. I am putting it broadly, Sir. This opens certain avenues, and I think that I should bring to the attention of the hon. the Minister the difficulty that I have during this Second Reading stage because once this Bill has passed the Second Reading, the principle will have been accepted. I want to refer, in the first instance, to section 52 of the Medical, Dental and Supplementary Health Services, Professions Act, 1974. As I see it, there is no doubt in my mind as to what section 52 means. It is in chapter V of the Medical, Dental and Supplementary Health Services Professions Act, and it says—

It continues about his partner, etc., and concludes by saying—

Now, the hon. the Minister has indicated that in certain areas a medical practitioner is so heavily engaged that he finds it difficult to undertake the routine supply or dispensing of medicine. In this amending clause—clause 17—the hon. the Minister seeks to find a way of assisting the medical practitioner in this problem. However, I find it difficult to equate the fact that this amendment will allow a person with Std. 8 and two years’ training to handle drugs right up to schedule 4. The hon. the Minister knows that there are nine schedules in the Medicines and Related Substances Control Act. Two of them refer to banned substances, in any case, so that they can only be supplied by the Minister or by his secretary under permit. Of the seven schedules, four schedules will now be made available for a person with Std. 8 education and two years’ training to supply under the direction of a medical practitioner. It need not be in his presence.

Mr. Speaker, let us have a look at the schedules. The first schedule is described as similar to the old Division Two poisons, and as the hon. member for Rosettenville has said, it lists a great number of substances. The second schedule refers to what used to be the old Division One poisons—more potent substances, though. Schedule 3 deals with substances like insulin, thyroid, digitalis, etc., substances which have to be supplied on a written or verbal prescription. Only a pharmacist can supply them on prescription. They must be entered into a prescription book. Then, we come to schedule 4, which is really the dividing line, the line over which the new personnel will not be able to transgress. There we find antibiotics, sulphonamides steroids, etc. These substances a pharmacist can dispense on a written or verbal prescription, but the verbal prescription must be followed by a written prescription within seven days. It seems to me that if these conditions apply, the classifications subcommittee of the Medicines Control Council is aware of the fact that these substances require care in handling and in administration. I do not believe that in this clause I can see sufficient control being exercised.

However, I want to go further. I want to refer the hon. the Minister to the Pharmacy Act. In section 29(2) it lays down the acts deemed to be specially pertaining to the profession of a pharmacist. It then mentions, inter alia—

The compounding or sale or supply of any medicine on the prescription of a medical practitioner or dentist…

It goes on to list the various persons, apart from the pharmacist, who are entitled to supply or dispense medicines. It also indicates that the keeping of medicines is permissible by a medical practitioner, and makes provision for the employment, under the supervision of a pharmacist, of a trainee pharmacist who may dispense. However, it is interesting to see that even the trainee pharmacist is limited. A trainee pharmacist is a person who must, first of all, have obtained a matriculation exemption. Further, he must have attended a university or college for advanced technical education and completed a four year course. In terms of the Medicines Control Act the trainee pharmacist is not allowed to dispense a schedule 7 substance, excepting under the personal supervision of a pharmacist. Here we have a restriction placed on an individual who has done four years’ training, who has done practical dispensing in his training and is now doing one year’s training in a retail pharmacy, in that only under the supervision of a pharmacist is he entitled to dispense a schedule 7 drug. On the other hand we have antibiotics, sulphonamides, etc., being supplied under the direction, not even supervision, of a medical practitioner. I think it goes too far because section 29(3)(d) of the Pharmacy Act, which lays down certain circumstances under which members in the armed forces may receive medicines, provides for—

In subsection (4) of the same section of the Pharmacy Act, it states that—

In the Bill we see no provision for consultation with the board and it would seem that it rests entirely at the discretion of the Secretary for Health. I have the greatest respect for the present Secretary for Health and I believe that he enjoys the complete confidence of everybody in the House in the manner in which he has administered his functions as Secretary for Health. However, he will not live for ever, and at some time there may be another Secretary for Health who may not be as objective or as fair as I believe the present Secretary to be. Then we will have this provision applied solely at the discretion of the Secretary for Health. It will mean in effect that he can decide what a reasonable distance is. I understand that should a pharmacy be established within a reasonable distance, the dispensation given to the doctor will automatically fall away, but it does not actually say that, although it may be implied. We intend to move an amendment in the Committee Stage in which specific provision will be made that this right will automatically fall away when a pharmacy is established within a reasonable distance. I trust that the hon. the Minister will in that respect give very careful and sympathetic attention to the amendment which we intend to move.

I want to come back to the schedules for a while. They are very complicated. The hon. member for Rosettenville reiterated that. I see all sorts of problems which may arise. The hon. member for Rosettenville said that if a doctor had to go away to a farm to visit a patient it was very difficult for him to go back to his dispensary to get the medicines and supply them. I can see the problems and understand all the difficulties. However, let me take a case in point. We have these seven schedules and I cannot see how a doctor can keep in his mind which particular schedule all these drugs happen to fall into. I have been told by somebody who is very highly placed in pharmacy that there are about 12 men in the Republic who fully understand and are completely au fait with all the ramifications of these schedules. The pharmacist takes certain precautions. In his pharmacy he has a range of medicines on his shelf. They are marked by law according to their particular schedule and there is furthermore a provision that where a person is being trained in a pharmacy, it is compulsory for that pharmacy to have an up-to-date copy of the Act and the regulations to which the trainee can be referred.

My problem is that all these conditions exist for the safety of the public. In terms of this proposed new section, if a doctor in a country area is called out to a farm within a reasonable distance of his consulting room, he examines the patient and then says: “I would like somebody to go to my consulting rooms to fetch such-and-such a medicine.” This is fine, as long as it is within schedule 4, but in his wisdom he may feel that this person needs more urgently a schedule 5, 6 or 7 substance. Is he, when out on the farm, in a position to judge what schedule the medicine falls under and is it fair to expect a person with a Std. 8 education, a minimum of training, to have the responsibility of supplying it? I do not think it is. I want to put a suggestion to the hon. the Minister in this regard. Our amendment makes it quite clear that we feel it is undesirable for an enrolled nurse to do so, but we are prepared to meet the hon. the Minister’s difficulties by saying that he should have a registered nurse, i.e. a sister or a registered nurse with a greater degree of training and a higher degree of education.

I believe, however, that there is another way in which the hon. the Minister can assist in this. I think I am correct in saying that in so far as some of the outlying areas are concerned, the department, in order that medical services may be provided, subsidizes a medical practitioner to go there to render essential services. I have here a copy of the Government Gazete—it is not an up-to-date one—which deals with vacancies for part-time district surgeons. When one sees that in a place like Dendron in the Transvaal—I do not know where Dendron is—the salary per annum for a part-time district surgeon is R10 800, that his drug allowance is R10 200 and that he is also entitled to undertake his own private practice, I believe that something should be done so that we do not have this differentiation between the people in the cities—who are safeguarded, because there pharmaceutical services are able to provide a service in full compliance with all the regulations laid down—and people in the country areas who run the risk of finding themselves having drugs supplied to them which may or may not have been duly checked by the person who has authorized their supply.

My suggestion is that just as the hon. the Minister and his department appear to have been able to make it possible for district surgeons to function in out-of-the-way places, when normally it would be difficult for them to make a viable living, it should be possible to subsidize pharmacists on a much lower financial basis, so that they will be encouraged to open pharmacies in these areas with the knowledge that at least they will have a firm and predetermined income on which they can rely until such time as they are able to build up a reasonably viable professional business. I believe that if the hon. the Minister gave thought to that, he would overcome one of the big difficulties existing in the pharmaceutical profession and that is the disproportionate location of pharmacies. One has 20 or 30 pharmacies in Sea Point alone and not one in Loxton. With sympathetic understanding and assistance by the hon. the Minister the time could arrive where there would be an outflow from the cities to the platteland areas of people who would be prepared to render a pharmaceutical service which would be in keeping with the intention of the schedules which have been laid down by the Medicines Control Act. I put that suggestion to the hon. the Minister for his sympathetic consideration.

Mr. Speaker, if one agrees with legislation, one must say so and have done with it. If the hon. member, who has just sat down, had been more familiar with the rural areas, he would have made other proposals in this content. I do not believe a pharmacist would be able to open a pharmacy at Dendron and make a decent living from such an undertaking. I have some sympathy with the hon. member in the sense—this is how I read the legislation as well—that it is not the intention of the clause, which he devoted so much time to, that medical practitioners should get nurses and other women to issue medicines if there is a pharmacy within easy reach of his practice. I do not think this is the intention, nor do I read it as such. This is simply to assist those people who must travel long distances in order to reach a medical practioner and who possibly have to telephone in order to obtain medicines. This is how I should like to see it.

I should like to make an observation about the form of the legislation before the House. It is what we could almost call an omnibus Act of the Department of Health. Normally the Bill would be covered by the General Law Amendment Bill. However, here a general amendment Bill has virtually been created for the Department of Health itself. I think the Bill is serving a good purpose in that it puts all health aspects in one hat.

I want to make an observation about the expansion of the Medicines Control Council. It was our privilege this morning to make a tour of some of the factories in the Cape Peninsula where medicines are manufactured. It was worthy of note that the chairman of the Pharmaceutical Society and certain factory managers made it known how proud they were of the Medicines Control Council. As far as they could judge, the Medicines Control Council and the control it exercises is better than anything anywhere else in the world. This is an exceptional development and I should like to believe—it was also my privilege to visit one of the factories about 8 years ago—that the development that has taken place can be attributed to the large contribution the Medicines and Related Substances Control Act made in that regard. This is what people tell me and they are very satisfied with it. Firstly, they are satisfied because they believe that approachable people serve on the Medicines Control Council. The people believe that under the control of the Medicines Control Council they are making particularly good progress in the manufacturing of medicines and quality control because the door of the Medicines Control Council is open to all manufacturers so that they can talk to one other and iron out their problems. If the Medicines Control Council were to have so much work that it could not cope with it all, it would be necessary to increase its staff complement, and I think hon. members ought to support us in this.

Another aspect which indicates the same developmental tendency is that of medical progress in South Africa. A new term is created in the legislation, viz. medical intern. For the sake of the uninformed, let me just point out that during the past 2 years a completely new syllabus for the training of medical students has been introduced under the auspices of the Medical Council. The training is very intensive and is more practically orientated than it previously was, so much so, in fact, that from the first year onwards a student no longer studies the normal routine subjects of the university, but begins studying medical subjects virtually from the start. The student completes his course within 5 years and in his 6th year—the course is therefore not being shortened—he works in a hospital as an intern. However, the young man or woman concerned is not yet a medical practitioner. He works in the hospital under the supervision and guidance of his lecturers. It is for that reason that a new name has become necessary. Such a person is registered with the Medical Council as a “student intern”. After that, in his 7th year, he must serve his internship at any approved hospital. I am therefore pleased to support this Bill because I see it as being indicative of development and progress.

Mr. Speaker, we on this side of the House support this Bill. We also support particularly the clause that refers to the uniform termination date of service on hospital boards. I think it is also appropriate to say at this stage that we, and I am sure all other members in the House, appreciate the work that is done by hospital boards. I served on a hospital board for some years and it was the first experience of anything medical that I have ever had and it was also the last. Service on a hospital board brings members of the public into touch with the working and the staff of the hospital to the mutual benefit of both of them. I hope that the work of hospital boards will be expanded and that the system will be improved in time because I think there is room for improvement.

In conclusion I want to refer to the remarks made by the hon. member for Rosettenville in regard to hospital boards. The hon. member is a distinguished member of this House and he always couches his pleas in moderate terms and I think he couched his pleas this afternoon in an appropriately moderate term when he said that he felt that there were not enough English-speaking people serving on hospital boards. That is his way of expressing himself and that may be his opinion. The hon. member for Sandton, on the other hand, made an interjection and he said: “Do not ask for crumbs; demand a fair deal.” That typifies the attitude of the hon. members sitting on my immediate right. They always provide radical opposition and there must always be confrontation of some sort or another, even in a sensitive field such as this.

Is a fair deal radical?

Our attitude is simply this. I have said that the hospital boards serve a good purpose. I believe that those people of a community who have the ability to serve on a hospital board, should be asked to serve on that hospital board on a basis of merit and irrespective of what language they speak. As far as language is concerned, the criterion, in my opinion, for any person to accept service on any public body, starting with Parliament, the provincial councils and all other bodies, is the ability to speak both languages. As far as we are concerned people with the ability to speak both languages should be given the opportunity to serve on hospital boards, regardless of whether they have Afrikaans or English-speaking backgrounds. The service that they are able to render on the hospital board should accordingly be measured in terms of their merit and their ability to speak both languages.

In conclusion I want to associate myself with the appeal made by the hon. member for Rosettenville for the recognition of the good work that has been done by what he called para-medical services, such as opticians. As he has said, there are a number of elderly people who are opticians in South Africa and it is hoped that they will not be put out of business in terms of this Bill.

Mr. Speaker, I first want to thank the hon. member for Rosettenville. As usual he again made a very constructive contribution this afternoon. He raised a few matters which I think I will not answer in detail. I think in the Committee Stage we can devote a little more time to specific matters that hon. members are worried about. Nevertheless, he raised some points of principle. I make bold to say that he sort of congratulated the department because of the fact that we eventually decided to bring a Bill like this before Parliament. I think he will later on have more cause for joy, when we introduce the Health Bill. We have now acquired the right to bring a omnibus measure—it does not cost a lot—on medical matters every year because medicine is a dynamic subject and changes from time to time.

In the first instance, the hon. member was a little concerned about the ethics of some of the professions. He particularly referred to the auxiliary professions. However, I must correct the hon. member because here we specifically refer to homeopaths and homeopathy is not at this stage regarded as an auxiliary medical profession. We have provided for them in a specific Act. It is only because we have had experience of the dealings of some of these unscrupulous practitioners that we are bringing this provision into the Act.

I appreciate his attitude as far as dispensing practices are concerned. We have to take account of practical problems in the outback, where it is not always possible to find the right people. Although schedules 1 to 4 contain a formidable list of medicines, these medicines have over the years been handled by people who are not better educated than the average enrolled, not registered, nurse, who has a Std. 8 certificate and two or three or more years’ training. The main point is that these nurses are always under the direct supervision of a general practitioner. He at least should know his stuff. I do not think he can learn everything about these medicines; it is impossible. I myself do not know everything. One just has to apply certain principles, one learns certain things and eventually one does not use more than about 30% of the scheduled medicines.

The hon. member also referred to the fact that some mental patients now have to pay for medicines and sometimes even for board. This has been the case with the admission of such patients to State institutions since last year. We brought that into the Act last year. It is an already accepted principle. Since last year we have had many voluntary patients. I want to make a distinction here: It is not certified patients that we are speaking about, but voluntary patients who are prepared and able to pay. These people are admitted to these institutions and can easily pay for medicines. They are voluntary patients and can therefore leave after a time. They need not stay there. They are not under very strict regulations. I think that it is therefore important that we provide for that.

The hon. member specifically mentioned opticians, some of whom have been practising for 20 to 30 years and who are perhaps not au fait with all the facts and developments in their specific field of knowledge. Nevertheless I must point out to him that, although I have great sympathy for these people, they are not required to sit for a written examination. I do not think the Act provides that they must sit for a written examination. These people can be assessed, but then we must take into account the position of the public. We are continually striving for better standards. That is important.

I think the other very important point is the fact that the hon. member thought fit to mention that we must keep politics out of the appointment of members to hospital boards. The hon. member can look at my record in that respect. That reminds me of a politician standing on a rostrum who once said “examine my record”. That was actually done and he eventually landed up in gaol! Nevertheless, I invite the hon. member to look at my record and that of my department over the last 4½ to five years. A year and a half ago we adopted the policy to appoint the member whose constituency is near the State institutions concerned. Quite a few English-speaking members have been appointed and I have said at the start that I have great appreciation for the work they did and for the dedication displayed by them towards questions of mental health and towards these institutions. They really are interested. Amongst them are some hot-heads, but they really are interested, and I am grateful to them. This matter is receiving our continued attention. I do not think the hon. member would want me to elaborate on what he said.

*The hon. member for Bryanston said there were many deficiencies in this Bill. It is not all that bad. There are a few minor deficiencies but these are not so great that we cannot pass this Bill. If he reads through the Bill he will see that the position is not all that bad. The legislation is scrutinized every year, and we try to rectify matters. In regard to clause 5 the hon. member asked for a definition of “any indecent act”. Quite justifiably he wanted to know the details in that regard. Let me say that in reality the court determines what an indecent act is. An act committed with a child below the age of 15 years is an indecent act. In this way there are many other aspects which we need not go into at this stage because it is unnecessary.

In respect of the third aspect which he raised here, I want to say that the pharmaceutical profession in fact asked for retail rights for companies. It was not in the Act before. They asked for it, and also asked us to deter big companies in this respect. Under the previous legislation we did not want to deprive a company of its rights. We did not want to deprive it of its livelihood. That is why we said at the time that, initially, they could continue, but eventually it was to be pharmacists only. Therefore there are two aspects: The one is that we are allowing them to continue and the other is that we are allowing pharmacists to form corporations or companies, to put it in this way, in connection with the retail trade. They asked for it, and in my opinion it was a very fair request. The hon. member also asked to what the public were able to have recourse. They can always turn to the civil court.

Let me deal with the question of enrolled and general nurses now. The hon. member put a question in this regard and therefore I want to explain that compared to the registered nurse, i.e. general and maternity sisters, one has the enrolled nurse who does not in reality have the advanced training, extending over 3½ years, which the registered nurse has. These people can in fact do this work, under supervision. I was in practice for 20 years, and I can give hon. members the assurance that if these people have received a basic training for a year or two, they can do the work up to the fourth schedule, but from the fifth, to the seventh schedules it is a different matter. Under the Medicines Control Act those schedules, up to the seventh schedule may be dealt with and handled under the supervision of a medical practitioner by enrolled nurses who are in point of fact in a lower category than the nurse who has been thoroughly trained so that she is capable of handling medicines in all respects. That is all I have to say to the hon. member for Bryanston.

I do not think that we should discuss further training in pharmacy for nurses any further at this stage. We do have many practical problems. This measure is a supplementary auxiliary measure for medical practitioners who have to do their work under extremely difficult circumstances. The Act was applied more strictly and these people were compelled to exercise control themselves over the issuing of medicines and to convince themselves that they had knowledge of this matter, but the mere handing out of medicine is really not something we need be concerned about.

I need not go into what the hon. member for Cradock said in detail, for that hon. member gave a synopsis of what is happening. I think he has a good understanding of this legislation. He knows what it is all about for I once explained to him what our actual problems with these amendments were, and I think he understands the problems very well.

The hon. member for Berea is always particularly interested in matters such as these. He raised so many aspects that I almost lost the gist of what he was saying after a while. I could reply to all his points, but we cannot take up too much time because we are still only dealing with the Second Reading of the Bill.

†I think that the hon. member can take it that I have already dealt with the matter of the pupil who has only had a Std. 8 education and who has perhaps had only one or two years of nursing tuition. I do not think that I want to elaborate any further on this matter. The Medicines and Related Substances Control Act, which the hon. member knows very well, provides that the Secretary may issue a permit to a welfare organization. Here is a further point to support my view that a nurse, at least, is perhaps sometimes in a better position to understand what she is doing than an official of a welfare organization. They may keep and supply schedule 1 to 4 substances. Regulations may be made in terms of which a registered or enrolled nurse may possess, keep and supply any scheduled medicines. That falls under the Medicines Control Act; we cannot get away from it. I just elaborated on this matter so that hon. members can know what is really in that Act.

The outflow from the nursing profession was mentioned by an hon. member, but I do not think we can do anything about that. I do not think that we should deal with that now, because that is a matter for lengthy discussion and one into which we must go a little deeper than we can at the present time. I think that by and large there is a very good control over the supply, the use and distribution of medicines by medical doctors. I think it is as good as it can be under the present circumstances in South Africa.

*Mr. Speaker, I do not know how many hon. members I might have left out. I listened very carefully to the hon. member for Simonstown and I took note of what he said. Unfortunately he is not here at the moment. He also raised the question of English-speaking persons. I think I have replied adequately on that score. It must be borne in mind that medicine is a profession. In that respect I should like to refer hon. members to the annual report which appeared today.

†I request hon. members to have a look at our annual report which they would have found on their desks today. In that report they will see that the medical profession is completely neutral in its approach to all races and people. The medical profession is not concerned in any partisan way with any specific group.

*I am now referring to the hon. member for Fauresmith, someone for whom I have always had very great appreciation. Without detracting from what he said I nevertheless want to mention that I am very pleased that he indicated those aspects of the legislation which emerged in this amendment Bill and expressed his appreciation in that regard. I am referring specifically now to the improvements which are being effected in terms of the new legislation, as well as to the fact that the hon. member mentioned that people have too much work to do. I also appreciate his having dealt with the other aspect of the legislation. Of course he made a very thorough study of it. I appreciate the fact that, in this respect, too, he made a very balanced contribution to the debate.

I think that I have now just about replied fully to all the arguments raised by hon. members and once again I thank them all sincerely for their support.

Question agreed to.

Bill read a Second Time.

Committee Stage

Clause 3:

Mr. Chairman, I was not quite sure whether the hon. the Minister, in his Second Reading speech, indicated that it would be possible for private doctors to have private patients in State institutions, or whether this would be limited to having only voluntary patients there. Is it possible then for a private doctor to look after a patient who has been certified and detained in a mental hospital and will it be possible for a private doctor to attend to such patient there? If the private doctor does not attend, or is unable to attend, to such a patient, will that patient be obliged to pay fees to the State hospital if such patient can afford it? Will that patient also be required to pay for medicines if he is able to pay for them, or has that not been decided yet. Could the hon. the Minister reply to these questions?

Mr. Chairman, it is the duty of the family of that patient, if he is certified, to decide whether they want to pay. Should they decide that they want to pay, no one can prevent them from doing so. However, he is not required to pay if he is a certified patient. A certified patient is actually under the control of the State and the State therefore takes full responsibility for him.

Clause agreed to.

Clause 17:

Mr. Speaker, I think one advantage of having a Committee Stage so soon after Second Reading is that it is not necessary to have to restate the case, and it is not my intention to do so now. I wish to move the amendment printed in my name, as follows—

This will mean that the Secretary may still effect the appointment, but at least it will be in consultation with the S.A. Pharmacy Board. I think that I have a good argument that many precedents are embodied in the present legislation and regulations in terms of which the Secretary or the Minister has to consult with the board. I do not want to take up the time of the House unnecessarily, but I would like to draw attention to section 49 of the Pharmacy Act where it is stated that the regulations may be promulgated on the recommendation of the board or after consultation with the executive committee of the board. This is something that has been in practice for a long time. The old Medical, Dental and Pharmacy Act of 1928 deals in section 37 with “Penalties for professing to be, or carrying on business as, a chemist and druggist when unregistered” —and provides that if the Minister is satisfied that if any person who is not registered as a chemist and druggist, or a body corporate which is not registered to carry on the business of a chemist or druggist, is competent satisfactorily to manufacture or pack any drug, medicinal or chemical substance, he may by permit after consultation with the board, authorize the body.

That is all we are asking in this amendment—that the Secretary may grant authority “after consultation with the board”. In this particular instance I was a member of the statutory body at the time when that law was operating and in my humble opinion it caused no administrative problems or delays. The board appointed a sub-committee to deal with these matters as they arose. If I remember correctly, there were two members of the board, who lived in close contact with one another, who were designated to deal with this particular aspect. They dealt with it and subsequently the matter was brought before the board for confirmation. I can recollect no problems with this particular manner of consultation in the ten years that I served on the Pharmacy Board. I believe that it is not fair to ask the pharmacy profession to give the Secretary for Health a blank cheque. That is what it amounts to. The Secretary may use his discretion in regard to the distance and does not have to consult with anybody. I have expressed my views on the character, ability and integrity of the present Secretary, but I do not think it is fair to ask the pharmacy profession to make such a concession. I seriously ask the hon. the Minister to accept this amendment.

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

I listened very carefully to the hon. the Minister’s reply to the Second Reading debate and how he felt about enrolled nurses. In his reply I did detect that he regarded an enrolled nurse as working under the supervision of the medical practitioner. If he looks at the section which is now being amended, he will see that there is no supervision here of a medical practitioner, but merely a “direction” of the medical practitioner. There is a vast difference between the two. What does one understand under “direction”? I believe it can be a mere telephone call. I can understand the position where the medical practitioner is doing his rounds in a rural area and does not have the opportunity to get back to his surgery during the whole day. When he finds that there is a case where he has to prescribe something while he is on a farm, he uses the farmer’s telephone to call up his surgery to tell the enrolled nurse to give some drug or other to the patient on the farm and that the farmer will collect it. That is what is meant by the supply of a drug “at the direction” of a medical practitioner. It is certainly not under the supervision of a medical practitioner. I do not want to labour the point, as I believe it has been dealt with in the Second Reading. If one has to look at the schedules, particularly schedule 4, it is quite frightening to see that under those circumstances, where an enrolled nurse receives a telephone call from the medical practitioner, the enrolled nurse is able to supply antibiotics, sulphonamides, steroids and a lot of other very dangerous drugs. It is for that reason I believe one should play safe in regard to this clause. In putting this clause into operation, it would be better to first see whether it can be operated without the services of an enrolled nurse. We must restrict the authority to supply to the registered nurse at this stage.

I do not believe there would be too great a difficulty for a medical practitioner to obtain the services of a registered nurse. There must be many registered nurses available in various towns, even if they are small platteland towns. I believe that even if they are retired, they still have the knowledge and reliability one cannot expect from an enrolled nurse. I hope the hon. the Minister will hasten slowly in these circumstances and agree that an enrolled nurse should not be one to supply these drugs at the direction of the medical practitioner. I think we must make this distinction. It would be quite a different matter if the enrolled nurse was supplying the drugs under the supervision of the medical practitioner. But I do not believe that supply under supervision would work in this case nor will it help to solve the situation. That is why this clause is couched in these terms, viz. that drugs would be supplied “at the direction” of the medical practitioner. For that reason there is this distinction. If one looks at the pharmacy Act, one sees in section 29(2)(b) the following—

What is going to happen here, however, is that no prescription will be available. There will merely be a direction. I believe it to be a telephonic direction which has to be understood well by the person receiving it. The person receiving the telephonic direction should be well versed in the duties of supply and should be able to supply and interpret the direction in the way in which it is intended. I think it is very important that this matter be given very careful attention by the hon. the Minister and that he should agree to delete the words “or enrolled”.

Order! Is the hon. member not moving his second amendment?

If the hon. the Minister prefers me to do so at this stage, I am quite prepared to do so. I thought the hon. the Minister might first want to reply to me on my first amendment.

Mr. Chairman, I want to support the arguments put forward by the hon. members for Berea and Wynberg. I am perturbed that the onus we are placing on the enrolled nurse is far too great for her to carry without having had some special training. In my Second Reading speech I mentioned that it could be dangerous to expect from the enrolled nurse to dispense. The conditions which the hon. member for Wynberg described are typical of the sort of thing that happens from day to day. Instructions are, in fact, given over the telephone. The line may be bad and the names of drugs are sometimes—the hon. the Minister knows this—so similar, although they consist of quite different components and act quite differently. So, a mistake can be made very easily indeed and if an accident should take place, the onus is going unfortunately to be put on the nurse. The dispensing was done under the direction of the doctor and not under his control and the nurse will have to bear the brunt of anything that may happen as a result of her misinterpreting instructions. I do not think that is fair. I want to make a practical suggestion, knowing the difficulties that are at present being experienced by the country doctors to get people to help in their consulting rooms. I know it will take time to apply this measure, but I would suggest to the hon. the Minister that an enrolled nurse can be employed, but would have to have at least six months’ training in the dispensing of pharmaceuticals. I think it would overcome the difficulty if she could have special training for six months before being employed in the doctor’s consulting rooms. To let an enrolled nurse, without any special training, to do this work is neither fair to the girl who is going to do it nor to the patient who might suffer from an inadvertent mistake on her part. That is the big danger. If the word “direction” can be altered, it will also help. I think the hon. the Minister should discuss the matter with the Secretary of Health so that if he finds that he cannot accept the amendment of the hon. member for Wynberg, perhaps he could alter it in the Other Place. I think it is such a serious matter that it should be given his immediate consideration. At the same time the hon. the Minister should give consideration to the suggestion I have made that an enrolled nurse should undergo a special course in dispensing if she wishes to take up the work which is going to be entrusted to her in terms of the provisions of this Bill.

Mr. Chairman, the hon. member for Wynberg is forgetting one important fundamental principle, and that is that when a medical practitioner instructs someone to give a certain medicine to someone else, the medical practitioner still remains responsible for any situation which may arise from the administration of that medicine. I have sympathy with the standpoint adopted by the hon. member for Rosettenville in asking for training to be given to enrolled nurses who are expected to distribute these medicines or pills. This is a long-term project which could receive attention. However, we are faced with a problem at the moment, and we must not lose sight of the fact that this concession is not being granted to medical practitioners with private practices only.

This problem occurs in the homelands especially, and the hon. member for Rosettenville gained personal knowledge of this matter on a tour on which we went recently. In those areas there are clinics which are situated far away from hospitals. The distances are vast and the roads are bad and there are trained or enrolled nurses on duty and they have to telephone the hospitals for instructions on specific diseases which they encounter.

I want to repeat what I said in my Second Reading speech, and that is that in practice we definitely do not find any medical practitioner or any isolated clinic having on his or its shelves all the medicines mentioned in the extensive list published in Schedules 1 to 4. Usually we find a few medicines on those shelves with which the nurse who has to deal with them is made au fait. Every medical practitioner who has any sense of responsibility will first train the nurse concerned by instructing her in the prescription of the medicines and in what circumstances they are to be used. She need not diagnose a complicated disease. All she has to do is to take the pills from a shelf, put them in an envelope and prescribe them to a patient. This is all she has to do and this, in fact, cannot be a source of danger.

Together with the hon. member for Rosettenville, I believe it is possible to follow up his suggestion for the sake of efficiency by possibly having these people attend a special course. We must realize, however, that we are overloading the syllabi of our nurses with all sorts of other facets of medicine of which they must have a thorough knowledge in practice. We must be very careful of not overloading the syllabi to such an extent that it may eventually become impossible for people to follow this profession.

Mr. Chairman, I understand the concern expressed by the hon. members for Berea and Wynberg in regard to this matter. That is why we shall support the amendment moved by the hon. member for Berea, but we do not agree with the amendment moved by the hon. member for Wynberg.

Although we sympathize with his concern, we feel that the hon. member may perhaps not be fully aware of the circumstances prevailing in remote areas. In those areas it is essential for a doctor to be able to contact his office to give instructions concerning the supply of medicines and other remedies to the public. In those circumstances it would be difficult, if not impossible, to have written into the legislation a provision requiring that work to be done under the supervision of a doctor. This may indeed be done on the instruction of the doctor and I assume—and I should like to ask the hon. the Minister this—the doctor accepts full responsibility for the supply of such medicines. However, in the circumstances which prevail in remote areas, it would be very difficult for the doctor to be present at all times when this work is being done. In addition to this, it would be placing a very heavy burden on the doctor if this work always had to be done under his supervision.

I should just like to return to the suggestion I made during the Second Reading debate. I said that I did not share the misgivings of other hon. members about the sense of responsibility or the ability or competence of nurses, whether they are registered or enrolled nurses, to do this work and to do it in a responsible and trustworthy manner. At the same time I want to repeat what I said during the Second Reading debate, and that is that all problems and misgivings in this regard could be eliminated if a special course were to be introduced to ensure that such nurses would gain specialized knowledge in regard to the requirements for the supply of medicines which are relevant here. I want to recommend that to the hon. the Minister once again. I believe that all misgivings could be removed if provision were to be made for a special course for nurses in this regard.

I wish firstly to deal with the amendment moved by the hon. member for Berea. His amendment reads—

I have great sympathy with his viewpoint, and he knows that. I believe in consulting and in the co-ordination of the boards which are acting on a high plane in regulating pharmacy, medical and all other matters concerned with the health of man and of our population. He will agree with me, however, that no provision exists in the Pharmacy Act, 1974, in terms of which the S.A. Medical and Dental Council must be consulted in respect of any matter pertaining to the pharmaceutical profession. The same applies to the S.A. Pharmacy Board in the Medical Act, 1974, in regard to matters pertaining to the medical profession. Here we are concerned with a right conferred on a medical practitioner to prescribe medicines. It is a right. It does not have to do with his technical knowledge, which has already been accepted as he has studied and has gained the knowledge. It is a right. One cannot encroach upon their functional areas and they should not encroach upon the functional areas of others. It is only fair, and if I were to change this Act, I would have to change the other Acts as well. We do make provision in the Act for consultation and liaison and for representation on the Medical Council by the Pharmacy Board. The pharmacists serve on the Medical Council and vice versa. Provision has also been made for the Department of Health to serve on both these bodies. We therefore have the people to undertake this co-ordination so that we can thrash out these problems, especially as they have no restriction on their agenda. They can thrash out these problems all the time. Co-ordination and consultation take place constantly at this level and therefore I cannot support the idea of providing, in the Pharmacy Act, for the medical profession to have a say in pharmaceutical matters. Consequently I can also not support the idea of providing for the pharmaceutical profession to have a say in medical matters. It is really a medical matter. I do not wish to get technical, but it is really a right which has been conferred, and if there is any board that I should consult as regards matters like this, it is the Medical Board. If, as the hon. member claims, the pharmacists have a stake in the matter, I should have consulted both boards, but I do not think that that is really necessary. I think that we will be guided by the practical position as we encounter it in the country areas. I am afraid that I cannot accept the amendment.

I am sorry to hear that the hon. the Minister is unable to accept the amendment. I listened carefully to his argument. This amendment deals with acts specifically pertaining to pharmacists, which are clearly defined in the Pharmacy Act. It seems to be completely wrong that where something has been specifically defined in an Act, another profession can impinge on those responsibilities without any sort of consultation whatsoever.

You are referring to the new section 52A of the Act?

Yes, I am referring to the secretary granting someone the right to perform an act specially pertaining to a pharmacist as defined in the Pharmacy Act. However, Sir, we shall shortly be dealing with the Health Bill and that Bill seems to make provision for interdepartmental consultation. If there can be interdepartmental consultation, which need not always work both ways but might be in the interests of the public, I cannot see why we cannot have consultation between statutory bodies or between the department and a statutory body, as there is in the cases I have cited. I believe the profession deserves the right to have this consultation so that the profession can be fully aware of what is going on. I appreciate the liaison that exists where a member of the Pharmacy Board can also be a member of the Medical Council and vice versa. However, those people usually meet four times a year and I do not think that that sort of consultation really fulfils the need which I believe exists in the light of what this particular clause envisages.

Amendment moved by Mr. L. F. Wood negatived.

Amendment moved by Mr. J. I. de Villiers negatived (Official Opposition dissenting).

Mr. Chairman, I have not moved my second amendment yet.

I am sorry, but the hon. member cannot move it now because I have already put the other amendments and the clause.

Mr. Chairman, a short while ago you asked me if I was going to move my second amendment then. I said I would first prefer to hear what the hon. the Minister had to say about my first amendment. I do not know, Sir, whether you listened to the debate, but the hon. the Minister has not replied to my amendment.

Order! I did listen and, when I put the question, no hon. member got up to speak. At that stage the hon. member did not even try to participate in the debate and therefore I proceeded.

Mr. Chairman, I am very sorry, but the hon. the Minister has not yet replied to what I said to my first amendment.

I have already put the amendments and I cannot go back on that.

You may be prepared to go back to give the hon. the Minister a chance …

No. The rules do not allow it. The hon. member can raise his amendment in the Third Reading if he wishes.

Mr. Chairman, I should like to move my second amendment now.

No, the hon. member cannot do that now. I have already put the question and …

Sir, I beg to differ.

I have given my ruling.

I am very sorry, Sir, but I do not agree with your ruling. I want to move my second amendment.

The hon. member will have to accept my ruling.

Clause agreed to.

House Resumed:

Bill reported without amendment.

Third Reading

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

Mr. Speaker, during the Committee Stage we moved amendments which were not accepted by the Committee. I regret very much that there has been this misunderstanding between the Chairman of the Committee and the hon. member for Wynberg. I was also under the impression that the hon. member for Wynberg could have been given an opportunity to move his second amendment, but we have to accept the ruling of the Chairman and it is regrettable that he was not able to argue on the amendment which he wished to put forward. However, the hon. the Minister did hear how we felt about one or two very important matters in this Bill and although the House did not accept the suggestions which we made here, I hope that the Minister will, when he has the opportunity to look again at this question, see how strongly we felt on these matters. Perhaps he may still be able to introduce amendments in the Other Place which will be acceptable.

I want to say again that if he is going to allow a duty to be placed on people, which, on acceptance of employment, they are not fully qualified to undertake, the responsibility for accidents which may follow such appointment will not rest only on the shoulders of the medical practitioner who is employing such a person; the Minister himself will also have to take the responsibility for allowing that to happen. I say in all sincerity to him and his hon. colleagues on that side of the House that we are not being frivolous about this matter. We know the difficulties that may arise in a country practice, but we sincerely hope that the hon. the Minister will look at this again and do what we ask him to do, namely to have persons who are registered to do this work. If they cannot do the work, the doctor must make other arrangements to see that no dispensing is done under any of the schedules unless it is perfectly safe to do so. I would say to the hon. the Minister again that he must look at this legislation, study it, and see if he cannot overcome the difficulties which are encountered by doctors who practise in country areas and who cannot get fully qualified assistants.

We are fully in accord with the other provisions of this Bill and at this stage I want to say to the hon. the Minister that we will support the Third Reading of the Bill.

Mr. Speaker, it is not my intention to delay the House, but I understand the difficulty and difference which the hon. the Minister and I have had during the Committee Stage over the question of consultation. I would, however, like to put on record my appreciation for the consultation that has existed between the Minister and his department, the South African Pharmacy Board and the Pharmaceutical Society of South Africa, with particular reference to bodies corporate, as referred to in clauses 9 and 10 of this Bill. I believe there has been a harmonious atmosphere which was engendered before the Pharmacy Act was passed in 1974 and that this harmonious atmosphere has continued where co-operation has been shown by the Minister and his department, and I know that I speak on behalf of my colleagues outside of this House when I say that this co-operation has been greatly appreciated.

Then I want to come to the question of the amendment in the Committee Stage—and I am not querying the Chairman’s ruling on this—which we were unable to discuss through, what I believe, was a misunderstanding. I want to ask the hon. the Minister whether, before this Bill goes to the Other Place, he will be prepared to give consideration to the effect which we sought to achieve by this particular amendment in clause 17, because as it stands at the moment, the secretary may, if he is of a certain opinion, give certain permission. It may be implied or accepted that should conditions change, and should a retail pharmacy be established within a reasonable distance, the secretary shall withdraw that permission. But, Mr. Speaker, I cannot see anything in this Bill which lays down any sort of administrative procedure which would imply or ensure that that would in fact take place. I can see the situation arising where the present secretary may, in his discretion, grant permission, and subsequently, when a new secretary comes on the scene and a pharmacy is established in the area, the prospective pharmacist sits with a problem of not knowing where to lodge his application in the first instance. The position may arise in which a new secretary may have a different interpretation or conception of what is intended by “a reasonable distance of a retail pharmacy”. I believe that, in the interests of fairness and in the interest of the pharmaceutical profession, it is only just to indicate clearly in this clause that should a retail pharmacy be established within a reasonable distance—and the secretary will have the right to decide—the authority shall expire. I ask the hon. the Minister to give his serious consideration to this before the Bill reaches the Other Place.

Mr. Speaker, bearing in mind that misunderstandings may arise in a debate of this kind, I nevertheless want to tell the hon. member for Wynberg—I am sorry that he is not present at the moment—not to be alarmed at the large number of medicines listed in Schedules 1 to 4. In many cases over the past 30 years, up to 1974, as from the time when those medicines became known, absolute laymen supplied those medicines in the rural areas. There was not a single case of charges having been brought against a person or of this having led to dangerous or irresponsible mishaps. In general, medical practitioners have such a fine record that the inclusion of the provision in the legislation that these people at least have to be nurses with a certain qualification and a knowledge of the danger of medicines, and the granting of permission to them to supply people with medicines mentioned in Schedules 1 to 4, constitute no danger, especially in view of the fact that they will now be more careful than before. I am dealing with the effect of this legislation as this has given rise to concern as a result of the amendment introduced during the Committee Stage.

†I also want to inform the hon. member that, in terms of the provisions of section 22(a)(12) of the Medicines and Related Substances Control Act, the Secretary has the right—at this very moment and as a principle—to empower enrolled or registered nurses to handle medicines listed in schedules 1 to 4. After all, it is not a question of principle.

*They already have the right to handle those medicines. We must just be sensible now. If we do have major fears, I want to eliminate those fears now, during the Third Reading debate. It is easy to make a mistake, but we always want to raise standards. However, over the years it has become apparent that, if we were to raise these standards at this stage, we would have progressed a long way. Of course, this does not mean that we cannot raise standards even higher in future if it becomes possible to put stricter, more severe, requirements to people, people who will have the right in this case to handle these medicines. In practice this amounts to such a person merely supplying the medicines to a patient after such medicines have been prescribed. It is the particular responsibility of a medical practitioner to issue a prescription.

†I believe we can accept that the nurse concerned will be fairly fully conversant with the limited number of drugs that are entrusted to her in matters of this kind.

*Now I just want to say that the hon. member need not have such a great fear. However, I understand the hon. member’s motive. He wants high standards. We also want high standards. However, we have to consider what happens in practice.

In conclusion I should like to say that the hon. member for Bryanston was concerned and said that we should think of a course for these people. This is a possibility for the future; viz. to give these people an opportunity to follow a course in this particular direction.

There is also the question of the expiry of a medical practitioner’s right to dispense if there is a pharmacy within reasonable distance. It must be understood that we must also consider what happens in the practice. We cannot consider this in theory only. If a pharmacy is opened and a medical practitioner has built up his supply, the medical practitioner has to continue for a while to provide the necessary service to the public. I know that this is the case, because I have dealt with circumstances of this kind myself. After all, one does not know whether the pharmacy is economically viable and whether it will remain in business. So one must have regard to the public. Hon. members will note that provision is being made in the clause by implication for the secretary to revoke the doctor’s right. The clause merely states that the secretary may grant the right, but this implies that he may also take that right away. Therefore the secretary will also be guided by circumstances and will decide whether the pharmacy is, in fact, able to provide the necessary service. I can assure hon. members that we do receive representations and complaints of this nature from time to time.

†If we make it a law of the Medes and Persians and put it down in writing in an Act, we are bound by it and it may then cause practical problems. So it is a question of practice that counts in an instance like this. However, I can well understand the motivation behind the hon. member’s amendment, viz. that seeing that we have accepted the principle that a doctor in the country should not prescribe if there is a pharmacist nearby, who is actually the professional man who must serve the public, the doctor must cease dispensing and just keep those medicines that are essential to have available at all times.

*I can well understand what the hon. member envisages with his other amendments, but it is impossible for me to change the legislation at this stage.

Question agreed to.

Bill read a Third Time.

Mr. Speaker, I move—

Health services in the Republic of South Africa are rendered in the tradition of and in terms of the Public Health Act of 1919. The history of that Act is unusual in that it took a congress, after the influenza epidemic of 1918, to place that Act on the Statute Book.

From the beginning mankind has lived in a time of change, and it has been necessary, on no less than 21 occasions, to amend the Act and effect essential changes. On each occasion strong representations were made for fundamental changes to be effected to the Act, precisely because it is an Act which was born out of emergency and disaster.

In its attempt to effect changes to the principles of the Act, the State, since 1924, has appointed eight commissions, committees and Select Committees to inquire into and make recommendations on the subject. Until this attempt, all previous attempts had been less successful or even in vain. The principal reason for this was that previously it had not been possible to succeed in reconciling the different standpoints with one another.

But as long ago as 1924 already it was felt that circumstances had altered to such an extent that changes had to be effected. Today this is true to an even greater extent. In our present situation, with our tremendous need for trained manpower and with the considerable costs involved in the rendering of health services, we cannot continue as we have in the past, for the Republic simply cannot afford it any longer. This proposal before you today, Sir, consequently arose as a result of the need to effect a change.

This need to effect a change is accorded general recognition and support, and it was largely as a result of that that we have succeeded in making this much progress with the measure. Many persons and bodies made contributions to bring about the proposed measure, and in this regard I should like to convey my appreciation, in particular, to the task performed by the commission, under the chairmanship of Dr. C. V. van der Merwe, M.P. for Fauresmith, which was appointed to examine the Health Bill of 1972. The commission had an exceptionally difficult task and I do not want to burden this House now with the problems with which the commission had to contend at the time. I should just like to say that the recommendations made by the commission were made in a period in which difficult circumstances were prevailing. For that period the recommendations were realistic and practical and would, to a large extent, have solved the problems which existed at the time. In addition the commission played an exceptional part in serving as a catalyst and in cooling down the heated state of the discordant relations which prevailed.

The commission contributed to a large extent to an altered climate being brought about in which we were able to accomplish a constructive development. I should like to convey my sincere thanks and appreciation to the commission for the exceptional task it performed. After the commission had submitted its report, we decided to continue the cooling down process before we started to prepare the legislation. In the meantime certain circumstances had also begun to change. Exceptional development took place, and is taking place in the constitutional sphere, and as a result of that the health function was transferred—or is in the process of being transferred—to self-governing territories, which had a major effect on the scope of the functions of other governing bodies.

There has also been a drastic change in the economy, which has helped to create a favourable climate for the establishment of the envisaged legislation, and when my department began to contact persons and bodies in connection with the proposed legislation at the beginning of last year, the department met with nothing but willing co-operation and responsible support. I want to convey to the other bodies as well, inter alia, the provincial authorities, local authorities and the private sector, my sincere thanks and appreciation for their assistance, co-operation and goodwill, for without this we would not have succeeded in making the progress we have made to where we are today. The goodwill was such that when I discussed the composition of the health matters advisory committee with the Administrators, the administrators unanimously indicated that the number of representatives from the respective bodies from which the committee was constituted did not matter at all and was of no importance. This matter was in fact one of the major and serious bones of contention in the 1972 Bill. This was representative of the goodwill which prevailed, a goodwill which can be expected when we are working in the interests of South Africa.

As a background I want to inform hon. members of the procedure adopted in the preparation of this Bill. On the basis of the report of the commission the department prepared a working document in the light of the prevailing circumstances and submitted it in March 1976 to a limited group of knowledgeable persons and bodies. The working document was revised in the light of the comment received, and the revised document was then submitted to approximately 80 persons and bodies. The department held discussions with the various directors of hospital services and I held personal talks with the Administrators of the provinces. In the light of the discussions and the comment received in this way, a draft Bill was prepared, which was published on 14 July 1976 for information and comment—the closing date for which was 18 September 1976. Afterwards the department held further discussions with bodies, where such discussions had been requested. In this way discussions were held with the United Municipal Executive. The published document was revised once again, and the Bill which is now before this House is based on that revised document. From the above it is therefore clear that we went out of our way to hold thorough consultations and to collect information.

†The draft Bill was published, coincidentally, a few weeks after the publication of the report of the Commission of Inquiry into Occupational Health. As a result of certain ambiguities in the text of the draft Bill, some bodies came to the conclusion that the recommendations of the commission were incorporated in the draft Bill, and as a result thereof raised objections against the provisions of the draft Bill. At the outset it was decided to prepare separate legislation if the recommendations of the commission to control occupational health were acceptable. It was never, and it is not the intention now, to control occupational health under public health legislation.

The Act of 1919 deals mainly with the control over epidemic and formidable epidemic diseases, the powers, functions and duties of local authorities and refunds of the costs incurred in respect of these services by local authorities.

The underlying philosophy of the present Bill is to create a piece of legislation, a blueprint, for the three tiers of Government to render health services in our country and to regulate the related functions between these authorities in the health field.

In place of the present rigidity of health legislation, a more flexible pattern is envisaged in which the powers, functions and duties of all the different authorities are reflected. Provision is also made for the co-ordination of services and the determining of health policy on a national basis so that the functions and duties of the different health authorities could be adapted to utilize available resources to the maximum, making the most effective health service available to the public. The endeavours of the different authorities can thus be co-ordinated and directed to attain optimum results.

For easy reference the Bill is divided into chapters, each chapter dealing with a separate subject.

Chapter I deals with the planning, coordination and rationalization of health services and the determination of health policy. In the draft Bill the first chapter was devoted to a health charter, in terms of which the respective health authorities were required, within their respective areas of jurisdiction, to provide and maintain all necessary measures to promote the health of the populace of the Republic of South Africa, enabling every individual to attain and maintain a state of complete physical, mental and social wellbeing.

The legal advisers, however, are of the opinion that such provision has little legal standing, as any contravention thereof did not make provision for a specific contravention indicating a crime with resultant penalties attached thereto.

Accordingly the legal advisers felt that such a provision was more descriptive of a condition or ideal which one is endeavouring to achieve, and should either be included in the long title or be deleted entirely, on legal technical grounds. The chapter was therefore reluctantly deleted on legal technical grounds.

One is aware of the problems involved, but we, and many other authorities, were of the opinion that inclusion of such a provision was absolutely necessary to ensure that every individual, irrespective of community status or population group, etc., has the assurance that Parliament has taken every possible precaution in the interest of his health and that of the public. In order to overcome this legal technical problem, this function has been allocated to the health policy council who will be compelled to see that the health authorities discharge their functions in such a manner that the provisions of the charter are achieved. Thus the highest health authority in the country, which is directly responsible to Parliament, will be accountable to carry out the aims envisaged in the draft charter.

In the past a variety of methods have been employed to co-ordinate and to make recommendations on the country’s health services; one such body in the past consisted of more than 100 persons. The present Central Health Services and Hospital Co-ordinating Council provides for the Minister to be chairman with the members consisting of those members of the Executive Committees of the provincial councils charged with hospital services, the Secretary for Health and the chairmen of the staff advisory and technical committees.

This council’s functions are to make recommendations to the respective health authorities with regard to the rendering of health services. Although great progress was made, it could never achieve its objectives due to the lack of legal powers to enforce its decisions. This place persons responsible to the electorate for the country’s health in an invidious position since it is expected that they advise the authorities to which they are attached while they had no control over acceptance or implementation thereof.

A further contradiction exists whereby the Minister as chairman of the council is to advise himself on the performance of his functions and the exercise of his powers.

It is evident that another method had to be devised to achieve this purpose. This apparently was also the greatest problem encountered by the commission of inquiry appointed on the Health Bill of 1972.

It can be seen that in the present Bill the problem has been approached from an entirely different angle. Provision is made in chapter 1 for the establishment of an advisory committee, consisting of representatives of the service-rendering bodies, namely officers of the Department of Health, the departments of hospital services of the provinces, urban and rural local authorities and the Department of Defence. The functions of the committee will be to investigate, consider and make recommendations to the Minister, for consideration by the National Health Policy Council, in regard to any matter relating to the health service rendered by the three tiers of health authorities. The committee will not possess any policy-making powers.

The committee will be assisted in the performance of its duties by expert subcommittees. Provision has been made for the compulsory appointment by the committee of separate sub-committees for personnel, dental and pharmaceutical matters and buildings for health services in order to continue the functions of present standing committees. The committee may also, in consultation with the Minister, appoint other sub-committees as the need arises. In this regard sub-committees are envisaged for medical and nursing services and local and regional health committees in which representatives of the public are included. In this way the Republic will have a set-up in which expert knowledge will be available to the committee, advising the committee of local and regional needs, and with public participation. This committee, consisting of persons on the executive level of the service-rendering authorities will be in the best position to utilize expert knowledge in order to advise the Health Policy Council.

Hon. members will see that a pyramidal structure gradually emerges, with committees at the lowest level, followed by the advisory committee and the Health Council.

The Health Policy Council will consist of the Minister of Health and those members of the Executive Committees of the provincial councils who are charged with hospital services, with the Secretary for Health acting as secretary.

Prior to any recommendation being considered by the council, the committee must submit such recommendation to the Administrators of the provinces for consideration by the Executive Committees. The Administrators have indicated that it will be expected from those members of the Executive Committees who are members of the council to present the views of the Executive Committees to the council. After having discharged this duty, such members shall be free to put their own views to the council and to vote as they please. The Minister will make the final decision after consideration by the council on any recommendation made by the committee. In practice the Minister will, at his discretion, probably refer any matter on which he differs in opinion with the other members of the council or on which he agrees with a minority of the members of the council, to the Cabinet for a final decision.

A decision on policy made in this way, will be made known and implemented in such time and manner as the Minister may determine.

Following this procedure, we will have a set-up in which expert knowledge is made available by sub-committees, to which public need is fully known through the local and regional sub-committees. All matters investigated by the experts can be considered on an executive level where all the participants in health services are represented.

The provinces will have the opportunity of expressing their views, while the responsibility for making a policy decision rests with the persons politically responsible to the electorate for the rendering of health services. I am of the opinion that in our circumstances, this arrangement meets our needs and is the most practicable solution to the problems of coordination of functions and duties and the utilization of all resources whilst exercising control over services.

Hon. members will notice that in the clause dealing with the functions of the council, viz. clause 12, reference is made to health services rendered by the department as well as by the provinces. These services are overlapping. In order to avoid repetition in the chapters dealing with these authorities, it was considered more opportune to refer to these functions in the particular clause.

Chapter 2 deals with powers, functions and duties of the Department of Health. The main functions of the department are the provision of certain facilities, the prevention of diseases and promotion of health. The department is also charged with co-ordination of its services with the services rendered by provincial administrations and local authorities and, if necessary, to provide additional services in order to establish a comprehensive health service for the Republic, thus setting up the necessary machinery to establish a comprehensive health service and rationalization of such services.

In the draft Bill provision was also made for the listing of the various Acts administered by the department. The original intention with the reference to these Acts was to give an indication of the comprehensive field of activities of the department in a single document, which would be the main Health Act. The legal advisers, however, are of opinion that this will be a duplication, and under these circumstances it was deleted. The possibility of publishing a notice containing this information in the same Gazette in which this legislation is promulgated, will be examined.

In chapter 3, for the first time provincial administrations will also be included in public health legislation. Furthermore, the functions of provincial administrations and their position in the health set-up in South Africa will be clearly defined. In terms of section 84(e) of the Republic of South Africa Constitution Act, 1961, provincial councils are empowered to make ordinances in relation to, inter alia, the establishment, maintenance and management of hospitals and charitable institutions. Through the years the provision of such services has devolved upon the provinces and is now confirmed in the Bill as a function of the provinces. In addition to this, the provincial authorities are also charged with the rendering of all ancillary services in the curative field. In the future the provinces will therefore be mainly responsible for all functions and duties relating to the treatment of the generally sick person.

Further, provision has been made for the co-ordination of such services rendered by a province with services rendered by the department or local authorities or adjacent provinces.

It is realized that some local authorities render a sophisticated curative service to the inhabitants of their districts. I am talking about the divisional councils. Should the provinces concerned decide that such local authorities should continue to render these services, the provinces would have to come to terms with the local authorities concerned.

With the implementation of these measures we are of the opinion that we will be able to streamline our curative health services, avoiding duplication of facilities established on the borders or provinces as well as those by local authorities. Problems have been encountered by patients as a result of restrictions on provinces and local authorities only empowered to act within their areas of jurisdiction. These problems will now be solved.

Chapter 4 deals with the powers, functions and duties of local authorities. In terms of these provisions local authorities will be charged mainly with the provision and rendering of non-personal health services. In addition to this, local authorities will also be required to render a preventive, promotive and community rehabilitative health service on a subsidized basis. In so far as a community rehabilitative health service is concerned, the local authority will have the obligation to ensure that the patient, after having recovered from an illness with the assistance of the curative services, is then rehabilitated within the community. In South Africa nothing has as yet been done in this particular health sphere, and I am of the opinion that it is about time that something should be done. I want to emphasize that the rehabilitation of the person recovering from a mental or organic disease, is primarily a community responsibility and everything possible should be done to encourage community participation. The way is now open to do just that. Provision has also been made for two or more local authorities to unite forces, cooperating for the purpose of exercising then powers and perform their functions in a combined operation. I am of opinion that in this way an opportunity will be created particularly for the smaller local authorities to provide a more comprehensive service to their inhabitants.

Much has been said and written about subsidies payable to local authorities in regard to subsidized services. In present circumstances it is not possible to make provision for the payment of a lump sum to a local authority while leaving it to the discretion of such local authority to render the necessary services. With limited resources at our disposal, it is imperative that we should utilize such resources to the utmost in order to make the best possible service available to the public, which is only possible with the necessary control.

In order to attain this purpose, it will be necessary to exercise control over the establishment and extension of such services, together with the expenditure incurred, on a central basis. This power will be exercised by the Minister. In this way all services can be co-ordinated.

However, it is also realized that the present system according to which subsidies are paid, is cumbersome and involves a lot of administrative work and red tape. The system has therefore been simplified to such an extent that provision has been made that instead of submitting detailed quarterly information about the establishment of the local authority’s health department, it will in the future only be necessary to furnish information about the variations in the approved establishment, viz. new appointments and resignations.

Hon. members will also notice that provision is made for the payment of a subsidy between the limits of 33⅓% and 90%. At present subsidies at the varying rates of 33⅓%, 50% and 87½% or ⅞ths, are paid in respect of the various categories of health personnel. It is the intention to pay a uniform rate of subsidy in respect of all categories of health personnel employed by local authorities. However, a careful analysis will have to be made to ensure that local authorities will not lose financially during the transition stage, and it is therefore not possible to specify the percentage of subsidy in the Bill at this stage. Furthermore, the finances of local authorities are being investigated by a committee of the Department of Finance and, should the committee make a recommendation that local authorities should be assisted by the State to a greater extent, such assistance could be given within the limits laid down in the Bill without any amendment being required.

Chapter V deals with regulations which may be promulgated in terms of the Bill. Criticism may be raised that this is again an example of governing by regulation. To this cliché I wish to reply that all matters which are dealt with in the clauses dealing with the regulations, are of such a nature that a change in the circumstances could be a daily occurrence, resulting in the necessity to adapt or amend the regulations expeditiously in order to protect the health of the public. I do not want to have a single death on my conscience as a result of a cumbersome system in which changes can only be effected by an Act passed by Parliament once a year. The majority of the powers to make regulations are already embodied in present legislation. The powers to make regulations have been updated to meet present-day needs. For example, extensive provision has been made for control over premises where food is handled, processed, produced, manufactured, packed, stored, prepared, displayed, served or sold.

As a result of the inter-relation of functions of the Government departments there might seem to be an overlapping of, or duplication, in the provisions in regard to certain aspects as far as other departments are concerned.

In this regard I wish to refer to the question of control over mollusc and fish farming, intensive animal feeding systems and water. These matters have been discussed with the departments concerned. The fact of the matter is that these subjects cover aspects which have a direct bearing on human health and, as the departments concerned do not have the expertise to safeguard human health, the necessary powers must be created in this legislation. For example, control over the intensive animal feeding system has been included at the specific request of the Department of Agricultural Technical Services. The feed, water, supplements, additives or the manner or methods applied in such projects, could be detrimental to human health, and it is therefore imperative that we must have the power to safeguard our health.

It is definitely not the intention to control farming activities as such or to gain control over bodies empowered by legislation to perform certain functions in regard to the provision of water. In order to achieve our purpose, it will be necessary to work in close co-operation with the departments concerned with a view to avoid overlapping or duplication. For this reason provision has been made that the regulations concerned may only be promulgated after consultation with the respective Ministers. Furthermore, provision has been made that the regulations which may affect the public in general must be published for information and comment before promulgation.

In chapter VI, which deals with the general provision, I wish to invite hon. members’ attention to clause 50. In this clause we have attempted to make it quite clear that it is not our purpose to control occupational health in terms of this legislation or to encroach upon the field of other departments or statutory bodies. The legislation to be repealed is set out in the schedule to the Bill.

*As hon. members will realize, it is unfortunately not possible on this occasion to deal with the Bill in detail or to provide the motivation for the respective provisions. Consequently I have only referred superficially to certain provisions. If hon. members were to look at the schedule to the Bill, however, they will see that there is legislation dating back to 1884, which is still being applied. The Vos Committee, which was appointed on 15 October 1924 to investigate certain aspects of the rendering of the health services, published the following findings—

This was a finding of 52 years ago. Since then, as the Schumann Commission expressed it in its report in 1964,—

The Vos Committee recommended that all hospital services should also be placed under the Department of Health. At the time, with the small population which existed then, this idea could perhaps have succeeded, but with our large population today, and considering the scope and diversity of services, I doubt whether it would be practicable.

In an attempt to become au fait with the most modern systems of rendering health services, the Secretary for Health and I undertook an overseas study of various systems in 1975. The department itself studied the legislation of other countries in this connection. The conclusion we arrived at, one which was also supported by experts abroad, was that we should devise a system with central determination of policy and coordination and with the implementation of services on a decentralized basis. Within this framework we can bring about the optimum utilization of facilities and manpower and take into consideration the distinctive needs of our heterogeneous population. We have tried to incorporate this philosophy in the Bill.

As far as health services are concerned, we have come to crossroads. We can no longer continue to work with antiquated legislation, which was obsolete as long ago as 1924, and which is completely inflexible and allows each governing body to struggle along on its own. This culminated in the absolute disequilibrium which exists at present, with a hopeless emphasis on curative services, particularly institutional services, such as hospitals, etc. Only about 2% of our total expenditure goes towards preventive services. The demands on our resources and services are too great to continue in this way.

In the Bill we have supple measure within which adjustments may be made and within which the activities of the governing bodies concerned may be directed in such a way that we can establish purposeful, streamlined and co-ordinated services, with the optimum utilization of resources from which the consumer may derive the greatest benefit.

The Bill is the culmination of the contributions of many persons and bodies. It is realized that in spite of the many contributions there may still be deficiencies, and that in its application in practice further problems may still emerge. Any suggestion for the improvement of the text or the elimination of supposed deficiencies will be considered with the utmost care for we should like to create the most practicable measures possible.

In conclusion I should like to say that I feel exceptionally privileged that it has fallen to my lot to be able to introduce this historic legislation. I have no doubt that you, Mr. Speaker, are also aware that we are making history, that an era has passed and that we are creating an instrument with which we can enter a new era. I am truly hopeful that this instrument will constitute great benefits to our country and its people. However, it must be remembered that the envisaged legislation is merely an instrument, and the way in which it is applied will determine the measure of success we shall achieve in meeting the needs of our people.

I think this is also a suitable opportunity to convey thanks and tribute to those who made this measure possible and who propagated change and made contributions over the years. It would be inappropriate to single out individuals and bodies, but I would, nevertheless, be guilty of a shameful dereliction of duty if I did not indicate the role played by the Administrators and members of the Executive Committees in the creation of the envisaged measure. Without their wholehearted co-operation and support it would not have been possible to have made this degree of progress with the measure. This co-operation and support had one premise only, i.e. what was best for South Africa. It may not be stated in the text, but for three years the officials of my department, with great dedication, made it their task to turn something which in my opinion, without wishing to offend anyone, has been neglected and shelved in the past into a statutory measure of which we may all be proud. I want to declare my thanks to them here, and put it on record. The departmental head and others never begrudged the time to do then best to establish a good measure, and a measure which meets with general acceptance throughout the length and breadth of our country. I trust that all persons and bodies concerned with health services will emulate this example in the best interests of South Africa and its inhabitants.

Mr. Speaker, the hon. the Minister has been good enough to give us a detailed and comprehensive survey of the contents, the aims and objects of this Bill. The Bill will replace the Act which was passed by Parliament in 1919. It is amazing how well this Act has stood the test of time. The legislation was placed before this House by Sir Thomas Watt, who was Minister of the Interior at the time. There was no Minister of Health in the Cabinet of the time. As a matter of fact, it is quite difficult to find out anything of the debate on that Bill. There was no Hansard and there is no record in the Press of the day. Mr. Speaker, it just shows what can be done and what good legislation can be brought into being if there is no Hansard and no Press. Before continuing with the discussion of the Bill, I would like to move—

Agreed to.