§ 3.36 p.m.
§ Captain Crookshank (Gainsborough)
I beg TO move, to leave out from "That" to the end of the Question, and to add instead thereof:this House, while bound by commitments entered into and payments already made, in anticipation of Parliamentary sanction, during the lifetime of its predecessor, deplores the failure of the Chancellor of the Exchequer to enforce his own instructions to Departments not to overspend so extensively their Estimates for the current year.My first words must be to express regret that my right hon. Friend the Member for Bristol, West (Mr. Stanley) is not well enough, though present, to take part in this Debate, and also that this Debate is unlikely to be graced with the presence of the right hon. Member for Colne Valley (Mr. Glenvil Hall), whose disappearance from our financial Debates we, on this side of the House, very much regret. Some day, perhaps, we will know the explanation. We recognise that in him we always had a most courteous opponent who went out of his way to try to solve some of the difficulties with which he was faced, and had a pleasant smile when he did not know the answer. When he did, he put up a very strong case on behalf of his leader.
Having said that, I should like to remind the House that on 24th October, the Prime Minister came down and announced the economies which he and his colleagues considered necessary to deal with the devaluation crisis, which was, of course, by no means the first financial crisis that we had had since the advent of the Labour Government. Of all the prophecies the Chancellor of the Exchequer has ever made, the one which has undoubtedly come out most accurate was that in which, 917 years ago, he told us that he could not imagine the Labour Party coming into power without a first-rate financial crisis. Well, we have had a series of them and the devaluation one was the most recent. The Prime Minister came down and told us that the Government had put together a string of economies to deal with it and said:These reductions are related to the anticipated expenditure during the next financial year—That is, after April.But they will be introduced as speedily as possible—This is the point I wish to stress—and will to some extent affect expenditure this year."—[OFFICIAL REPORT. 24th October. 1949; Vol. 468, c. 1020.]The total was to be £90 million. The economies were to some extent to affect expenditure this year. Two days later we debated that statement of the Prime Minister and the Chancellor of the Exchequer again said the same thing:Some can be put into effect at once.And later on:We cannot, of course, expect this programme of economies to come into full effect in the current financial year, but it will be fully effective in the next financial year."—[OFFICIAL REPORT, 26th October, 1949; Vol. 468, cc. 1344 and 1345.]It would not come into full effect in the current year but obviously something was to happen.
Then the Chancellor concluded his speech with the famous peroration, which no doubt has been echoed time and time again during the recent election, in which he pointed out that no devaluation or economies or any other Government action would be of any use unless we all collectively and severally played our part. He said:We are not out to fight one another to see who can get most; we are all fighting together…There was not much sign of that last month. I thought we were fighting against each other. We were all to fight together as a team for the survival of a way of life, and these economies—that is, the £90 million of which some were to come into effect this year—like devaluation, are a prelude and no more to a new surge forward to conquer the hard currency markets without which our standards, our standards of living, indeed, our civilisation 918 itself, must fade and wither away."—[OFFICIAL REPORT, 26th October, 1949; Vol. 468, c. 1353,]All this was to be the result of the first step taken in economies in public expenditure. And just to make quite sure that it only was the first step, the Lord President of the Council the next day came down from the heights of the peroration and told us:We have made the present instalment of cuts to serve notice on everyone, inside and outside this country, that the Government mean business about economy, but it would be quite wrong to assume that economy begins and ends with the cuts announced by my right hon. Friend. … Anyone who imagines that the present list represents the end of the Government's efforts to achieve economies is going to be undeceived before long."—[OFFICIAL REPORT, 27th October, 1949; Vol. 468, cc. 1554 and 1555.]So that by the time the Debates of October were finished, we had built up this great picture of the vital necessity for public economy, of cuts already made—admitted, according to the Prime Minister, that they would only take effect to some extent this year, admitted by the Chancellor that they could not take full effect during this present year, but also admitted by the Lord President of the Council that they were merely a prelude to something more. That was at the end of October. Then silence. Nothing about it during the election but, on 6th March, the Estimate of £148,402,365 first presented to this honourable House for payment.
That is a staggering bill in itself, quite apart from the fact that it followed all the talk in October about the needs and the intentions of the Government to set about dealing with public expenditure. A staggering bill. Added, of course, to an earlier list of Supplementary Estimates in the region of £22 million. After all, this represents something like a shilling in the £ of the standard rate of Income Tax and it is this and allied problems that we wish to discuss today by putting down this Amendment. If the Lord President had not been quite so definite last week that there could be no general financial Debate before Easter, this Amendment might not have been put down, but he was unwilling to give us an opportunity and, therefore, we have sought it within the rules of procedure now open to us.
The Government knew long ago that a great big bill was bound to be presented 919 this spring. This money has not all been spent since the beginning of the Christmas Recess. By the end of the year it must have been quite obvious that a big bill was coming along. Last year the Supplementary Estimates were presented on 3rd February. Of course, it could not have been done as early this year since there was no Parliament, and they were presented at the earliest moment. However, I must say that it is coming a little near suppressio veri on the part of the Government to have a general election campaign and not to give any warning that these great bills were in the drawer awaiting the declaration of the poll. I have no doubt that some of my friends, as I did myself, warned audiences that this would happen but, of course, warnings from the official Opposition are very different from statements of facts, as they might have been, from the Government themselves.
However, here we are on 14th March, the first day on which matters of this kind could be raised, the Address in reply to the Gracious Speech having been passed. Owing to the lateness of the season—which arises from the date of the General Election—there is the fact that these commitments have been entered into and, indeed, largely paid, a great proportion out of the Civil Contingencies Fund. Obviously, at this stage this House can do nothing but feel itself bound to pass them.
Forty different votes—40—asking for supplementary grants. What is remarkable is that out of those no fewer than 12, and some of them for large sums, have already drawn much, if not all of what is required from the Civil Contingencies Fund. It is obvious that today—or, indeed, on any day between now and the end of the financial year—we cannot discuss all 40 of those Votes because there is not the time, though naturally we would reserve any rights we have in this matter. That is why I have moved this Amendment, because we want to, point out to the House, and through the House to the country, the failure of the Government to do anything like what they should have done in pruning public expenditure, which they promised to do as recently as October.
Before I come to my main theme, I want to make this remark. During the last Parliament we reformed to some ex- 920 tent our handling of Supply days and of Estimates. In the old days Supplementary Estimates were not part of Supply Days; special time had to be found by the Government for them, and each Vote had to be put separately from the Chair. As we all know, it led at times to discursive and detailed debate. The Select Committee on Procedure decided to abolish that, to increase the number of Supply days, and to make the Supplementary Estimates come within their ambit. I am not so sure, on reflection and in view of the experience both of this year and of last year, that the House was entirely right in doing that. I will say why.
The knowledge that the details of administration—not of policy, because policy is not open to Debate on Supplementary Estimate discussions—if a Supplementary Estimate were produced, would have to be explained and argued before the House was certainly a great deterrent to Ministers and their Departments in producing Supplementary Estimates at all. In those days, not so long ago, it was considered, I will not say a disgrace, but a very bad mark on any Department to have to produce a Supplementary Estimate; a bad mark from the Chancellor because they wanted more money, a bad mark from the Chief Patronage Secretary because they wanted more time. Under this new system, rolling up Supplementary Estimates into Supply days, the House has lost something of its control.
The second mistake that I think that we did in the last Parliament was when in 1946 we enormously increased the amount of the Civil Contingencies Fund. My right hon. Friend the Member for Bristol, West, at that time pointed out the risk that was inherent, because, he said, if Departments come along and have spent the money out of the Fund instead of coming here ahead of time for a Supplementary Estimate, to that extent our powers of criticism are somewhat reduced.
It may be that this new Parliament will have, or will desire, to look into this matter again. Be that as it may, the effect is that under the new system we can, on the Motion that Mr. Speaker should leave the Chair, raise rather wider issues than we could on any particular Estimate; and in the Vote which comes 921 before us today—obviously, I do not intend and I am perfectly certain nobody else intends, even if it was, which I doubt, completely in order, to go into every single detail—we must obviously take note that in this figure of £148,402,365 there are two or three enormous Supplementary Estimates.
Very nearly £100 million is required by the Ministry of Health and the Department of Health for Scotland. One's only comment about that, I think, is how extraordinarily out these Estimates are and how extraordinarily out they were last year. Of course, last year we all recognised—it was admitted on every side of the House—the difficulties with the new Health Service of making what, I presume, was much more than a guess. One had hoped, however, even then that an intelligent guess would have been within 40 per cent. of the right answer. It was not. That was the margin of mistake last year. This year we find that the mistake is 37 per cent. up. That seems to be a great deal in the second year and I hope that possibly the Minister will be able to give us some explanation.
The Ministry of Health is not, of course, the only big excess. There are the Ministry of Food, the Ministry of Supply, and so on. These big excesses have all occurred in spite of the policy of the Government, because in the Budget speech on 6th April last year the Chancellor made no provision at all for the possibility of any Supplementary Estimates. Before the war there was a time when it was quite normal for Chancellors of the Exchequer to take a small sum, because, whatever happens, something is bound to crop up. It may be a new small item of unimportant policy, or perhaps a new Vote is required, and Chancellors safeguarded themselves, so that the out-turn of their Budget would not be spoiled. by taking something in hand.
The present Chancellor of the Exchequer, much more rigid and austere, does not hold, apparently, with that sort of policy—in fact, very much the reverse, for in his Budget speech he was telling us:Looking at Government expenditure as a whole, I have thought it advisable to issue today a Treasury Circular asking all Departments to review again the expenditure which is likely to flow from the development of existing policies, so that it can be kept within the bounds of what is considered feasible. In par- 922 ticular, I have emphasised that only in special cases, such as, for example, major changes of policy, can any Supplementary Estimates in future be permitted."—[OFFICIAL REPORT, 6th April, 1949; Vol. 463, c. 2084.]Note the words, "be permitted." I think the circular itself uses the words, "will not be allowed." That was the direction given by the Chancellor, presumably with Cabinet authority and that of the Prime Minister, to his colleagues—"No more Supplementary Estimates. No more excesses this year excepting in changes of policy."
§ The Chancellor of the Exchequer (Sir Stafford Cripps)
§ Captain Crookshank
These are the words then used:In particular, I have emphasised that only in special cases, such as, for example, major changes of policy.…Are there other special major cases?
§ Sir S. Cripps
The right hon. and gallant Gentleman cannot have any difficulty in understanding English. One example of a special case is a major change of policy.
§ Captain Crookshank
I want to know what other examples there are besides major changes in policy. If the right hon. and learned Gentleman runs out on a quibble like that, the country and the taxpayers will know where lies the blame. Of course, at that time and ever since everybody assumed that what was meant was that if there was a major change of policy Supplementary Estimates would have to be introduced, but that in the normal run they would not be introduced.
I have looked through these Supplementary Estimates bearing that in mind. I have every desire, naturally, in controversy to be fair to the Chancellor; and I think I am being fair to him. The only cases I can find, however, in this great collection of the 40 Votes, where the change of policy argument or excuse, whatever it is, can be introduced, are these. First, of course, there was all the extra expense which results because of devaluation.
§ Sir S. Cripps indicated assent.
§ Captain Crookshank
The right hon. and learned Gentleman agrees there. That, of course, was not a change of policy; it was nothing about policy at 923 all. It was forced on the Government. It having happened, however, it obviously flowed from that result that Embassies abroad, Foreign Missions, travel and the like and, very likely, some of the goods purchased under the trading services of the supply Departments, would require more money because of the changed value of the pound. For what it is worth, therefore, we will give the Chancellor that one although it was not any great policy move.
Secondly—I am glad that the right hon. and learned Gentleman, apparently, is obliged to me—there is mention of a loan to Burma of £500,000. That is a new item of policy; perhaps it will be explained. There is another £600,000, which appears to be some form of a gift or uncovenanted obligation, to Brazil. That is, presumably, some new policy point. There is money for the Council of Europe. That, certainly, was a new piece of policy, but not adopted particularly by the Government. It was only at very long last that they agreed to the views expressed about that by my right hon. Friends on this side of the House. That was, anyhow, a new policy and the money spent for it comes within the definition of the Budget speech. The last item in that class which I can see is the increase in pay of the police, which the House accepted as the result of the inquiry into all that matter. There may be scattered about here and there some other items of new policy, but I have not been able to find them.
All the rest of this expenditure I call merely "over-spending," out-running the moneys which had been voted by this House at the time when the main Estimates were before it. The big moneys, as I have said, are partly in the Ministry of Health, partly in the Ministry of Supply, and partly in the Ministry of Food. Those are the three very big items and it will be interesting to hear from the Minister of Health whether, in his view, it has all been a matter of circumstance which he could not forecast at all—there are people who are victims of circumstance, and the Minister may one day again find himself so placed—or whether, in fact, there never has been any effective control on expenditure. I should like to know which it is, for we have had examples of both. In the last 924 Parliament we had instances where Ministers were victims of events, and we have also had experience of when there really never was any effective control. In this connection I need go no further than mention the word "groundnut."
It does appear that the Minister has been able either to estimate so carefully or to have sufficient control to make his figures come out right over the doctors and over the local authorities, but all the rest seems to have no relation to the figures he originally put before us, so that the final outcome is an increase in the order of 37 per cent. on his original Estimate. I want to know from the Minister more particularly about this because this is a very big hole in the picture.
This is a very big hole through which the money has been pouring, whether rightly or wrongly, or controlled or uncontrolled. That is exactly what I want to know. In November the Minister was saying that he shuddered to think of the ceaseless cascade of medicine pouring down British throats. He may have shuddered to think about it, but has he done anything about it? Has he any control over it? Otherwise we shall be shuddering over the ceaseless cascade of public money going into these services—against what was apparently thought necessary at the beginning of the year. Some explanation of this is very much required from the right hon. Gentleman this afternoon.
The second big difference is in the expenditure required for the Ministry of Supply, particularly for the trading services of the Ministry of Supply. Perhaps we could have some explanation about that. The really big figure is in what has happened in trading in non-ferrous metals, where we find a credit of £2,250,000 turned into a loss of £13,500,000. Again, these are staggering figures. They are no surprise to us on this side of the House, because we entirely disapprove of and disagree with this theory of the Government going in for this sort of trading, particularly as we know that by the way they do it they have no opportunity of doing, such as ordinary merchants do, hedging, and if the market goes wrong they find themselves in the very difficulties in which they are today.
925 The same occurs in the extra demand for the Ministry of Food; £15 million and more for that. We and the whole country are in difficulties when making any remarks at all on the figures which occur in the Estimates for the trading services because they are only just an in-and-out cash account and take no kind of cognizance of whether there has been any change in the stock position. Therefore no one can tell and, unfortunately, the Government do not help because they give no information on these topics, although they might very well do so.
The fact remains that these vast sums are now being asked from this House in excess of what was expected at the beginning of the year, and it is that which requires an explanation and why the Chancellor's instructions on the day of his Budget Speech have been flouted. After all, the Chancellor of the Exchequer is the Minister in charge of finance and of economic affairs. There was a time when there was diarchy, but he brought them all into himself after he became Chancellor. We do not know exactly what the Minister of State is to do to relieve him of some of the work, but the responsibility is his.
Here we have a Government, and no one more than the Chancellor of the Exchequer, telling us how vitally important it is to plan. That is the secret of success, according to them. Surely financial planning is the one essential of the whole lot. Of course it has always existed. We remember the character of Molière who discovered he had been talking prose all his life without knowing it. I imagine that every Chancellor in the past has been doing some planning, even in the days of Gladstone, though whether or not he was prepared to accept it in the meaning which the present Socialist Government does, I am not sure. This Government are always talking of planning and here we have in finance the keystone of the whole arch of Government. It is a catastrophe.
This is not the first case. If this were the first and only time since we had a Labour Government that there were vast Supplementary Estimates possibly some excuse might have been found, but it is not the only time. I am talking only of Civil Estimates on Revenue Account which have nothing to do with the Ser- 926 vices. In 1946 the Supplementary Estimates were £33 million, in 1947, £145 million, in 1948, £222 million. This year there has been a drop, but they are still £169 million. This from the arch planners, and they can look back as much as they like to 1919, 1921 and 1922, which I have here with me, but they will find nothing comparable in the way of Supplementary Estimates. In the fourth year after the last war—
§ Captain Crookshank
Hon. Members who make those remarks forget what I said at the beginning, that in October the Prime Minister, the Chancellor of the Exchequer and the Lord President of the Council told us how necessary it was to make economies on what was then announced as only the first steps—
§ Captain Crookshank
No, I cannot give way. These Supplementary Estimates are a condemnation of the administration of the Chancellor. He just has not had his way. The right hon. and learned Gentleman smiles, but does he think he has had his way. Does he consider that £169 million of Supplementary Estimates do come within the wording of his pledge and his instruction, because, if he thinks so, I am perfectly certain that no one else does.
For our part we merely say that we are quite certain, as were right hon. Gentlemen opposite as recently as October, that economies and cuts have to be made. Let there be no mistake about it. Anyone who was not in the House then should read the Debate of 26th October. Let them read the Chancellor's speech, particularly columns 1335 and 1336 in the OFFICIAL REPORT, in which he pointed out that owing to devaluation and in order to get back even to the Budget position, a great many harsh things must he done. We are perfectly certain that they have to be done and that taxes must come down.
We regard high taxation as a grave evil, and we have said so repeatedly during the past few weeks in the country. We are certain that expenditure must be reduced 927 in order that taxes can be reduced. By cutting expenditure we can increase at least our chance of keeping inflation at bay—and that is of paramount importance—we can increase our chance of capturing foreign markes. During the election the Chancellor said it could not be done, but in October, before the date had been decided, he was not only saying it could be done, but that it must be done and nothing has changed since then.
One cannot escape the conclusion that this terrific taxation under which the country is groaning today does damage our economy at home and does affect the cost of living and harm the credit of sterling abroad and does reduce every kind of incentive. For that reason we must make our protest today and it is right that we should and that we should be joined by hon. Members on all sides of the House, because it was the Chancellor himself who told us, hon. Members will recall, that their traditional role is to be the defenders of the taxpayer against the rapacity of the Executive.
Do not let us forget that all this was in the Budget speech less than a year ago. Do not let us forget that the responsibility of the House of Commons for finance still remains and cannot be abrogated. We were encouraged by those words in April. We thought that they meant something on the part of the right hon. and learned Gentleman. We thought that the instructions he was giving to his colleagues would bear fruit. Instead we find a mammoth Supplementary Estimate today of £148,402,365. The Chancellor knows perfectly well what should be done. He tried in April to do it by a circular, and that failed. He knew in October what should be done by that strong speech. He failed. He stands condemned, and in the words of our Amendment we deplore his failure.
§ 4.12 p.m.
§ The Chancellor of the Exchequer (Sir Stafford Cripps)
I intend this afternoon to keep quite strictly to the terms of the Motion and the Amendment, and I am quite sure that no one in the House will expect me to go into such attractive channels as that sketched by the right hon. and gallant Gentleman the Member for Gainsborough (Captain Crookshank) on taxation which he has just mentioned. That is for a later period. I am really 928 delighted that the Opposition have raised this matter in the way in which they have done. It is wise and right that the House should have an opportunity of an explanation as regards the general volume of Supplementary Estimates which have been submitted to it.
The right hon. and gallant Gentleman mentioned, a moment ago, what I said in my last Budget speech regarding the position of the House as the guardian of the finances of the country, and I am very glad that in this new Parliament the Opposition are to do something at least to exercise that right of guardianship which they so signally failed to do in the last one. [HON. MEMBERS: "Oh.") I hope they will realise that the concessions and extensions for which they are constantly pressing, and which they have so generously offered during the election, have to be met out of the revenue which is raised under the authority of this House, and perhaps the fact of the supplementary Votes will call to their minds the many occasions on which resistance has had to be put up by the Government to pressure by them for further expenditure.
During the war, as the House knows, the whole structure of our financial control through Parliament was put aside for obvious reasons, and in the first years after the war it was difficult to re-create, either in the country or in this House or indeed in Government Departments, that care for accurate estimating and control of expenditure which had been the practice before the war. It was indeed in order to encourage a greater degree of care and accuracy in this matter that I made, at the time of my last Budget, the statement which the right hon. and gallant Gentleman has quoted, the words of which I should like to emphasise once again.
I said:In particular I have emphasised that only in special cases, such as, for example, major changes of policy, can any Supplementary Estimates in future be permitted."—[OFFICIAL REPORT, 6th April, 1949; Vol. 463, c. 2084.]There are obviously a number of types of special cases other than major changes of policy with which everyone in the House would agree, and examples of which I shall give shortly when I deal with the Supplementary Estimates. There are others which require considerably more 929 justification because they would appear to be on the face of them, and some of them indeed may be, actual overspending. I suppose it is an absolute commonplace that no Chancellor of the Exchequer can ever regard any Supplementary Estimates with any degree of equanimity, and during the past year I have set my face very strongly against them except in special cases.
The right hon. and gallant Gentleman suggested that this was some carefully concealed position which was not brought before the country or Parliament before the election. He must have failed completely to follow the statements of the Chancellor of the Exchequer at least upon these matters. I made specific reference to them when I spoke at the Guildhall on 4th October. After having, as usual, made the review of the Budgetary position which the Chancellor always makes at that particular dinner at the Guildhall. I then said:On the expenditure side the, outlook is not so good. Below the line expenditure is not far off the proportionate estimate but above the line it is likely to be exceeded. As a result of obligations under the Atlantic Pact and Western Union the expenditure on Defence is almost certain to exceed the original estimates by quite an appreciable amount.Owing to the economies subsequently imposed on the Defence Ministries, there has, as the House knows, been no Supplementary Estimate in connection with those new services. I went on:There will also be increased cash requirements by the trading Departments for renewal of stocks which have in some cases been run down and may require replacement, and in respect of the higher sterling prices in others, but I hope that most of them will be recouped, though probably not till the next financial year. The maintenance of the Health Scheme and the improved conditions for those employed in it, such as the nurses and hospital staffs, may also entail some additional expenditure. So that if the balance of the Budget is vitiated it is more likely to come from increases in expenditure rather than from a shortfall in revenue.That was perfectly fair notice to the country at that time of what I was anticipating in four major categories—defence, the trading services of the Ministry of Food and the Ministry of Supply and in the case of the Ministry of Health. Although in one case that has not materialised in the others it has. I will explain how and when as I come to them.
930 Of course, every Chancellor and everyone who studies the accounts of the country knows perfectly well that the expenditure over the year will not fall out exactly as it is estimated. More will be spent here, there will be underspending there, so that some Votes will be exceeded while others will not be reached. The aim is of course that overall there should be no excess of expenditure above the aggregate of all the Estimates; that is to say, as the right hon. and gallant Gentleman said just now, the balance of the Budget should not be interfered with by Supplementary Estimates.
Although that is the hope and expectation it would not be very wise to put the matter in that way to one's colleagues because if one did so their natural optimism would lead each one individually to imagine that he could overspend while all his other colleagues would do the underspending. Therefore, the principle must be that each Department must not exceed for each of the services for which it is responsible its own Estimate for that service, plus anything that it can properly, with Treasury consent, transfer from its savings on other services. In other words, there must be a qualified ban on Supplementaries.
In considering the success or failure of the ban we must, of course, consider the savings which are available to offset the Supplementaries. Unfortunately, as the House knows, it is not possible to state with certainty how much those savings are until we have passed the end of the financial year, and I hope to have more to say about them when it comes to a Budget speech. But this I can say, on the basis of 11 months' expenditure, that the net excess over the Estimates as a whole will certainly be not nearly as large as the total of the Supplementaries.
That comforting fact does not in any way diminish the desirability for accurate estimating or for control of expenditure within the estimated figure. As the right hon. and gallant Gentleman has stated, for the current year the Supplementaries are 50 in number amounting to £170 million; 10 in the Summer batch, amounting to £21 million and 40 in the batch just published amounting to £149 million. A great many of those are quite trivial and of a purely technical character. There are, for instance, 15 token Supplementaries in the most recent batch none 931 of which indicated any degree of overspending. A further number consist of cases where an unavoidable obligation has been anticipated in time and so is being discharged this financial year instead of next financial year.
To give an example of that, among the miscellaneous expenses is an item of £2½ million for money spent on buying silver recovered from the coinage, buying it from the Mint and stockpiling it to meet the obligation, of which the House is aware, to return silver bullion shipped to us during the war under Lend-Lease arrangements. It proved possible to effect this recovery of silver from the coinage during the current year faster than we had expected. There has in fact been de-hoarding. The House will remember there was a good deal of trouble from hoarding in the preceding period. In the same way, to take another example, under Development and Welfare in the Colonies there is an extra item of £5,950,000. It proved possible—to our great gratification let me say—to spend more of the resources already allocated by the relevant Acts of Parliament owing to the increased availability of materials and equipment. That was merely an anticipation of future expenditure to which we were pledged, made possible because there was greater availability in the world of materials and equipment for the carrying out of capital works.
The third group of small excesses arises where payments at a pre-determined rate had to be made to individuals or funds and the outcome in numbers differs from the actuarial expectation. There are a number of these which could not be withheld without a breach of some legal obligation. One example of them is the £1,600,000 for the Ministry of National Insurance. A further set arise from the increase in rates of pay resulting from awards of one kind or another which could not be pre-judged in the Estimates o but equally could not be disregarded once the awards had been given. For instance, the larger part of the Post Office £2 million was due to this, and the right hon. and gallant Gentleman has mentioned the Police in accordance with the decisions of the Oaksey Report.
A further small number of Estimates are concerned with expenditure abroad other than the trading services, with 932 which I will deal in a moment, and they have been affected by the devaluation of the £. It has been necessary in some cases to give greater allowances to officers of ours who are abroad, the expenses of foreign stations have been greater in the case of travelling and so forth.
So far, I have dealt with a number of categories of Supplementaries which were for one reason or another unavoidable, and which may well have their counterpart in under-spending of a similar nature elsewhere. Of the remaining Votes there are a number for overseas services arising out of new policy decisions, in the carrying out of which our prestige and interests abroad are very much concerned. Let me give as an example of that the Colonial and Middle Eastern Services Vote, in which there is an item of £6 million for the maintenance of the internal security of Malaya. Then there was the completely new Vote for £10 million for Burma war damage payments, a matter that had not been settled when the original Estimates were laid. In practice, none of these new items of expenditure could have been avoided, nor, indeed, would the House have wished us to avoid them. They all arise out of special circumstances, and they are almost entirely non-repetitive in nature. In all they amount to some £20 million.
That brines me to the three largest Supplementaries which are, I presume, the real basis of the present Amendment. I will take them in rising order of magnitude; the Ministry of Food, the Ministry of Supply and the National Health Service. First of all, the Ministry of Food. That is for £13,880,000, and it consists almost entirely of a requirement for £15 million extra cash for trading services, against which there are certain small savings set off.
There are a number of items in the subheads, but broadly speaking, it can be said that stocks have increased by £23.9 million over the estimated level. This is reduced to a cash requirement of £15.3 million by the net result of changes in procurement costs and selling prices of various food stuffs. That is, of course, not an overspending, as we have more than an equivalent in extra stocks in hand representing that extra expenditure.
933 Next, the Ministry of Supply, which is £16 million. This is rather more complicated to trace out because it arises from a variety of excesses and savings and a large deficiency in the Appropriations in Aid. This latter deficiency is in reality a reflection of the reduced expenditure under the production subheads, as too is the increase in "Research and development." The House will appreciate that if less is produced, say on behalf of the Army, less will be paid for in Appropriations in Aid by the Army. Therefore, we get a corresponding reduction on both sides. That leaves the "Trading services" and "Assistance to industry" to account for almost the whole of the £16 million. This, again, is difficult to trace owing to changes that have been made in accountancy under the different subheads. But, as in the case of the Ministry of Food, it is in reality a cash deficiency only and it is accounted for by an increase in the level of the stocks of tin, copper and lead in particular.
Consumption by industry has been lower than was anticipated, and the very special position of tin and the action we had to take as regards it after devaluation has been a major contributing factor to the accumulation of those large stocks. So here too it is not an overspending but an increase of stocks which are being held equivalent to the extra cash which is being issued.
I have disposed of all the Supplementary Estimates except that on the Health Service, which is larger than all the others put together and is certainly one which could only be justified upon some very special considerations. The question which I am asked, if I may put it rhetorically, is, "How did I, as Chancellor of the Exchequer, come to pass such an Estimate and how can I justify the extra £98 million that will have to be spent by the end of the year?" Or, to put it more shortly, "Why is this a special case such as I mentioned in my Budget speech?" It is not desirable, as the right hon. and gallant Gentleman has said, that I should take the House into the details of this Estimate. That is a field somewhat unfamiliar to me but it is one with which my right hon. Friend the Minister of Health, who will be speaking later, is fully acquainted.
934 What I desire to do is first to point out to the House why this is a very special case. Let me take, first of all, the largest item—hospitals and specialists. The estimates which formed the main Health Estimates for 1949–50—that is for the last Budget—had their origin in the Hospital Management Committees in August, 1948. The time-table laid down for that estimating was as follows: submission by the Management Committee to the Regional Hospital Board not later than 1st September, 1948; examination by the Regional Board and submission to the Ministry of Health by 15th October, 1948, together with the Board's own estimate; submission to the Treasury by the Department, together with the estimates submitted by the Boards of Governors of the teaching hospitals direct to the Minister, during the month of December, 1948.
After discussion, those were settled in January, 1949, and submitted to the House on 3rd February, 1949, so that when these particular estimates came into being the management committees themselves had only very recently been appointed and, indeed, in some of them, had only skeleton staffs available at that time. There had not been time for an adequate review of the hospitals which had been grouped under their care—grouped for the first time—and in many cases no satisfactory accounts existed upon which estimates could be firmly based.
It will be borne in mind that 1948–49 actual expenditure was only for the first nine months of the Service and, of course, was anyway not available as a guide. The question arose when we examined these accounts in January as to whether in such circumstances steps should be taken to ensure that the greatest economy should be practised by reducing aribitrarily the total asked for and by spreading back the diminished total over the various Boards and Management Committees. It was impossible to judge how accurately the estimates had been made as no earlier comparable records existed other than the estimates which had been made—which were known to be wrong—for the preceding nine months.
Therefore, it was decided to reduce the estimates by some £12 million with a view to bringing about economies, or at least avoiding extravagances, and it was the 935 sum so reduced that formed the basis of the main Estimates. Unfortunately, it subsequently turned out that the Management Committees and Regional Boards had in fact under-estimated their expenditure and not over-estimated as had been suspected. This reduced overall sum—reduced by the £12 million I have mentioned—was made the basis of a request to the Management Committees and Boards in February, 1949, to submit revised estimates on the reduced basis. That is to say, the £12 million was spread over the country and they were asked to go through their estimates again so that they did not amount to more than the new total that was given. But it became clear after a good deal of discussion and correspondence that to bring the Estimate within the lower sum could not be done without closing hospital beds, and that the Government were not prepared to do.
In June, 1949, the Regional Boards and Boards of Governors were told that in making these revised estimates for which they had been asked it was not desired that economies should be made which would result in closing beds or in the reduction of other services essential to the care and welfare of the patients. It was the revised Estimate produced on this basis which eventually gave rise to the increase of £50 million in the items "hospital and specialist services."
There are several special items in the £50 million besides the £12 million cut which I have already mentioned. These were items which did not come into being or were not ascertained until after the original Estimate had been put in. The first was the implementation of the Spens Report on specialists, including arrears back to July, 1948. Some allowance had been made for this in the original Estimate but the sum which has to be paid in the current year is actually £10 million more than the original provision. The Whitley awards to nursing and other staff cost a further £7 million in the current year and they, of course, were not included at all because they had not been awarded at the time; neither were the increased numbers of the staff which have since been procured in those hospitals which were admittedly understaffed before. The balance in amount, which the House will see is somewhere round about £20 million, is underestimating due 936 to lack of material upon which to make estimates, and due to some extent to prices which have increased. So much for the hospital and specialist services.
So far as the general medical services are concerned, the small difference there is due to a speeding up in payments. The amount of the central pool is fixed at 18s. per head for 95 per cent. of the population. The other three items of importance, pharmaceutical services and dental and supplementary ophthalmic services, show between them an excess of about £45 million. Though there is an element in this of price changes, by far the greatest factor is the element of consumer demand. It was here that there existed a large pent-up demand, and there was no possible way of estimating how big it was or how long it would last. In fact, it continued much longer than was estimated at a much higher level, and only now is the curve of demand beginning to flatten out.
These, then, are the very exceptional circumstances of the launching of this vast new Service and the difficulties which arose as to the making of accurate forecasts of public demand and of the backlog of expenditure that had to be met. When these new factors were first encountered in the early summer of last year, there were only two ways of dealing with the matter—either to shut down beds and discontinue other services so as to keep within the estimates, or else to instruct the committees to maintain their services but with the greatest possible economy. We unhesitatingly took the second alternative, which was, we are convinced, absolutely right, and I am quite sure that right hon. Gentlemen opposite would have done the same thing.
It would have been quite unthinkable for any responsible Government suddenly to discontinue this essential Health Service on the grounds that a Supplementary was undesirable. This does not by any means indicate that we are content with the situation as it now exists, and I am quite sure that all those concerned with its administration, from my right hon. Friend downwards, are keenly anxious to see that there is no inefficiency or extravagance in this great new Service.
There is, too, of course, as every one recognises, a limit to the speed of development of this Service, as there is in education or indeed in any other social service provided by the community for its use. 937 The method of control and organisation in this particular case in the hospital section of the Service was praised by many people in the belief that it would be less bureaucratic and more in conformity with particular local considerations. It was, of course, an experimental form of organisation, calling into being a vast volume of that voluntary service in which in this country we have always excelled. I am certain that we should all wish to express our gratitude to the great army of volunteers on the Management Committees and Regional Hospital Boards for the devoted work which they have given.
My right hon. Friend, when he speaks, will give the House some account of the many ways in which he is proposing to assist these bodies to arrive at a more co-ordinated control of their finances and of the finances of the Service, but there are two matters which are perhaps more relevant to my duties as Chancellor of the Exchequer and which I should therefore like to mention now. First, I believe it is necessary to call a halt to further development of these services. We must, therefore, regard the Estimates for the forthcoming year as a ceiling beyond which we must not be carried by new developments or extensions of existing services which cannot be provided out of ascertained economies in other directions. I think that, on that matter, we can be greatly assisted by the fact that the Management Committees, in these estimates which they have made for the forthcoming year, have had a year's experience behind them, unlike the former occasion when they had no experience behind them.
Second, we must, now that so large an annual sum of money is at stake in the hospital services—some two-thirds of the total Vote—find some means to associate my right hon. Friend's Department more directly with the Management Committees and the Regional Boards, so that both he and I may be assured that there is no possibility of the budgets being exceeded once they are passed, or of the savings under one sub-head being dissipated unnecessarily on another. This will, I believe, be of the greatest assistance to the Management Committees and Regional Boards in what is a most difficult and not always very pleasant task—the task of controlling and limiting expenditure. How best that association can be achieved will be settled after my right 938 hon. Friend has consulted the Regional Hospital Boards and the Management Committees upon it.
The objective, therefore, as the House will see, is to place a ceiling in the way which I have described upon total expenditure, and, at the same time, to reinforce the present Budgetary system of control which is in operation. There is, as we all realise there must be in such a great new Service as this, ample room for perfecting the machinery and organisation and for checking the comparative expenditure of different units as soon as a uniform basis for estimating and costing in each unit has been worked out. All this work is proceeding busily under the guidance of my right hon. Friend and is already yielding considerable results, and the two extra factors of control that I have indicated will, I believe, reinforce the work already in band.
We certainly shall not be satisfied until we can feel that the new Service has been thoroughly examined in all its incidence and so knitted together in its organisation as to enable us to feel certain that there is no waste and no extravagance. We want to provide the best Health Service that we can for what the nation can afford to pay, and a first-class Health Service is worth a great price to the nation. It is not, therefore, something that we can either expect or hope to get on the cheap, but it must, of course, be weighed in its cost against all the other desirable and necessary items of expenditure by the community, and we must bring expenditure on health into its proper proportion with food subsidies, education and all the other matters that vitally concern the safety and happiness of the people.
It is for that reason that we are determined to see that the best possible National Health Service is built up within the limits of expenditure that can be afforded. For the present, as I have said, we must place a ceiling upon the total which we can so afford and see that within that total the best use is made of our resources. I have attempted to explain to the House why it is that in these various Supplementary Estimates there is either a technical reason or a reason which is not overspending, except in the case of this very special circumstance of the Health Service.
939 I believe that it would have been disastrous if we had done what is suggested in this Amendment, that is, refused in the middle of the year to provide any more money for the Health Service. No one would so have done. We have taken the steps which we believe are necessary in order to see that money is not being wasted or ill-spent and that development will not proceed faster than the country can afford. In the circumstances, I hope that the House will reject the Amendment.
§ 4.51 p.m.
§ Mr. Walter Fletcher (Bury and Radcliffe)
At the beginning of his remarks the Chancellor of the Exchequer took it upon himself to twit us that within the last Parliament we did not exercise that right of guardianship which it is the duty of the Opposition to provide. That, I think, came very ill from him. We remember only too well an occasion last. year on the Budget when he wished to avoid a discussion which we desired to bring about on the Purchase Tax. By a very shabby trick he avoided that discussion. Does he really think that he has the right to stand up and twit us with not exercising that right of guardianship? Let me assure him that that right will be fully exercised in this Parliament, as it undoubtedly was in the last.
It was very noticeable that towards the end of his speech the right hon. and learned Gentleman indulged in a veiled vote of censure on his right hon. Friend the Minister of Health and then ended on a note which was really an apologia. I have no doubt that we shall hear from the Minister of Health—who is quite capable of defending himself. As for the beautiful phrases that we have heard from the Chancellor, I think we could readily paraphrase them, as regards the Health Service, by saying, "We rushed ahead without a sufficient survey of the whole field which we could have made and from which we could have ascertained many of the facts, and we did not really count the cost."
I do not believe that any parish council having to spend public money, or any private business planning ahead, would have fallen into such a margin of error as is shown in these Supplementary Estimates. I believe that the House, which will undoubtedly have to pass them, will, 940 nevertheless, be perfectly right in saying that this is the worst example of lack of real planning that has ever been seen. Indeed, I have no doubt that this document will be known as the "Obituary of Planning." It was very significant that when the Chancellor was talking about the Health Service it reminded a great many of us, I have no doubt, of the same muddle and the same desire of the Minister to get personal kudos, and to be able to say that he alone had secured a great victory, as we saw in the case of the recent Minister of Food in connection with some of his schemes in East Africa. Indeed, the right hon. and learned Gentleman has brought the "peanut" method of finance back on to the home front.
In this Parliament, which will be known, I think, as the Parliament of "St. Even Stephens"—as we are a much greater parity—we shall be vigilant. Let the right hon. and learned Gentleman be certain that he will not be let off one single bit of his Estimates. Since the Labour Government came into office in 1945, there has been in every walk of life, whether in business, in local councils or in the case of people, a very strict control. The individual is controlled through the financial policy of the Government, through the Bank of England, through the Exchange Control. No business, whether in import or export, or manufacture, can escape the heavy hand of the Chancellor of the Exchequer working through various agencies, but, very largely, through the Exchange Control of the Bank of England. The Chancellor knows quite well that a permit has to obtained for practically everything. He has been most vigilant in that form of control to see that people who want to go away for holidays are limited to £50 here or £75 there.
Control over expenditure, trade, and industry has been exercised to the absolute maximum. It is quite clear from these Supplementary Estimates that there has not been the same measure of control over Government Departments. Surely, the first duty of the Chancellor of the Exchequer must be to control Government Departments and not to hamper, as he has very frequently by his financial control, the freedom of the individual and the progress of trade and industry. He has not put first things first; very much the opposite. He has been flouted by the spending Departments.
941 Of course, the Chancellor's position in 'this matter has been very much weakened, and we listen to him with a great deal less respect than we did a little while ago. At the time, just before devaluation, when his authority was great and when he went all over the world speaking with real authority, he was a man to whom when he talked to us or lectured us we listened not only with patience—that was necessary—but with some degree of respect. But, alas, he has inherited from his predecessor various "songs in his heart." "No, No, a Thouand Times No" was his theme song until we got devaluation, but the next day it was "The Man that Broke the Bank at Monte Carlo," and he cannot expect entirely to escape the consequences of that great fall from grace and authority which has been the result of his bad planning and bad estimating.
That is a grievous thing for this country, because when he now goes abroad, as he is going very shortly on O.E.E.C. and other business with America, he cannot talk with the same authority that he had before. These Supplementary Estimates are a condemnation of his lack of vigilance and of his lack of knowledge of how to handle these matters. He cannot expect that the new authority which he was trying to build up in recent months can be anything but greatly diminished by it.
Let us turn to one of these Estimates, that of the Ministry of Supply on page 70. The Chancellor attempted to explain—I thought not very clearly or convincingly—the very great difference on nonferrous metals. I am very glad to see that the Minister of Supply is present. In days gone by—a good many years ago—when we were both working in the City, he dealt very largely in non-ferrous metals. He is a great expert on them. Possibly, the explanation of this is not that given by the Chancellor. The profit motive was undoubtedly present in his mind in those days, and very much to his advantage. Is it possible that now, it a fit of repentance, in a hope of gathering treasure in Heaven, and in salving his Socialist conscience, he may think it a good thing to make a cracking loss on behalf of the taxpayer where before he made very satisfactory profits in other ways?
942 I would call on him, if he will when he comes to reply, to give a better explanation. It is believed in circles well-informed on these matters that this is not as the Chancellor explained, only the taking in of extra stocks, but that it is bad trading by the Government in nonferrous metals, and that, in the case of lead in particular, many of the results of bulk purchase and state trading have resulted in sharp losses and have nothing to do with devaluation and nothing to do with increases or decreases, and that there is no balancing factor on the other side to offset them.
Nothing is easier for the Government, with an inside line of defence in these matters, than to conceal trading losses. Perhaps this is one of the years mentioned in the phrase—which we have heard referred to so frequently in many Bills—"taking one year with another." Is this a year which we are going to take or are going to leave? I hope it is the year when they are going to take once and for all, and that we are not going to have to take it on the chin year after year until we take the count. The House is entitled to some explanation of the State trading of the Ministry of Supply in non-ferrous metals.
The real importance of these Supplementary Estimates have hardly been touched upon by the Chancellor. It was very well indicated by my right hon. Friend who opened this Debate, and that is their effect on us and on our position overseas, and particularly their effect within the sterling bloc. We are the bankers of the sterling bloc. If we are to produce the impression—and nobody can deny that Supplementary Estimates of this sort cannot fail to increase that impression—of bad and improvident finance, of not really knowing our business, of not thinking ahead, of not doing what we did traditionally as bankers of the sterling bloc and as the depository of good finance and wisdom, then these cracks already appearing in the sterling bloc will widen into great fissures and will break it up.
It is an extremely serious matter. It is no smiling matter. I notice that the Chancellor is smiling to his right hon. Friend the Minister of Health. They may be smiling to instil Dutch courage, which they will need, into themselves. 943 As the Chancellor knows from what happened at Colombo, there is in the sterling bloc at present a very great sense of disequilibrium. We shall find ourselves in a parlous condition if the dollar-earning capacities of these parts of the sterling bloc outside the United Kingdom go too far, and when their dollar need gets greater, they are no longer willing to make the contribution they make at present.
That is why it is vital that we should not have to show to the rest of the world such thoroughly bad estimating as is revealed in the Estimates before us. We know quite well that one Department has already had to be censured for bad accounts, which were presented in a way not acceptable even to the auditors. That has not happened here, but a figure of £170 million of largely avoidable Supplementary Estimates does create a very great doubt whether we are a good debt not only among most people in this country, who have to pay for this in the end, but also among most of the people who are lending, and are willing to lend us, money to carry on.
These Supplementary Estimates must, in the end, show themselves in the cost of production of the goods we have to sell. We have been exhorted by every Member on the Front Bench opposite to increase production and to lower costs. But Supplementary Estimates amounting to £170 million translate themselves in the long run into increased costs. How are we going to have this glibly promised full employment which the Government talks about as if it were a solid to be taken out of the refrigerator and sliced up and given out to people? The Minister of Health, who talks with that evangelical glow of enthusiasm which he can turn on like turning on a refrigerator with a knob at any moment, should count the cost of that when it is translated into dearer goods in competition with other countries.
Let us hope that the Government are not going to try to repeat the £170 million they have tried to gloss over this year as unavoidable. I think the old Scottish verdict of "Not guilty, but don't do it again" will have to be brought in by the country. This was bad estimating that could have been, and should have 944 been avoided. To come forward now with an apology, which is not a full explanation, will certainly call for greater vigilance if possible from the Opposition than we have exercised before. And it will call for greater power to make that vigilance effective.
§ 5.5 p.m.
§ Mr. Messer (Tottenham)
I have been rather caught out. It was certainly my intention to speak, but rather later, after I had heard a little more of what the Opposition really intended by their Amendment. There are three lines of criticism that can be levelled at these Supplementary Estimates. The first is the quite mechanical question whether or not the Minister should have been able to foresee exactly how much would have been required. The method which has been adopted with regard to hospital finance is a very important part of the supplementary estimating.
I sometimes wonder whether the country realises just what happened in the fusion of the voluntary hospitals with the municipal hospital service. Anybody who has had experience of either the municipal service or of the voluntary service will know that there were certain checks in existence. For instance, the voluntary hospitals could only spend up to the amount they were able to collect, plus what capitation fees they were able to obtain from patients. There was nothing to control them, except their knowledge of what they would be able to raise by appeal, by indiscriminate charges and by contributions from hospitals savings associations and suchlike bodies.
The municipal service was different in that management committees of hospitals were able to assess, to some extent, what would be required. It was always more than their main committee would permit. Then it had to run the criticism of the finance committee of the borough or county council. After that it had to go through the county council itself. When we had this new experiment of a management committee we had something which was completely untried. These management committees were completely unable to foresee, with any degree of exactitude, what would be required. It was very largely a shot in the dark.
Only this week I was present at a meeting of a regional hospital board and we had to consider the case of a manage- 945 ment committee which had underestimated to the extent of £40,000. Could the Minister have foreseen that a management committee was going to under-estimate to the extent of £40,000? It was clearly outside the realm of possibility. Neither he nor anybody else could have done it. The House may ask why anybody was responsible for such a bad estimate. It resulted from the fact that there was nothing on which to base it. The voluntary hospitals, which form a group under that management committee, were unable to obtain data from which a realistic estimate could be made. So it was imposible for the Minister to do anything but accept this estimate, although it finally proved to be wrong.
There is a second line of criticism. Having allowed the estimate, should the Minister have said, "You are not going to get any more money, you must work within your estimate, no matter what the consequences may be." Indeed, if the Amendment is accepted its implication seems to be that what he should have done was to restrict the service. Those who are facing great tragedy because of disease cannot listen with equanimity even to what the Chancellor of the Exchequer has said. There is need for expansion. There is need for a great deal more to be done than has been or is being done. Let us take certain services. Although if we look at the national curve of mortality figures for tuberculosis it looks encouraging, in fact it is increasing. The truth is that T.B. morbidity is increasing. There are at present no fewer than 10,000 tubercular people waiting to get into sanatoria. In one of the 14 regions there are no fewer 2,000 waiting to get into a tuberculosis bed in a hospital or a sanatorium. Among those people are some who have waited since January, 1949, and some females among them who have waited since October, 1948.
The implications of the Amendment are that not only have those people to wait still longer, but that we are to reduce the facilities which already exist for dealing with tuberculosis. That is unthinkable. I want to persuade the House, if I can, to spend even more money on this service, because more money is required. I repeat what I have said before in this House: no better investment can be made than safeguarding the health of the people. 946 Spending money first in preventing disease is the better way of using it. It is far better to spend money in preventing a person going to hospital than to spend money in keeping a patient after he has gone into hospital. Even so, if we fail to prevent a person becoming a patient there is no reason why we should be afraid of spending money in maintaining him when he is in hospital.
I want to deal specifically with three grave matters which are facing hospitals at present, and tuberculosis is one of them. The second is the care of old people. I am not one of those who, blinded by political prejudice, believe that a change which has been made by my own party is necessarily perfect and that everything that happened before was necessarily bad. What we have found since the introduction of the new service is a greater difficulty in getting accommodation for old people in hospitals than we found before. While I do not want to go back to the days of the relieving officer, I do remember that the statutory officer was sometimes in a position to get a bed for a patient, and we find that very difficult at present. The reason is that we are now upgrading our hospitals. Those places which were infirmaries are now being turned into hospitals, and the cost of this service results from the fact that whereas at one time they were staffed by medium-standard people, they are now being staffed by specialists. We are upgrading these hospitals but the tendency is to use them for acute cases, thus rendering less opportunity for the accommodation of these chronic cases.
I have with me a file and if I were merely talking sentimental tosh, I could affect hon. Members by reciting some of the cases in this file. There are people suffering from cancer, with nobody in the house to help them, and there are some people who are doubly unfortunate in that they are unable to do anything for themselves, and accommodation cannot be found for them. Then there is the type of old person who falls between two stools. The hospital authority says, "This case is not a hospital case because the person is not suffering from any sickness that can be certified." The person has arrived at that stage of physical deterioration which requires some measure of care and attention, and the hospital authorities say, "This is a job for the welfare authority 947 of the county or the county borough." The county or the county borough says, "No, this person requires medical care and attention; he is the responsibility of the hospital board." Such a case falls between those two stools.
Then there is the case which fluctuates. An old person may be ill for a short period and well for a short period, arriving at that stage when he is in a decline as a result of those rapid fluctuations. Such a person also falls between the two stools, and is accommodated neither in a hospital nor in a welfare home. These are matters which require urgent attention, and I am mentioning them because I want to refer to the expense of this service. Such people must be looked after. We have got to find the money to enable such people to be cared for. It is no good saying that we must cut our garment according to our cloth, if that means that some people get the benefit of the shelter of that cloth and others are denied it. We have got to see that the cloth is so distributed that that section of the community which is most in need of it gets what is required.
Then there is the third class of case—a class of case which is pathetic not only in itself but also from the point of view of the relatives of those who are affected. Here, again, one does not know how to meet it. Everybody who is engaged in muncipal work knows how difficult it is. A child is submitted to an education committee as being ineducable. The education committee, advised by its officers, certify that the child is ineducable. As soon as that happens the child is no longer the responsibility of the education authority; it is dealt with by the health authority. It is mentally deficient, and at present there are in the homes of this country large numbers of such children who cannot be accommodated. I mention these things only as illustrations to show that if the logic of the Amendment is followed, money cannot be spent on such children.
It is no good hon. Members opposite saying, "We are not opposed to the National Health Service." It is no good their reiterating their election speeches in which they said "The Health Service belongs to us; this is our Health Service." It does not. I happen to have been the vice-chairman of the County Councils' 948 Association when we had the first discussion which preceded the White Paper issued by Mr. Ernest Brown. That was nothing like this Health Service. It was not a comprehensive health service. It was not a free health service. It was not a health service which gave to everybody an equal opportunity. Even so, Mr. Ernest Brown was not allowed to continue. Then Mr. Henry Willink came in. Further discussions took place, and even Mr. Willink's plan was not like the present service. It is not a bit of good any hon. Member opposite saying "We believe in the Health Service," and putting down an Amendment which has as its object the curtailment of that service. It is true that there is room for criticism in the service; that is due to the nature of things. If my right hon. Friend had introduced a scheme which was perfect at the beginning, I should not have had to point out its imperfections.
I am quite ready to admit that in this magnificent scheme, this splendid scheme, there are things, beyond the control of my right hon. Friend, which require consideration. In the first place, the hospitals are unfitted to be dealt with under the Treasury system of finance. This will give some explanation of why there has been such moderate estimating. In the old days a local authority would estimate its requirements. All the chief officers would be called in to say what would be required by them for the forthcoming financial year and, when the budget was passed, that money was available to be spent; but if, at the end of the financial year, that money had not been spent, they were able to carry forward their balance on to the next year. This meant that any economy which could be effected within the financial year was at their disposal for the following year.
Treasury finance is not like that. Treasury finance falls at the end of the financial year and if, after an estimate has been made, the estimate has not been expended, then they cannot carry forward the unexpended balance. That possibility no longer exists as an inducement for them to make effective economies to enable them to do work which might be required later. The effect is likely to be this: I hope it will be understood that while, nominally, the regional boards are responsible for passing the estimates of 949 the management committee, in actual fact they are not in a position to check very closely because members on the other side of the House have always insisted on the necessity for complete independence on the part of management committees. Because they have insisted on that complete independence, the regional boards, for instance, are not in a position to do anything in regard to establishments. They can advise, they can guide, they can direct, but they have no authority and we would not want them to have authority. What we require is machinery to deal with the situation which still makes for flexibility and adaptability at that point in the process in contact with the patient.
The methods of Treasury finance can be an inducement to wasteful spending, for the management committee, having estimated and not having been able to use the whole of the money in its estimate, would be tempted to spend that money where otherwise it might have been saved. I realise that in this scheme we have to go a long way yet before we can satisfy ourselves that all the holes have been stopped up. But, as has been indicated by the Chancellor of the Exchequer, steps are being taken towards that end. The King Edward Fund and the Nuffield Trust are at present engaged in research for the purpose of ascertaining whether it is possible to have a unit costing system, so that there could be some datum line when estimates are being made. That work is going on, but I suggest that it would be possible for us to effect economies if we were able, first of all, to establish the realistic nature of the estimate first submitted and then able to apply some such test as unit costing. The regional board itself might then be in a position to indicate in what way economies in administration might be effected.
I realise that I am speaking as if nobody else has had any experience in hospital administration, but I know enough about the hospital world to say this: that the teaching hospitals—and I am a member of the board of governors of teaching hospitals—and the voluntary hospitals—and I have a large number of voluntary hospitals attached to the region of which I happen to be chairman—realise that at this juncture the necessary changes which had to take place have left both the Minister and the Chancellor 950 quite incapable of correctly estimating what it would cost.
Let us take the question of nurses' salaries. If the Amendment is carried, notwithstanding the fact that we have set up machinery for the determination of wages and salaries, notwithstanding the fact that there has been the Spens Report and that we have to pay that which we could not possibly estimate, does it mean that it is to be argued that we should not continue with the development of the work—work which cannot stand still and which is probably the most important social work we have in this country? I am sorry to see the Opposition take this early opportunity to put such an Amendment on the Order Paper for, although they have made it comprehensive so that it covers other services, the fact is that it is aiming at the Health Service and the country had better take note of that.
§ 5.27 p.m.
§ Dr. Hill (Luton)
May I crave the indulgence of this House, which is customarily and so generously given to new Members in addressing the House for the first time? I will, if I may, and within the realm of the Amendment before the House, refer to some aspects of financial control, in particular in the hospital field. Before doing so, may I say that it gives me particular pleasure on what is to me, a unique occasion to follow the hon. Member for Tottenham (Mr. Messer) who has done such magnificent work in the building up of this service both at the regional board level and in the position in which he is highly honoured—that of chairman of the Central Health Services Council?
Despite his admonition, I would desire to say just this: that whatever controversies may have raged in the past as to the form the Health Service should take, whatever battles may have been won and lost, it can now he fairly stated that both inside and outside this House the people of this country are anxious that the National Health Service, with such changes as may from time to time be necessary, shall be a resounding success.
Beginning, if I may, with hospital and specialist services, the Supplementary Estimates bring the total under this heading—the heading dealing with advances to regional boards and boards 951 of management—to the level of £215 million, some £45 million higher than the corresponding figure for the first year, bringing the nine months period up to date to 12 months. A significant point is that of that total expenditure—and it is of particular significance in view of what we have heard this afternoon—some 95 per cent. is for day-to-day expenditure and only some 5 per cent. is for capital expenditure. In pre-Act days the expenditure of local authority hospitals was conditioned by the prospect held before the members of local authorities of periodic re-appearance before the electorate. The voluntary hospital field expenditure was conditioned by the money available for the prospects, bright or dim, of obtaining that money.
Now I turn to this administrative set-up—I should say, in parenthesis, that I believe the set-up to be a right one and my only misgivings are whether Scotland has not achieved something better than ourselves. In this administrative set-up the difficulty, it seems to me, is this, that the expenditure of the hospital management committees, lacking such checks, is contingent upon the prospect of a successful argument with the regional hospital boards, and the check upon the regional hospital boards is the prospect of a successful argument with the Ministry of Health. In consequence, there is a weak element of accountability. As has been said, the budgets, the estimates, of hospital management committees are gathered together by the regional hospital boards, where they may be summarised and criticised, but the Minister's role and the Minister's problem is to exercise central control after the budgets have been assembled and received, after they have been through the regional mill; and his difficulty, it seems to me, is to impose, often too late, cuts—for it is as cuts that they are regarded—on the regional boards and hospital management committees.
Now the right hon. Gentleman has—I think, rightly—proclaimed his intention to permit the highest possible measure of local responsibility and local autonomy, and the difficulty which has to be resolved is, how to reconcile that local responsibility, that local budget preparing, with central financial control. Already the Minister has sought to impose a cut only 952 to find it impossible. I am glad—for I understand it to be the case—that the Minister has decided in future to make allocations of money, not earmarked for particular hospital management committees, but to regional hospital boards for their allocation. I believe that to be a step in the right direction.
Even so, and even if all possible central economies are effected, it is impossible not to expect a substantial increase in hospital expenditure. The proportion of expenditure for capital development is in the region of 5 per cent., and under the present system there are few hospitals which cannot effectively sustain arguments for rebuilding a new wing, or buying a new piece of apparatus—arguments which the Minister, under this set up, will find it impossible to resist. If we may look at the problem in isolation for a moment I would say that I see the prospect of increased expenditure on hospitals—justifiable in relation to hospital considerations—of £100 million or even £200 million in the next few years.
This brings me to this point, that if it be assumed—and I assume it—that there is a limit to what can properly be raised by taxation without killing, or at least injuring, the goose that lays the golden egg; if that be true, and if it be true that such increased expenditure is a reasonable possibility, then we are led up against the crucial issue of the priority of social services in relation to limited resources. We are approaching—the Chancellor of the Exchequer made me wonder today whether we had reached it now, in his view—we are approaching a decision as between hospitals and houses, as between clinics and schools; and sooner or later there must be a proper allocation of resources as between one form of social service and another.
I do not presume to say whether the limit has been reached, or what the priority should be, but I do believe that the one way of strengthening the hand of the Minister of Health in this matter—the one way—is the pre-determination of a sum of money, at whatever level it may be, which is available to be expended on the Health Service. Now, this would mean in the case of the hospital services an annual allocation of money to regional hospital boards, and in turn the allocation to hospital management committees. Clearly, that allocation must be sufficient 953 to meet maintenance costs, with a reasonable allowance for capital development.
In this way the local hospital management committees would receive a control comparable in some ways to the accountability of old. It might have this further advantage. The public, recognising the element of State provision, to which the Chancellor of the Exchequer referred today, would return once more—recognising the character as well as the limit of the provision—to that old and friendly and supporting attitude towards the hospitals of this country. I do not mean a return to flag days and the like, but there are still people and organisations who are anxious to help their fellow men, and who find in service for the hospitals opportunities which, in their experience, cannot be equalled in other fields. Apart from anything else, I believe that the existence of such opportunities does good to the people who take advantage of those opportunities.
I hope I shall not weary the House if I refer very briefly to two other aspects of the Supplementary Estimates. It is, perhaps, inappropriate here to refer to the comparison between the cost of general practitioner services, relating as they do to the general medical care of the whole body, and cost of dental and supplementary ophthalmic services, which, though important, relate to circumscribed parts of the body. Nor is it the occasion to refer to general practioners' remuneration, which, in some ways, needs improvement; nor to the margin between the general practitioners' and the specialists' remuneration, which needs to be narrowed. The point I want to stress is this, that the sort of allocation to which I have been referring in relation to the hospital field, exists within limits, and subject to periodic review, in the general practitioner field; which is one of the reasons for the more modest Supplementary Estimate that has been found necessary in that field.
But the dental and pharmaceutical services, the greatly increased cost of the dental service, and, even more important, the tragedy of the decay of the school dental service—these things are attributable, in my view, to three main causes. There are too few dentists to provide a comprehensive dental service however it is organised. The dental Spens Report is not being applied to the school dental 954 services, with the inevitable result that dentists in considerable numbers are leaving for other more remunerative forms of work. Third, the present system of remuneration being the same for all qualities of work, it provides for a minority an incitement to hasty and so to unsatisfactory work.
The solution is one of immense difficulty. If we apply—I confess I am doubtful on this point—the allocation principle to these services it will be possible to give expression at long last to the Government's policy of priority for the dental care and treatment of mothers, by providing a complete service for those priority groups, provided that steps are taken to attract back to those dental services the practitioners who have left. The list of priorities could from time to time be extended, but it would mean this. Bearing in mind that there cannot be a comprehensive service because of the shortage of dentists is, perhaps, not so tragic to contemplate. It would mean this, that outside the priority groups there would be a fixed sum of money which would be available as grants in aid for those whose needs were less in this dental field. Whatever else is done we must restore the school dental service and the dental service for expectant and nursing mothers, and reverse the conservative tendency, which, because of haste, has already begun—I do not use the word "conservative" in a political sense—to return to the old and more vigorous "pull it out" methods in our schools and clinics.
May I say one word on the pharmaceutical service which at present is the greatest problem of all? The increase in cost is due in part to an increase in the number of items of service. I believe that the increase there is actually some 7 per cent. It is due in considerable part to the increased cost of the newer drugs which, although expensive, contribute to the service elsewhere by shortening periods of illness. It is due to the tendency—not surprising in view of the initial propaganda—on the part of the public to seek to obtain under the National Health Service arrangements those minor medications and dressings which formerly they were willing to pay for themselves. I admit that, among other causes, is the pressure of the middle- 955 class, covered by this scheme, for the standard of medication to which they have been accustomed in the form of the better proprietory medicines, and that is, in part, responsible for the increased cost. The remedy is very difficult apart from a cash barrier.
I hope that the Minister of Health will say something about what I will call the shilling scheme. I know that the effect of the announcement of that scheme reduced the burden on practitioners, but I hope that the tendency to regard a large number of the lesser items which are demanded of the service and of the doctors in particular as frivolous will cease. The whole of this service was to bring people to the doctor for the trivial to prevent it becoming a tragedy, and there is a tendency in all quarters to regard the trivial as being mainly or wholly frivolous. Of the shilling scheme, I would say this: I can see its force and effect in one direction, but, speaking only for myself, I have the most serious doubts as to its practicability, and I have serious doubts whether it will be possible to devise a scheme which is fair to all sections of the community, particularly to the larger families.
Lastly, may I thank the House for the patience with which it has listened to me—recognising that the strain on some Members may have been greater than usual—and thank the whole House and its staff on behalf of the new Members generally for the friendliness and cordiality with which they are received into the Parliamentary community.
§ 5.43 p.m.
§ Dr. Barnett Stross (Stoke-on-Trent, Central)
It falls to me on behalf of the whole House to congratulate the hon. Member for Luton (Dr. Hill) on his first speech in this Chamber, and to say that we have been very happy, certainly on this side, to hear him. We hope that we shall hear him in this vein—I think his true vein—very often because his enormous experience, and, if I may say so, his undoubted sincerity when he speaks on this subject will endear him to the whole House.
To follow the speech made by some one who, as it were, was making it from these benches, and speaking very strongly against the Amendment, is somewhat difficult. I say at once—and surely it is 956 not offensive to say so—that I found myself in agreement with everything that the hon. Gentleman said; in particular when he was speaking of the small percentage of funds available for the capital improvements of the hospital service—a mere 5 per cent. Those of us who have worked as medical men know full well what are the crying needs.
I am reminded that only a few days ago—I hope that on this point the Minister will listen to me carefully—I went round a very large hospital of a thousand beds in North Staffordshire. I saw evidence of a great deal of capital expenditure in the way of new building—but I was told that no new building was permitted but-reconstruction and rebuilding were allowed. Obviously a great deal of money was being spent on patching, when, in fact, we could have got something much better had it been spent according to a proper plan. I hope that the Minister will bear in mind that a service of this type must burst through any bonds that tend to restrain it because it is a moral service and a human service, and the demands of the people have to be met. It is far better not to waste our money by patching and repairing when we can get a better result by saying, "Here is so much money for you; spend it in the best possible way."
I thought that there was a suggestion when the hon. Member for Luton was speaking of a little regret at the terms meted out to the general practitioner. The general practitioner does indeed bear the brunt of the service on his shoulders. He has to face up to all changes that occur in the first place. I sometimes used to wonder when I was in practice why the word "specialist" was not applied to the general practitioner, because he is a specialist in his own line, and a very wise one when he has had sufficient experience. It has been fascinating to know that his average salary is £1,530 a year, but his prescriptions cost £1,700 each year.
The last speaker gave some of the reasons why the drug bill is so high. Sir Henry Cohen and his committee are considering a type of advisory pharmacopoeia which will help the medical practitioner. It is very essential and very desirable. Certainly, in my day, and, to a lesser extent now, treatment was not considered as being of the utmost importance by way of training because there was many 957 other things to learn. The curriculum was overcrowded, and the medical man, when a house physician or house surgeon, and, later on, in practice learnt much by reading and discussion with his colleagues.
This brings me to the point that his education will improve vastly and many of the problems which we are discussing now will not be so apparent when the health centres are ultimately built and available. When he is in practice and if he has not full experience he tends to be affected a little by the high pressure salesmanship of the people who come round and wish to sell new lines of drugs. Some of these, as has been said, are expensive. In no way should anyone think that I am saying anything derogative of the great firms who have turned out so many excellent products.
It is true that there is a certain fashion in prescribing and fashions in prescribing can be particularly expensive because fashions change, and chemists tell me that that they have been left with great stocks on their hands because no one wants any more of a particular product. That is all somewhat unsatisfactory. In the olden days, one got some kind of guidance with a rather rudimentary pharmacopoeia given to the practitioners who worked for the National Health service. He knew that he could go outside it in any direction he liked, but when questioned he would have to defend his choice, and, if the defence was untenable, he was surcharged. I myself see nothing wrong in that as a principle. The whole of the pharmacopoeia should, of course, be open to each and every medical man; the question of surcharge if he does not know his work, or if he shows excessive licence in prescribing, expensive and unnecessary proprietary articles, is a matter upon which we all have our own views, and upon which most of us are agreed.
In the past there has been a good deal of controversy about the cost of the dental service. I think that we have now begun to realise that the dentists as a whole have done a very good job; but it was a job that very badly needed doing. None of us had realised what the needs were. Probably the ordinary general medical practitioner in a great urban area was the person who knew best how sadly deficient people were in care and attention in this respect, and it has not surprised me that 958 there was a great rush on the service. I was delighted to hear the hon. Member for Luton make a plea for the re-establishment, as quickly as possible, of a priority service for children, and expectant mothers.
I have often wondered whether the Minister could not cut the Gordian knot fairly simply by stating as a condition of service for the dentist that he should treat a percentage of children. We all know very roughly how many children there are in an area, and I think it is well worth while asking the dental profession whether they will not work out their own scheme in that particular way. Certainly the public are becoming very restive over the fact that the people who need dental care most are those who tend to be most neglected, because the dentists do not find time to do the work for them.
The ophthalmic services have also been very costly, and it has become significant that because we needed very many more spectacles they became dearer as time went by and as the service went on. I should have thought that spectacles and their provision would have become cheaper if there was such a great demand. I am told that it is normal business practice if there is a very large turnover the goods become cheaper. In this particular case that has not been so; there has been a greater demand for spectacles and they have become more expensive, and I think there is something very unusual about it.
Another point which the Minister should perhaps have considered but did not was the giving of a suitable incentive to the optician, because from a financial point of view the optician found it desirable to prescribe two pairs of spectacles rather than one. I should have thought that it might have been wiser to have paid only a very small fee for the second pair. At any rate, there is a spate of double spectacles provision all over the country, in a way that did not exist before, and ophthalmic surgeons and men who are cognisant of these problems have put it to me that the incentive has been wrongly balanced. I will put it no higher than that.
This Health Service is one we boast of as being universal in type, as comprehensive as any in the world, and one which we wish to be entirely and freely available 959 to the public. I have heard the Minister say that he felt it was quite reasonable within the service that people who had money to spend should be able to buy privacy but not priority. I think everybody agrees with that, but unfortunately priority is being bought throughout the country. I have never read a letter in the House before, but I do crave indulgence to be allowed to read part of a letter I received yesterday from one of my constituents. He states that he has a child aged six who was examined in April of last year by the school medical officer and found to be underweight, and also very deaf due to enlarged and septic tonsils. He says:We were told that there was a big waiting list but we would hear in due course, when my son would then undergo an operation for the removal of his tonsils. Now, 11 months later, we are still waiting and the child cannot even hear a wristlet watch tick when it is held to his ear. His general physical condition has deteriorated to such an extent that the school medical officer has prescribed a course of sun-ray treatment. Of course"—and this is the point—if I were to pay for an operation I could nominate my own date. However, I cannot see the purpose of a National Health Bill if one has to contribute the scheme and yet pay doctors' fees in addition if immediate treatment is thought desirable for a child's welfare.I have great sympathy with the point of view expressed there. The child is becoming progressively deaf and 11 months have passed by. I can vouch for the truth of the assertion that in the area from which this letter was written—as indeed in many areas—if this father were willing to pay a fee, perhaps not even a very high fee from some points of view, he could have immediate attention for his child. I hope the Parliamentary Secretary will tell the Minister that we on this side feel very strongly indeed about this unfortunate hiatus in the Service, or this omission from what we felt was promised to us, or what we promised to the public. If money is the trouble we should not be afraid to spend more money.
My last word on the subject is this, and I am sure I shall carry the whole House with me. No one has yet pointed out that the best way of saving money is not to spend it, and one of the most costly things about sickness and ill-health is that we have to care for those in the community who are sick and ill. 960 Before the war, we used to estimate that on average about 800,000 people would be sick at any given time, and in those days we used to say that if we could prevent 200,000 of them going on to the sick list in a given number of years, by having a comprehensive Health Service, such as this one is we would save about £60 million a year. Well, that was in the old days, when we did not pay out very much in benefit to people who were sick, and when standards were very low. I estimate that today, if we can cut down the 800,000 sick people to 600,000 we could save £150 million a year. That is a very good way of saving money, and with that in mind I am sure that the Treasury, the Minister, and all of us should not be too squeamish about existing costs.
§ 5.59 p.m.
§ Mr. Iain MacLeod (Enfield, West)
I think the only thing that draws new Members of this House to their feet to take part in these Debates is the sure knowledge that they can rely, as I rely tonight, on the traditional courtesy and kindliness of Members of this House.
We are today considering an Amendment which has been put down arising out of Supplementary Estimates amounting to about £148 million. Of that vast sum something like two-thirds, or nearly £100 million, is attributable to the National Health Service. All hon. Members are very familiar with the growth of the cost of this scheme from its first presentation to this House in 1946, when the House discussed it on the basis of a scheme costing £152 million a year, or about £3 per head, until the proposed Estimate for next year, which is about £400 million, or some £8 per head.
The first point I should like to make is that, formidable though these figures are, they are net figures and they do not show the full cost of the Health Service scheme, partly because of the transfer payments from National Insurance and partly because of various recoveries, and also because of the superannuation scheme, which shows inevitably in its first few years a surplus which will have to be repaid later, but which at the moment disguises the true cost of the scheme. It is true to say that when an announcement is made, such as the Chancellor made this afternoon, that 961 there is to be a ceiling put on this scheme, we must remember that, in the absence of drastic action, the cost of this scheme will inevitably increase, for, apart from the reasons I have given, we are an ageing population, and for the next generation, in the absence of dramatic scientific or medical discoveries, the demands of sickness will inevitably increase.
It follows that the Chancellor of the Exchequer and the Minister of Health have got themselves at the moment into the position of Alice and the Red Queen. The House will remember that the inhabitants of Looking-glass Country had to do all the running they could do to stay in the same place, and if they wanted to get somewhere else they had to run twice as fast. If our resources—and this has come from both sides of the House—are inadequate—and they are and they will be for a long time to come—then it follows that we must establish priorities as between the social services and also within the social services. On this theme of priority I am quite certain there is general agreement on both sides of the House. The Minister of Health last year at the Socialist Party conference said that priorities were the religion of Socialism, and last night, speaking in this Chamber in the housing Debate, he returned to the theme of priorities, about which we have heard both from the hon. Member for Stoke-on-Trent, Central (Dr. Stross) and from my hon. Friend the Member for Luton (Dr. Hill). We should look for a moment on this scheme to see if, in fact, the correct priorities are being observed.
I should first like to refer to a matter that has been touched on already, and that is the bill for the general dental services, which at the moment is exceeding the bill for the general medical services. If we include Scotland, that means that some 10,750 dentists are being paid more in terms of gross income than some 21,000 doctors. Even if one makes all the adjustments in favour of the heavier cost of practice expenses that dentists have to bear to the full 52 per cent., which is I believe the amount allowed, the dentist at the moment is paid by the State far more in terms also of net income than is the doctor. I have no hesitation 962 in saying that that is an indefensible position.
I am myself both the son and the grandson of a doctor. I believe that relative to their training, their qualifications, their ability, the load of responsibility that they ceaselessly shoulder, and above all the hours during which doctors are at their patients' service—in my father's house as in every other general practitioners that was 24 hours of the day and seven days of the week—doctors are by far the worst remunerated profession in the service. I have not the slightest doubt that there is no question, and there never will be of a doctors' strike, for it is unthinkable for doctors to have anything remotely resembling a strike, but I think we should be wise not to presume too far on the infinite and most statesmanlike patience which the medical profession has shown in these last two years.
The second point I wish to make has also been touched upon. In Section 22 of the parent Act and in the White Paper which preceded it, and in the speeches of the Minister of Health on Second Reading and in Committee, stress was laid over and over again on the need for priority dental treatment for certain classes. Quite obviously that is a sound principle, for if the teeth of expectant mothers and those of infants and young children be sound, then in a generation we will have dentally a sound nation. Hon. Members know that, in fact, these priority classes—I am not arguing about the responsibility; I am stating a fact—are being neglected today, and there are many areas in this country in which the school dental service has virtually broken down. Wherever the responsibility may lie—and I know it causes the Minister of Health, the Minister of Education and the Secretary of State for Scotland great concern—the fact is inescapable that almost the only thing that was made deliberately by the Government a priority in the Health Service has failed.
The third point and the last on priorities which I should like to make is—there is a small Supplementary Estimate put down under research, presumably referring to the Minister's powers under Section 16.
§ Mr. MacLeod
Too small perhaps, but I remember reading last year that the Minister of Health stated that he was awaiting information from the Peckham Health Centre to enable him to determine whether he could make a grant under his powers under Section 16. I do not know whether that has been done or not, but I know that on the same day that I read about these Supplementary Health Estimates for nearly £100 million I also read that the Peckham Health Centre was closed because it could not collect £20,000, which is one five-thousandth part of the amount to be passed in this House tonight. I suggest there is something sick at heart in the service, something desperately wrong with the priorities in a service in which that sort of thing can happen.
If it has been agreed that these figures are formidable, all thinking people, whether they are inside or outside the House, and everyone concerned with the future of this service are also agreed that the priorities are clearly in many cases unsound. Is it possible for us to suggest what has gone wrong? Very diffidently in a sentence or two before I sit down I should like to give my view on what has happened. The traditional function of the social services, as I understand them, is to rescue the needy from destitution, the sick from ill-health, and the unfortunate from the consequences of their misfortunes. It is a principle that was expressed very clearly by my right hon. Friend the Leader of the Opposition at our Brighton conference two years ago when he said this:The scheme of society for which we stand is the establishment and maintenance of a basic minimum standard of life and labour below which a man or woman of good will, however old and weak, will not be allowed to fall.I should like to take with that something said by my right hon. Friend the Member for Warwick and Leamington (Mr. Eden) in this House on 26th October, which was very badly misrepresented in the course of the recent election. This is what he said:Has not the time arrived when we must, as a nation, recognise that the principle of the social services ought to be that the strong should help the weak, and not to try to aid everybody alike indiscriminately? That is the whole basis on which I want the examination of this problem."—[OFFICIAL REPORT, 26th October. 1949; Vol. 468, c. 1366.]964 I agree that that is the basis on which we should examine this problem of the minimum standard, and, secondly, of the duty of the strong to help the weak.
Today—and this is what I think has gone wrong—the conception of a minimum standard which held the field of political thought for so long, and in my view should hold it still, is disappearing in favour of an average standard. To an average standard, the old-fashioned virtues of thrift, industry and ability become irrelevant. The social services today have become a weapon of financial and not of social policy. This may sound Irish, but it is both true and tragic that, in a scheme where everyone has priority, it follows that no one has priority. This principle goes deep in the difference between the two sides of the House.
Perhaps I may sum up my argument in one sentence. I would put it like this: I believe that the conception of the minimum standard and the duty, which ought to be a proud duty, of the strong to help the weak, not only forms a nobler and juster basis for our social services but is a basis that is infinitely better matched to the independence and the character of our countrymen.
§ 6.12 p.m.
§ Mr. Baird (Wolverhampton, North-East)
It falls to my lot, and I am honoured, to congratulate the hon. Member for Enfield West (Mr. lain MacLeod) on a most sincere and able maiden speech. Those of us on both sides of the House who have specialised in the health services will welcome a very able recruit to our ranks. It is not for me to be controversial following his speech, but I would point out to the House that last night the Liberal Party went into the Lobby with us and that after the maiden speech of the hon. Member for Luton (Dr. Hill) we expect the National Liberals to go into our Lobby tonight. After the able speech to which we have just listened we can also expect some of the Conservatives to do so.
I want to speak for a few minutes about the cost of the Health Service. I think hon. Members will agree with me that the cost of the general medical service is reasonable. With regard to the cost of the hospital services, there, again, we are on common ground in thinking that the cost 965 is at least justifiable. Where there is criticism—and there is—of the Health Service is in regard to specialist or supplementary services, such as the dental, the ophthalmic and pharmaceutical services.
My first point is that it is in those services that this party and the Minister went furthest in sacrificing our principles when the Health Act was framed. These services are not upon a salaried or capitation basis, as is the case in other branches, but they are paid upon an itemised scale of fees. We have, to a certain extent, imposed the National Health Service on people, some of whom have a private enterprise outlook. Where there is an itemised scale of fees there is a great temptation to put private profit before national interests. That is why we have these swollen Estimates for the specialist services. They are open to grave abuse.
I remember, shortly after the National Health Service was introduced, travelling in a train with a leading and distinguished dental surgeon. He was outside the service but he was chairman of his local dental committee. He told me that he had resigned that week from that position because, at every meeting he went to, the dentists who gathered there, instead of discussing professional matters spent almost all the time discussing ways and means of getting round the regulations of the National Health Service. That is typical of a certain number of the profession, at least. The question we have to ask ourselves, speaking especially about the dental service, is: why could the Minister not make a closer estimate of the cost of the dental services? We must face the fact that no one can assess the amount of preventable ill-health that we had in this country before the Act came into operation.
With regard to the dental service, the Minister has another defence. I remember when the Teviot Committee on Dentistry was set up the British Dental Association produced evidence to that committee showing that if a national dental service was set up there was no reason to believe that the present dental population could not satisfy the dental needs of the people. The argument was that even if we had a free, general, dental service, a large number of people were not educated to appreciate dental services. 966 A pamphlet published by the British Dental Association as late as the beginning of 1948 said:The Minister's attitude to many of the suggestions made by the Association have been affected by his constant emphasis upon an alleged shortage of dentists. The Association"—this is the senior dental Association in this country—is of the view that, providing the conditions of service are attractive enough to bring into the service the full strength of the profession, there are sufficient dentists to meet any demand that is likely to take place in the immediate future under the National Health Service Act.The great mass of the dental profession are now working within the Act, and there is a great shortage of dentists in this country. As late as 1948, the dentists of this country, the people who ought to have known best what the probable demand for dental services would be, and they believed that they could satisfy the demand. How can we possibly expect the Minister to assess the demand for dental services when the profession itself could not assess it.
The second question which we have to ask ourselves is: can we assess the cost of the service? If money has been wasted on the dental service, how has it been wasted and what can we do to save on the dental estimates? I can speak only from personal experience, but I have heard from hon. Members opposite and we all heard it during the election that far too many people were getting two pairs of spectacles or sets of false teeth which they did not require, under the National Health Service. With regard to the dental aspect of that matter there has been a certain amount of over-prescribing. A certain number of people have obtained dentures although they already had a fairly efficient set. They have obtained new ones.
Hon. Members opposite were always asking us for clinical freedom for the dentist. We gave the dentists about 99 per cent. of clinical freedom. If there has been over-prescribing for dentures and spectacles the fault lies with the professions concerned. They have the remedy in their own hands. They must say to patients, when necessary, "Your present appliances are efficient and you have no need for new ones." but as long as these practitioners are paid according to an 967 itemised scale of fees there is always a temptation to supply further dentures, because that means more profit.
I believe that the amount of over-prescribing is very small indeed. I can only speak from personal experience as a practising dentist, and I know that we cannot base the whole of arguments upon practical experience, but 99 per cent. of the people who go to a dentist's surgery for dental treatment really require that treatment. Not once, or twice, but many times in a month I have people coming to me who have been wearing dentures for 20 and 30 years, dentures which are ill-fitting and causing a deterioration in the patient's health, but, because of the cost, they have put off having them replaced. They are having the work done now and that is justifiable.
The other day a woman of 30 or 35 came to me with no teeth. Looking into her mouth it was obvious that she had not worn teeth for years. She told me that her husband was a regular soldier, and a soldier's pay is not too high, even under the Labour Government. She said she had her teeth out in 1939 and saved up enough money to get a new set of dentures, but then her husband came home from Dunkirk and they "blued the lot." They have not been able to save enough since. That is not a good argument for my case, but there is that type of class of people who require the service, but, for one reason or another, have not been able to afford it.
The main branch in which we can help the general public is among the younger generation. There are young people who, 'when at school, had the facilities of school dental service and had free dental treatment in the Forces. When they came out of the Forces, in 1945, their mouths were in good condition and they had healthy teeth, but, for two years, they have had tie) treatment because they could not afford it. Now they are flocking into dentists' surgeries week by week by hundreds of thousands. They are people of whom I have heard it argued by hon. Members opposite that they did not appreciate dental service, and that if they could have it free they would not avail themselves of it. Young people are becoming tooth conscious and they want to retain their own teeth. That is why there 968 is a large demand on the service at present.
The hon. Member for Luton suggested that perhaps if we devoted our time to the priority services and made a grant in aid to the other services the problem might be solved, but in the same speech he said that the shilling prescription for pharmaceutical service could not work. That, also, is a grant in aid and if it could not work a grant in aid for dental services could not work either How is it possible to save on the dental services? I believe that in the long run the best way of saving money on the health services is to set up a fully salaried medical service. Until we do that we cannot get the efficiency necessary for a service such as this. Even though the Act is on the Statute Book I believe that the ultimate aim must be a fully salaried service. I have come to the conclusion, after listening to speeches from the other side of the House—and I think the House will be in agreement—that members of the dental profession are being paid too much under the Act and that there must be a further cut in their income. I hope the House will be united, because I have been accused of making foul speeches attacking my profession. I hope the House will he united, as it seems to be tonight.
The hon. Member for Luton and the hon. Member for Enfield, West, spoke of a school priority dental service, but the main reason why the school dental services have broken down is because we are paying such inflated salaries to the dentists in private practice. It is all right talking of the Spens Committee, but there have been considerable increases in the incomes of the school dental officers. When I came out of the Services the average income was about £400 or £450; it is now commencing at about £850, and is going up. The point is that 'the dentist in private practice is making much more than was recommended by the Spens Committee. I do not think we can solve the problem simply by paying the dentists in the school service as much as those in private practice are paid. The school dental service is based on local authorities. If the school dental officer is paid £1,200 or £1,300 on a rising scale, solicitors and doctors will want to go up, too.
969 I consider I have done more in regard to the school dental service than any other hon. Member. I have been interested in it since I came into the House five years ago. The problem will not be solved simply by pushing up incomes. I would point out to hon. Members that the main culprits in the school dental service are the dentists themselves. The school dentists allowed negotiations to be conducted for them by the British Dental Association. Whitley machinery has been offered to the school dentists whereby they could negotiate increases in salaries and terms and conditions but the British Dental Association, for political purposes, have refused to use that Whitley machinery. This has been going on for two years, and I hope that hon. Members on both sides of the House will bring pressure to bear on the dentists to go into the Whitley machinery and get the matter settled as soon as possible.
The biggest saving which can be made on the dental services is in regard to supervision. At present the dental services are supervised by the Dental Estimates Board, situated at Eastbourne with an establishment of 12 dental officers who are supposed to examine any controversial estimates which come before them. They refer any matters with which they are not satisfied to the dental inspectorate of the Ministry of Health in Whitehall, who have inspectors all over the country. I ask the Minister what has been the saving up to now, the net and definite saving in dental costs, by referring such cases? I believe it has been very considerable, but, just as the school dental service is breaking down, the Ministry of Health Dental inspectorate is breaking down and the Estimates Board in Eastbourne is breaking down. They are paid a salary of about £1,000 a year and they are drifting into private practice. Whereas they had an establishment of 12, they now have five officers. The regional dental officers of the Ministry of Health are leaving week after week to go into private practice.
I make a proposition to the Minister that if he would increase salaries of these inspectors—who must be men highly qualified, because they have to take decisions over the heads of ordinary practitioners—and if he would employ a further 30, which would cost £45,000, the 970 Minister would save not £1 millon, not £2 million, but a considerable number of millions of pounds. I believe that is the way we have to do the job. The dentist has proved that he is not worthy of clinical freedom. I say that in all sincerity and after consideration. There must be more supervision than at present, and it can only be done by paying the inspectorate a higher salary than at present.
During the election campaign, after I had been suggesting that the Tory Party had voted against the National Health Service Act, my Tory opponent claimed that, "If I thought the Conservatives had voted against the Health Act, I should not be standing on this platform." We know that during the election the Act was an electoral asset. It has been a successful Act in every way, and the Tory, Party are now trying to climb on to the band wagon.
This House has a right tonight to ask the Tory Party and hon. Gentlemen opposite where they stand with regard to the Health Service. Where do they stand with regard to their Amendment? Do they want to cut the Health Service? If so, in all honesty they must come forward tonight and say so. So far, not one of them has specifically stated what expenditure he would cut. The House has a right to know what aspects of the Health Service they would cut if they were on this side of the House and in the Government. The people of the country want to know and have a right to know.
§ 6.31 p.m.
§ Major J. R. Bevins (Liverpool, Toxteth)
I support the Amendment which has been moved from this side of the House, and in asking for the indulgence of the House I should like to bring the Debate back to the rather general line on which it commenced. I have the honour to represent a Liverpool constituency which is predominantly industrial, and I should like to make it plain to hon. Members on both sides that in the course of my election campaign I made public retrenchment the major plank of my appeal to the electorate. I am quite convinced, notwithstanding the smiles of the Minister of Health, that there is very profound disquiet about public expenditure, not only on both sides of this House, but amongst all sections of the community, The greatest single step that this House 971 could take to put the country on the road to economic sanity is economy on a large scale.
Why do we on these benches advocate State economy? It is important to understand that we are advocating economy not merely or primarily because we want to see a lower level of taxation, or because we realise the important impact which extravagance has upon the cost of living. Basically, we are objecting to Government extravagance because on economic grounds we regard the actions of the Government as damaging to the national interest. Not only today, but for a considerable time past, there has been agreement between the two Front Benches that, if devaluation is not to plague our future, we must increase very largely the physical volume of our exports to overseas countries, and especially to the dollar area. That, however, it is simply impossible to achieve so long as the Government, which, after all, is the biggest spender in the country, is imposing such an enormous demand upon our productive capacity. That is the basis of the case which we on this side are trying to put across. We feel, therefore, that unless extravagance is curbed, the existing wounds in our external trading position are likely to become running sores which will debilitate the whole of our economic system.
Neither I nor my colleagues are opposed to the social services in any sense whatever, but I ask hon. Members opposite if they would not agree with me when I put to them this proposition. The most important problem which the House has to consider is how we can reconcile and harmonise the social security and the economic security of the individual citizen with the economic security of the nation. We are not concerned this evening with the long-term solution to that problem, but there is a duty on both sides of the House to say how we propose to approach that problem on a short-term basis. I believe that it is possible, by improvements in administration, by eliminating fanciful form of over-organisation and some of the frills which have crept into State administration since the end of the war, to effect very large-scale economy.
I was not greatly impressed by the case which was made out this afternoon by the Chancellor of the Exchequer. If 972 I understood him aright, the right hon. and learned Gentleman admitted that certain Departments had exceeded their Estimates but said that, as there had been equivalent savings in other Departments, there was really nothing about which to be perturbed. I should have thought that if certain Departments had failed, quite rightly, to reach their estimated expenditure, that did not constitute any excuse for gross over-spending in other Departments. I take leave to wonder whether, when the Minister of Health and some of his colleagues were so blithely spending public money during the last 12 months, they had the smallest appreciation of the fact that any economies whatever were being effected in other Departments.
I agree that control of expenditure, not only personally but in the spheres of local government and, particularly, of national government, is an exceptionally difficult matter, because the opportunity to check the bedrock detail of expenditure so very rarely arises. It is the cumulative effect of a multiplicity of small items of expenditure, which in themselves are perfectly justifiable and virtuous, that creates the difficulties in which we find ourselves today. It is all very well for the Chancellor of the Exchequer to talk about his new ideas, his new system for creating a sense of economy in Government Departments, but we shall never get the retrenchment for which we on this; side are asking until there is a conscious will on the part of all Ministers of the State for economy. It is quite plain this afternoon that that will does not exist, and that the longer right hon. Gentlemen opposite are in office, the more we are likely to see spate after spate of Supplementary Estimates presented to the House.
I take that view for a very simple reason, which, if the House will bear with me, I will try to explain. Hon. Gentlemen opposite, as is well known, fall into two schools of thought. There are some who believe that the eventual goal of the Socialist State will be brought about by the redistribution of ownership. They advocate the nationalisation of industry or a capital levy or a combination of the two. There are other hon. Gentlemen opposite who believe that the same end can be achieved by the redistribution of incomes through taxation and the social services.
973 It will not have escaped the notice of the House that the first school of thought sustained a slight setback on 23rd February. The nationalisation chariot was rather unceremoniously kicked into the ditch by the British public and, judging by the Gracious Speech and what has gone since, I should imagine that the Prime Minister, and certainly the Lord President of the Council, are perfectly happy to leave that chariot in the ditch. At the same time, the redistribution of incomes chariot goes backwards and forwards in a very uncertain fashion, with the Chancellor of the Exchequer trying to restrain it and, I suspect, the Minister of Health trying to urge it on.
That brings me to my final point. The Chancellor, speaking in this House in April last year, used these words:…There is not much further…possibility of the redistribution of national income by…taxation."—[OFFICIAL REPORT, 6th April, 1949; Vol. 463, c. 2083.]That, if it implied anything, implied that it was not possible for State expenditure to rise. However, that appeared to be a heresy because six days later the Economic Secretary to the Treasury used these words:…There is quite a way to go…in the redistribution of property by taxation."—[OFFICIAL REPORT, 12th April, 1949; Vol. 463, c. 2652.]I took that to be a direct stimulus to the squandermaniacs on the Front Bench opposite. In order to clinch the argument, the Minister of Health, speaking in his own particular idiom in South Wales in October, said this:Further redistribution has to take place because redistribution is also retribution.There lies the moral justification in the right hon. Gentleman's own mind for the enormous Supplementary Estimate that has come from his Department today. I am not one of those hon. Members who believe that the Minister of Health is incompetent or inefficient. I do not expect, when he speaks later in this Debate, that he will be apologetic. However, I do regard him as a clearheaded and logical Socialist who knows where he is going. He is going towards his Socialist goal by the wholesale redistribution of incomes, and a man who believes that, as he does, may be perfectly right according to his own lights but, considering the economic plight of this country, I submit he is fatally and miserably wrong.
§ 6.46 p.m.
§ Mr. Griffiths
—to accord the traditional congratulations to the hon. and gallant Member for Toxteth (Major Bevins). The House noted the clarity of his speech and I am sure that he is glad to have got that contribution off his chest. I know it is traditional to avoid controversy in maiden speeches, but I, too, represent a Lancashire constituency and I quite appreciate that we Lancastrians sometimes transgress a little in that direction. I hope the House will hear the hon. and gallant Member often in the future, when my colleagues will have an opportunity to reply to him in greater detail than I can do tonight.
The attitude of the Opposition on the subject of the National Health Service has undergone some violent oscillations in the period since it came into operation. They have exhibited a kind of Dr. Jekyll and Mr. Hyde attitude towards it. This afternoon we have heard what one might call the contribution of the Dr. Jekyll in the speeches of the hon. Member for Luton (Dr. Hill) and the hon. Member for Enfield, West (Mr. Iain MacLeod). However, those of us who were here in the last House and have observed the trends in these last two or three years, will have observed that all too often the Mr. Hyde in the Tory Party was in command.
We remember their vote against the National Health Service Bill on Second Reading and again on Third Reading. We have noted that they and the Press which supports them have exploited every opportunity of abusing the service. They have fostered discontent based upon the unavoidable delay in the provision of spectacles, of dental treatment, of deaf aids and other appliances—a delay caused by the rush of people to avail themselves of the provisions of the service. It has been a demand on such a scale that it has revealed a measure of deprivation hitherto apparently undreamt of by the Opposition.
However, as we approached the General Election we heard increasingly the other voice of the Opposition expressed in terms of "we fought for the 975 National Health Services all the time." So far from introducing any economies or making any suggestion to His Majesty's Government where economies might be effected, they actually proposed to increase expenditure on the service. For example, in the party policy statement they proposed to make provision for the free supply of drugs to doctors' private patients.
This is really a most extraordinary approach to a searching inquiry into alleged extravagancies. No mention of curtailment whatsoever; only a specific proposal for an increase in the scope of the service which would undoubtedly increase the expenditure. Now we are again having the other side of it—the criticism of increased cost, a general criticism of the scope of the service, without the Opposition giving us the benefit of their detailed advice as to where they would effect the economies.
I wish to refer to two services where the additional sums required in the Supplementary Estimates have excited some attention. I refer, first, to the dental services and, secondly, to the supplementary ophthalmic services, I would note in passing that both these services are articulated through private enterprise, both are administered by the instruments of private enterprise. I would remind hon. Members that when the Minister laid regulations before the House seeking to put a maximum ceiling on the earnings of the dentists, it was the Opposition who opposed it. Despite the fact that in the country they grumble and sneer about the amount earned by the dentists, when it came to placing a maximum on their earnings by action in this House, they spoke against it.
Similarly during the recent General Election the joint emergency committee of the ophthalmic opticians put to the leaders of all the political parties a questionnaire which sought their views on the future development of the supplementary ophthalmic services, I noted the reply of the Conservative Party on this point. In a letter sent to the secretary of the joint committee signed by the right hon. and gallant Member for Kelvingrove (Lieut.-Colonel Elliot) they replied that they were favourable to the continuation of the existing supplementary ophthalmic service. The spokesman of the Labour 976 Party reiterated the party view that for the time being the supplementary service shall be continued, but at the earliest possible date the eye service, to be carried on in the hospitals, shall be enlarged to cope increasingly with a major portion of the demands for an eye service, in which the opticians and others would all play their proper professional parts.
The attitude of the Opposition is that they stand for the continuation of the existing supplementary ophthalmic service. It must be obvious that whatever may be the merits of the existing supplementary service, it is undeniable that it is a more expensive form of distribution of a public service than would be obtained through an eye service carried out in hospitals and clinics. I agree that there are some merits in the existing service which we recognise, for example the right of the patient to choose the individual practitioner with whom he or she may previously have been familiar, and the right to use what is often the convenient location of the premises or consulting room where they can receive the service of those people.
The consequence of this articulation through the field of private enterprise is to be found in the action which has been taken, and which is reflected in the demands of these Estimates, by the manufacturers of lenses and frames which are needed in the eye service. Before the National Health Service came into operation the prevailing price for ophthalmic lenses and frames varied considerably, but in the main the average price was slightly lower than the standard price laid down by the Ministry of Health. Immediately the service came into operation that price became the minimum price which the manufacturers and wholesalers charged to the consultants for supplying the appliances to the public. It is all funnelled through a variety of wholesalers and manufacturers.
One can see the immense benefits which would accrue to the Exchequer through being able to operate the eye service through a hospital or clinic system, with the Ministry of Supply or some other body responsible for placing long term contracts, which would ease the supply situation and would also reduce the cost. I am surprised that the Conservative Party who, when talking about the eye service often indulge in 977 the same sneers and gibes as they indulge in about the dental service, could have replied to the people who submitted this questionnaire, and have told them that they are in favour of the continuation of the present scheme, which whatever its merits cannot possibly be justified on the grounds of economy.
I turn to the question of the Estimates and the amounts which for the moment these services are costing. I note that the Select Committee on Estimates, in their examination of the National Health Service, brought out very clearly the point which has been made today by some of my hon. Friends that it was quite impossible in the first months of the service, with the lack of information and data then before the Department, to give anything like a sound estimate as to the cost, although I must say, if I may again give as an example the ophthalmic service, I think they made an extremely bad guess. I see that their original estimate was that on a 12 months' basis the cost would be £2,273,000. They based that increase for the ophthalmic service under the old National Health Insurance cost. That was a service covering only eight million people and it cost £1,375,000 in a year. That was a contributory service, and there was a financial deterent to obtaining it. It was more than optimistic of the Department to allow for an increase of only double when the service was being expanded to cover the whole population without a financial barrier being there.
Any hon. Members who have read the evidence given before the Select Committee on Estimates, and have read the questions put by its members and the answers given by witnesses, will have come to the conclusion that in respect of the estimates which have run so considerably above the figures originally given blame cannot be attached to the Minister's advisers. Because of the complete absence of knowledge on the subject, all or nearly all of us grossly underestimated the great amount of work that had to be done in these fields.
I believe that with good will and an end to attempting to use the National Health Service as a political shuttlecock we shall be able, as we proceed, to make economies where they are obviously 978 necessary. What we on this side of the House refuse to do is to make those economies at the expense of the wellbeing of the community. If my right hon. Friend works along these lines, as I believe he will, resisting all pressure to obtain economies at the expense of the majority of the people, while certainly making economies where individual pressure groups are exploiting the welfare of the community, he will have the support in the Lobby tonight of all his friends who agree that the National Health Service is providing good service for the people of this country.
§ Colonel Stoddart-Scott (Ripon)
The hon. Member said that the Conservatives voted against the reduction in the payment of dentists. Will he give us the date? There have been two reductions in dentists' pay. In the first case we did not even pray against it; it was the hon. Member for Wolverhampton, North-East (Mr. Baird), who prayed against that reduction. Nor on the second occasion did we pray against the reduction. Will the hon. Member state the time when we voted against the reduction of dentists' salaries?
§ Mr. Griffiths
I cannot state the time but the incident to which I have referred is within the recollection of the House.
§ 6.58 p.m.
§ Mr. John Grimston (St. Albans)
We are considering today the dereliction of the Chancellor of the Exchequer in not enforcing his own declared policy, and most attention has so far been concentrated on the 'Minister of Health. I am glad to see the Minister of Supply in his place because I propose to say something about the second largest item in the supplementary Votes, namely, the buying of non-ferrous metals. The main nonferrous metals are copper, lead, tin and zinc. I took particular care to try to note what the Chancellor of the Exchequer said in his opening speech. He tried to explain the expense by these words, "It is not a case of overspending but of holding higher stocks, particularly of tin, lead and copper."
I hope I noted those words aright because those figures have to be examined in considerable detail, and my case is that by no means the whole of this supplementary amount is accounted for by the holding of higher stocks. After 979 all, stocks are declared and I have here figures from the Non-Ferrous Metals Statistics Bulletin which give in detail the holding of stocks of all the metals. Anticipating some kind of excuse such as that which the Chancellor made, I have calculated how much the declared stocks of the Ministry have increased.
They are something under £8 million in the year January to January, 1949–50. The budget of the original Estimate was for a credit balance of £2¼ million, and the Minister is now asking for a further £13½ million; so he has to account for a deficiency greater than he expected of £15¾ million. The holding of stocks accounts for just under £8 million. But there is a further point which the Minister did not make, and which is certainly not clear from the reading of these estimates, and that arises from the devaluation of the pound in September of last year. Again, I have got out the figures. At that time the Minister's declared stocks of metal were, in round figures, 200,000 tons of copper and 120,000 tons of zinc, and so on. I would remind the House what happened on that occasion. The Minister stopped selling metals. At that time I said that in his position I would have done the same. I hold no criticism against him for doing it, because it will be evident later that all I am asking for is that consumers in this country shall be empowered, by whatever machinery the Government likes to approve, to buy their metals at world prices in this country.
The devaluation of the pound brought a fortuitous profit to the Minister of Supply on the declared stocks of his metals. He may have secret stocks, I do not know. But on the declared stocks he made a profit of £13 million. So we have the position that he has spent £15¾ million more than he expected, and he made a fortuitous profit of £13 million which, I hope, in view of what the Government have said about devaluation, he cannot have foreseen. So he has to account for £28¾ million in extra stocks. His declared extra stocks amount to under £8 million; therefore, he has to account for £20¾ million hidden away in metal stocks.
The only place he could have hidden these stocks is in tin which he holds abroad. It is known that he holds large 980 quantities, but if he has to hold the whole of the £20¾ million in stocks of tin abroad it means that he must have bought the entire output of the Far East for six months and put it into stocks, and made no sales at all. These figures can be checked by any hon. Member who wishes to do so. I suggest that the excuse of the Chancellor of the Exchequer that this extra Vote is wanted entirely for higher holdings of stocks does not bear examination.
No one has ever suggested that even the Ministry of Supply could lose as much as £15 million in trading in metals; nevertheless, there is much in the present system of selling which should be improved and which I think the Minister personally would like to improve. After all, before the war when he was on the Metal Exchange, he made a very nice thing out of it and he knows the workings of the Exchange. At that time the only criticism of the functions of the Metal Exchange of which I was aware was that every day there were small and vexatious alterations in price. But it had many advantages from the point of view of the country and of the consumer. In the first place, the country did not have to foot the bill as the result of any bad contracts into which any party had entered. Under bulk buying, of course, through Votes such as this, it is the country that foots the bill.
Another thing we could do before the war, but which cannot be done now, is that metal could be covered forward at an economic price. The Minister will know that there are certain trades, for example the supplying of generators for large hydro-electric schemes, in which orders may be given today and not wanted for delivery for three or four years or more. Under the system of buying ahead at an economic premium which prevailed before the war, manufacturers could contract themselves without having to run the risk of fluctuations meanwhile in the price of metal. Today that is denied them, unless they are prepared to pay the absolutely exorbitant premium which the Minister has imposed on forward purchases of metal in order to discourage them.
A further thing that could be done before the war and cannot now be done under the present system of the Minister, is to get metal delivered into the works 981 of the consumer for a few shillings above the price which ruled all over the world. Before the war one could buy copper in America, Germany and England at one price. Today the basic English price, because of the overheads of the Ministry, because the Ministry had to pay the price of Atlantic freight and other charges which the Minister does not describe too well, consumers in this country start at a disadvantage of at least a ton in the cost of copper over their American competitors. Copper enters into every single mechanical export from this country, and how can the Government support a system which causes us to pay these fractionally higher prices for our raw material than have to be paid by our keenest competitors in the United States? Surely the Minister must get out of the way for the consumer to negotiate the lowest possible price with the supplier to see that we get our metal at the lowest possible world price.
Before the war, metal could be brought into the works where I work for 6s. above the New York price. Today if I want to buy metal, say six months ahead, delivered to my works, I must pay £10 over the world price. Does the Minister really think that the services he renders to industry are such that the difference between £10 and 6s. is a fair one for industry to have to pay? For our part we would be very glad to see the Minister out of business, leaving us to negotiate decent contracts with the suppliers of metal, who are very few and who are well-known people operating in the business.
The Ministry overheads, which is a heavy charge, is based on services which the suppliers of metal themselves used to perform before the war. This is an important point, and I hope that I shall receive the attention of the Minister. Before the war suppliers of metal paid the shipping charges on metal to this country. Under the arrangement which I know the Minister is trying to negotiate he hopes to get rid of some of the shipping charges. Hitherto, the Minister has been paying the charges on copper which previously the copper suppliers themselves used to pay. All the functions of the Ministry were formerly performed by the copper producers themselves, and by the producers of other metals; and I cannot see any advantage which can justify the Minister intervening between 982 the miner and his metal and the consumer and his product.
We used to hear that the benefit of the bulk buying system assumed by the Minister would be that we would get steady prices for our metal. That "went west" a long time ago. In 1946, as the Minister well knows, metal prices were rising throughout the world. He lagged behind in raising his price, and he was selling metal at a lower price and having to buy it in subsequently at a high price. So, as metal prices advanced throughout the world, the Minister lost millions and millions of pounds through bad buying. Then I regret to say that he panicked. When metals had reached their top he bought right and left, and when they fell in the middle of last year, he again had heavy stocks which he had bought at a high price. Again, he had to cut his losses.
The Minister shakes his head, but on this very point he was visited by a deputation from works council of our factory, of which I was not a member, who put this point to him because the men were feeling most acutely the shortage of work occasioned by his policy. It is no good the Minister shaking his head and saying that these things did not occur, because they did. When the price was brought down by the Minister he lost a very large sum of money. I am sorry to say that we are again in this position at the moment. The Minister is holding extremely heavy stocks of metal. The price today is roughly as high as it has ever been since about 1917, and the Minister is in a most vulnerable position.
What the right hon. Gentleman will do when prices fall, as they will one of these days, is again to come to this House and tell us that, because, unfortunately, he could not foresee the position he is holding heavy stocks when the world demand has fallen away. He will have to face a heavy loss on his stocks and he will come to this House and ask us to pay the bill. I ask him now, before it is too late and before he is made to suffer that further humiliation, as he certainly will, to work out a system of transferring back to private traders the buying of the metals we need.
I ask the Minister to open the London Metal Exchange to give us once more the opportunity of making for stock, standard products in bad times. Under the present system of the Minister when prices again 983 look weak elsewhere in the world, all our orders in the trade will fall away. We shall be in the same position as that in which we were in the middle of 1949. We shall not be buying metal from him and we shall not be able to hedge or insure our metal prices against the loss which we know will be inevitable.
Consequently, unless we have a Metal Exchange, with some way of hedging our surplus production and keeping our men employed in times of falling prices, not only will the country have to pay the price of bad buying but the men in all our works will suffer short time, as, unfortunately, they did in the middle of last year, entirely caused by lack of appreciation on the part of the Minister of the problems involved. To sum up, we say that the amount the Minister is asking for in this Supplementary Estimate is understated because he does not give a fair idea of the fortuitous profit he made through devaluation; that the amount of stock which he holds by no means accounts for the whole of the amount covered by the Estimate; and that he has not taken the advantages which he 'has had hitherto of giving back to the metal fabricating and producing interests in this country an opportunity of buying their metal at the world prices which, unfortunately, today are the New York.prices and not the London prices, as they always were before the war. He has not given us the opportunity of hedging our forward sales or of producing for stock in bad times.
I am absolutely convinced of the accuracy of the figures I have given. An attempt to escape from the size of this Vote with the argument that this is not a case of overspending but one of holding higher stocks, particularly of tin, lead and copper, does not tell the whole story.
§ The Parliamentary Secretary to the Ministry of Supply (Mr. John Freeman)
I hope that the hon. Gentleman will forgive me for interrupting. I have been trying to follow his figures, but I am afraid that with the best will in the world I will have to wait until tomorrow to read with some care what he has said to find out where the fallacy occurs. I cannot allow it to go by without denial that the figures are accurate: they are not. The fallacy may be that the hon. Gentleman started his speech by taking the year 984 January to January whereas, in fact, we take the year April to March. As soon as I can read with some care what he said I will try to clear up the position. The hon. Gentleman's figures are not accurate.
§ Mr. Grimston
The Minister could not have taken them for the year April to March, because the March figures have not yet been published. I have taken the most accurate published figures. Of course, I could make a debating point of the fact that I happen to have taken figures which are less favourable to my argument than the ones which the hon. Gentleman has indicated that he will publish.
§ Mr. Grimston
No, but I have got the build-up of the stocks, and the hon. Gentleman will find that there has been no considerable change. In fact, by no argument of that kind can the whole £20 million, which is the real figure for which the Minister must account, be justified. Therefore, I make my plea that the Minister should re-establish the London Metal Exchange, as it is in his power to do, as the world centre, and, at the same time, give a great fillip to the manufacturing industries which will enable them to maintain employment in times of falling prices.
§ 7.16 p.m.
§ Dr. Morgan (Warrington)
I do not wish to speak for very long on this subject because I am afraid that if I do, I shall tend to be critical. I ought to express my surprise that the Opposition have put down an Amendment to this expenditure on the Health Service. Good health ought to be the right of every citizen on equal terms. This service was a new venture although, in the background, it has been considered in various schemes for a long time. The present scheme is one of six or ten which were considered for a long time. If I had had my own way I should not have chosen this scheme, but out of loyalty to the party, to the Minister and to the Government, I necessarily had to accept the scheme and its particular administrative set-up. I think that a better one could have been chosen from the schemes available. I wish to stress the fact that the Opposition have chosen expenditure on health—
§ Dr. Morgan
I have been in Parliament for a good many years, and before I was in Parliament I watched Parliamentary procedure for a very long time
§ Dr. Morgan
I wish the hon. Gentle man would concede that I am a man of Parliamentary experience. I may appear to be a novice, but I am not quite an idiot. Believe me, I know exactly the motives behind Amendments and matters of that kind. I have been watching Parliamentary procedure for many years and I know exactly the moves behind the scenes. I wish the hon. Member would allow me to present my own case in my own way without interrupting on trivial points which are of no real importance.
I am a member of a profession which wants to see good health among the people. I have practised in every phase of medicine. I have been into the slums and seen the conditions in which the best citizens of our country—the workers—have had to work. In the constituency which I now represent they have a Tory legacy of pail sanitation with human excreta being removed every afternoon. All over the country people have been suffering these degrading conditions, from the point of view of preventive medicine. This is a personal treatment scheme, and it is one of the best pieces of legislation which has ever been passed through this Parliament. [Interruption.] I do wish hon. Members opposite would not cause me to get hot under the collar.
My hon. Friend the Member for Tottenham (Mr. Messer), with whom I usually agree, made a remark about prevention being better than treatment. Of course it is, but before there can be prevention, there comes the education of the practitioners who are to carry out the treatment and provide a diagnosis. Although this does not concern the present scheme, and might well be the subject of legislation later, I say that it is a disgrace that the profession is left as 986 it is left in this country, to decide the subjects of the curriculum and what education is to be provided.
§ Mr. Messer
Does not my hon. Friend agree that it is far better to prevent a pain than it is to cure that pain once it has been acquired?
§ Dr. Morgan
On the contrary, the pain may prove to be the proper road to a diagnosis. [[Laughter.] It is all very well for hon. Members to laugh, but I know more about this than they do. Pain may be a very good guide to a diagnosis within 24 hours. I see and study patients every day.
The teaching schools are brought within this scheme, but I wish that the boards of governors had not been separated from the regional hospital boards. That is a pity, and I think it is wrong, but this scheme has been accepted and I do not want to be too critical about it, because we must back up the operation of the scheme we have got and hope for reforms later. Some of us have been thinking about this scheme for a long time. It is a personal treatment scheme, and it is different from preventive medicine, social medicine and industrial medicine. This is a scheme which is to be made free and available to all on equal terms and, that being so, I dislike the system of priorities. I know it is essential in certain cases, such as for mothers and children, but I want to see the day when there is no shortage of doctors or dentists, no question of hospital accommodation not being available, which is the case today.
Some of our hospitals are a disgrace, reminiscent of the old Poor Law system, and we want to make a complete sweep of them as soon as we can. Obviously, we cannot do everything at once, and these things will have to come about gradually. That is why I deprecate the idea of parsimony coming into the question of the cost of the National Health Service. I would rather consider the question on more generous lines. Let us take the case of research conducted by the Minister of Health in his own Department. There is another department of medical research which goes on under the auspices of the Privy Council. The strange thing to me about this state of affairs is that the Minister of Health is spending a quite trivial amount. I think 987 the amount expended on medical research might be 10, 20, 30 or even 40 times as much as the figure which is put down here. We want more and more research; I would not criticise any expenditure on medical research.
The speech to which I now want to turn was that of an hon. Member who I am sorry to see is no longer in his place—my hon. Friend the Member for Luton (Dr. Hill). I know that it was a maiden speech, but the hon. Gentleman is no maiden speaker to me. I have heard him in different conditions, but he spoke today as if the medical profession had really always been in favour of this scheme. I have always looked at the National Health Service Act from the point of view of the patient, the person to be treated, but most Members of Parliament, and, indeed, many people in the country, tend to think of it from the point of view of the doctors.
I have sat with the B.M.A. listening to them discussing the scheme from the point of view of cost—the remuneration of doctors, the grading of doctors, specialists' fees and the pay of the general practitioner. Not once did they consider the conditions under which patients would be dealt with and whether they would receive proper treatment. I have heard Lord Horder saying that the National Health Service Bill was an attack on the freedom of doctors to prescribe for their patients, without bringing one bit of evidence to prove what he said. Perhaps this is not in order, but, after all, these questions go to the very foundation of the whole scheme.
The hon. Gentleman to whose speech I would refer spoke sometimes as a Conservative and sometimes as a Liberal, sometimes sauve and calm and sometimes forceful. He showed a delightful personality and is a great master of his subject, though always looking at it from one side of the picture. [HON. MEMBERS: "Chuck it."] I have been advised by the Front Opposition Bench to "chuck it", and, in these circumstances, I think I ought soon to stop, because I would not dare to talk to the House in this way when other people think that I am not sticking to the subject.
There are still a few gaps in the National Health Service. Much more money will need to be spent and many More reforms to be carried out. I think 988 that the Conservative Party, who opposed this scheme when it was going through the House and yet pretended in the country that they did not—[HON. MEMBERS: "No."] Well, I heard them opposing it in the House and in Committee, on the Second Reading and again on Third Reading, but I heard speeches in two constituencies—the one I formerly represented and my present one—in which they were pretending that they were in favour of the scheme. I think they are being hypocritical about it, because they hate the Government and want to put a spoke in the Government's wheel whenever they can. They are choosing the most inopportune subjects on which to try to do so, when they ought to try to develop some consideration over the preventible ill-health that there is in the country. They ought to be considering how public finance, instead of being cut down, can be devoted to this cause. They should be ensuring that the money is well spent, in the proper way, under proper conditions, but without any extravagance, in order to achieve a very deserving objective.
§ 7.29 p.m.
§ Mr. Spearman (Scarborough and Whitby)
I can assure the hon. Member for Warrington (Dr. Morgan) that I will not compete with him in his knowledge of Parliamentary procedure or of the medical profession. Perhaps, in return, he will agree with me that he is not at his strongest in his appreciation of the economic situation.
The Chancellor of the Exchequer and other speakers from the other side of the House have attempted to show that these vast Supplementary Estimates do not constitute overspending because the money has been well spent. They might have a case to do that if the economic situation of the country was quite different from what it is today. They might have a case to do that if there were still vast taxable resources, which there were, indeed, up to the beginning of the Second World War. But the situation is very different today. We were told at the time of devaluation that the Government were going to make a cut of £120 million, and that that was only the beginning.
In fact what has happened? The Government are spending, not £120 million less, but £120 million more, and 989 there is great evidence that far more is to come. To what is this change of mind due? is it due to some windfall of which we have heard nothing, or is it that the Government have given way to the line of least resistance? Is it that the extremists in their party have shouted more loudly than the moderates, and that that is the reason why there has been this whittling away of the plan so solemnly entered into last October?
I do not want tonight to try and score off the Government on their most vulnerable points of where they have been most extravagant. I think that at this stage of the country's affairs it is more useful to try not to exaggerate the difference between us, but to bring down that difference to the minimum. I am not talking to those hon. Members opposite who might say they are Marxists at heart. They believe that by a doctrine which I consider entirely unsavoury they can defy the economic laws. I believe that a large number of hon. Members opposite, and certainly a very large proportion of those who voted for them in the country, are social reformers at heart. They want to make this country a more spacious one, with freedom and greater resources, and with people better off and happier. In that we can concur. Our target is the same, although our methods may be very different. It is to those people that I am referring tonight.
We can agree with them in upholding the welfare State. I am bound to say that I and most of my hon. Friends, I am sure, would much prefer it if people were well and happy, not because of the bounty of the State, but because their own earnings and savings were so great that they could afford it themselves. We realise that that state of affairs is a long way off, and in the short run we must and do support the welfare State. Therefore, we are in agreement with hon. Members opposite on that point. They, on the other hand, are in agreement with us on the limits to which it can be taken. Let me quote what the Lord President of the Council said at Lewisham in January. He said:We must all recognise that we have taken big risks in assuming so many commitments so soon after a crippling war, and we cannot undertake more substantial commitments, however desirable, until we can be sure of meeting the commitments which we have already undertaken.990 Quite obviously, if hon. Members opposite thought there were no limitations they would raise pensions and other social services which we all wish to see, but they know, as we know, that there are strict limits to what the country can afford.
What I want to ask hon. Members opposite is how they arrive at the amount which they are now spending. Was it just because of pressure from those who shouted loudest or was there some plan? We all know that if the Government spend too little and if savings are too great, then those savings will not be re-invested in capital re-equipment, and that there will be a slump and a waste of resources. On the other hand, we also know that if expenditure is too great, there will be inflation with all its dire consequences. I see no evidence of the Government making a careful plan to avoid those two evils; they seem to be chaotic as to where they are going.
The Government policy at the present time is to spend so much that profits are easy to make, and to tax so much that those profits cannot be spent. That is a very inefficient way of doing things. It means keeping on the inefficient in industry wasting resources, and it means the efficient getting no benefit. There is no stimulus to them to cut their profit margins, to be more efficient, and, above all, to divert their labours to the export market which is so vital to the country. What we want to see is keen competition, profits harder to make, and well worth making. About 100 years ago a wise man said that we have to take men and women, not as we would like them to be, but as they actually are. If we want them to do a good job of work we have to make it worth their while. The Socialist Government appear to have forgotten that elementary fact.
The present Government expenditure is grossly excessive. When I say that, I do not mean that this country could not afford to spend £4,000 million; what I say is that it cannot continue to spend 40 per cent. of the national income. We ought to be able to expand the national income, but this proportion is quite incompatible with our resources. I wish to put the following proposition to hon. Members opposite. The present Government expenditure means keeping down wages and will lead to unemployment. 991 Quite obviously, I should not make an assertion of that sort without giving my reasons, which I propose to do, and I hope that they may, perhaps, be passed on to the Minister of Health and that he may reply on the point.
It seems to me, if it can be shown that the present Government expenditure is in fact keeping down wages and is going to lead to unemployment that that is a very serious issue indeed. We all agree that the investment programme has got to be carried out, and we all know that there is going to be great suffering unless we can build far more houses. We have heard in the Debate today of the great necessity for building hospitals, and, above all, we must build new factories and re-equip them so that we can produce in competition with manufacturers abroad, and thereby make sure of the necessary supplies of food and raw materials.
How is that going to be financed? Not by personal savings, because we can all agree that they are not there. Not by a Budget surplus, because it is clear that that is quite insufficient. There is only one way in which that investment programme is being financed today, and that is out of business profits. Today, wages are being limited in order to increase profits, and dividends are being limited in order to increase savings. That is a most artificial state of affairs. If wages rise—and I am sure they will; in many cases I think they should—either prices will follow, in which case we shall get a most disastrous inflation, or else prices will not rise and then the inefficient will fail which will lead to heavy unemployment.
It is one thing to bolster up inefficient firms and then to put them out of business, thus leading to an enormous increase in unemployment, and quite another never to have bolstered them up at all. Excessive expenditure, such as that carried out by the Government today, means three things. It means inefficiency, and we cannot afford that; it means keeping down wages—and why should they be kept down?—and it means unemployment. All of us, in whichever part of the House we sit, hate unemployment. Most of us here have had the good fortune not to have experienced it directly, but most of us have friends who have suffered from it. We know that it is not only the deprivation from which they have suffered; it is 992 the hideous frustration and the feeling of not being needed. We know how appalling is heavy unemployment, and all of us, on whatever side we sit, are, I believe, determined to avoid that.
But there are two schools of thought about unemployment. There is that shared by the Chancellor of the Exchequer who said in this House on the 27th September, 1949:The fact is that some temporary hardship for a comparatively small number of workers who have to change their jobs is inevitable if we are to preserve that industrial flexibility which, as a great exporting and importing nation, we must have. Otherwise, if we fail to be able to export enough to pay for our essential raw materials, the incomparably greater hardship of mass unemployment will be inflicted upon the whole nation."—[OFFICIAL REPORT, 27th September, 1949; Vol. 468, c. 31.]It is clear the Chancellor of the Exchequer believes that some degree of transitional unemployment is inevitable.
Then there is the other school of thought, as described by Mr. Roberts, the General Secretary of Public Employees who said:Full employment is a good thing. But if it is achieved by allowing large numbers to be employed in jobs of no economic worth, full employment can lead to disastrous consequences. We believe that until all our industrial and labour resources are brought under effective control and directed as the crisis necessitates, we shall continue the present ruinous drift.There you have the choice between small transitional unemployment, which the Chancellor of the Exchequer says is inevitable, and curing it by totalitarian methods. Is there any doubt which choice the people of this country would make?
I implore the Government not to take too touchy a view of this question of unemployment, and to face the facts as they actually are. If they are going to try to avoid any minute transitional unemployment by vast excessive expenditure they are going to bring the whole country down. They would be like a vain woman who, in an attempt to get rid of a few grey hairs, was prepared to swallow quack medicines and poison her whole system. We are in a very precarious position. It is absolutely vital that the Government should start—and they have not done that yet—to plan our expenditure, not on what we would like, but on what we can afford to spend in maintaining the economic position of this 993 country, in maintaining employment and food supplies. It is not today's consumption, it is tomorrow's production that will settle the fate of this country.
§ 7.42 p.m.
§ Mr. Clement Davies (Montgomery)
I am sorry to find that, on this occasion. I disagree with my very old and respected friend the hon. Member for Warrington (Dr. Morgan). The issue is not the Ministry of Health and its expenditure. Nor is it the Ministry of Supply or any other Ministry. The Act governing the Health Service is on the Statute Book and has to be carried out, and these money commitments have been made. That is not the issue. It may be that on some other occasion, when the Ministry of Health comes to give an account of its trusteeship, we can discuss whether this money has been wisely or rightly spent, whether some more should be spent or anything of that kind. Nor, if the hon. Member for Scarborough and Whitby (Mr. Spearman) will allow me, is it a question whether we are spending too much or too little, or whether there should be some transitional unemployment or anything of that kind. The time for discussing that will arise when the Chancellor of the Exchequer introduces his Budget, and I am sure that the hon. Gentleman and I will take advantage of it.
The point tonight is a very narrow one. The Chancellor of the Exchequer made certain statements when he introduced his Budget in April of last year and, very rightly, he has called the attention of the House to them when the Supplementary Estimates are being brought before us. The amount of the Supplementary Estimates on this occasion is very heavy. It is always the duty of the House to inquire very closely into Supplementary Estimates and into the need for them and the way in which the money has been spent. Particularly is it so now, in view of our precarious position and in view of the statements made, rightly, from time to time, by the Chancellor of the Exchequer.
I can always agree with the axioms and maxims laid down by the Chancellor at that Box. I only wish he would adhere rigidly to them at all times. They are absolutely sound, in so far as they are statements of principle. The Chancellor, having made the statement that, owing to 994 our difficult position, Supplementary Estimates for this year would only be allowed in certain extraordinary cases, or in peculiar circumstances. We are now, rightly, asking for an explanation why these Estimates have come forward to such an extent at the present moment.
The Government have been called upon to explain their position and the Chancellor gave the explanation this afternoon. Correctly, he did not enter into any detail about the smaller items. His explanation of two major items—Supplementary Estimates for the Ministry of Food and the Ministry of Supply—he dealt with very shortly, but it was necessary for him to give a further explanation with regard to the Ministry of Health. I can understand it.
As I said earlier, the Act is on the Statute Book, and it has to be carried out and administered. A good deal of it is new. Usually, these Estimates can be made fairly accurately, based upon past experience, but there has not been very much past experience in these cases. I can well understand that, as time went on, there arose this difficulty: was the Chancellor of the Exchequer to adhere rigidly to the axioms he laid down at that Box, in which case the Act could not be administered as, I am perfectly sure, we all desire, or was he to give way and allow this money to be spent? On the whole, I think we all agree, and nobody is challenging the Vote tonight for that expenditure. But we are departing from the powers that ought to be exercised by this House. It is the duty of the House to watch expenditure with real care. It is our duty to protect the country, lest there should be unjustified expenditure. The Chancellor of the Exchequer called attention to this.
The right hon. and gallant Gentleman the Member for Gainsborough (Captain Crookshank), who opened this Debate, referred to a paragraph in column 2092 of the OFFICIAL REPORT of 6th April, 1949, that is to say to the third paragraph in that column. With your permission, Sir, and with that of the House, I should like to read the earlier two paragraphs which bear on this. The Chancellor had already pointed out that further redistribution of income by taxation could not be carried on very much longer. It had been done to such an extent that there was not much more scope. He went on: 995We must, therefore, moderate the speed of our advance in the extended application of the existing Social Services to our progressive ability to pay for them by an increase in our national income. Otherwise, we shall not be able to avoid entrenching, to an intolerable extent, upon the liberty of spending by the private individual for his own purposes.Those are the words of the right hon. and learned Gentleman, who had already directed the attention of the Committee to the fact that the Government were taking 40 per cent. of the national income and that the individual no longer had any control over it. He went on to say:Hon. Members will recall that their traditional role is to be the defenders of the taxpayer against the rapacity of the Executive. Over many years now, the widening of the franchise and the introduction of services of immediate personal benefit to the people have naturally led Members on all sides of the House to take a keen interest in services of such benefit to their constituents and to press for their extension.That is quite right. That is what we have all been doing. He then said:The roles of the private Member and the Executive in relation to expenditure have thus tended to become reversed. But do not let us forget that the House of Commons' responsibility for finance still remains, and cannot be abrogated, and that while Members may press for all round increases of expenditure, the time comes, as it has come today, when they have the responsibility of finding that money and meeting their own demands. I would venture to hope that, when demanding fixture increases for the services in which they are interested, hon. Members will keep fully in their minds the other side of their responsibilities.—[OFFICIAL REPORT, 6th April, 1949; Vol. 463, c. 2092.]He then continued in the next paragraph, which has already been read.
That is the right position. The Chancellor of the Exchequer is always in a difficult position, but he is in a particularly difficult position during these years. When he has to consider in April what his Budget is to be, he should have from all the Ministers their estimates, as accurately as they can possibly make them, with all the experience they have had, of what is required for the coming year. Then he should make up his mind how that expenditure can be met by taxation. That is why we go into Committee of Ways and Means, to consider the ways and means by which we can raise it. That is the moment when we review the whole national position—the national wealth and what can be given to the Government. If that is upset we 996 upset the whole calculation for the year. That is why the Chancellor was so right in saying that at all times Supplementary Estimates are to be deprecated unless there is some change of policy or something unexpected happens to alter the situation.
We ought to know the position. The situation is very difficult. Obviously, the Chancellor had called for an estimate from the Minister of Health, and said, "You are asking for too much," and tried to cut him down about £12 million. But that £12 million has been vastly exceeded since that time. One of my complaints is that the House was not informed sooner of what has happened. In April we were dealing with the Budget, and we had no warning from the Chancellor. Then there came the Finance Bill, and again we had no clear warning of what was happening. But, what was worse, in July came the usual July crisis, when we were warned that we were spending far more than we could possibly afford, that we had drifted on, that we were in real peril and that there was only one thing to do, namely, to make drastic cuts. I will not quote what was said then by the Prime Minister and the Chancellor, but no reference was made to this increased expenditure.
Then came the devaluation of the £, and, following upon that, we had the Debate in September. We were again warned about our perilous position, and I should have thought that it was then that the Government should have taken this House into their full confidence as to what the position really was. They should have said, "While we are making certain cuts in capital expenditure, while we are asking that there shall be a drastic reduction here and there, we warn you that the expenditure incurred by the Ministry of Health is far greater than we have anticipated it would be." But there was no word. On the other hand, I find this. On 27th September the Chancellor of the Exchequer said:Then as regards Government expenditure. Present commitments preclude any reduction in the general level of expenditure on the Defence Services.…He went on to say:In the other fields of Government expenditure, we are making a fresh investigation—as of course we do annually in connection with the Estimates—to see whether we can cut out, curtail or retard any services not essential to 997 major Government policy, and also to cut out administrative waste wherever it is found. Under the stress of a more pressing necessity to contribute substantially to the success of the main economic policy of which I have just spoken, we must and shall be ready to prune off less necessary services which should result in a substantial—though not a spectacular—reduction in Government expenditure. These economies will be put into effect in the normal way as and when each is decided upon. All these matters will of course be brought together and can be considered when the time comes to review them at the end of the financial year."—[OFFICIAL REPORT, 27th September, 1949 Vol. 468, c. 29.]I should have thought that that was the moment when he could have said, "Whereas we can cut, for example, the Ministry of Supply or make a cut in regard to some other Ministry, I really want to warn the House that there has been a very great extension of expenditure in respect of the Ministry of Health." That is the real complaint—that he was not taking the House into his full confidence at that time so that we could judge of the matter fully.
I am not complaining, but we should realise what the position is. We are often asked what we would cut—we who have not the advantage of sitting on the Government Front Bench and without the advantage of having civil servants to assist us. We have got to get our information as best we can—perhaps from Government statements, and from here, there and everywhere. Therefore it is all the more incumbent on the Government, when statements are made from the Despatch Box by a Minister, and especially by the Chancellor of the Exchequer, that a full statement is made so that we may judge what is the position.
The Chancellor has explained how it has happened. I have got to accept the explanation, and I do. But it must be remembered that he set a ceiling upon what the expenditure could and should be last April. He has now said that next April when he introduces a new Budget he will again set a ceiling. He said that last April. What I am hoping is that he will keep his word better than he has been able to do during this last year. It is absolutely essential, for this reason: the position is very difficult; we are still in very great danger. As far as I can see, there is still very strong inflationary pressure. Prices are still going up, and, to meet this situation, one can understand the demand for increased 998 wages, increased railway costs and things of that kind.
It is essential that next April the Chancellor should be able to tell us how much he considers we can afford and stick to it, instead of allowing Ministers to extend the amount as the year goes on, and hoping that the House of 'Commons, with a majority behind the Government, will pass it. That is not the constitutional practice. I hope that the constitutional practice will be restored and that in future this House will keep a closer eye upon expenditure.
§ Mr. Nigel Birch (Flint, West)
Before the right hon. and learned Gentleman sits down could I ask him how he will vote?
§ Mr. Davies
I thought I had made that perfectly clear; if not, I will make it clear now. I said that I accepted what had been said by the Chancellor of the Exchequer, and there is an end to the matter as far as we are concerned. I do not fight the battles of the hon. Gentleman's party; they must fight their own.
§ 8.1 p.m.
§ Mrs. Braddock (Liverpool, Exchange)
I have listened to the whole of this Debate, and I am getting used to peculiar things happening in the House of Commons, but the most amazing thing I have ever heard was the vicious attack which was made by the right hon. and gallant Member for Gainsborough (Captain Crookshank) on the Supplementary Estimates and the way in which it gradually petered out until we did not know exactly what anybody was going to do. I was surprised, too, by the interjection made when my hon. Friend the Member for Warrington (Dr. Morgan) was speaking—an interjection from the Opposition benches to the effect that nobody had made an attack upon the cost of the health scheme. Almost every speaker I have heard has made specific reference to the Supplementary Estimates asked for the Health Service and the right hon. and gallant Member for Gains-borough very seriously attacked the Minister because he had been unable to estimate at the time the Estimate was presented what the cost of the service would be.
The Chancellor of the Exchequer made reference to the position, but I want to extend the explanation he gave. I have 999 been privileged to serve on a local authority in Liverpool and to have had 20 years hospital service. Having watched the position in relation to local government, I know that in the past there were two ways of assessing what should be done for hospital services. One way was always based on the question, what was it going to cost the rates? If there was to be anything done in hospital services or any extension of hospital services the question was, how much is it going to cost the rates of the city? If it happened to be a Conservative local authority the main argument was that they should not ask for an extra rate in the city for an extension of hospitals or other services at all, because asking for an extra rate might jeopardise the political situation in a municipal election.
I remember in Liverpool, in the biggest single hospital authority in the country, the necessities for hospital services and extensions being continually refused because it would mean asking for an increase in rates to be met by the citizens of the area. From the point of view of the voluntary hospitals the position was even worse because they were completely dependent upon legacies, upon collections from university "rags," upon endowments and upon voluntary hospital schemes for what they could do in improving the hospital services. They never could make an estimate as to what additional work they would do, because they never knew exactly how much money would come in from the various sources to enable them to make improvements.
Thus, when the service was integrated in the new National Health Service, it was almost impossible for management committees, regional hospital boards or boards of governors to assess what was required because, as a result of the neglect of so long a Conservative administration, hospitalisation in parts of the country was, in many instances, in a very bad state indeed. Most of the hospitalisation was in institutions where the conditions were not suitable for nursing sick people. Old people were thrown into them if anything went wrong. If those old people had reached a stage at which their usefulness for the State was ended, they went into an institution where doctors visited them perhaps once in three or four weeks or sometimes once in two or three months.
1000 There were very serious hospital conditions affecting my own authority, for instance. We had four institutions where it had been possible to make very little improvement or alteration. Every kind of attention which was needed was improvised to meet the peculiar and immediate set of circumstances which existed. No new buildings were being put up, none whatever, because such work depended on how much we could ask from the rates to pay for the improvements.
When the Health Service took control, boards of governors and management committees were asked to assess what was needed in the first 12 months. If they had put in a correct estimate of what was needed the Supplementary Estimate which is being sought tonight would have sunk into insignificance, but they put in for the minimum. They made a mistake, or perhaps the Ministry thought they were putting in for the maximum, because it has usually been the position that if you wanted to get a little, you put in for a lot more, so that you stood a chance of getting a little after it had all been cut down. But the management committees and boards of governors did not do that this time. They were very serious in the job they undertook. I am a member of both a board of governors and a management committee, and I know the extent to which inquiries were made to discover what was the minimum which was needed and the minimum which could be requested. So the estimates were presented, but those minima did not meet the necessities. It was only discovered that those minima did not meet the necessities when we began to deal with the actual necessities.
Let me give an instance—the maternity service. Lots of the maternity services have been services adapted in institutions. In the past a woman remained at home for her confinement because there was always somebody next door or along the street who was prepared to look after her, but when there is full employment and when all the women of the country are working as well as all the men, there is nobody to look after the woman if she stays at home. Thus, the demand for hospital beds for maternity purposes has been out of the estimated proportion.
We have only to look at the figures to see the number of women who desire to go into hospital for their confinement. 1001 That need cannot yet be met and while, at the moment, every step is being taken to see that, where possible, cases which present no difficulty shall remain at home, it is still impossible to be certain that the women can have at home the attention they need. There is still the lack of people in the area to look after them when necessary. Maternity accommodation is something which has been needed, and the estimate in this connection was made when the estimates were put in. Of course, lots of estimates have been turned down because we cannot go on with the job of rebuilding all the maternity units.
Another important item in relation to the present new scheme is the method of treatment of aged persons. In the past it was regarded as all right to put them into an institution and to take no further notice of them until they died. Now every aged person, however senile he may be, goes through the same procedure as an acute case which goes into hospital, and that has required more doctors, more staff, more attention and more nurses That in itself is something which has come under the new Health Service—a very great improvement as far as the aged people are concerned. One of the things they dreaded more than anything else was to be taken ill in their homes when there was nobody to look after them, to be pushed into an institution and to remain there for it to be said that they were senile and that nothing further could be done for them.
There is a completely new method of dealing with them, and some people who were in institutions under the old scheme for many years are now being got out of bed and being dealt with by new physiotherapy units and being sent home. It costs money, and one cannot estimate it; and I do not believe that the Minister or his Department will be able to estimate in this year's Estimates exactly what the Health Service will cost. I do not believe that the £350 million that the Chancellor of the Exchequer is suggesting as the maximum will be sufficient, because of the leeway that has to be made up on the neglect in health and hospital services generally in the past.
Another necessary improvement is in the nurses' homes throughout the country. They are nothing in which to take any 1002 pride. If we are to attract the best type of nurses into the service we have to give them something equivalent to the homes they come from, and nurses generally come from middle class families, because the matriculation certificate has to be obtained before they can be accepted for training in the nursing profession. We offered them in the past, under local government, very bad nurses' home conditions. Indeed, I have seen a nurses' home where conditions were nearly as bad as those in the institutions into which old people were pushed when they were taken ill.
I agree that there should be priorities. I think, emphatically, that the first priority is housing. I would stop all building of every sort for the next 12 months to see that people got housing accommodation, because I believe that housing people decently prevents them from having to accept hospital accommodation. However, that would not meet the view of the majority of people in this House. I would stop the basic petrol ration altogether and use the dollars that that costs to get softwood to build houses that are so urgently needed. Hon. Gentlemen opposite do not agree with that. They are shouting for additions to the petrol ration.
If they were sincere in the objections they make to the Estimates they would take definite steps to see that the things needed to be done were done to meet the criticisms they put forward. I do not believe in their criticisms. They are hypocritical. I listened to their speeches on the wireless and in the country. If they had been returned to office and had kept their promises to do all the things they said they would, I do not know what the Supplementary Estimates would have been. Nobody would have been able to meet them at all. So all this talk and criticism, I believe, is very often to get at an individual whom they want to criticise. [Laughter.] I believe that to be so.
§ Mrs. Braddock
This attack on the increase in the Supplementary Estimate for the Health Service is fundamentally hypocritical. I have talked to the people who matter. I have talked to those who are in actual productive work in the country, 1003 those who are creating the wealth of the nation so that they can have a share in so much additional welfare services. They say that, as they are producing the extra wealth, that extra wealth ought to be distributed among the social services that they themselves need, and that at the moment there is far too much profit being made by those who are doing no productive work at all.
I was talking to two dockers among the crowd on the dock side during the election, and they said, "We have been hearing a lot of talk about crisis, Mrs. Braddock. The Tories seem to be thinking about crisis all the time. If the sort of thing that is happening to us now is a crisis, the more crises we have the better, because we are getting a full week's wage, and we do get decent work and decent conditions, and if all this be the crisis that the Tories are talking about, let us have a lot of crises and keep on having a lot of them."
The right hon. and gallant Gentleman who opened the Debate for the Opposition made the definite statement that the Ministry of Health had not the ability to estimate what was needed for the Health Service. I say that the benefits the people of this country have had by the adoption of the new Health Service have been very cheap indeed in relation to the amount of money that has been given for it, or is asked for in the additional Estimate, or could be asked for in a Supplementary Estimate—because it is not possible to say in advance in what set of circumstances hospitalisation may be, or what may be required for it. The money required ought to be gladly voted by every section of the House, because on the medical service depends the good running of the productive capacity of our people.
§ 8.16 p.m.
§ Sir Hugh Lucas-Tooth (Hendon, South)
The hon. Member for Liverpool, Exchange (Mrs. Braddock) at one moment in her speech looked as if she were going to forget the excellent advice given by the Minister of Health in his speech last night. He said:One of the consequences of full employment is that if we want to have more of a particular thing we can only have it at the expense of some other thing."—[OFFICIAL REPORT, 13th March, 1950; Vol. 472. c. 865.]1004 I think that the right hon. Gentleman was suggesting that that was not the attitude on this side of the House, but that it was accepted by himself and his hon. Friends. Now, when we sought last night to criticise the Government because of their conduct of housing, and demanded that a greater part of the national effort be devoted to housing, we were described as dishonest because we were claiming that we would take more out of the national pot than there was in it.
§ The Minister of Health (Mr. Aneurin Bevan)
Will the hon. Gentleman permit me? I did not say that at all. I said that the Opposition did not face up to the obligation to say what they would take less of if they were going to have more housing.
§ Sir H. Lucas-Tooth
I am much obliged to the right hon. Gentleman. When we come forward today and criticise the Government for bringing forward Supplementary Estimates for no less than £150 million, and suggest that if those Estimates had not already been spent there would have been that much more available either towards the reduction of expenditure or for the building of houses, I think we meet the right hon. Gentleman's case.
§ Sir H. Lucas-Tooth
It does not apply only as regards the various parts of the social services. It applies, as my hon. Friend the Member for Luton (Dr. Hill) said in his speech today, within the Health Service itself. If we on this side of the House sympathise with the doctors and suggest that under the Health Service they are not getting as good treatment as might be desirable, we are told we are pressing for concessions and currying favour with our own friends for electioneering purposes. On the contrary, when we criticise the size of the dental and ophthalmic estimates, and complain of the additional amount, then we are told we are attacking the people's health. The right hon. Gentleman really cannot have it both ways.
We criticise these Estimates on the ground that they are taking too large a part out of the nation's total available wealth. If this money had not had to be voted tonight there would have been that much more available—and I should have liked to 1005 see some of it available—to spend on housing and that much more available to reduce the general burden of taxation. I say that we ought not really to be discussing these Supplementary Estimates here at all, or, at any rate, by far the largest part of them.
I should like to deal with what is much the largest part of these Estimates—those that are concerned with hospitals. The addition required for the expenditure on hospitals is approximately £50 million, or about one-third of the total now asked for. I will concede that last year accurate estimating for the hospitals was obviously extremely difficult. I criticised the right hon. Gentleman when we had the Supplementary Estimate last year on the ground that, although the estimating was difficult. he had recklessly kept the Estimate so low that he must have known that it would be less than the sum total ultimately required. We have now come to the second year of this scheme. Again, I say, the Estimate submitted last spring was quite unreal, and I do not wish to use an offensive word, but I think that it was dishonestly low.
§ Mr. Bevan
The hon. Gentleman should listen to what is said now and again. The Chancellor of the Exchequer made it quite clear in his speech today that the next Estimates, that is to say, the Estimates to be presented, forming a part of the next Budget, are the first Estimates that the hospital authorities will have, based upon a full year's experience.
§ Sir H. Lucas-Tooth
I will read to the right hon. Gentleman a passage of a speech which I made during the Budget Debate of last year. I think that it has a great bearing on what the Chancellor of the Exchequer said. I said:The current Health Estimates are quite unreal. Let the Chancellor of the Exchequer ask any hospital what is the present position about this vast Estimate for tens of millions of pounds for hospitals and he will hear what happened. In the first place hospitals sent in their estimates for the current year last Autumn in the ordinary way. They were expressly told that they were not to take into account any contingency in spite of the fact that in any business, whether in the sphere of industry, commerce or hospitals, contingencies are bound to arise. Having sent off their estimates after taking no account of contingencies, heavy increases were imposed on the hospitals under the Spens Committee's Report on additional pay for specialists. After those increases had been imposed on the hospitals they were each told that a cut had to be made not on an estimate 1006 taking into account these specialists' increases, but on the original estimate, the cuts amounting to between 5 and 15 per cent. in each case. The fact of the matter is that those cuts cannot possibly be made, and it is no use the Government pretending that by circularising a Department and saying that supplementary estimates will not be honoured, that that will effect cuts; it will not.…I think that the policy which is being courageously pursued by the Chancellor is the right one, but I do not believe that he can carry it out, sitting on the Government Front Bench and knowing the views and obvious intentions of his colleagues who sit beside him."—[OFFICIAL REPORT. 12th April. 1949; Vol. 463, c. 2672–3.]I received no reply to that speech. The significant thing is that I received no denial at all that the Estimates presented in this House last spring were based on the footing that no contingencies were to be taken into account, and the Spens Committee's Report, agreed to at the time of the Budget, was also ignored. I suggest that either the Chancellor of the Exchequer was misled by the right hon. Gentleman at the time that he made his Budget statement and remains misled in view of the statement which he made in the House this afternoon, or, alternatively, the two right hon. Gentlemen have conspired to mislead this House. That is the only possible conclusion.
There are the facts which were known to me on the actual date of the last Budget. I say that the position is just the same today as it was last spring—that the House is faced again with a fait accompli, that an increased expenditure has already taken place, and that it will require very much more drastic measures to deal with this constantly increasing rise in expenses of the Health Service. If it is agreed, as it seems to be in all parts of the House, that we have reached some limit which is as much as the country can pay in respect of the Health Service, I think the time has come for the Government to make it quite definite that we shall not have any further increase next year. I have no evidence that the Government will produce that result by reason of the policy which they are now pursuing.
§ 8.26 p.m.
§ Mr. Somerville Hastings (Barking)
In the short time which I shall detain the House, I want to speak only on the Supplementary Estimate for health. Many of those who have spoken on this matter from the opposite benches suggested that this was really new 1007 expenditure. I do not think that that is the case. In so far as it is, it is surely an indictment of what has been done for the health of the nation before. Actually, a great deal of the expenditure on health was made privately in the past by the individual and now it is being made as part of an organised service, and is, therefore, much more efficient, and, in many cases, much less costly. What we have done is to transfer to a large extent individual expense and made it collective. I for one am very glad about that. I am glad to do my bit while I am strong and well, not only that I may get help when I become ill, but so that I may help others who are suffering illness and therefore in a bad position to bear the heavy expense.
Another thing that was stressed from the other side with very great truth but perhaps put in different language came to this: That the one thing necessary today is to increase production. I am sure that we are all in complete agreement. Then, to some extent by inference, it was suggested that we must not expend so much on the social services and on the Health Service. I suggest that, because of the value of manpower and the need to increase production we must spend on health all that is necessary, provided it is spent with care and economy. We must deny to no one anything necessary to restore him to health when he is suffering from affliction. I make that suggestion, not so much from the individual point of view as because of the needs of the nation. This principle has probably been true at all times, but it is infinitely more true today because so much more can be done now than could be done 50, and even 20, years ago in the treatment and cure of disease.
When I was a student at hospital they taught us that germs were such hardy things that any chemical which would destroy a germ would destroy us first. Well, we now know that that is not true; there are new drugs, pencillin and the sulphonamides, and diseases such as pneumonia, which often caused death, are now almost invariably cured; diseases, which were almost invariably fatal, such as infective heart disease, are now yielding to treatment. The same thing applies to surgery. We can do so much more for the welfare of the patient, we can get so many more recoveries, that I 1008 believe expenditure on health today is more worth while than it has ever been.
Another factor often forgotten in connection with health expenditure is what one might call the capital value of the individual. Anyone who suffers premature death or is prematurely incapacitated is really a net loss to the nation—a loss monetarily as well as in other ways. A child costs a great deal of money before he comes to working age; he has to be maintained, fed and clothed, at a cost of at least 10s. a week for 15 years; he has to be taught in school at a cost of not less than £15 a year for 10 years. All that adds up to many hundreds of pounds, and money is very well spent on maintaining the working capacity of the individual.
Most of us had great sympathy with the Minister of Health when he was working out and introducing this great and comprehensive Health Service, which I think we all admit is the best of its sort in the world. The Minister took care, above all things, to get it working, and he made concessions which some of us did not like at the time, although looking back I think that these concessions were wise, because he had to produce a scheme that would work. We must congratulate all the health workers for what they have done in this great service, and perhaps most of all the doctors, who did not like it—at first, at any rate—but who nevertheless put their backs into it. The Minister's great task was to devise a comprehensive scheme, and then to get it to work, and there were other considerations which to some extent perhaps had to be forgotten at first. I suggest that his great care now should be not to spend money unnecessarily, and also—and this is the most important thing—to improve the efficiency of the scheme.
I should like, if I may, to make one or two suggestions for saving money while at the same time improving efficiency. It will be obvious to all that a staffed bed in hospital costs very little more when it is occupied than when it is empty, although there are, of course, extra drugs and extra food when the bed is occupied. I suggest that more should be done to keep all the beds of our hospitals in constant occupation. I am not without some experience as a member of a regional hospital board and also as the chairman of a teaching hospital group. 1009 More use could be made of the fever hospitals for convalescent cases. In hospitals it is quite easy, as is done in some, to have convalescent wards to which cases can be transferred when an emergency arrives and is admitted.
I am also convinced that a bed bureau for a whole group of hospitals is essential and that there should be one individual doctor who takes great care to see that all the beds are filled and none of them kept empty. In the teaching hospital to which I am attached, we have an arrangement which is very useful. We have reports every month of the percentage occupation of the beds in each of the wards and each of the departments. That is very useful, because it is at once seen if there is any slackness. There are many other methods whereby the use of beds can be watched more carefully. I would remind the Minister that he has only got to send a directive to the hospitals when the greatest care will be taken to carry out his wishes.
There is one other way where money might be saved and efficiency ensured—with regard to the specialists working in the hospitals. If more full-time specialists were employed there would be less travelling time to pay for. There are specialists at the present time doing work in 10, 12 or even 13 different hospitals. That means that their attendances must be fairly infrequent, and patients, who could be discharged if the surgeon or physician attended more frequently, have to wait perhaps as long as a week before their discharge can take place. In that way I suggest that money could be saved also. We have heard today of many of the teething troubles of our great Health Service, and I would remind the House that a baby is always most troublesome at first and sometimes very expensive.
§ 8.37 p.m.
§ Mr. Nigel Birch (Flint, West)
There has been a very strong smell of ether about the whole of this Debate so far, but if I may be forgiven by the hon. Gentleman the Member for Barking (Mr. Hastings), not being either a doctor or a dentist or connected with hospitals, I will not pursue that subject further, and quite rightly, because this Debate is really upon the conduct of the Chancellor of the Exchequer and not so much on that of the Minister of Health. I want to pursue the line which was taken by the right 1010 hon. and learned Gentleman the Member for Montgomery (Mr. C. Davies) who, I see, has now fled the field. He did the dance of the seven veils, but the seventh veil remains in position. I still do not know which way he is going to vote.
This is a Debate upon Treasury control, and on whether Treasury control is efficient the whole question of national planning depends. The Chancellor of the Exchequer is responsible both for Treasury control and for national planning. I thought that today he made a rather feeble defence. He blamed us for not making a row about expenditure in the last Parliament. That does not require an answer from me. Then he said it was very difficult to get Departments to behave. We used to be told he was the iron Chancellor. Evidently that is not so, because all we had was a long, hard-luck story.
Hon. Gentlemen opposite so often say that any expenditure upon good objects must in itself be desirable. There are always good objects to spend money on. Every Department has many hundreds of such projects and human wants are many, but we have not infinite resources and I think the Minister of Health, if he will allow me to commend him, made a very sensible remark about that last night. He said:We are up against the disposal, in a prudent way, in the interests of the nation as a whole, of the total national resources of the country."—[OFFICIAL REPORT, 13th March. 1950; Vol. 472, c. 862.]Suppose the Chancellor of the Exchequer, after he had made up his Estimates last year, had said, "As I calculate it, I can, without danger of revaluation or inflation, spend another £170 million." That is the total of the Health Supplementary Estimate. Would he have spent that sum as this Supplementary Estimate has been spent? I do not believe he would. I believe that we would have had more houses. I believe that people might very well have wanted the scales of National Assistance raised. They might rather have raised teachers' salaries or old age pensions than lay out this £170 million in the way in which it has been laid out. What the Chancellor of the Exchequer would have done if he had had honest estimates presented to him of the cost of the Health Service, is rather an 1011 interesting speculation. My hon. Friend the Member for Hendon, South (Sir H. Lucas-Tooth) put the case very clearly.
Leaving aside the high total of all the Estimates, I believe that to anyone 'who was in the last House and particularly to one who, like myself, sat the whole of the time upon the Select Committee on Estimates, one of the lessons that must have been gained was of the all-pervasive bad administration that there had been in financial matters. I will instance four reports of the Select Committee on Estimates: the report on the expenditure of agricultural executive committees; the report on Government hostels; the report upon Government hospitality, and the report upon expenditure in Germany. In all those reports hon. Members can read how grossly bad and careless was the administration.
I will give one more illustration, a very minor instance of what has happened in connection with groundnuts. This incident was commented upon and described in the book which Mr. Alan Wood, who was chief officer of the Information Division of the Overseas Food Corporation, wrote and which the former Minister of Food, not very correctly but very prudently, suppressed. Mr. Wood is circulating some of these comments in the "Sunday Dispatch." He has pointed out what happened in one instance, when 10,000 acres of ground were planted with sunflowers—the ground had not been properly cleared—in order that the then Minister of Food could state in the House that 50,000 acres had been planted in all. That was told to me by one of the men in East Africa when I was there the other day. We demand an inquiry into the things which are going on in East Africa, but we do not get one, because there is a great deal too much to conceal. I am very willing to produce my witness if we can get an inquiry, as we will one day.
I do not believe that there is any precedent for this kind of waste and dishonesty. I believe that the angry shade of Gladstone must be howling in the corridors of Downing Street. What would have happened in any previous Administration if a Minister deliberately wasted money to save his face? He would have been sacked. What happens 1012 in this Administration? He is promoted. Such are the rewards of dishonesty and extravagance at the present time.
The responsibility rests clearly upon the Chancellor of the Exchequer in these matters. He made, in the last Budget, the bland statement that no economies could be made. Then we get the usual crisis. Economies are promised, and further economies are promised by the Lord President who said that we should soon be undeceived if they did not come along. What happens? First we get the Supplementary Estimates. Not only those, but we get the Estimates for next year, which clearly show that any promised economies will be wholly negligible.
Looking for a moment at a rather wider field than I have touched on so far, the pure field of administration, surely the thing we have to grasp is that the really important controls in this country are the controls exercised by our budgetary and monetary policy. And the level of our expenditure is the most important of all those controls. Those important controls have been wrongly used throughout, and that is the main reason for our difficulties, for the gap in our balance of payments, and for rising prices. The Government have consistently run the country into high expenditure. They have tried to mitigate it, first, by disinflation through taxation—a policy now at an end—and, second, through detailed controls. I wonder why they are so addicted to those? The Chancellor of the Exchequer gave two explanations during the election campaign, one rather more improbable than the other. The first explanation was when he said:One of the reasons why I have asked the people of this country to exercise restraint and austerity has been…because I like the people of this country.Spare the rod and spoil the child! The more probable and typical explanation he gave was in a speech made, with most exquisite appropriateness, at Brixton:You must have controls in order to direct your policy so that people cannot do…as they like.That is what the warders say at Brixton. That is not the way to lead free men. The whole basis of leading free men is to direct your policy so that, as far as possible, public and private interests coincide. That will never be done under a policy of frustrated inflation such as we have had.
1013 Hon. and right hon. Gentlemen opposite will never face up to the real situation.Ah, take the Cash and let the Credit go Nor heed the rumble of a distant Drum"—has been the policy all the way through. With taxation at this level, with devaluation behind us and possibly more in front of us, with prices rising and with 1952 not far off, I think the rumble of the drum may be heard rather distinctly.
The Chancellor of the Exchequer in another speech, with which I will not weary the House, delivered at the Music Hall, Edinburgh, accused my right hon. Friend the Member for Woodford (Mr. Churchill) of "blustering and irresponsible vulgarity." He had his friends with him. He added:But then the poor old man has never had the slightest appreciation of peace-time economics.All I can say for myself is that it is not for me to pronounce on those distinguished men, but I can say that my right hon. Friend has been right. He knew where this was leading. He knew it was leading to devaluation, he knew it was leading to high prices, he knew it was leading to a lack of balance in our economic situation. If the right hon. and learned Gentleman was himself right about the consequences of his own policy, if he understood peace-time economics, he has shown a singular lack of candour. Nine times he denied the possibility of devaluation. The cock must have crowed three times.
I think the two masterpieces of his lack of candour were, first, his devaluation—or, should I say, his revaluation broadcast. That was a real triumph; he never mentioned expenditure at all, but said the real choice was between acute deflation—which, of course, is wholly a suggestio falsi—and then went on to say that there would be no rise in prices, or a negligible rise in prices, as a result of his policy. He has been proved wrong there already. He rivalled that broadcast, but did not surpass it, in his election broadcast, where the only mention of expenditure was to say that it could not be cut down.
The Chancellor then proceeded to draw a few red herrings, saying that we had provided as much help to other countries as America and Canada had provided to us; in fact, on a comparable basis, we 1014 have had £1,600 million as opposed to giving over £900 million. That, of course, the Chancellor calls "almost exactly the same." That proves conclusively that it was the dollar which ought to have been devalued and not the pound. The broadcast was topped up, of course, with a directly untrue statement about our intentions upon food subsidies.
I charge the right hon. and learned Gentleman with an administrative failure, with following a policy which would inevitably lead to a rise in prices, to devaluation, to high taxation, to detailed controls and to a lack of balance in our balance of payments. I charge him, above all, with an inexcusable lack of candour, both in his broadcasts and in "Let Us Win Through Together," that extremely dishonest document for which he was also responsible.
Hon. Members may say that all these things happen in elections and that there are occasions when people say things which they really do not mean, but the right hon. and learned Gentleman has sought to attain power by accusing himself of all the cardinal virtues. He has deliberately used that as a weapon. He started the election campaign in York by a meeting under the chairmanship of the Archdeacon, at which he said:We would debase ourselves and our faith if we allowed our politics to become less high-minded than our religion.I end with these words to the right hon. and learned Gentleman:Except your righteousness shall exceed the righteousness of the scribes and Pharisees.…
§ 8.53 p.m.
§ Mr. Osbert Peake (Leeds, North)
All hon. Members who have sat through the Debate this evening will agree that we have heard three first-class maiden speeches. If there is one thing about which I am convinced, it is that the level of maiden speeches today is very much higher than it was when I first came into the House in 1929. [An HON. MEMBER: "I quite believe that."] That was the year in which the right hon. Gentleman the Minister of Health also entered the House.
I have no desire on this occasion to anticipate the general Debate which will cover both finance and economic affairs and will, no doubt, take place when the Budget is introduced after Easter. By 1015 then, I hope, the Economic Survey for 1950 will be available. I hope also that we shall have in our hands by then the White Paper on National Income. We shall, of course, then be able to hear from the Chancellor of the Exchequer the out-turn of the financial year 1949–50.
I want to confine myself to the Amendment and to the very disquieting situation which is revealed by these Supplementary Estimates totalling £148 million; disquieting in the light of our general financial position, and of the various declarations by the Chancellor, both in his Budget speech of April last and in his speeches during the October devaluation crisis. We are handicapped in our examination of these Estimates by the time factor. It is essential for us to spend some eight days upon financial business in order to get the Consolidated Fund Bill by 31st March, and that really leaves us virtually only one day upon which we can debate these Supplementary Estimates.
I want to begin my remarks by making a very strong protest against the complete abuse which the Government have made of the Civil Contingencies Fund. If hon. Members will look at page 38 of the volume of Supplementary Estimates, they will find that in the Supplementary Estimate for the National Health Service for England and Wales, a sum of £54 million has been advanced from the Civil Contingencies Fund in respect of this service, and that another £6 million was advanced in respect of the Scottish service. The original Estimate was for £240 million, the Supplementary is for £100 million, and a little simple arithmetic will show anybody that the National Health Service had spent all its money for the year by the end of November. At that time, or, indeed, well before that time, it must have been known that a heavy Supplementary Estimate would be necessary. Yet it is only now revealed on 7th March that, at some date unspecified but no doubt about the end of November, this advance of £60 million was made from the Civil Contingencies Fund.
I say that when we debated this matter on the Finance (Miscellaneous Provisions) Bill, 1946, at which time the amount in the Civil Contingencies Fund was increased to £250 million, no one contemplated that that Fund would be used to 1016 finance an ordinary service or that it would be used to conceal the fact until after a General Election, that that particular service was hopelessly bankrupt. Of course, we can well imagine what took place in the Cabinet at the end of November: "Let us draw on the Civil Contingencies Fund, and let us see that Parliament is dissolved before it meets again in January and before we have to divulge this appalling batch of Supplementary Estimates."
Of course, I can also imagine that it might have been more convenient for right hon. Gentlemen opposite if, instead of them winning the election by the bare margin of six seats in this House, we on this side had won by a similarly small margin. How convenient for them if it had been our task to present to the House and the nation this Bill for £148 million! I can tell the Minister of Health who is responsible for his hon. and right hon. Friends sitting on those benches and for us sitting on these—[An HON. MEMBER: "The electorate."] No, not at all; it is the Lord President of the Council. His wangle, to use the mildest possible word in regard to it, over the redistribution of seats—[HON. MEMBERS: "Oh."]—and the Report of the Boundary Commission have given right hon. Gentlemen opposite exactly seven seats more than they would have had if a fair system of redistribution had been adopted. I commend this comforting thought to hon. and right hon. Gentlemen opposite whenever they regret their somewhat precarious situation.
Now let there be no mistake about the meaning of our Amendment and what the Vote is to be taken about this evening. I will read it out. The hon. Member for Tottenham (Mr. Messer)—I think I still have the name of his constituency right—
§ Mr. Peake
I hope the hon. Gentleman will not be so modest; I actually agreed with part of his speech. The hon. Member was inclined to take the view that this Debate was for or against the National Health Service. Of course, we have only to read the Amendment to see that it is nothing of the kind. The Amendment expressly safeguards existing obligations and commitments, and it goes on to deplorethe failure of the Chancellor of the Exchequer to enforce his own instructions.…1017 This Amendment is purely and simply a Vote of Censure on the Chancellor of the Exchequer, and its consequences, if it were carried, would be that we should have a new Chancellor of the Exchequer. We might even have a new Government as well, but we should certainly have a new Chancellor.
The Chancellor's statement in regard to Supplementary Estimates in his Budget speech of last year has already been quoted. He said he had emphasised that only in special cases, such as, for example, major changes of policy, could any Supplementary Estimates be permitted in future. There was a Treasury circular sent out to all Departments. I am told that Cabinet sanction was to be required for any Supplementary Estimate, and yet, if we look at the Order Paper today and see the immense list of Departments seeking supplementary money, it would appear that the exceptions have become the rule. There is practically no Ministry which is not seeking supplementary money. It is a case, I think, of them "all being out of step except our Jim," and the Chancellor would persuade us that these are all special cases, all exceptional cases. There must be one Minister somewhere—I do not know who or where he is—who has not put forward a demand for a Supplementary Estimate, and who is not, therefore, a special case.
But the real question which this raises in one's mind is whether there is.any real Treasury control. Some of the things that fell from the Chancellor's lips today I found very disquieting and very disturbing. He seemed to suggest that even now, five years after the end of the war, Treasury control over departmental expenditure had not yet been reestablished. To my mind, these Supplementary Estimates mark a complete and bloodless victory for the spending Departments over the Treasury. It is the victor, apparently—the right hon. Gentleman the Minister of Health—and not the vanquished in this battle, who is going to reply for the Government tonight. We are always pleased to see the right hon. Gentleman, and sometimes we are quite pleased to listen to him. We all wish him well in his recovery from his recent indisposition, and we all certainly trust that he will not try to do too much too soon.
1018 It is a very queer thing to me that when a gamekeeper is being censured, one of the poachers, with a hag full of hares and pheasants over his shoulder, should be brought forward to give him a testimonial. I can only imagine that the Patronage Secretary had it in his mind that possibly this Amendment would be carried, that he would find himself in need of a new Chancellor of the Exchequer and that he is giving the right hon. Gentleman a try-out in the job for which he is designated in the future. It will be most interesting to see how the right hon. Gentleman conducts himself in the office which no doubt he aspires to hold.
As the right hon. Gentleman is here and is going to reply to the Debate, perhaps I might put to him one or two questions, which I am sure he will answer with his usual courtesy. The range of these Supplementaries is wide. The largest, however, is that of the National Health Service. Is there any machinery of financial control in the National Health Service? If so, what is it, and why now, for the second year running, has it completely broken down? What are the Government going to do about it? What reforms have they in mind to ensure that it does not happen on yet a third occasion? Would the right hon. Gentleman tell the House also what has happened to the charge of Is. for every prescription which the Prime Minister announced in the course of his grave statement on economy, on 24th October last, and which he said would achieve a saving of £10 million?
It is as long ago now as the last Budget speech since the Chancellor of the Exchequer said:There is, indeed, a very good argument for imposing some special charge or tax in connection with the Health Services, both to help to finance them and to bring home to people generally the simple fact that they have to be paid for out of taxation. It is argued, with some force, that this might help to make people more economical in their use of the Services. But, on the whole, I have come to the conclusion that we should await the outcome of another year before taking any such action, and I hope that there will be such economy in the use of the Services as to make it unnecessary."—[OFFICIAL REPORT, 6th April, 1949, Vol. 463, c. 2093.]What has happened about this tax? I could hardly expect the Minister of Health to give me an answer to this question, because I am quite sure he will get 1019 away with this one with the stock reply that he "cannot anticipate his Budget statement."
Let us look for a moment at these Supplementaries in relation to the general financial background. Last October we had the devaluation crisis. We had the Government's programme announced, first on the broadcast by the Chancellor of the Exchequer on the night of 21st September and given in detail in this House by the Prime Minister on 24th October. The Government's programme of economies totalled no less than £250 million. Of course we all know now that programme was very largely eyewash. So far as it was a reduction of capital expenditure, it took the form of a reduction of unattainable targets, mainly of the great public corporations. In fact, in order to build up the total of £250 million of economies the Chancellor actually had to include an additional £10 million of new taxation, an increase in the Profits Tax. But the Budgetary cuts, after separating the capital expenditure cuts, were to total £90 million in a full year. Yet when we look at the Vote on Account, where we find the figure for civil estimates for 1950–51, we find that the expenditure for 1950–51 on the Civil side alone is to be £155 million more than was estimated for the current financial year.
What has become of these Budgetary cuts of £90 million which were announced last October? What was the purpose of all this camouflage about economy following upon devaluation? It must have been known then that huge Supplementary Estimates were going to be required. I ask the Minister of Health who is to reply: who was intended to be reassured and comforted by this economy programme, by these declarations of cuts in this, that and the other? After all, they were a flat contradiction of what the Economic Secretary to the Treasury had stated to the House in a Debate on 23rd June, when he told us:…the idea that tens of millions of pounds can be saved by administrative economies…is sheer moonshine."—[OFFICIAL REPORT, 23rd June, 1949; Vol. 466, c. 520.]
§ Mr. Peake
The hon. Gentleman said that the idea that tens of millions of pounds could be saved by administrative economies was sheer moonshine. There may have been other words, but that is the effect of what he said. At any rate, the Government came forward within three months and announced a programme of cuts of £90 million, and surely there must have been some purpose in bringing forward this programme of economies in October? I should like to know just what it was, because it does not now seem that it is going to be achieved. It now seems that it is, in fact, going to be completely disregarded.
We think that the Chancellor has been a grievous disappointment. When he first took office we had high hopes, but we discovered that no positive action ever follows from his pious aspirations. On every occasion that the right hon. and learned Gentleman has to meet a crisis he reminds me of the re-election of Mr. Speaker. After a proper show of reluctance, he gently and generously yields. Seeing that the Chancellor has failed us, it seems to me that we must in this Parliament look for more effective control of expenditure to the House of Commons itself.
The Chancellor in his Budget speech reminded us of the traditional role of Parliament as against the Executive. I could hope that this Parliament might show itself a better guardian of the public purse than has the right hon. and learned Gentleman. With some years of experience of the Committees of this House which concern themselves with public expenditure, I believe that there is a great advantage in the fact that upon those Committees there will now be a better balance of party power. In both the Public Accounts Committee and the Estimates Committee the parties will be virtually evenly divided, and in those circumstances I believe that both those Committees, which have done valuable work in the past, will be able to do even more valuable work in the future.
I believe that the key to our economic difficulties lies in our domestic budgetary position. A desirable degree of disinflation and a stable cost of living could be swiftly achieved by a moderate reduction in Government expenditure and if anybody asks me, where do I want to 1021 economise, I would have no difficulty at all in answering that question—no difficulty at all. When we debated economy in October last, the right hon. Gentleman the Lord President of the Council, whom I am sorry to see is not in his place this evening, made the following statement:We have made the present instalment of cuts to serve notice on everyone, inside and outside this country, that the Government mean business about economy, but it would be quite wrong to assume that economy begins and ends with the cuts announced by my right hon. Friend the Prime Minister on Monday.He went on to say:Anyone who imagines that the present list represents the end of the Government's efforts to achieve economies is going to be undeceived before long."—[OFFICIAL REPORT, 27th October, 1949; Vol. 468, c. 1554–5.]Perhaps the Minister of Health will undeceive us tonight. I should take as a basis, as a springboard from which to start discussing economy, the list drawn up by the Lord President of the Council in October last and not yet divulged to the country.
In the two or three minutes that remain I want to say on the general issue that there are two methods of endeavouring to combat inflation in time of peace—two methods open to Governments. The first method, which has been tried by Chancellors ever since 1946, consists of heavy, swingeing increases in taxation. That has been tried and has been found wanting. The second method, the alternative to that, is retrenchment, economy, and that has never yet been given a chance. I think we in this House have got somehow in this Parliament to try and live together, whether we like it or not, for a period at any rate, a period which is sure to be months and which may be for a year or more.
During the period that this Parliament lasts, unless something is done, we shall drift to another, a real and a severe financial and economic crisis. I could wish that we could put aside considerations of party advantage in order to combine and secure that measure of retrenchment and disinflation which, in our hearts, most of us here believe is necessary to achieve safety. If we could do so, if we could pool our ideas and agree on necessary economy measures, this Parliament, though not likely to be of long 1022 duration, might, I believe, achieve something of lasting value and deserve well of our country.
§ 9.20 p.m.
§ The Minister of Health (Mr. Aneurin Bevan)
It is my happy privilege once again to felicitate a number of speakers upon their maiden speeches.
§ Mr. Bevan
The right hon. Gentleman, as usual, was not in his place and did not hear his hon. Friends speak. I am merely doing the honours of the House, as is customary in these circumstances, in saying that I think everybody who listened—although it was not the right hon. Gentleman—will agree that the speeches were of an exceptionally high standard.
If I am permitted on this occasion, not to be invidious but, nevertheless, to select one speech in particular, I should like specially to congratulate the hon. Member for Luton (Dr. Hill) upon the speech he made. It is one of the conventions of the House of Commons that one can say kind things about a maiden speech but not unkind things. I thought I was going to be put under very considerable strain; but I found myself in much agreement with what the hon. Member said. Indeed, as he proceeded to the conclusion of his speech I felt very proud of myself as, in the various associations that I have had with him, I had converted him to the support of the National Health Service.
All I can hope is that, as we have closer association in the immediate future, I may be able to convert him away from hon. Gentlemen opposite. The hon. Member will know how much we appreciated his speech because there was very much more applause on this side of the House than on that while he was speaking. As I say, I can say agreeable things about a maiden speech, but there is this difference between his speeches and the speeches of his colleagues in the same party: he understood what he was talking about and they did not.
Let me say a word or two about what I may call the genesis of this Debate. We have had from the right hon. Gentleman the Member for Leeds, North (Mr. Peake) a description of what he thinks 1023 happened in a Cabinet meeting. I will give the House an imaginative description of what happened in the "Shadow Cabinet." I think it was Ferdinand Lassalle who said, "You ought not to try to be clever in big things." That is precisely what the Opposition have tried to be. What really happened? They had a meeting, and they said, "There are these vast Supplementary Estimates, and the biggest of them all is the Supplementary Estimate for the Health Service. What are we going to do?" "Now," said his colleagues to the Leader of the Opposition. "you be careful this time. Do not be as naughty as you were last year."
The right hon. and gallant Gentleman the Member for Kelvingrove (Lieut.-Colonel Elliot), I am quite certain, wagged an admonitory finger at him and said, "Last year you got us into trouble over this. Do not do it again. You came down to the House of Commons and you accused the Minister of Health of wanton extravagance, and then you had such a hiding. It is better that you do not do it again this time." Well, they had to do something about it. They could not very well allow—it would have been wrong in them—large Supplementary Estimates of this sort to go by on the nod. It is a very important matter.
The Leader of the Liberal Party was quite right in italicising the gravity of coming before the House of Commons with heavy Supplementary Estimates of this sort. They must be examined. But the difficulty that lies before the Opposition is the difficulty that they will be faced with all through this Parliament, whether it lasts long or whether it be short, and that is: how will they justify their promises to their millionaire subscribers, and the promises that they made to people in the country? Their difficulty is manifest. On this occasion it would not pay to select the Minister of Health to be the victim, because he happens to be the custodian of the National Health Service, and they have been doing their utmost in the last year or so to assume its foster parentage; so it is not the Minister of Health that they must seek out—not for any reasons that are flattering to him, because I am quite certain that if they could put me on the grid they would be delighted to do so.
1024 It is a most unfortunate position for them, because if they attack the Minister of Health, it would then be apparent that their real enemy is not the Minister of Health but the Health Service; so they say "We won't do that; we will attack the Chancellor of the Exchequer. Do not attack the Minister of Health for having a Health Service but attack the Chancellor of the Exchequer for allowing him to finance it." Then they can appear before the country as being custodians of the nation's finances at the same time as they are anxious to cut the social services, so that they can satisfy their millionaire friends who subscribe to the Woolton millions, without appearing to dissatisfy those electors whom they deceived at the last election. It is a very difficult performance to carry out, and the Amendment has been very ingeniously devised.
I can imagine that the right hon. Gentleman, who, on this occasion, did not lose his temper and say things he could not ultimately defend, helped them to devise this because he is a very agile Parliamentarian and he has had some experience of going in opposite directions at one and the same time. After all he made a number of speeches during the election. I watched his performances with very great admiration. He had so many "ifs and buts" and promises to give, that one did not know whether he was promising less petrol or more petrol. He managed to convey the impression to a vast number of motorists that if he came back at the head of the Government there would be. no difficulty about dollars for petrol. He helped to advise them. I congratulate him. It still enables him to ride two horses for a little while longer.
The fact is that as the Debate has shown, the Amendment is not directed against the Chancellor of the Exchequer. As a matter of fact after my right hon. and learned Friend made his speech today the Debate was over. After the explanation about most of the Supplementary Estimates as distinct from that of the National Health Service had been given the House practically emptied, and, indeed, has been almost empty all day. So vigilant and angry are the Opposition about this profligate way of conducting the national finances that the benches opposite have been almost empty. [HON. MEMBERS: "No."] Yes; indeed, it looked at one time as if the Debate would 1025 collapse. Cannot the Opposition keep up their indignation for a few hours?
It is, as I say, the National Health Service which is really the target of the attack, and we must keep the Oppositions' nose to it. We must not permit them to ride off on the assumption that all that is really involved here is a Gladstonian attitude towards the Supplementary Estimates. What is involved here is whether the Chancellor of the Exchequer and the Government were right in permitting the expansion of the National Health Service to go on in the last year. That is what is really involved. Indeed, the hon. Members for Hendon, South (Sir H. Lucas-Tooth) and Flint, West (Mr. Birch) almost said so.
§ Mr. Birch indicated dissent.
§ Mr. Bevan
What was the suggestion? The Opposition were in this difficulty. Last evening they made a long attack on the Government for not spending enough of the national resources on housing. This evening we are having the opposite effect: we are spending too much. To try to reconcile that contradiction we had a suggestion from these two hon. Gentlemen opposite—and this is particularly interesting, in view of what the hon. Member for Flint, West, said about the Chancellor of the Exchequer's knowledge of finance and economics. What did they say?
The hon. Member for Flint, West, said, "In the order of priorities we would, in fact, have saved on the National Health Service and used the money for more houses." That is in effect what he said, as will be seen from his speech in the OFFICIAL REPORT tomorrow. His know ledge of economics is so profound that he did not understand that housing is on 1026 the capital investment account and that health is on the current expenditure and revenue account, so what he would have apparently done last year was this. He would have said to the Chancellor of the Exchequer: "No more money for that wicked man the Minister of Health. No more money for him. He cannot have this £50 or £60 million for the hospitals." He would then have gone along to the surgeon at the hospital who was rendered idle as a consequence of lack of finance and said, "You have got to be a mason and build that flat around the corner." These are the economists! These are the experts!
The hon. Member for Hendon, South, talked about the ophthalmic service, the dental service, and the hospital and other services. He would not have found the money. He said, "We could have spent this money on more houses," so the dentist could have used his drill on building houses. This is the sort of thing that we have to listen to all day from the benches opposite.
§ Mr. Bevan
Yes, and always have to; and it is one of the reasons why I have privately held the view—although I cannot get many to share it—that the proceedings of the House ought to be broadcast so that all the country could hear the nonsense we have to listen to. It has been seriously suggested to us that the saving on this account could have been used on the capital investment programme. I hope the hon. Member for Luton will be able to explain to the members of his Association how I have saved them from a fate worse than death.
The right hon. Gentleman the Member for Leeds, North (Mr. Peake) made a most remarkable statement about economics. How can the Conservative Party come to the House of Commons and talk about a reduction in national expenditure in the face of this disgraceful document, "The Right Road for Britain." The right hon. Gentleman the Leader of the Opposition smiles, but he almost brought off his Goebbelesque trick of saying different things to different sections of the population.
§ Mr. Bevan
The Goebbelesque trick of promising different things to different sections of the population in the hope that the election would be over before they could compare notes. Did the hon. Member for Flint, West, who was so indignant, go to the electorate on that document? He did, and he has just told us that he would not have found the money for the National Health Service. Did the hon. Member for Hendon. South, fight on that?
§ Mr. Bevan
I know the right hon. Lady did, because we have not yet educated her constituents, but the time will come. There is something rather indecent about an Opposition coming to the House of Commons and protesting about Supplementary Estimates on the Health Service in view of the statement contained in this document, because under it they would have expanded expenditure on the Health Service. They did not promise to contract it; they promised to increase it. Yet almost the first speech made by the hon. Gentleman the Member for Flint, West, in the new House of Commons is the statement that he would not have found the money last year for the Health Service. If the Opposition were decent they would resign and offer themselves again to their constituents.
It comes very ill from the hon. Member for Flint, West, to attempt to chastise my right hon. and learned Friend the Chancellor of the Exchequer in the fashion that he has, in view of the fact that he and his party have been carrying on organised deception of the electorate for the last few months. It has been made perfectly clear this evening, that we had to wait at least one year on the behaviour of the population before it was possible to form the least idea of what the expenditure on the National Health Service would be. In fact, I said that last year when I made my speech before the House of Commons on the Supplementary Estimates. I told the House then that there would be a Supplementary Estimate this year and I gave the reasons for it. It was not challenged.
After the estimates were made, negotiations continued with a large number of health workers, including the specialists, 1028 and it was not possible to put into the estimates what the result of those negotiations would be. That is inevitable while a great Health Service is being built up, and if hon. Members opposite are really friends of the Health Service they should recognise candidly that while it was being built up, negotiations were taking place within every branch of it.
It was my duty and part of my task to try to raise the standards of the staffs of hospitals so that we could get people into the hospitals. It was one of the disgraces of the hospital system that we had woefully neglected the standards of our nurses and could get no nurses. There is nothing new about the fact that there would be a Supplementary Health Estimate. It is also wrong to say that the Chancellor of the Exchequer has deceived the people of the country. He did not deceive the right hon. and gallant Member for Gainsborough (Captain Crookshank), who told us he knew all about it. He told us he warned his constituents. I dare say that many of his hon. Friends also warned their constituents that there would be Supplementary Estimates. He told us that today. At the same time that he was warning his constituents that there would be Supplementary Estimates, he was showing this book—"This Is the Road"—to his constituents, offering them more.
I am myself convinced, and have been convinced, that it was absolutely necessary that we should first of all allow people to behave before we could form a view of what that behaviour would be like. For example, who could tell what the behaviour pattern of the population would be in respect of spectacles, dentistry, drugs or doctors? Who could tell? I do not know even now, and no one knows, how many people in this country would need aural aids. Do the Opposition know? No one knows. We can only know when people have had enough time to come forward, and when there has been enough time for doctors to examine them and see how many people need aural aids. Therefore, it is utterly impracticable to say what the behaviour pattern of people is until the pattern has had time to form itself. As the Chancellor of the Exchequer quite properly said today, it is only these new Estimates that provide us with one full year's experience of what the people of 1029 the country will do with the National Health Service.
I have been told from every quarter, not only in this House but in the Press and elsewhere, that the hospital services cost so much because there is rank extravagance and maladministration. There are hon. Members in this House on hospital management committees and regional hospital boards. Are they conscious of maladministration in their hospitals? I would ask the hon. Member for Hendon, South, whether the hospital, of the governing body of which he is a member, maladministers its finances? I ask the hon. Member for Putney (Mr. Linstead) where he knows of any instance of wanton extravagance in his group? [HON. MEMBERS: "Answer."] [Laughter.] I do not know what the hon. Member laughs about. The fact is that there are large numbers of members of all parties—Socialists, Liberals, Tories and members of no party at all—who serve upon these hospital management committees and hospital management boards. When hon. Members accuse hospital authorities of maladministration they are really indicting members of their own party in different parts of the country.
I am not saying that there ought not to be a tightening up of hospital administration, and there will be. There must be a closer identification of the central Government with the local units of hospital administration. The reasons for that are perfectly obvious. Because we have inherited from the past—[Laughter.] do not know what hon. Members opposite are laughing about—we have inherited from the past a hospital system with no system of accountancy at all. It is only just now beginning. However, so that there might be an appreciation of the situation I have had certain figures got out, because I am quite sure the House would like to be reassured about this and that hon. Members would like to know whether the British hospital system has cost the country more than the hospital systems of other countries.
Since 1946 hospital costs in the U.S.A. have gone up 40 per cent., in Sweden 50 per cent., in England and Wales about the same figure. The Royal Masonic Hospital, which is outside the National Health Service and is a very good hospi- 1030 tal indeed, did not start off, like some of our infirmaries, from a low level. It started off from a high level. It had not to be built up and yet its costs increased from 1946 to 1948 by 55.8 per cent. The costs of the King Edward VII Sanatorium—another excellent institution outside the Health Service—increased by 69.4 per cent. The costs in the National Health Service rose by 40 per cent. In other words, those hospitals outside the Health Service were subjected to the same influences as the National Health Service itself, and their costs rose in exactly the same proportion or, in some institutions, even more.
I will say where I think some economies ought to be made in the administration and cost of the Health Service. I will give some instances where I think savings could be made quite quickly, and that is in the cost of proprietary medicines which have become part of the racket of civilised society. This is where I hope we shall have the co-operation of the medical profession. Take one preparation, Agarol emulsion, six ounces of which cost 3s. The same preparation, on our list, costs 10½d. Genasprin, 1s. 9½d. The same preparation, on our list, 2½d. Dexedrine tablets—I think the ladies use these for slimming—3s. 2d. On our list, 9½d. All these preparations are the subject of heavy advertising and many of the doctors prescribe them. I hope to get the co-operation of the medical profession and of the whole House and of all parts of the country to cut out proprietary medicines which are unnecessarily expensive.
There is another aspect of the Health Service in respect of which I hope to get the assistance of the Opposition. The supply organisation of the Ministry of Health attempted to get bulk purchase—I know that is a word which the Opposition does not like—of glassware into hospitals. We asked for tenders from manufacturers in Great Britain. We could get no tenders because they said, "We always sell through the retailers." We asked the retailers, but they said, "We do not tender because we always sell at the price fixed by the manufacturers." So, we had to get them from Germany to break the monopoly. As a consequence we have saved a large sum of money, even after paying import duty.
1031 The same thing is true of dental goods. We have sent to the Monopolies Commission a price-fixing cartel for dental goods because we know very well that dentists are being held up to ransom by a price ring. These are some of the ways in which we are proposing to have money under the National Health Service, and I know that the Opposition will be very happy to help me in that.
§ Mr. Peake
Before the right hon. Gentleman finishes his speech I hope he will enlighten us upon the saving in the National Health Service announced by the Prime Minister on 24th October last by the one shilling charge on prescriptions, which, the Prime Minister said, would result in a saving of £10 million, although that was not, he added, the primary purpose of the charge.
§ Mr. Bevan
If he imagines I am going to answer questions relating to the Budget he is making a very great mistake. That is entirely a matter—[HON. MEMBERS: "Answer."] I know the Opposition are anxious to get me away from this matter, because, as the hospital service establishes itself, and as the bulk purchase organisation of the National Health Service comes into operation, very large sums of money will be saved. On X-ray apparatus, by cutting out the retailer, we have already saved £150,000 a year. We have already saved, on X-ray films, £280,000 a year. On hearing aids and batteries we have hayed £1,500,000. See how happy the Opposition look!
§ Mr. Churchill
Surely, the right hon. Gentleman is not going to refuse even to refer to the question of the fee on prescriptions.
§ Mr. Bevan
We have already saved, on streptomycin, £240,000. [Laughter.] Have not the Opposition been covering the country with posters, "Let us fight the high cost of living?" I want to help them to support the low cost of loving. [HON. MEMBERS: "Of what?"]—of loving. By cutting out retailers' costs—this has a direct relationship to the cost of living—we have already saved £2,558,000 a year, and we are proposing 1032 to go on. As the National Health Service establishes itself, and as the supply organisation establishes itself, we shall, of course, get very many savings in various directions.
I end by saying that there is one very great saving which can be obtained, but only by the co-operation of the medical profession. We wanted, we tried hard not so long ago, to try to bring about a reduction in hospital costs. If the right hon. Member for Leeds, North (Mr. Peake), would please listen—he asks questions but he does not listen.
§ Mr. Bevan
Reference was made by the hon. Member for Hendon, South earlier in the Debate to an attempt that was made last year to obtain a reduction in the expenditure of hospitals. It was, as I have informed the House, an essay in financial discipline. The result was that hospitals started to complain that if the cut was applied hospital beds would be closed. What did the Conservative Press say when we tried to bring about this economy in hospital administration? Headlines, in the "Daily Mail," said "Patients Die for Lack of Beds"; in the "Daily Graphic," "Thousands may be Denied Beds in Hospitals"; the "Liverpool Post," "Hospitals Have to Turn Children Away," and the "Yorkshire Post"—one after the other—with the "Daily Graphic" coming out on top. There were the "Evening News," the "Evening Standard," with "What Does He Mean?"—that is, Bevan. "What economies does the Minister expect from hospitals which have prepared their budgets with care?"
In other words, as soon as an attempt was made by the central Government to try to get some of the hospital authorities to exercise a sense of financial responsibility, we had that debauch of vituperation from the Press, in which the Government and the Minister of Health were accused of condemning people to death. The fact is, of course, that the Opposition will have an exceedingly difficult life during the next few months, as this Parliament continues. It is becoming exceedingly difficult for them now, and, as the months go by and as the bill comes home, as the Opposition realise that they have made a series of 1033 irresponsible promises which they can never carry out, as the nation finds out how it has been deceived by them, then we shall have a sharp reversal of the tendency revealed at the last election.
One right hon. Gentleman ended his speech by saying that if this Amendment were carried this evening it would mean another Chancellor of the Exchequer. This Amendment is treated by my right hon. and learned Friend as a Vote of Censure. There is no doubt about the significance of the vote. A vote of this kind places the Government in jeopardy, and we shall regard it not only as an
§ attack upon the Government itself but as a concealed and cowardly attack upon the National Health Service devised by people who have not the honesty to make it openly.
§ Question put, "That the words pro-posed to be left out stand part of the Question."
§ The House divided: Ayes, 308; Noes, 289.1037
|Division No. 3.]||AYES||[10.0 p.m.|
|Acland, Sir Richard||Crossman, R. H. S.||Hannan, W.|
|Adams, Richard||Cullen, Mrs. A.||Hardman, D. R|
|Albu, A. H.||Daggar, G.||Hardy, E. A.|
|Allen, A. C. (Bosworth)||Daines, P.||Hargreaves, A.|
|Allen, Scholefield (Crewe)||Dalton, Rt. Hon. H.||Harrison, J.|
|Anderson, A. (Motherwell)||Darling, G. (Hillsboro')||Hastings, Dr. Somerville|
|Anderson, F. (Whitehaven)||Davies, Edward (Stoke, N.)||Hayman, F. H.|
|Attlee, Rt. Hon. C. R.||Davies, Ernest (Enfield, E.)||Henderson, Rt. Hon. A. (Tipton)|
|Awbery, S. S.||Davies, Harold (Leek)||Herbison, Miss M.|
|Ayles, W. H.||Davies, R. J. (Westhoughton)||Hewitson, Capt. M.|
|Bacon, Miss A.||Davies, S. O. (Merthyr)||Hobson, C. R.|
|Baird, J.||de Freitas, Geoffrey||Holman, P.|
|Balfour, A.||Deer, G.||Holmes, H. E. (Hemsworth)|
|Barnes, Rt. Hon. A. J.||Delargy, H. J.||Houghton, Douglas|
|Bartley, T.||Diamond, J.||Hoy, J.|
|Bellenger, Rt. Hon. F. J.||Dodds, N. N.||Hubbard, T.|
|Benson, G.||Donnelly, D.||Hudson, J. H. (Ealing, N.)|
|Beswick, F.||Donovan, T. N.||Hughes, Emrys (S. Ayr)|
|Bevan, Rt. Hon. A. (Ebbw Vale)||Driberg, T. E. N.||Hughes, Hector (Aberdeen, N.)|
|Bevin, Rt. Hon E. (Woolwich, E.)||Dugdale, Rt. Hon. J. (W. Bromwich)||Hughes, R. M. (Islington, N.)|
|Bing, G. H. C.||Dye, S.||Hynd, H. (Accrington)|
|Blackburn, A. R.||Ede, Rt. Hon. J C.||Hynd, J. B. (Attercliffe)|
|Blenkinsop, A.||Edelman, M.||Irvine, A. J. (Edge Hill)|
|Blyton, W. R.||Edwards, Rt. Hon. N. (Caerphilly)||Irving, W. J. (Wood Green)|
|Boardman, H.||Edwards, W. J. (Stepney)||Isaacs, Rt. Hon G. A.|
|Booth, A.||Evans, Albert (Islington, S.W.)||Janner, B.|
|Bottomley, A. G.||Evans, E. (Lowestoft)||Jay, D. P. T.|
|Bowden, H. W.||Evans, S. N. (Wednesbury)||Jeger, G. (Goole)|
|Bowles, F. G. (Nuneaton)||Ewart, R.||Jeger, Dr. S. W. (St. Pancras, S.)|
|Braddock, Mrs. E. M.||Fernyhough, E.||Jenkins, R. H.|
|Brockway, A. Fenner||Field, Capt. W. J||Johnson, J. (Rugby)|
|Brook, D. (Halifax)||Finch, H. J.||Johnston, Douglas (Paisley)|
|Brooks, T. J. (Normanton)||Fletcher, E. G. M. (Islington, E.)||Jones, D. T. (Hartlepool)|
|Broughton, Dr. A. D. D.||Follick, M||Jones, Elwyn (West Ham, S.)|
|Brown, George (Belper)||Foot, M. M.||Jones, J. H. (Rotherham)|
|Brown, T. J. (Ince)||Forman, J C.||Jones, W. E. (Conway)|
|Burke, W. A.||Fraser, T. (Hamilton)||Keenan, W.|
|Burton, Miss E.||Freeman, J. (Watford)||Kenyon, C.|
|Butler, H. W. (Hackney, S.)||Freeman, Peter (Newport)||Key, Rt. Hon. C. W.|
|Callaghan, James||Gaitskell, Rt. Hon. H. T. N.||King, H. M.|
|Carmichael, James||Ganley, Mrs. C. S.||Kinghorn, Sqn.-Ldr. E.|
|Castle, Mrs. B. A.||Gibson, C. W.||Kinley, J.|
|Champion, A. J.||Gilzean, A.||Lang, Rev. G.|
|Chetwynd, G. R.||Glanville, J. E. (Consett)||Lee, F. (Newton)|
|Clunie, J.||Gooch, E. G.||Lee, Miss J. (Cannock)|
|Cobb, F. A.||Gordon-Walker, Rt. Hon P. C.||Lever, L. M. (Ardwick)|
|Cocks, F. S.||Greenwood, A. W. J. (Rossendale)||Lever, N. H. (Cheatham)|
|Coldrick, W.||Greenwood, Rt. Hon. A. (Wakefield)||Lewis, A. W. J. (West Ham, N.)|
|Collick, P.||Grenfell, D. R.||Lewis, J. (Bolton, W.)|
|Collindridge, F.||Grey, C. F.||Lindgren, G. S.|
|Cook, T. F.||Griffiths, D. (Rother Valley)||Lipton, Lt.-Col. M.|
|Cooper, G. (Middlesbrough, W.)||Griffiths, W. D. (Exchange)||Llewellyn, D.|
|Cooper, J. (Deptford)||Gunter, R. J.||Logan, D. G.|
|Corbet, Mrs. F. K. (Peckham)||Haire, John E. (Wycombe)||Longden, F. (Small Heath)|
|Cove, W. G.||Hale, J. (Rochdale)||McAllister, G.|
|Craddock, George (Bradford, S.)||Hale, Leslie (Oldham, W.)||MacColl, J. E.|
|Crawley, A||Hall, J. (Gateshead, W.)||McGhee, H. G.|
|Cripps, Rt. Hon. Sir S.||Hall, Rt. Hon. Glenvil (Colne Valley)||McGovern, J.|
|Crosland, C. A. R.||Hamilton, W. W.||McInnes, J.|
|Mack, J. D.||Paton, J.||Thomas, I. R. (Rhondda, W.)|
|McKay, J. (Wallsend)||Pearson, A.||Thomas, T. George (Cardiff)|
|Mackay, R W G (Reading, N.)||Peart, T. F.||Thorneycroft, Harry (Clayton)|
|McKinlay, A. S.||Poole, Cecil||Thurtle, Ernest|
|McLeavy, F.||Popplewell, E.||Timmons, J.|
|MacMillan, M. K. (Western Isles)||Porter, G.||Tomlinson, Rt. Hon. G.|
|McNeil, Rt. Hon. H.||Price, M. Philips (Gloucestershire, W.)||Tomney. F.|
|MacPherson, Malcolm (Stirling)||Proctor, W T.||Turner-Samuels, M.|
|Mainwaring, W. H.||Pryde, D. J.||Usborne, Henry|
|Mallalieu, E. L. (Brigg)||Pursey, Comdr. H.||Vernon, Maj. W. F.|
|Mallalieu, J. P. W. (Huddersfield, E.)||Rankin, J||Viant, S. P.|
|Mann, Mrs. J.||Rees, Mrs. D.||Wallace, H. W.|
|Manuel, A. C.||Reeves, J||Watkins, T. E.|
|Marquand, Rt. Hon. H. A.||Reid, T (Swindon)||Webb, Rt. Hon. M (Bradford, C.)|
|Mathers, Rt. Hon. George||Reid, W. (Camlachie)||Weitzman, D.|
|Mellish, R. J.||Rhodes, H.||Wells, P. L. (Faversham)|
|Messer, F.||Robens, A.||Wells, W. T. (Walsall)|
|Middleton, Mrs. L.||Roberts, Goronwy (Caernarvonshire)||West, D. G.|
|Mikardo, Ian||Robertson, J. J. (Berwick)||Wheatley, Rt. Hn. John (Ed'nb'gh, E.)|
|Mitchison, G. R.||Robinson, Kenneth (St. Pancras, N.)||White, Mrs. E (E. Flint)|
|Moeran, E. W.||Rogers, G. H. R. (Kensington, N.)||White, H. (Derbyshire, N. E.)|
|Monslow, W.||Ross, William (Kilmarnock)||Wigg, George|
|Moody, A. S.||Royle, C.||Wilcock, Group-Capt. C. A. B|
|Morgan, Dr. H. B.||Shackleton, E. A. A.||Wilkes, L.|
|Morley, R.||Shawcross, Rt. Hon. Sir H.||Wilkins, W. A.|
|Morris, Lt.-Col. H. (S'ffield, Neepsend)||Shinwell, Rt. Hon. E.||Willey, F. T. (Sunderland)|
|Morris, P. (Swansea, W.)||Shurmer, P. L. E.||Willey, O. G. (Cleveland)|
|Morrison, Rt. Hon. H. (Lewisham, S.)||Silverman, J. (Erdington)||Williams, D. J. (Heath)|
|Mort, D. L.||Silverman, S. S. (Nelson)||Williams, Ronald (Wigan)|
|Moyle, A.||Simmons, C. J.||Williams, Rt. Hon. T. (Don Valley)|
|Mulley, F. W.||Slater, J.||Williams, W. T. (Hammersmith, S.)|
|Murray, J. D.||Smith, Ellis (Stoke, S.)||Wilson, Rt. Hon. J H (Huyton)|
|Nally, W.||Smith, H. N. (Nottingham, S.)|
|Neal, H.||Snow, J. W.||Winterbottom, I. (Nottingham. C.)|
|Noel-Baker, Rt. Hon. P. J.||Sorensen, R. W.||Winterbottom, R. E (Brightside)|
|O'Brien, T.||Sparks, J. A.||Wise, Major F. J.|
|Oldfield, W. H.||Stewart, Michael (Fulham, E.)||Woodburn, Rt. Hon. A.|
|Oliver, G. H.||Stokes, Rt. Hon. R. R||Woods, Rev. G. S.|
|Orbach, M.||Strachey, Rt Hon. J.||Wyatt, W. L.|
|Padley, W. E.||Strauss, Rt. Hon. G. R. (Vauxhall)||Yates, V. F.|
|Paget, R T||Stross, Dr. B.||Younger, Hon. Kenneth|
|Paling, Rt. Hon. Wilfred (Dearne V'lly)||Summerskill, Rt. Hon. Edith|
|Paling, Will T. (Dewsbury)||Sylvester, G. O||TELLERS FOR THE AYES:|
|Pannell, T C.||Taylor, H. B. (Mansfield)||Mr. William Whiteley and|
|Pargiter, G. A.||Thomas, D. E. (Aberdare)||Mr. R. J. Taylor.|
|Parker, J.||Thomas, I. O. (Wrekin)|
|Aitken, W. T.||Butler, Rt. Hon. R. A. (S'ffr'n W'ld'n)||Duthie, W. S.|
|Alport, C. J. M.||Carr, L. R. (Mitcham)||Eccles, D. M.|
|Amery, J. (Preston, N.)||Carson, Hon. E.||Elliot, Lieut.-Col. Rt. Hon. Walter|
|Amory, D. Heathcoat (Tiverton)||Channon, H.||Erroll, F. J.|
|Arbuthnot, J. S.||Churchill, Rt. Hon. W. S.||Fisher, N. T. L.|
|Assheton, Rt. Hon. R. (Blackburn, W.)||Clarke, Col. R. S. (East Grinstead)||Fletcher, W. (Bury)|
|Astor, Hon. M.||Clarke, Brig. T. H. (Portsmouth, W.)||Fort, R.|
|Baker, P.||Clyde, J. L.||Foster, J. G.|
|Baldock, J. M.||Colegate, A.||Fraser, Hon. H. C. P. (Stone)|
|Baldwin, A. E.||Conant, Maj. R. J. E.||Fraser, Sir I. (Lonsdale)|
|Banks, Col. C.||Cooper, A. E. (Ilford, S.)||Fyfe, Rt. Hon. Sir D. P. M.|
|Baxter, A. B.||Cooper-Key, E. M.||Gage, C. H.|
|Beamish, Maj. T. V. H.||Corbett, Lieut.-Col. U. (Ludlow)||Galbraith, Cmdr. T. D. (Pollok)|
|Bell, R. M. (S. Buckinghamshire)||Craddock, G. B. (Spelthorne)||Galbraith, T. G. D. (Hillhead)|
|Bennett, Sir P. (Edgbaston)||Cranborne, Viscount||Gammans, L. D.|
|Bennett, R. F. B. (Gosport)||Crookshank, Capt. Rt. Hon. H. F. C.||Garner-Evans, E. H. (Denbigh)|
|Bennett, W. G (Woodside)||Cross, Rt. Hon. Sir R.||Gates, Maj. E. E.|
|Bevins, J. R. (Liverpool, Toxteth)||Crosthwaite-Eyre, Col. O. E.||Glyn, Sir R.|
|Birch, Nigel||Crouch, R. F.||Gomme-Duncan, Col. A.|
|Bishop, F P||Crowder, F. P. (Northwood)||Gridley, Sir A.|
|Black, C. W.||Crowder, Capt John F. E. (Finchley)||Grimston, Hon. J. (St. Albans)|
|Boles, Lt.-Col. D. C. (Wells)||Cundiff, F. W.||Grimston, R. V. (Westbury)|
|Boothby, R.||Cuthbert, W. N.||Harden, J. R. E.|
|Bossom, A C.||Darling, Sir W. Y. (Edinburgh, S.)||Hare, Hon. J. H. (Woodbridge)|
|Bower, N||Davidson, Viscountess||Harris, F. W. (Croydon, N.)|
|Boyd-Carpenter, J. A.||Davies, Nigel (Epping)||Harris, R. R. (Heston)|
|Bracken, Rt. Hon. Brendan||de Chair, S.||Harvey, Air-Codre. A. V. (Macclesfield)|
|Braine, B.||De la Bère, R.||Harvey, I. (Harrow, E.)|
|Braithwaite, Lt.-Comdr. J. G.||Deedes, W. F.||Hay, John|
|Bromley-Davenport, Lt.-Col. W.||Digby, S. Wingfield||Head, Brig. A. H.|
|Brooke, H. (Hampstead)||Dodds-Parker, A. D||Headlam, Lieut.-Col. Rt. Hon. Sir C.|
|Browne, J. N. (Govan)||Douglas-Hamilton, Lord M||Heald, L. F.|
|Bullock, Capt. M.||Drayson, G. B.||Heath, Colonel E. G. R.|
|Bullus, Wing-Commander E. E.||Dugdale, Maj. Sir T. (Richmond)||Henderson, John (Cathcart)|
|Burden, Squadron-Leader F. A.||Duncan, Capt. J. A. L.||Hicks-Beach, Maj. W. W.|
|Butcher, H. W.||Dunglass, Lord||Higgs, J. M. C.|
|Hill, Mrs. E. (Wythenshawe)||Macpherson, N. (Dumfries)||Shepherd, W. S. (Cheadle)|
|Hill, Dr. C. (Luton)||Maitland, Comdr. J. W.||Smiles, Lt.-Col. Sir W.|
|Hinchingbrooke, Viscount||Manningham-Buller, R. E.||Smith, E. M. (Grantham)|
|Hirst, G. A. N.||Marlowe, A. A. H.||Smithers, Peter (Winchester)|
|Hogg, Hon. Q.||Marples, A. E.||Smithers, Sir W. (Orpington)|
|Hollis, M. C.||Marshall, D. (Bodmin)||Smyth, Brig. J. G. (Norwood)|
|Holmes, Sir J. Stanley (Harwich)||Marshall, S. H. (Sutton)||Snadden, W. McN.|
|Hope, Lord J.||Maude, A. E. U. (Ealing, S.)||Soames, Capt. C.|
|Hopkinson, H.||Maude, J. C. (Exeter)||Spearman, A. C. M.|
|Hornsby-Smith, Miss P.||Maudling, R.||Spence, H. R. (Aberdeenshire, W.)|
|Horsbrugh, Rt. Hon. Florence||Medlicott, Brigadier F.||Spens, Sir P. (Kensington, S.)|
|Howard, G. R. (St. Ives)||Mellor, Sir J.||Stanley, Rt. Hon. O. (Bristol, W.)|
|Howard, S. G. (Cambridgeshire)||Molson, A. H. E.||Stanley, Capt. Hon. F. (N. Fylde)|
|Hudson, Sir A. U. M. (Lewisham, N.)||Moore, Lt.-Col. Sir T.||Stevens, G. P.|
|Hudson, Rt. Hon. R. S. (Southport)||Morrison, Maj. J. G. (Salisbury)||Steward, W. A. (Woolwich, W.)|
|Hudson, W. R. A. (Hull, N.)||Morrison, Rt. Hon. W. S. (Cirencester)||Stoddart-Scott, Col. M.|
|Hulbert, Wing-Cdr. N. J.||Mott-Radclyffe, C. E.||Storey, S.|
|Hurd, A. R.||Nabarro, G.||Strauss, Henry (Norwich, S.)|
|Hutchinson, G. (Ilford, N.)||Nicholls, H.||Stuart, Rt. Hon. J. (Moray)|
|Hutchison, Lt.-Com. Clark (E'b'rgh W.)||Nicholson, G.||Studholme, H. G|
|Hyde, H. M.||Nield, B. (Chester)||Summers, G. S.|
|Hylton-Foster, H. B.||Noble, Comdr. A. H. P.||Sutcliffe, H.|
|Jeffreys, General Sir G||Nugent, G. R. H.||Taylor, C. S. (Eastbourne)|
|Jennings, R.||Nutting, Anthony||Taylor, W J. (Bradford, N.)|
|Johnson, H. S. (Kemptown)||Oakshott, H. D.||Teeling, William|
|Jones, A. (Hall Green)||Odey, G. W.||Thomas, J. P. L. (Hereford)|
|Johnson-Hicks, Hon. L. W.||O'Neill, Rt. Hon. Sir H.||Thompson, K. P. (Walton)|
|Kaberry, D.||Ormsby-Gore, Hon. W. D.||Thompson, R. H. M. (Croydon, W.)|
|Keeling, E. H.||Orr, Capt. L. P. S.||Thorneycroft, G. E. P. (Monmouth)|
|Kerr, H. W. (Cambridge)||Orr-Ewing, Charles I. (Hendon, N.)||Thornton-Kemsley, C. N.|
|Lambert, Hon. G.||Orr-Ewing, Ian L. (Weston-super-Mare)||Thorp, Brigadier R. A. F.|
|Lancaster, Col. C. G.||Osborne, C.||Tilney, J. D.|
|Langford-Holt, J.||Peake, Rt. Hon. O.||Touche, G. C.|
|Law, Rt. Hon. R. K.||Perkins, W. R. D.||Turton, R. H.|
|Leather, E. H. C.||Peto, Brig. C. H. M.||Tweedsmuir, Lady|
|Legge-Bourke, Maj. E. A. H.||Pickthorn, K.||Vane, W. M. F.|
|Lennox-Boyd, A. T.||Pitman, I. J.||Vaughan-Morgan, J. K.|
|Lindsay, Martin||Powell, J Enoch||Vosper, D. F.|
|Linstead, H. N.||Prescott, Stanley||Wakefield, E. B. (Derbyshire, W.)|
|Lloyd, Rt. Hon. G. (King's Norton)||Price, H. A. (Lewisham, W.)||Wakefield, Sir W. W. (St. Marylebone)|
|Lloyd, Maj. Guy (Renfrew, E.)||Prior-Palmer, Brig. O||Walker-Smith, D. C.|
|Lloyd, Selwyn (Wirral)||Profumo, J. D.||Ward, Hon. G. R. (Worcester)|
|Lockwood, Lt.-Col. J. C.||Raikes, H. V.||Ward, Miss I. (Tynemouth)|
|Longden, G. J. M. (Herts. S. W.)||Rayner, Brig. R.||Waterhouse, Capt C.|
|Low, A. R. W.||Redmayne, M.||Watkinson, H.|
|Lucas, Major Sir J. (Portsmouth, S.)||Remnant, Hon. P.||Watt, Sir G. S. Harvie|
|Lucas, P. B. (Brentford)||Renton, D. L. M.||Webbe, Sir H. (London)|
|Lucas-Tooth, Sir H.||Roberts, H. (Handsworth)||Wheatley, Major M. J. (Poole)|
|Lyttelton, Rt. Hon. O.||Roberts, P. G. (Heeley)||White, J. Baker (Canterbury)|
|McAdden, S. J.||Robertson, Sir D. (Caithness)||Williams, C. (Torquay)|
|McCallum, Maj. D.||Robinson, J. Roland (Blackpool, S.)||Williams, Gerald (Tonbridge)|
|McCorquodale, Rt. Hon. M. S.||Robson-Brown, W.||Williams, Sir H. G. (Croydon, E.)|
|Macdonald, Sir P. (I. of Wight)||Rodgers, J. (Sevenoaks)||Wills, G.|
|Mackeson, Brig. H. R||Roper, Sir H.||Wilson, G. (Truro)|
|McKibbin, A.||Ropner, Col. L.||Winterton, Rt. Hon. Earl|
|McKie, J. H. (Galloway)||Ross, Sir R. D. (Londonderry)||Wood, Hon. R.|
|Maclay, Hon. J. S.||Russell, R. S.||York, C.|
|Maclean, F. H. R.||Ryder, Capt. R. E. D.||Young, Sir A. S. L. (Partick)|
|MacLeod, I. (Enfield, W.)||Sandys, Rt. Hon. D.|
|MacLeod, J. (Ross and Cromarty)||Savory, Prof. D. L.||TELLERS FOR THE NOES:|
|Macmillan, Rt. Hon. Harold (Bromley)||Scott, R. D.||Mr. Buchan-Hepburn and|
§ Main Question again proposed.
§ It being after Ten o'Clock, the Debate stood adjourned.
§ Committee Tomorrow.