CLAUSE 22.—(Care of mothers and young children.) (Hansard, 21 April 1947)

§ Mr. Westwood
I beg to move, in page 22, line 4, to leave out Subsection (2), and to insert: (2) Where the aforesaid arrangements provide for the supply of anything that may be prescribed, not being a drug, a medicine, or an appliance of a type normally supplied, the local health authority may recover from any person so supplied such charge as the authority may determine having regard to the cost of supply; Provided that the authority may remit the said charge in whole or in part if in the circumstances of any particular case they consider it reasonable to do so. This Amendment has been put down in the light of criticisms which were expressed during the Committee stage. This new Subsection differs in two respects from the existing Subsection. Firstly, it will not now be possible for a local authority to recover a charge in respect of anything which has not been prescribed by regulation made by the Secretary of State for Scotland, and subject to annulment by either Houses of Parliament. Even those regulations cannot prescribe, as something for which a charge can be made, any drug, any medicine, or any appliance above the normal standard. Secondly, it is now made clear that the procedure will be for the local health authority to fix a standard charge reflecting the costs involved. There will be no question of considering the special circumstances of any patient, unless the patient pleads inability to pay that stan- 622 dard charge. As I have already explained, the kind of article for which charges may be authorised, include such things as layettes, cots and meals for children attending day nurseries.
It is not the Government's intention to authorise charges for the supply of anything which is provided as an integral part of health treatment. The line is a difficult one to draw. In many cases the most effective contribution which could be made to the health of a family would be to provide them with a new house. Under the Clause in the form now proposed, the House of Commons will determine where the line is to be drawn. At the present time, certain articles are provided at special terms by the Ministry of Food for expectant mothers and young children. The most important of these is milk. As long as milk continues to be a rationed article, it is unlikely that local authorities can also supply milk. Other articles supplied by the Ministry of Food include orange juice and cod-liver oil. Neither milk nor orange juice are supplied free of charge, except in cases of financial need assessed on a means test basis, by the Assistance Board acting as agents for the Minister. When the supply difficulties disappear, it will be a matter for consideration to what extent commodities of this kind should be provided by the local authorities, rather than nationally.

§ Lieut.-Colonel Walter Elliot (Scottish Universities)
The Committee spent a considerable amount of time on this problem, and I am not at all sure that the solution which has been found is very clear or very satisfactory. I am not clear to what extent the present wording differs from the wording to which the Committee took exception. The Secretary of State for Scotland said that milk would be exempted under: anything that may be prescribed, not being a drug, a medicine, or an appliance, etc. That is to say local authorities may recover from any person the cost of milk. Am I right?

§ Mr. Westwood
Yes.

§ Lieut.-Colonel Elliot
What about orange juice and cod liver oil?

§ Mr. Westwood
I mentioned those.

§ Lieut. - Colonel Elliot
The local authority can also recover from any person in the case of cod liver oil. Does the right hon. Gentleman think that that 623 meets the views that were expressed hen we discussed this matter in Committee? As regards the necessity for providing appliances, that is certainly right, I think. The local authority may recover such charge as they may determine, having regard to the cost of the appliance. But there is nothing which discourages the mothers of young children so much from applying for such things as cod liver oil and orange juice as the extraordinarily long and complicated regulations. Particularly is this so in the case of priority milk. I think it right that we should consider whether these do not themselves act as a deterrent to the mothers of young children. The preoccupation of a young mother with young children does not leave her much time to go into these forms and the minutiae of the extremely meticulous procedure which is laid down by the Treasury. The right hon. Gentleman has a certain amount of latitude to reply on this, as we are still in Committee, and I cannot help feeling that we shall not be inclined to part with this provision as it stands at this stage. I do not believe that the right hon. Gentleman has hit on a solution which meets our wishes in this matter.

§ Mr. Westwood
I have endeavoured to reach a reasonable solution. At the moment, responsibility for providing cod liver oil and milk is national, and we are dealing only with local authority responsibility. I pointed out, in submitting an Amendment to the Standing Committee stage, that as supply difficulties disappear, we shall have to consider to what extent the kind of commodities we are now discussing should be provided by the local authorities, rather than nationally. At present, the supply of these commodities is provided through the Assistance Board, and is based on the ability of the individual to pay in accordance with the charges which have been fixed. I do not know what will happen in the future, but I want to encourage the use of these commodities. I have tried to get a reasonable compromise, following the pledge I gave in Standing Committee, and it is for the Committee now, and, finally, the House to say whether I have been reasonable.

§ Mr. Willis (Edinburgh, North)
As one who raised this matter in Standing Committee, I would like to express my appre- 624 ciation of what my right hon. Friend has done to meet us. The suggested Subsection is undoubtedly a great improvement on the original Subsection. I cannot help feeling, however, that it is not even yet altogether satisfactory. Am I correct in assuming that the local authority can still exempt milk and orange juice from charge?

§ Mr. Westwood
The local authority is not empowered to provide those things.

§ Mr. Willis
Then the local authority must charge until such time as other instructions are issued.

§ Mr. Westwood
Yes.

§ Mr. Willis
It would have been an improvement if the local authority had been allowed to make purchases of these commodities, and to distribute them through their health centres. We are grateful for what my right hon. Friend has done, but we want to see everything that is necessary for the health and well-being of the people who attend these centres, exempted from the means test.

§ Sir T. Moore
Would it not solve the Minister's problem and, at the same time, give much wider cover to local authorities and the people concerned, if a comma were put in to the Bill after the word, "appliance"? The Subsection would then read: … not being a drug, a medicine or an appliance, of a type normally supplied. … That would seem to cover the question raised by my right hon. and gallant Friend the Member for the Scottish Universities (Lieut.-Colonel Elliot), and the hon Member for North Edinburgh (Mr. Willis). Suppose an iron lung was required—they are now being used in connection with certain types of disease—and had to be brought from a distance. Would it have to be paid for by the person who needed it? Surely it would be free.

§ The Joint Under-Secretary of State for Scotland (Mr. Buchanan)
That is not an appliance supplied by a local authority, and is not covered here at all. What are covered here are purely personal appliances.

§ Sir T. Moore
Then why put it into the Bill? Why introduce the words, "local health authority"?

§ Mr. Buchanan
An iron lung is not an appliance within the meaning of this Subsection. It is not something which is provided for everyday use. It comes within the general hospital service.

§ Sir T. Moore
Under the definition Clause, which we went through very carefully in Standing Committee, I cannot see how the word "appliance" can be said not to include an iron lung. Surely something should be laid down to show definitely what is the obligation of the Government or the Secretary of State, and what is the obligation of the patient and the local authority. I would like an answer on that point.

§ Mr. Gallacher (Fife, West)
the Minister will remember the strong feeling there was when this matter was discussed in Standing Committee. The right hon. Gentleman, with his usual consideration for the views of the Committee, has tried to meet us, but he has still failed to fulfil the demands which we made. When we were discussing this matter, the view was expressed that many things might be provided, towards the cost of which people could be expected to make a contribution, but we all felt that it would be very bad if there was any limitation on the supply of orange juice, milk or cod liver oil. I think that it would be better if the Amendment read: Where the aforesaid arrangements provide for the supply of anything that may be prescribed, not being a drug, a medicine, or an appliance of a type normally supplied, the local authority may, on application, supply these particular things free of cost to the person concerned. It is obvious that if families felt that they were in a position to make a contribution for anything extra supplied, they would do so. But in any case where there is the slightest difficulty, then on the application of the parents, guardians, or doctors, or whoever it may be, the local authority, without any charge, or any threat of a charge, should supply priority milk, orange juice, etc., which is required and which is outside the particular drugs, medicines or appliances specified. The Minister should apply his mind to finding the surest and safest way of supplying needy patients, and also children—especially children—with what they require to build them up, rather than to finding how he can get re- 626 payment to the local authorities. If he did so he would get a better solution.

§ Mr. Scollan (Renfrew, Western)
I am surprised at the Amendment which the Secretary of State has put forward. While it may be the best which he can get from his colleagues, it is very far from being what we should like. I was astonished to hear that anyone who wanted to escape payment for things that may be prescribed by a doctor would have to go to the Assistance Board. Is that correct?

§ Mr. Scollan
I thought the right hon. Gentleman said that the Assistance Board was to carry it out. What will be the position in Glasgow, where people for many years have had doctors prescribing cod liver oil, orange juice, or milk, which has been given free? We are now heralding with great trumpetings this new Health Bill which asks them now to pay for what they formerly got free. To ask for payment for orange juice is an amazing thing, especially when the ordinary practitioner can prescribe vitamin C tablets, which cost a little more, without payment. I think that since this matter left the Scottish Grand Committee, those who have been considering it have taken a more conservative attitude than was shown previously and do not want to concede all that we desire. On the question of appliances, I should have thought that no Health Bill was worth while which did not give an appliance such as a truss in a case of rupture, free of cost. Apparently, the local authorities will give one anything if one pays for it; but what I am concerned about is what people will get for their ordinary contributions.

Mr. McKie (Galloway)
Surely appliances which are normally supplied would cover a truss?

§ Mr. Scollan
No, it will not cover a truss. The doctor may prescribe a truss, but if it costs a certain amount, the patient will have to pay according to his income. Then, with regard to an invalid chair, supposing an ordinary contributor to the scheme develops an illness, and an invalid chair becomes necessary and is prescribed by the doctor. Will this scheme cover the provision of such a chair without the patient having to pay for it? The main things, however, about which I am concerned, are the three items which have been mentioned, and I think that if a 627 doctor prescribes them as being necessary for the health of the patient, the patient should not have to pay for them.

§ Mr. Henderson Stewart (Fife, East)
The Secretary of State must realise that hon. Members are not quite clear about what is meant by the Amendment, and that some further definition is required. We understand what is wanted, but the focal authority may not know what is intended. I think that drugs, medicines and appliances as normally supplied is a phrase which is comprehensible to us, and that the Minister is trying to say that where appliances of a rather unusual character are supplied, the patient should be required to make some contribution towards the cost. What are these special types of appliances which are not, in the words of the Bill, "normally supplied"? If I were the representative of a local authority listening to this Debate, I should not know the answer. Surely, the Secretary of State can give us a list of the things which he has in mind. I do not think that the question of a truss comes into this matter. We are dealing here with children and nursing mothers. But there may be other appliances which the county councils would like to have on their lists, and it should be stated definitely that if patients are supplied with certain things, they will be charged for them. I do not think that it is unreasonable to ask the Secretary of State to assist us in this matter.

§ Mr. Hector Hughes (Aberdeen, North)
I do not think that any further definition is required. The amended Subsection is a great improvement on the old Subsection, and it is perfectly clear. Under the old Subsection, a charge could be made in respect of any articles provided. In this Amendment it is made clear that a charge would only be made for articles excluding those not being of a type normally supplied.

Mr. McKie
May I congratulate the hon. and learned Member for North Aberdeen (Mr. Hector Hughes) on finding something on which he can support the Minister? I cannot take the optimistic view which the hon. and learned Member takes about these words. I was surprised at the way in which the Secretary of 628 State, on this occasion, seeks to cast his responsibilities on to the local authorities. The Secretary of State, having recommitted this Bill, is asking us to agree to a new Subsection in lieu of the old Subsection, which specifically named the Secretary of State. He is now moving a Subsection in which the name of the Secretary of State does not appear. I join with the hon. Member for West Fife (Mr. Gallacher), and other hon. Members, in asking the right hon. Gentleman or the Joint Under-Secretary to give us some idea of what they have in mind. What are the medicines or appliances which the local authorities can decide to give free to patients—many of whom may not be in very flourishing circumstances?
In addition to cod liver oil and orange juice, I would mention tomato juice. We all know that tomato juice is being recognised more and more by the medical profession as beneficial for people who are in normal health. How much more is the juice of this excellent fruit needed for persons who are not in good health, for young children and nursing mothers. With regard to appliances, I think that the right hon. Gentleman should give us some enlightenment on what he has in mind. I am glad that we have had an illustration on the question of a truss. I speak with some knowledge of the rural areas, and I know that in the old days agricultural labourers often suffered from very bad ruptures. In those days they were fitted out with iron trusses. I suppose that is the kind of truss which the Secretary of State had in mind when he drafted this new Subsection, which says: an appliance of a type normally supplied.

§ Mr. Willis
This Clause deals with mothers and young children.

Mr. McKie
Perhaps the hon. Gentleman is not aware that there are many young children who suffer from rupture almost from birth. Is it the Minister's intention that only the most crude kind of truss shall be made available without charge, or will more up to date appliances—I have never had to wear one myself—be among the things which local authorities can provide? The Committee is entitled to more explanation than we have had so far, and I hope that the right hon. Gentleman, if he is unable to do anything to clear up our doubts today, will be able to give us satisfaction, by way of greater clarification, in another place.

§ Mr. Westwood
I am rather amused at the suggestion by the hon. Member for Galloway (Mr. McKie) that I as Secretary of State for Scotland am seeking to place my responsibility on the shoulders of the local authorities. If the hon. Member will read the Bill—

Mr. McKie
I have read it.

§ Mr. Westwood
I am perfectly sure the hon. Member has not, because Part III of the Bill, which includes Clause 22, is the part dealing with services provided by local health authorities. It was never suggested that this was to be a service provided by the Secretary of State. This is a responsibility of the local authorities; we are imposing upon them a duty to do certain things, and I have given full consideration to what I thought were the views of the Committee. For instance, invalid chairs have been mentioned. The answer on that is that it would be the local authority's duty to provide an invalid chair, but it would equally be its duty to see that a person able to do so should pay for such a chair. On the other hand, the Amendment makes it perfectly clear that where there is any inability to pay on the part of the patient, he can get these things free.

§ Mr. Scollan
Will the Secretary of State tell us who determines the need of the patient?

§ Mr. Westwood
The local authority. Surely we can place a certain amount of responsibility on the local authority? Here are new duties which are being imposed upon them; I have had consultations with them on this as on other subjects, and the local authorities will not agree to provide free all those things which are not part and parcel of a health service.

§ Mr. Scollan
Will there be a uniform standard of need?

§ Mr. Westwood
It will be for each local authority to determine. There will be never uniformity of standards so far as local authorities are concerned, but we shall gain experience as a result of the administration and if we find that local authorities are not playing the game, it will not be impossible to get the necessary power to take reactionary authorities by the scruff of the neck and make them do what progressive authorities are doing. I have endeavoured to meet what I thought 630 were the reasonable claims made when we were discussing this in Committee. Reverting again to the point about the invalid chair, if a person is able to pay for it, he will have to pay, if the local authority so determines. The point raised by the hon. Member for West Fife (Mr. Gallacher) is however met; if it is a case of a needy patient, it will be the duty of the authority to provide the invalid chair without charge. I am all out for seeing that those who require these things shall have them, but neither I nor the Government will be party to compelling local authorities to provide everything free under this Clause, irrespective of the real need of the patients themselves. I have done everything possible to meet the claims put before me in Committee, and I hope the Amendment will now be agreed to.

§ Commander Galbraith
I would like to make certain that I understand what is provided. We are first dealing with the care of mothers and young children, and I think I followed the right hon. Gentleman correctly; he said that anything normally supplied, would be supplied without charge but, where the cost was excessive, a charge would be made fo it, although that charge might be remitted in whole or in part.

§ Mr. Buchanan
In fairness to the hon. and gallant Gentleman and to my hon. Friends behind me, I ought to make it perfectly clear that here we are dealing with children and expectant mothers, so that the invalid chair does not come into it much. The chief item here is what we call in Glasgow "maternity bundles"—I do not know what they are called elsewhere, but they include the things that are absolutely necessary to the expectant mother. Those things will be free to every woman without any means test at all, as a result of this Amendment. Before, there had to be a test. In regard to drugs, it is intended to give all the necessary drugs free, but there are certain things referred to by the right hon. and gallant Member for the Scottish Universities (Lieut.-Colonel Elliot), such as cod liver oil, for which a small charge is made. This Bill does not propose to make any alteration in those charges, but if in future this or any other Government decides to make them entirely free, it will be for the Secretary of State in future regulations to bring them into line with 631 the rest. That is what the Clause does; it brings a range of articles for the expectant mother outside any test, and gives them free to all.

§ Mr. Rankin (Glasgow, Tradeston)
The hon. Gentleman said that the invalid chair would not come into this part of the discussion, and that it was not important because we are dealing here with children and expectant mothers. But the invalid chair does come into it, because unfortunately one of the after-effects of a birth may be paralysis, and the only type of apparatus—

§ Mr. Buchanan
In order to save time, may I tell the hon. Gentleman—

The Deputy-Chairman
We cannot have two hon. Members on their feet at the same time. The hon. Member rose to put a question, but he seems to be making another speech.

§ Mr. Rankin
I am sorry if my question sounded like a speech, and I will try to put it briefly. In cases such as I have mentioned the invalid chair is a piece of apparatus normally supplied; where does it come in here?

§ Mr. Buchanan
The answer is quite simple. Any trouble or illness arising as a result of childbirth which is not covered by this Clause, will come under the general health service. Here we are dealing with the expectant mother, and not with any illness which may or may not appear after the birth of the child.

§ Commander Galbraith
I am sure the Committee is grateful to the Joint Under-Secretary for his lucid explanation. He has fully confirmed the view I was expressing, but I would like to go a stage further, and find out what happens in other cases. Young children and expectant mothers require such things as have been mentioned by my right hon. and gallant Friend the Member for the Scottish Universities (Lieut.-Colonel Elliot)—milk, cod-liver oil, orange juice, and things of that nature. These I understand are supplied not by the local authorities but by the Ministry of Food, and the local authorities cannot therefore remit any charge made for them. Whether or not it is possible for the Ministry of Food to do so I do not know, and I would like to have an answer on that. Where these things are necessary for children or for 632 their mothers, they should be available free to those who have not the means to pay for them, and perhaps some arrangement could be made whereby some small bulk supply could be made available to the local authority to enable them to meet urgent needs. The local authority knows the circumstances far better than the Ministry, and might be allowed to remit the charge in proper cases.

§ Mr. Westwood
I should be willing to consider that suggestion, which might possibly be covered in the regulations. I would like the Committee to note that nothing can be charged for at all under the proposals we are now discussing until it is covered and prescribed in regulations to be made by the Secretary of State, and subject to annulment by either House of Parliament. This was to safeguard the position and make sure that certain things which did not come within the regulations would automatically be free.

§ Mr. Rankin
That does not apply to food.

§ Mr. Westwood
I was saying that I was willing to consider these suggestions, and see if we could cover it. I am determined that those who really need these things and who are in any financial need shall have them provided. I presume that is also the desire of hon. Members on both sides of the Committee. I will take the points made into consideration when we are dealing with the regulations, and having given these explanations I trust the Committee can now come to a decision.

§ Mr. Westwood
I beg to move, in page 22, line 14, to leave out Subsection (4).
This Amendment should be read in connection with two later Amendments dealing with the Schedule, to which I shall not refer at the moment as they come on later. This Amendment deletes from the Bill the provision which sought to make the local health authority the local authority for the purposes of Part I of the Children and Young Persons (Scotland) Act, 1937. The effect of that provision would have been to require the local authority to refer to their health committee those functions which relate to the supervision of foster children boarded out privately for reward. Since the Bill was drafted, however, the Clyde Report on the 633 care of homeless children has been received, and consideration is being given to it. In connection with that report, legislation was promised by the Prime Minister, and I think it is preferable to take this point out and deal with it in the legislation on the subject of foster children in accordance with the recommendations made by the Clyde Committee.

§ Lieut.-Colonel Elliot
The Secretary of State, taking the Report of the Clyde Committee into consideration, is thinking of handling the care of young children rather under the Home Department than under the Health Department. It is of course a very interesting development that is foreshadowed there, and one in which hon. Members in various parts of the Committee feel a great deal of interest. When does the right hon. Gentleman think he will be able to introduce legislation of the type he has in mind? Would there be a joint Bill, or a separate Bill for Scotland?

§ Mr. Westwood
We should have to consider that. I do not know whether it could be done in a United Kingdom Bill, but it it were possible, I would like to have a separate Bill for Scotland. The right hand and gallant Gentleman knows that sometimes, in order to save the time of the House, there is a United Kingdom Bill in which the interests of Scotland are not sacrificed. Sometimes it is advisable to follow that course. I do not make a pledge that there would be a separate Bill, but I hope to deal with the whole problem in the new legislation which was suggested by the Prime Minister in answer to a Question in the House recently.

§ Lieut.-Colonel Elliot
I would not insist upon separate provisions for Scotland in this instance, because I know there is pressure on the Government's programme at the present time, but I think this is the first time we have had a pronouncement from the Secretary of State on the attitude he intends to take toward the Clyde Report and the means he intends to use to implement it. I am sure the Committee and the local authorities in Scotland will be very interested to hear this. Could the right hon. Gentleman give a further undertaking to issue some memorandum or White Paper on the subject fairly soon, because the local 634 authorities would wish to have an opportunity to consider it? In Scotland, so far as the boarding out of children is concerned, we consider ourselves more progressive than England, although there have been cases in Dundee and elsewhere of great brutality towards young people, which would make it necessary to have some sort of safeguarding provisions such as the Clyde Committee had in mind. If the right hon. Gentleman could give an undertaking that there will be some sort of memorandum which the local authorities can consider, we will not detain the Committee longer on this Amendment.

§ Mr. Westwood
I can give the right hon. and gallant Gentleman an assurance that I will have the fullest consultation with the local authorities. Thereafter, if it should be necessary to issue something by way of a public statement, I should be only too willing to do so. I am trying to carry the local authorities with me in this great problem, a problem which, I think, we shall be able more easily to solve as a result of the good work that was done by the Clyde Committee.

§ Lieut.-Colonel Elliot
I hope there will be some public statement, since the matter is one that has created widespread interest and on which many Questions have been put in the House. I am sure the opinions of outside persons, as well as the opinions of local authorities, would be valuable. I do not press the right hon. Gentleman further now, but I ask that there should he some sort of statement which people can begin to consider now.