HC Deb 15 March 1949 vol 462 cc1911-22
The Minister of Health (Mr. Aneurin Bevan)

With permission, I desire to make a statement about analgesia in childbirth.

At the end of 1947 more than 7,000 of the 16,000 midwives then practising were trained in the administration of analgesia. During 1948 practising midwives were trained at the rate of 240 per month and at this pace training will be completed in two years. If the Central Midwives Boards at any time consider that they need to make further rules in the matter, the Boards already have ample powers in the Midwives Acts.

The number of cases in which analgesia was administered by midwives has already increased greatly. In 1938 analgesia was administered by domiciliary midwives in England and Wales in less than 1,200 cases; in 1944 it was administered in 5,100 cases, while in 1947 domiciliary midwives were able to give this relief in almost 44,000 cases. Returns for 1948 are not yet complete, but those so far received show that in the 72 areas to which they relate good progress was again made: in these areas analgesia was administered in 16,500 cases in the six months of 1948 during which the National Health Service was in operation as compared with 9,100 cases in the last six months of the previous year.

It is the Government's policy and determination to secure that full facilities are provided as quickly as possible for women to have analgesia in childbirth, and much progress has already been made. I have given figures relating to the training of midwives. In so far as it is necessary to ensure that sufficient analgesic apparatus and drugs are provided for the use of domiciliary midwives employed in the National Health Service, that the apparatus is maintained in a proper state of efficiency and that facilities for transport are provided, I am satisfied that I have all the necessary powers to place a duty on local health authorities in these matters.

Part III of the National Health Service Act requires local health authorities to carry out a number of duties relating to local health services, including duties to make arrangements for the care of expectant and nursing mothers and to secure that sufficient midwives are available for attending domiciliary confinements. Local health authorities are further required to carry out those duties in accordance with proposals submitted to and approved by the Minister of Health or, in Scotland, the Secretary of State, who may before giving approval alter them and may at any time require the submission of revised proposals. In submitting their proposals for approval most local health authorities included provisions relating to analgesia. Where they did not do so, or we thought the provisions were inadequate, the proposals were altered before being approved. Thus duties have already been imposed on local health authorities in these matters.

The National Health Service Acts have placed upon the Minister and the Secretary of State the duty of providing an adequate hospital service, and there can be no question that by reason of this duty an obligation rests upon them to see that proper arrangements are made for the administration of analgesia in their hospitals.

I am sure that the views spoken with such sincerity and deep feeling in recent Debate will be carefully observed by those authorities, both local health authorities and hospital authorities, which are concerned with the care of women in childbirth and will create in them also a determination to see that there is no delay or hindrance in making that full provision which this House and the Government desire.

Mr. Thorneycroft

I thank the right hon. Gentleman for his courtesy in making that statement, which is of great interest to all parties. We welcome the good news he has given us about the figures. The statement is not, of course, debatable, and the only way we could have a Debate on this would be if the Government found time for the Motion now standing in the names of 330 hon. Members of all parties.

[That in the opinion of this House the Government should take all necessary steps, including the provision of time, in order to facilitate consideration of the Analgesia in Childbirth Bill.]

However, I thank the right hon. Gentleman for his courtesy in making the statement and also for providing me with a copy of it a few minutes ago so that I could see its main lines.

I should like to put three questions to him. I gathered that the gist of his statement is that he does not regard the Analgesia in Childbirth Bill as necessary. Will he say how he reconciles what he has just said with the various criticisms which were made about that Bill 10 days ago, when we were told that the Bill would be a bad one because if it became law it would give such a priority to the mothers and the analgesia service that it might wreck the National Health Service? I understand that the right hon. Gentleman's case today is that he is going to do by regulation what would be done by the Bill. It seems to me that whatever may be said for either of those arguments, they are quite inconsistent with each other. [HON. MEMBERS: "Speech."] I am trying to confine myself to three short questions to the right hon. Gentleman.

As to my second question, the right hon. Gentleman says that he can do it by regulation. Duties are quite plainly laid down in the National Health Service Act—the duty to provide a health centre and the duty to provide machinery for vaccination and so forth—but that Act does not prescribe a duty to provide an analgesia service. How can anyone by regulation turn a permissive power into a public duty? Arising out of that, I want to ask the Minister about the Burton-on-Trent case. That scheme was produced in June of last year and amended and approved by the Minister, and yet as a result of all that, only 20 women got that relief out of 1,100. [HON. MEMBERS: "Speech."] I am now coming to my last point. Will the right hon. Gentleman say how it is that he is now taking an opposite line to the one he took when he was speaking so ably in the Debates on the National Health Service Bill? The same point was then being made against the Bill. It was then suggested to him that there was no need for a duty to be imposed, and he said: If we are to have a health service we must have a national service and we cannot permit backward local authorities to deny the citizens in their area the health facilities available elsewhere. Therefore it must be a duty. We say exactly the same thing today. We thank him for his statement—

Dr. Stephen Taylor

On a point of Order, Mr. Speaker. Are the same facilities of Debate to be given to other hon. Members?

Mr. Bevan

rose—

Mr. Thorneycroft

All I was saying—the right hon. Gentleman looks at his watch, but there are thousands of people affected by this—all I was saying was that while I thank him for his statement, as far as I am concerned I shall pursue this Bill and shall endeavour to bring it into law by every means, so that every woman will have relief from pain as a matter of right and not of option.

Mr. Bevan

The hon. Member has misunderstood this matter from the very beginning, and that is the reason why he is anxious now not to admit that he has been in error from the start. There is a misunderstanding which it is absolutely essential should be cleared up, not only in the House but in the country; it is a misunderstanding based upon a lack of knowledge of what the National Health Service Act is. The National Health Service Act imposes duties upon the Minister of Health and the Secretary of State for Scotland to provide a Health Service, and there is no statutory limitation upon the kind and extent of Health Service they can provide. Limitations are imposed by nature, by our resources, by the state of medical knowledge at the time, and by the amount of rationed resources at any moment that the country is prepared to give to health matters as distinct from other claims by the country. In other words, there is no statutory inhibition, no statutory limitation, and, therefore, no need for statutory easement. That removes all of what the hon. Member has said—

Mr. Oliver Stanley

On a point of Order, Mr. Speaker. I did not wish to interfere before, but I should like to ask you under what procedure are we now acting? I understood that you permitted statements to be made when there was some new matter which a Minister wished to bring urgently before the House. I submit that the statement the Minister has made today is merely the speech that his Parliamentary Secretary ought to have given during the Second Reading of a Private Member's Bill. The fact that the right hon. Gentleman now makes that speech, naturally leads my hon. Friend to make today a speech in reply which he would have made then, and the Minister is now proceeding to make the winding-up speech which, presumably, he would have made on that Friday if he had been here. May I ask, Mr. Speaker, on a point of Order, whether the privilege of ministerial statements has ever before been extended to explanations of something which has occurred in the past rather than to statements of new developments or new policies?

Mr. Bevan

It would be extremely bad indeed if long statements made by the hon. Member for Monmouth (Mr. P. Thorneycroft) were permitted to go out to the country with no correction from the Front Bench.

Mr. Thorneycroft

The right hon. Gentleman is being a little less than fair. I could hardly be in a more difficult position than I am. The right hon. Gentleman can make two speeches, and all I can do is to ask questions on a matter of this sort.

Mr. Speaker

The right hon. Gentleman asked me about a point of Order. I am not responsible for what Ministers say. If they want to make statements, they are responsible for them, and I cannot say that they shall not make statements.

Mr. Bevan

I desire to answer the other two questions put by the hon. Member. I understand, however, that his right hon. Friend is attempting to protect him from the reply. The answer—

Mr. Stanley

On a point of Order, Mr. Speaker. I put to you a perfectly proper point of Order about the procedure, which I must say puzzles me. Is the right hon. Gentleman in Order in attributing to my desire to get your guidance some ulterior motive?

Mr. Speaker

I did not hear the words "ulterior motive." Surely it was not meant. It is the responsibility of the Minister. If he thinks a statement should be made in the public interest one can blame him or praise him, but that is his responsibility and not mine.

Mr. Bevan

My justification is that a great deal of anxiety and unnecessary pain has been created by misunderstandings which it is my duty to clear up. In answer to the second question of the hon. Member, there is no question whatsoever that his quotation from a statement I made is accurate. I said that it would not be desirable that backward authorities should be able to deny the health services to any of their constituents. That is why I have said that I have taken powers to impose upon them a duty, and I have imposed that duty upon them and, therefore, the recommendations of the hon. Member are wholly unnecessary. That was stated by the Parliamentary Secretary the Friday before last, but there were some hon. Members more anxious for publicity than to relieve pain in childbirth.

Lady Tweedsmuir

Does the Minister appreciate that we who have supported this Bill are perfectly aware of the facts and statistics? Does he also appreciate that under the terms of the National Health Service Act, while he has power to make it a duty on local authorities to provide midwives, nurses and ambulances, he has only a permissive clause to provide analgesia, and it is that which we seek to remedy? May I also ask him whether he will give the Scottish figures?

Mr. Bevan

The hon. Member is entirely inaccurate. I have said already that the Minister of Health and the Secretary of State for Scotland have the power to modify, change, enlarge any of the duties imposed upon the local health authorities at any moment. That includes the power to impose upon them the duty of using analgesic apparatus, or any other form of apparatus that may be necessary and medically useful in alleviating pain in childbirth. As I have said, there are nothing but physical limitations imposed upon the service, and enlargement of statutory powers is not necessary.

Captain Crookshank

The House decided it was.

Mr. Bevan

I am not criticising the House. I am merely saying what the liability is, and therefore any enlargement of the law is unnecessary.

Mrs. Castle

Can we take it from my right hon. Friend's statement, with its emphasis on the encouraging progress which has been made, that he agrees that this is a matter which local health authorities should treat as one of priority, and that he is prepared to instruct them to that effect?.

Mr. Bevan

I am not prepared to select out from a general service one matter for priority. It might easily be asked, why should I not give priority to research in cancer, why should I not give priority to research in rheumatism. In other words, this is not aimed to give the best possible Health Service but to exploit human pain as a political stunt.

Hon. Members

Shame.

Lieut.-Colonel Walter Elliot

Mr. Speaker, a very grave accusation has been launched by the right hon. Gentleman against hon. Members in various parts of the House. I think it is up to him to withdraw that statement.

Mr. Bevan

Not only do I not withdraw the statement, but I should have thought myself that, having regard to the statement I made at the very outset this afternoon, stating the progress that has been made, making it quite clear that no further Bills are necessary to enlarge the powers, to continue the discussion is itself evidence of a desire not to relieve pain but for publicity.

Mr. Stanley

On a point of Order. Would it be in Order for me now to move, "That this House do now adjourn," in order that this discussion may continue on a regular basis, and that charges recklessly flung by the Minister of Health, under the guise of a statement, can be properly answered by those against whom the accusation is made?

Mr. Speaker

I am afraid the Rules of the House do not allow that. The Adjournment can only be moved by one of the Front Bench on the Government side.

Lieut.-Colonel Elliot

May I ask that one of the Front Bench on the other side will move the Adjournment in order to allow this extremely grave charge—no graver charge could possibly be made—to be threshed out here and now?

Mr. Driberg

Would it not in any case be out of Order to discuss legislation on the Adjournment?

Lieut.-Colonel Elliot

May I say that we desire to discuss administration, not legislation, since the Minister claims that he has this power, and he has been asked already by my hon. Friend the Member for South Aberdeen (Lady Tweedsmuir) to give the figures to show how far this power has been exercised in Scotland, or that, if that is not a question for the Minister, then the Secretary of State for Scotland should answer. These things can be explored now if the Government dare—[Interruption.] If the Government do not dare, then we draw our conclusions as to who is trying to exploit human suffering.

Colonel Stoddart-Scott

If I understood the Minister aright, he said in his statement that he has all the necessary power to place a duty on local health authorities in these matters. Does he intend to use that power? That is the question I want to ask, because the Bill makes it compulsory that he shall use those powers. That is the difference between what the Minister said and what the Bill intends to do. Does the Minister realise that at least one local authority in Wales will not even permit a midwife to have a motor car or to apply for a motor car allowance if one is presented to her by some local nursing authority?

Major Bruce

Which authority?

Colonel Stoddart-Scott

Newport. What does the Minister intend to do about that? Will he use his powers to make local authorities like that do what the Bill wishes him to do throughout the whole of the Kingdom? My third point is a very brief one. The Minister spoke about the number of midwives already trained and that they were being trained, I think, at such a rate that in two years all the midwives in the country would be trained to use analgesia. Is he speaking about midwives in England and Wales only, or is he including also Scotland? What is happening to the training of Scottish midwives is a point of very real importance.

Mr. Bevan

As I understand it, the figure of 240 per month is the figure for Great Britain. The answer to the hon. and gallant Member's second question about Newport—I hope he took proper pains to find the facts first—is that in Newport, as I understand it, the analgesic apparatus is sent by ambulance. With regard to the first question, I have already answered that I am perfectly satisfied that I have got the powers to impose the duty and that, as the figures have shown, the duty has been imposed. The figures are improving and we shall have enough trained midwives, not within the four years stated in the Bill, but within the two years as given by my hon. Friend the Parliamentary Secretary.

Mr. Eric Fletcher

May we assume from the Minister's statement, which will be very generally welcomed on this side of the House, that effect will now be given to the recommendation contained in the recent Report on Neo-Natal Mortality, presented to the Minister and quoted in the recent Debate, that every maternity hospital in the country will as soon as possible be equipped with analgesic apparatus?

Mr. Bevan

Certainly.

Sir William Darling

On a point of Order, Mr. Speaker. May I learn from you, Sir, whether a statement is to be made by the Secretary of State for Scotland, or whether the statement made by the Minister of Health for England and Wales is to cover Scotland also?

Mr. Speaker

I cannot answer that. That is nothing to do with me.

Mr. Bevan

With regard to the question by my hon. Friend the Member for East Islington (Mr. E. Fletcher), the answer is, "Certainly." Of course, these apparatuses are being provided in the maternity hospitals as quickly as they can be made available and midwives trained to use them. With regard to the last part of the question, it is fairly evident, from the vital statistics we have been able to announce from time to time, that this Government takes more care of mothers and children than any previous Government.

Dr. Segal

While acknowledging the very impressive figures given by the Minister, especially for the year 1947, may I ask my right hon. Friend to say how many confinements occurred during 1947 at which no form of analgesia whatever was administered? Could he also say how many years must reasonably be expected to elapse before every case of confinement in this country can hope to receive some form of analgesia?

Mr. Bevan

With regard to the first question, I think the hon. Member should put it down. Of course, the number of childbirths in which analgesia was not given in 1947 will exceed the number of births where analgesia was given. When a new thing is being introduced into the medical world, there will always be a number of people who will not benefit by it immediately. That is true of everything. That is the reason why I am anxious that people's expectation of relief should not be unnaturally excited beyond the capacity to relieve them at any given time. With regard to the last part of the question, as I have already said, whereas four years have been spoken of as the date by which we hope to train all the midwives in Great Britain, we shall train them in two years.

Lieut.-Commander Gurney Braithwaite

May I ask for your guidance, Mr. Speaker, whether, if on a future occasion a Private Member's Bill receives a Second Reading without a Division and, is, therefore, before the House and awaiting discussion in Committee, it will be proper for the Minister whose Department is affected to come down and make a supplementary statement with a view to influencing the House in its further consideration of the Bill?

Mr. Speaker

That is not a question for me.

Mr. Frank Byers

In order to alleviate a certain amount of anxiety which still exists, could the Minister undertake—if not today, at some future date—to give an estimate of the date in the future when he anticipates that analgesia might be available for the population, even if it is four, five, or even six years ahead?

Mr. Bevan

As I have said, the power to provide analgesia for a mother in childbirth depends upon two things: upon the provision of the apparatus and upon the training of the midwives. At the moment it looks as though, as I have said from the figures, we shall have trained the practising midwives of Great Britain to give analgesia within two years. I cannot at the moment, however, say whether analgesia will be possible in every birth at that time, but we shall do our best to provide it, because we are anxious that women should be able to have their children painlessly. I urge most earnestly upon the House and the country not to cause unnecessary pain to mothers by suggesting that any laggardliness on the part of anybody here is responsible for the fact that in the meantime births will have to occur without analgesia. That is what I am anxious to avoid, and if I spoke strongly it is because I know that in this field it is so easy to excite unnecessary anxiety. I hope that a degree of moderation will be exercised.

Colonel Gomme-Duncan

The right hon. Gentleman has given very important figures for England and Wales, and it is of the utmost importance that we should have the equivalent figures for Scotland. May I ask whether we can have those of the actual cases from pre-war to 1947? It is important that we should have them.

The Secretary of State for Scotland (Mr. Woodburn)

The hon. and gallant Member had better put down a Question, but perhaps I might explain that medical science in Scotland does not necessarily advise that analgesia should be used in every case. That is the first point. In most cases in Scotland doctors are available for treatment in maternity cases and therefore they have powers at the moment to use whatever methods are necessary for relieving pain. Therefore the question of analgesia is not on a par in Scotland, since these facilities exist, with conditions in England where midwives play a greater part and where perhaps more anxiety is caused than in Scotland. That is why I have not made a statement and my right hon. Friend has made a statement about England and Wales.

Colonel Gomme-Duncan

There is great anxiety about this in Scotland. I shall certainly put down a Question, but I thought the right hon. Gentleman would have the information today. Can he say that midwives in Scotland will he trained in the same time as the Minister of Health said they would be trained in England and Wales?

Mr. Woodburn

I am hoping so, but if the anxiety exists it is curious that the matter has not been raised. [HON. MEMBERS: "It is the mothers."] I gathered there was more excitement in the House of Commons than among the mothers.

Mr. Thorneycroft

Despite the accusation which the Minister made against me and hon. Members with whom I was associated of all parties, I wish to say that, as far as I am concerned. I shall give all the support I can to administrative measures. We all want the maximum relief in this matter, but at the same time we shall pursue this Bill and try to get it on the Statute Book, with or without the help of the Minister.

Mr. Bevan

As I stated earlier, the hon. Member is more concerned about the Bill than about the mothers—

Hon. Members

Shame.

Mr. Thorneycroft

Not at all.

Hon. Members

Withdraw.

Mr. Stanley

I should like to raise two points of Order. The first is whether the right hon. Gentleman is in Order in wildly casting these aspersions on hon. Members in all parts of the House simply because they do not happen to agree with him. Secondly, I wish to ask whether it is not clear from the last statement of the right hon. Gentleman that, in fact, this use of the procedure of statement has been a gross misuse of the House to influence the course of a Bill now under the consideration of the House, which secured a Second reading without a Division; and as the speech he now makes was not made then, should we not proceed in the ordinary way to consideration by Committee? Is there any other instance of where it has been possible for a Minister between the Second Reading and the Committee stage to introduce an intermediate stage in our Debates?

Mr. Speaker

I am bound to say I regret these provocative statements. I always hate to see motives imputed to hon. Members. Everyone is entitled to an honest opinion, whatever it may be. I do not think that what was said by the hon. Member for Monmouth (Mr. P. Thorneycroft) justified the rebuke he received. He may have an arrière pensée; I do not know, but we are entitled to give everyone credit for the honesty of their principles.

Mr. Thorneycroft

May I say I do not press for a withdrawal, but I think the country can judge between us.