§ Mr. Powell
I beg to move, in page 3, line 19, at the end, to insert:(3) Regulations made for the purposes of subsection (1) of section one of this Act may provide that there shall be afforded to every person from whom a charge is recovered in pursuance of this Act upon the occasion of the recovery of the said charge the opportunity 1639 to apply for an assistance grant to meet his requirement for the service in respect of which the said charge is recovered.This proposed subsection stands on the Order Paper in pursuance of notice which I gave during the Committee stage that I should table an Amendment on these lines. It seeks to implement and to carry a stage further—a stage to which I hope the Government will agree—an assurance which was given by the Parliamentary Secretary in Committee, to which perhaps I might refer the House. The Parliamentary Secretary said:It is important that we should make sure that all those who receive attention from a dentist or an optician are fully aware of the way in which they can make their claim"—that is, a claim for relief under Clause 4—and of how they can get relief in case of hardship. That is a matter which we must very carefully bear in mind as we proceed with this Measure."—[OFFICIAL REPORT, 2nd May, 1951; Vol. 487, c. 1227.]The proposed new subsection which I am asking the House to insert in the Bill requires two things. It requires that upon the occasion of a patient being called upon to pay the charges that can be imposed under the Bill that patient should not only be informed in the clearest possible way that he has a right to apply to the National Assistance Board for partial or complete repayment of that sum, but also that the means of doing so should be automatically afforded to him at the time.
The manner in which I would conceive such a provision being put into effect is that a simple form of application to the National Assistance Board for repayment would be included in the document by which the charge is made and is receipted. It might be possible, indeed, to achieve the two objects with the same piece of paper so that all the patient had to do was to fill in the form, tuck in the flaps and post it.
This provision, if inserted, will, I believe, meet a large part, though not the whole of the anxieties which were expressed at an earlier stage of the Bill about the operation of the means test under the Assistance Board. When a proposal was made to substitute for the Assistance Board as the reimbursing authority some other machinery there was almost universal agreement on both sides of the Committee that the Board was in 1640 many respects unsatisfactory, and the chief objection that was taken was to the alternative machinery proposed.
Under this Amendment, although the work of assessment will still fall upon the Board, all those difficulties which were apprehended from the necessity of the patient making a separate, direct and personal application to the Board will be neutralised. Thus I feel that this subsection goes a long way to meet the anxieties which were expressed repeatedly by hon. Members in all parts of the Committee on the last stage of the Bill.
That is why I was particularly disappointed to hear that the hon. Member for Shettleston (Mr. McGovern) intended to take no further part in the proceedings on this Bill, because I have been promising myself valuable support and encouragement from him. In the Committee stage, referring to the operation of the National Assistance Board which by this Amendment I propose to modify, he said:.…all I say in connection with this is that for some people to have to go to the Assistance Board is a humiliation. Therefore, they will not go there, with the result that their standard of health and eyesight will deteriorate because there is no guarantee they will get their teeth or spectacles."—[OFFICIAL REPORT, 2nd May, 1951; Vol. 487, c. 1356.]Under the subsection which I am proposing they will not have to go to the Assistance Board. The making of the application will be an automatic operation which will have no stigma attaching to it, and which will be carried out by the patient if he desires to do so at the time when he is called upon to pay the charges.
Perhaps the strongest arguments in favour of this Amendment were advanced during the Committee stage by the hon. Member for Reading, South (Mr. Mikardo), who pointed out that, rather than go to the Board, many persons who were in real need of these appliances would either defer having them altogether or else would resort, as in the past, to purchasing them from quacks. It is precisely that band—if I may so describe it—of demand for these appliances which lies between the regular recipient of National Assistance on the one hand, and, on the other hand, the type of patient who will unquestionably be called upon properly to meet these charges, which this Amendment is designed to meet.
1641 I hope that the Government will not resist the object of the Amendment on the ground that the deterrent effect of these charges would thereby be reduced. The only deterrent effect which will be reduced is the deterrent effect upon precisely the type of person whom we do not want to deter. I must say that the information which we have been given on this subject so far has been defective in itself and tends to make one rather uneasy. This matter was raised earlier by my hon. Friend the Member for Luton (Dr. Hill), and I thought he received a most unsatisfactory reply. It is difficult from the information that we have so far received to ascertain exactly what dimensions the Government imagine the deterrent effect of these charges will assume, but I venture to calculate them briefly as follows: I will take the dental service rather than deal with both the dental and the optical services.
Taking into account the effect of the Bill, the estimates for dental charges this year for Great Britain are approximately £38 million. We know that the Government estimate that in the current year the savings resulting from the operation of the Bill will be about £8½ million—half what is anticipated in a full year. Thus, the full cost of the dental services in the year 1951–52, without this Bill, would be approximately £46½ million. On Second Reading, we were told by the Minister that about 60 per cent. of the cost of the dental services is referable to dentures, and if that proportion holds good then £28 million would be the cost of the provision of dentures in a full year, without this Bill.
In that case, £14 million is the amount which will be saved simply by charging a patient half. In fact, the expected saving is £17 million, so that at least £3 million per annum is expected to be saved by the Government as a result of dentures which are not provided because these charges are imposed. That is to say, there is roughly a 10 per cent. deterrent effect. I suspect, however, that it may be that the calculation has been a higher one; and here I turn to another point on which I feel the House has not had the fullest possible guidance. During the Committee stage the Secretary of State for Scotland was asked whether these calculations——
§ Mr. Deputy-Speaker
I am sorry to interrupt the hon. Gentleman, but I am not clear as to the relevance of this matter to his Amendment, which seems to me to deal with the application for an assistance grant in certain circumstances.
§ Mr. Powell
I am sorry if I have not made it clear. The connection is this—that the effect of the subsection which it is proposed to insert in the Bill will undoubtedly be to enable certain persons to obtain dentures and spectacles who otherwise would not do so because it was necessary for them to make a separate and direct application to the Assistance Board. From information which has been given so far, it appears to me that the Government are actually counting upon that deterrent effect in the calculations upon which the Bill is based.
If, of course, they can tell the House that they have no such intention, then a consideration which is relevant to my Amendment will disappear; but so long as we suspect that part of the object of the Bill is to deter persons from obtaining dentures and spectacles by reason of the fact that if they wish to avoid a charge they will have to go to the National Assistance Board, then we have a right to attend to the case of those persons who ought not to be so deterred. I was endeavouring to estimate the rough dimensions of this element of deterrent effect which the Government anticipates. I think that in so far as that consideration is germane, the Government should be able to indicate the weight which they attach to it, for it is a material consideration.
I conclude by saying that this Amendment, or certainly the object which it has in view—namely, that a patient should have the opportunity automatically and without stigma of ascertaining whether his means are such that he is entitled to a refund—goes a long way to meet many of the objections to the Bill which have been raised on both sides of the House. The Minister and the Parliamentary Secretary have already shown themselves at any rate partly aware of the difficulties and I hope they will accept the principle which is enshrined in the Amendment.
§ Mr. Iain MacLeod
I beg to second the Amendment.
I think everybody would agree that it is most undesirable that a dentist should 1643 know which of his patients goes and which does not go to the Assistance Board for help under the Bill. Two categories already exist—the private patient and the National Health patient; but the main category of 97 per cent. or 98 per cent. of the population must not be subdivided in the way which many people fear will take place.
The solution offered by my hon. Friend the Member for Wolverhampton, South-West (Mr. Powell), is that the receipt itself should carry on the back a simple extract of the rights given under the Bill, and I think that would meet the objection which has been raised that the dentist would know the circumstances of his patient. It would also do something to remove the fear which exists in the minds of many people that some of those who most need this help will not go to the Assistance Board for it.
Those people who have been to the Assistance Board before will no doubt go again. Those who can afford to pay for the appliances will not go to the Board whether they receive a notice on the receipt or not. But those with whom the House is no doubt particularly concerned—those in full-time employment—except in most exceptional cases will not go to the Board where they are earning a reasonable wage which is yet sufficiently low to entitle them to a certain amount of refund from the Board under the Bill. If something on the lines of this Amendment were adopted, we should make it easier for those people to obtain the relief which the Bill affords.
§ 6.15 p.m.
§ Mr. Blenkinsop
We have every sympathy with the intention behind the Amendment and, indeed, in Committee I said that we were anxious that everyone should know how he could claim assistance towards meeting these charges in the event of hardship. But we are by no means certain that this Amendment would help us very much in gaining that end.
This is really an administrative matter and I can assure the hon. Member for Wolverhampton, South-West (Mr. Powell) and my hon. Friends, who I am sure are interested, that we shall take administrative steps to see that those who go to the dentist or to the optician, know how they can make their application for assistance. 1644 Already we have drafted a form of words which can be included in a notice to be available in the dentist's waiting room and in the optician's premises or in similar places so that everyone may see just how he can make an application if he desires to do so.
The hon. Member for Wolverhampton, South-West, suggested that, in addition, forms of application might be made available at the same place That straightaway raises the danger that the dentist will get to know precisely who is making an application to the National Assistance Board and who is not.
§ Mr. Iain MacLeod rose——
§ Mr. Blenkinsop
I appreciate that hon. Members may say that the man could take the form away, fill it up and send it to the Assistance Board without anyone knowing. But this is purely an administrative matter. There is no difference between us on this. We all want everyone to know how they can make their applications. We have already gone some way in making preparations to ensure that everyone shall know about it, and we are prepared to consider whether we should provide administratively for some application forms to be available. We will consider whether it will be advisable and helpful or not.
I cannot go beyond that. In fact, the Amendment does little more than say that those who go to an optician or a dentist should have the opportunity to apply for assistance. They already have that opportunity. The Amendment does not help us at all. I appreciate the point of view which has been expressed by hon. Members and which, I am sure, is shared generally in the House. We will take account of it in the administrative arrangements which we make.
§ Mr. Powell
I appreciate the spirit shown in the hon Gentleman's reply, but I would ask him not to reject out of hand the possibility of providing the patient with the means of preferably a postal application to the Assistance Board. I think he will find that he can do that without there being any possibility of the practitioner getting to know. I agree that this is an administrative matter. We have had a substantial assurance that there is an intention to deal with the matter administratively. Consequently, I beg to ask leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.1645
§ Motion made, and Question proposed, "That the Bill be now read the Third time."—[Mr. Blenkinsop.]
§ 6.22 p.m.
§ Mr. Bing (Hornchurch)
I hope the House will excuse me for intruding in the debate for the first time at so comparatively late a stage, but there are one or two general observations which I think are shared on this side of the House and which I may perhaps put briefly to my hon. Friend on the Front Bench. On this side of the House we feel that one of the troubles with the Bill has been that we have so much concentrated on this departure from the Health Service that we have done a great deal to obscure to the world as a whole the very great benefits which still remain. For that reason it is necessary to say, in passing, that we have been looking at this in only a limited sphere and that, however much the Bill may affect the Health Service in a particular degree, at any rate it leaves untouched an immense field of that Service.
Secondly, and on the same theme if I may, my right hon. Friend the Minister of Health throughout the Committee stage and other stages appealed to us all to judge him by his speech on Second Reading. I prefer to judge him not by that speech, to which I shall turn in a moment, but to judge him by his very great and humane work as Minister of Pensions. With a Minister who has acted so ably and so well in those circumstances, it would be very wrong for anyone on this side of the House to suggest that he has not the interests of the service at heart.
When I come to look at the details of his speech and the reasons he gave for the Bill, I honestly feel that my right hon. Friend is like a very able and courteous advocate who, out of sheer inadvertence, has accepted two briefs from rival solicitors and then, to his embarrassment, has found that they both relate to the same case, but has nevertheless determined to go ahead and to present both the arguments as well as he could in the same speech.
If we look at the arguments which are advanced for the Bill we see that they fall into three categories, each of which seems to be quite distinct. Before we decide to pass the Bill we ought to decide exactly what is the principle upon which the Bill is based.
1646 As I understand it, the first point made is that these charges are necessary because there must be some ceiling to the Health Service. We ought to know a little more about the reason why a particular point was chosen for that ceiling. Why was every expenditure held to be satisfactory until we reach precisely the point where we have to pay for teeth and spectacles.
Why was that the ceiling which was fixed? What are the principles on which it was determined? To take the second point. If it is alleged that we have to charge for some illnesses to make up for the additional cost in the Service as a whole, or alternatively, as the Secretary of State for Scotland suggested, in order to pay for the excess cost of re-armament, why should we not charge the tuberculosis patients, say, for the cost of re-armament? Why should that fall on the people who need spectacles or false teeth?
§ Mr. Deputy-Speaker (Major Milner)
The hon. and learned Gentleman will, I hope, relate his remarks to the contents of the Bill. He appears to be going back to the earlier stages of the Bill.
§ Mr. Bing
With great respect, the point which I was on, was the reason why we should pass the Bill in the form in which it is amended now. This is a Bill which will impose certain charges. Why are those charges necessary? There are three reasons given, one, that there may be a ceiling; second, that spectacles and teeth are the appropriate things to charge; third that these particular charges will prevent abuses. It is to each of these three points that I was directing my argument.
The first point I want to ask my right hon. Friend is this. Why—on what basis—was it decided to place this ceiling? If we are to have a comprehensive Health Service it does not seem to me that £8 a head is a very big sum to choose for it, 1647 but if £8 a head is not the right sum what is, in fact, the right sum to charge for the whole thing from the global point of view? Because under £8 per head we have to include the chronic sick, we have to include maternity and child welfare, we have to include epidemics, and we have to include preventive medicine.
The Secretary of State at an earlier stage reproved everyone for not going to the statistics. It is always a little difficult for back bench Members to have access to all the statistics, but I should have thought that, when dealing with the reasons for this ceiling, he would at least have referred to the figures contained in the Registrar-General's report for the last quarter of 1950, which takes a sample of the population and gives the number of times this sample go to their doctors. Unless we know what is the number of times the population as a whole have to go to their doctor we cannot say whether we are paying too much for the whole service or not. If one looks at the sample figures one sees, for example, that in September out of every 100 people 40 men under 65 were going to the doctor in that particular month, and 67 men over 65; of the women over 65, 76 were going out of every 100 in one particular month.
What are the causes, then, of this rising cost of the Health Services with which we have to deal? Because it is no use at all passing this Bill unless we deal with the root difficulty—no use saying we make these charges and do not then find a final solution, because, in fact, the rising costs are due to other factors.
§ Mr. Speaker
We must deal with what is in the Bill and not the general background. That was dealt with on Second Reading. Now we are dealing only with what is in the Bill. Therefore, the general aspect of the background and of the cost of the Health Service and so on is strictly out of order on Third Reading.
§ Mr. Bing
I appreciate that very clearly. The point I was attempting to deal with was this. If we are to pass the Bill in this form, in which we have provision to review the matter after a number of years, it is proper to know at that time, when we come to review it, whether we shall have to deal with additional charges, and so, whether this will meet the situation put before us. However, I will leave 1648 that particular point and come to the second question with which I should like my right hon. Friend to deal.
Why are these charges placed on these particular appliances? Who, in fact, wear false teeth? I do not know what degree of inquiry has been made into this, but just recently, speaking on the Report stage, the Secretary of State for Scotland, answering an argument dealing with the incidence of the need for dentures in Ayrshire, said that: Of course, there were many more dentures needed in Glasgow because people there were not so healthy as they were in Ayrshire. If that, in fact, is so, then, of course, it is true that the people who need them most are——
I am sure my hon. and learned Friend is not one to misrepresent me. I think that what I said was that the incidence of caries was unlikely to be higher in Ayrshire than in Glasgow.
§ Mr. Bing
There may be a number of local factors, but, generally speaking, that is so, and I think that if one searches one's own experience one does find that, generally speaking, the poorer people are those who earlier require false teeth. Let me give one personal example. During the war I happened to be concerned with parachuting. In parachuting it is necessary to remove one's false teeth before leaving the aircraft. As one may be in difficulties on reaching the ground, it is necessary in some form, to retain teeth and be able to replace them when one arrives.
Generally speaking, the average age of the people taking part in this was under 30, and yet in the particular units I had to deal with there were amongst the other ranks quite a number of people who had to apply for special celluloid boxes in which to place their dentures. I think that all of us would find, if we searched our own experience, that in a great many cases the people who have false teeth are the poorer people of the community, and that 1649 is due to general social maladjustment that we are trying to overtake, though we cannot overtake it all at once.
Turning from teeth to the spectacles position, again I do not speak with the medical knowledge of some of my hon. Friends, but I would say that there are a great many defects of vision which are hereditary; and, therefore, if a husband and wife both have to go to the oculist for glasses, the chances are that their children will have to go, too; thus when their children reach a working age, they will form a group upon whom disproportionate burdens will fall. The matter is made the worse because, as I understand the Bill, the figures which we are charging, which the House is now imposing, are average figures, and, therefore, the charge of 10s. a lens may be more than the total cost of any of the particular lenses which may have to be fitted for any member of that particular family. In those circumstances we may be imposing more than the total cost of the spectacles upon a whole family of people who have a hereditary but a simple defect of sight. That does not seem to me, on the face of it, to be a very reasonable way in which to approach this problem.
The third argument for the Bill, as I understand it, is that it will check abuses. How will it do that? That is a question to which no answer has been given yet. If a person is advised by his dentist that he needs a set of dentures or by his oculist that he needs glasses, will the fact that he cannot afford to pay for them turn him into an expert who knows whether he needs them or not? That really is the proposition which is put before us, and the test of skill is transferred from the skilled man—from the oculist and from the dentist—to the patient.
The only basis upon which the patient is supposed to judge is that the poorer he is, the more strict he will make the test. Other things being equal the poorer a man is, the less able he is to make the test, the less experience he has had of oculists and dentists the more he is likely to be taken in by the type of advice he is given. If he is somebody brought up with a long history of dentist attending, then he may have a hearty contempt for them, but the ordinary person who goes just once in a way has 1650 the utmost respect for my hon. Friend the Member for Wolverhampton, North-East (Mr. Baird) and his professional colleagues and is much more likely to take their advice.
If, in fact, it is true that there are such great abuses in the supply of dentures and in the supply of spectacles, then this Bill does nothing to check them by placing a charge in this way. Surely there are equal abuses in all the other respects? If there are dentists who are prepared to extract teeth or oculists who are prepared to prescribe glasses when they are not required, surely this is the wrong approach to the whole problem, and we ought to be employed in examining the whole conduct of the people doing these things—and doing these things in respect of other things as well.
§ Mr. Bing
I appreciate that. I was merely using that as an illustration for judging the validity of the arguments given to us.
My final point is on—if I may call it so—the total cost argument. It is the argument which we have had advanced in favour of making all sorts of charges—and, of course, in favour of making a charge for prescriptions when we were dealing with that matter previously; and it has been said that this is going to effect some sort of saving. The general argument which we very often have in this House when discussing this sort of difficulty is that we can afford to use a certain amount of the national product, a certain amount of labour, a certain amount of material for a particular thing. Therefore only by imposing a charge upon it to discourage people from doing this particular thing and to encourage them to do something else, can we restrict its use.
Let me take one example which was very familiar to the Parliamentary Secretary in the days of the wider responsibility of the Ministry of Health. He often had to deal with the question of the making-up of roads. There the test was not who were going to pay for it, or whether the money was coming out of the public funds or not, but whether the money should be spent or not. In this case, is 1651 it suggested that by imposing these charges we shall ensure that there will be fewer spectacles and that there will be fewer teeth? Is that the argument?
Is the argument that there are now people who are wearing teeth and wearing spectacles who have no right to wear the one or the other? Because if that is the argument, it ought to be stated far more clearly than it has been stated up to the present. Is the object of this Bill, in short, to remove abuses of that sort, to prevent people for some unknown reason of obtaining false teeth or glasses when they do not require them? That is generally the reason advanced for imposing charges which discourage use.
To continue my illustration from the point of view of roads, it is said that it does not matter whether the charge for roads comes out of the pockets of the people whose houses front on to the roads or out of taxation or from the rates. A limit is set on the amount of money spent on roads. In this case is it suggested that £x is the limit to be spent on teeth and spectacles and that by imposing a charge, it will keep it down to that amount?
I think that it is right that, as I am speaking on this side of the House, I should say that whatever may be our view on this, in view of the vociferous way in which we have plunged into this discussion, it would have been better if we had consulted—I hesitate to say it—even with the British Medical Association, because we know from the speech made by the hon. Member for Luton (Dr. Hill) that what they suffered from was not taking the very good advice, which, no doubt, they had throughout all their discussions, of their secretary. A practical approach to these problems and discussions with the profession might have saved us all the heart-searching that we have had on these benches.
The Bill now, thanks to the activities of many of my hon. Friends, is a great deal improved, but it does not do away with the lesson that when technical matters of this sort are to be brought forward, we should study them in leisure and with care before we submit them to the rough and tumble of debate in the House.
§ 6.42 p.m.
§ Mr. Linstead (Putney)
I am glad that it falls to the Minister of Health and not to me to give a detailed answer to the criticisms of the Bill which have been made by the hon. and learned Member for Hornchurch (Mr. Bing). I believe that there is a detailed answer to many of the criticisms which he has put forward with the skill of an advocate, and they have, I think, sought to find a greater amount of reason in the Bill than its rough and ready provisions admit.
I would, however, make this one comment upon one of the last points made by the hon. and learned Gentleman. He inquired why it was that we had been thrown into the passage of this Bill so rapidly and with so few consultations with the people concerned. It seems to me that if there is to be legislation of this kind, it must be rapid legislation, because, if the Bill is not passed quickly, we shall at once get people who had notice that charges are to be imposed seeking to avail themselves of the services so long as they are free. Whatever criticism there may be, I do not think that there can be proper criticism of the speed with which the Minister is seeking to get the Bill on the Statute Book.
I am one of those who support the Third Reading of the Bill, but, frankly, I do so with no particular enthusiasm. I regard this as an unpleasant public duty which, I think, we on both sides of the House, have to assume. It has for a long time been obvious that there are differences of opinion among the party on the other side of the House on many subjects. It has been obvious that there has been a split, but I think that it is regrettable and unfortunate that these differences should have crystallised around the subject matter of this Bill. The result has been that it is the patients of the National Health Service who have been made the shuttlecock in a political quarrel.
§ Mr. Linstead
That is the result of the circumstances in which the Bill has come to be brought before the House. To me the question which is presented by this Bill is whether this particular charge is necessary in order to keep the Health Service going for the next three years. I say for the next three years because that is the change which has 1653 been introduced into the Bill, and I would suggest, Mr. Speaker, that its introduction allows us on Third Reading to go perhaps a little wider than would otherwise be the case.
I have some knowledge of certain parts of the Health Service. I have considered very carefully whether there are not other ways by which the sum of money which this Bill is to secure, could be made available. That the money is needed, I have no doubt at all, because in every direction under the Health Service, the need is infinitely greater than any resources which have yet been put at the disposal of the service. Looking at the administration of the Health Service on merit, I am bound to say that I could find nowhere economies of any size which would compensate for the charges which will be forthcoming if this Bill becomes law. I think that it is perhaps worth quoting a remark—and I hope, Mr. Speaker, that I shall not be out of order in doing so, having regard to the fact that this Bill now refers to the period of three years—which was made by the right hon. Gentleman for Huyton (Mr. H. Wilson), when he made his resignation speech in the House. Referring to the relationship of this particular charge to the total Government expenditure he said:I should have thought that it would be possible to examine even the current expenditure that is now going on on re-armament. Who can say there is no possible wasteful expenditure there which cannot be pruned without injuring the effectiveness of the programme?He also said, in another part of his speech,Thirteen million pounds out of a budget of £4,000 million is well within the margin of error on any possible series of estimates."—[OFFICIAL REPORT, 24th April, 1951; Vol. 487, c. 229.]I think that it is significant that these two obvious sources of obtaining the money needed for the Health Service—sources which must have been examined by the Cabinet—had been rejected by them. I think we must assume that the Cabinet came to the conclusion that over the next three years either the economies could not be made, or, I would prefer to say, ought not to be made in the opinion of the Cabinet, and, therefore, that readjustment of the Budget figures——
§ Mr. Speaker
We are not discussing the Budget figures now. The hon. Member is getting too wide in his remarks.
§ Mr. Linstead
I will do my best to keep within the rules of order, Mr. Speaker, but may I respectfully draw your attention to the fact that we have now imported a period of three years into the Bill, and that possibly we are now entitled to look at the cost of the Bill in relation to the national expenditure over that period? I appreciate your ruling, however, and will do my best to keep within it.
A point which I want to make is that the fact that this Bill has been proceeded with in the light of the considerations that were advanced by the right hon. Member for Huyton must mean that the Cabinet had come to the conclusion that the Health Service had been getting, shall I say, financially out of hand, that it could not be cut, and, therefore, it must help to pay its own way. I would suggest that it is important that that should go on record—that they recognised that the Health Service had been attracting to itself too large a part of the country's resources. Personally, I can draw no other conclusion than that for the presentation of the Bill. Certainly, it is not too large an amount in comparison with the needs of the service, but too large a proportion in comparison with what is available. I think the reason for that state of affairs is that in the introduction of this Service, the right hon. Gentleman the Member for Ebbw Vale (Mr. Bevan) took a chance—it may well have been a justified chance—in offering a Service which was based on demand——
§ Mr. Speaker
We are now discussing the Health Service as a whole. The Bill does not deal with the Service as a whole, but with spectacles, false teeth and sanatoria. The Third Reading limits us, in the main, to that.
§ Mr. Linstead
I will do my best to keep to that, Sir, but I submit again that the amount of income which the Bill seeks to provide is to be used for the general purpose of the Health Service. I will conclude my argument on this particular point by saying that the need for this Bill has arisen from the fact that the original conception of the Health Service was an unlimited demand on limited resources.
I would add, in agreement with the hon. and learned Gentleman the Member for Hornchurch, that it is a pity that the 1655 charges could not have been more widely spread over all those to whom the service applies. Where they do fall they fall heavily, and if one looks over the whole field one suspects that the charges could really have been more fairly shared. But it is difficult, when one looks at the operation of the Health Service, to see just where the charges could have been made, and I come to the conclusion, regretfully, that this is a rough and ready way of obtaining within the service certain resources which the service undoubtedly needs if it is to continue, let alone expand. For that reason we have got to accept this as rough justice on that basis.
I will sum up my remarks by saying that, as I see them, these charges are a recognition by the Cabinet that the Health Service up to now has had more than its proper share of our resources; that they recognise that it is right that the excess should be met by the user and not by the general body of taxpayers. I would emphasise that it is unfortunate that the charges fall so heavily on two sections only, but in the circumstances I accept that as an unpleasant necessity. In my view these charges are the inevitable result of the policy which has been pursued since the Health Service was introduced.
§ 6.54 p.m.
§ Dr. Barnett Stross (Stoke-on-Trent, Central)
I do not find myself in agreement with the hon. Member for Putney (Mr. Linstead) in his last statement, when he said that the Cabinet had come to a decision that the Health Service was taking too large a share of our national resources. It has worked out at about £8 per head per annum for man, woman and child, and looked at in that way I cannot agree that it is too large a share for important and vital aspects preventive and curative medicine.
However, if I may leave that for a moment, may I say that I listened with great sympathy and with broad agreement to many of the points made by my hon. and learned Friend the Member for Horn-church (Mr. Bing). There is, however, one aspect of his statement which I think should be qualified. He said that poverty and caries ran side by side and that there is an association between them. That is quite true in this country since about 1860, or perhaps since the Industrial Revolution, but it is not true in all parts 1656 of the world and should not be used as a dictum for ourselves for all time.
New Zealand has a very high standard of life and its children have the worst teeth in the world. That is because of the large quantities of white flour which are used as well as the large amount of sweets made out of sugar. So with a much higher standard of life than almost anywhere else in the world we get the worst teeth. The peasants of Britain in the time of Henry VIII had very excellent teeth, and it will be recalled that Henry VIII was very disturbed when he sought a wife from abroad, because the people in the aristocracy both abroad and in Britain had very bad teeth. He particularly asked his Ambassador to make sure that she did not suffer from halitosis and that comfits were not used to conceal that possibility. That never occurred among normal, ordinary common folk who lived on the produce of the land. It is not only poverty of money which counts, but poverty in legislation that does not understand nutrition.
§ Mr. E. Fletcher
As a matter of interest, would my hon. Friend not confirm that in those days there were no such things as false teeth and dentures?
§ Dr. Stross
In those days, looking at the skeletons of our forefathers, there was little need for false teeth, because so many had teeth in very good condition. The expectation of life was not great; it was about 28, but those who survived and did not die from infectious disease and who lived to a ripe old age had very good teeth. It is true that there was no protection, such as we have now, against infectious disease. I do not want to make too great a point of this, but I am sure my right hon. Friend the Member for Ebbw Vale (Mr. Bevan) must agree broadly with what I am saying here.
I have been favourably influenced by the way in which the Bill has been amended. I think two points were of great importance. The first was that there should be inserted in the Bill what is now provided—that the charges cannot be varied in an upward direction. We think that very important, and I am sure we are all grateful to my right hon. Friend the Minister of Health for it. The other point, which is more debatable, is when should the charges be brought to an end. Personally, I think that the term is a year 1657 too long, but it may well be that times will improve and we shall get some amelioration before 1954. What we were most anxious about was that the principle should be safeguarded, and we have some safeguards here. There were people like myself, who, in the first place, were really frightened that a Government of another complexion might use this as an excuse for destroying what we think is important in the service.
§ Dr. Stross
My hon. Friend says, "So they will." All the more reason, therefore, to see that they never get a chance. We cannot disguise from ourselves that right hon. and hon. Gentlemen opposite for years past have criticised this Service throughout, and they think that there should be charges in more than one direction—perhaps in all directions. We shall see, if the time ever comes when we have to change sides, what they are going to do about it.
§ Dr. Stross
At the moment we have some protection that by 1954 these charges will come to an end.
Lastly, may I mention those affected by tuberculosis who will go abroad. We all welcome that provision, but at the same time let us not place too great a reliance in the efficacy of this. I believe the advantage of the scheme lies in the fact that there are beds, nurses, and doctors, who are not fully engaged abroad in treating their own cases as our medical services are here, and in that respect it is a good thing that we are able to take advantage of the sanatoria, hospital beds and personnel. But we should not run away with the idea that other countries have a better technique in treatment than our own. It would not be true to say so. I heard someone say on Second Reading there would be days of extra sunshine. I am not at all certain that this is an advantage in treating pulmonary tuberculosis. Nothing causes a flare up in quiescent tuberculosis more quickly than excessive sunbathing.
So far as the operative treatment is concerned, I do not think that many countries are better in that respect than we are. Perhaps there is Sweden. We 1658 have used in the Bill the words "treatment outside Great Britain." I am glad that we are not limiting ourselves to any specific country. There is a certain variant of pulmonary tuberculosis that can be well treated in some of the great sanatoria and hospitals in Sweden. I remember someone who was very experienced in the treatment of this disease telling me when I was younger that he could treat pulmonary tuberculosis successfully in a cellar if he had certain things like the right kind of food and an incentive in the patient to live. It is not where we treat but how we treat an ailment that is often most important.
This Bill has a number of advantages, although in the House of Commons we are apt to get somewhat myopic about these problems, and sometimes we cannot see the wood for the trees. I have done my best to try to find out outside what people think about these charges. I do not think they are excessively worried, on condition that the principle of the Service is not being tampered with. I feel that we have some safeguard there, and I am very glad of it.
§ 7.3 p.m.
§ Sir Hugh Lucas-Tooth (Hendon, South)
The hon. Member for Stoke-on-Trent, Central (Dr. Stross), finished his speech by referring to the advantages of the Bill, but I did not notice in the course of his speech any description of those advantages. He probably feels, with the hon. and learned Member for Hornchurch (Mr. Bing), that the greatest problem which the Bill raises is, "Are people wearing teeth and spectacles that they do not need?" That is an oversimplification of the problem which we have to face this evening in considering whether or not to pass the Bill. It is quite true that people do not wear false teeth and spectacles unless they need them. If we put the problem in that way and we accept that answer, we may say, "That disposes of the matter. The Bill is bad and there is an end of it."
The truth is that a good many people who get false teeth and spectacles can perfectly well afford to pay for them, and indeed are both anxious and willing to do so. I do not think it lies with hon. Gentlemen opposite to suggest that there is a very substantial proportion of people in this country who cannot afford the amount of money which we are here 1659 considering, since we have had six years of Socialist Government. The question is grossly over-simplified. While nobody wears spectacles that he does not need, he may very well get himself a new pair before there is any real necessity to do so. The trouble with the Health Service arrangements up to date is that they encourage a person to get new spectacles as quickly as possible when there is the slightest alteration in his sight, without any regard to genuine need, especially when looked at in the whole context of national finance.
§ Mr. Rankin
Surely the decision in getting new spectacles does not lie with the person himself but with the registered medical practitioner. It is only on the practitioner's prescription that the spectacles can be obtained.
§ Sir H. Lucas-Tooth
The hon. Member is quite mistaken. It is true that in the first place, before getting spectacles, the person has to get a medical certificate, but when he has got it, the matter does not rest with the doctor any longer but with the person himself and with the optician who supplies the spectacles. I do not know whether the hon. Gentleman is suggesting that opticians do not act honestly in the matter.
§ Sir H. Lucas-Tooth
The truth is that after he has received a certificate from a doctor that he needs spectacles, the person can get new spectacles every time there is the least variation in his sight, and there is no further check upon him.
§ Mr. Manuel
The hon. Member is certainly right in his statement about the medical inspection and the certificate the first time. If the person then feels that he needs another pair of glasses he goes direct to the optician. Surely it is the duty of the optician to see whether he needs new spectacles or not. If he does not, then an abuse is connived at by the optician merely to make more profit than he should do out of the Service.
§ Sir H. Lucas-Tooth
In the ordinary way, a pair of spectacles lasts a person a fairly long time. In my own case, I have not had my eyes tested for a matter of five years. I strongly suspect that if I had them tested I should be advised at 1660 once to get a new pair of spectacles, but the pair I have in my pocket are adequate to my needs and I have not done so. I have to pay for my spectacles. I believe that if the same were true of people in general there would be a definite falling off in the demand for spectacles, without any burden being placed upon the people.
§ Mr. Goronwy Roberts (Caernarvon)
How far would the hon. Member go over the whole range of the Health Service, in regard to the principle of payment? Would he and his party extend it to the whole range of the Health Service?
§ Sir H. Lucas-Tooth
If I attempted to do so, Mr. Speaker would call me to order very smartly. We can only deal with spectacles and teeth. I have given a good reason for putting a charge on spectacles at the present time.
Different considerations apply to teeth, but hon. Members know perfectly well that the 10,000 or so dentists in this country are entirely insufficient for our needs. To cover the teeth of the people of this country properly we should need something like 15,000 dentists. We are about 5,000 short. If we are 5,000 short, someone must suffer. It is obvious that someone has to suffer, and the choice which the House has to face is whether we are to continue to allow 61 per cent. of the whole of the activities of the dental profession in this country, as has been the case under the scheme, to be devoted to the provision of false teeth, or whether we are to try to direct those activities to the dental care of the children and nursing mothers, and the general conservative treatment of the teeth of our people. That is the problem, and I have no hesitation in saying that the right choice is to try to divert the treatment away from dentures and towards conservative treatment.
§ Mr. W. Griffiths (Manchester, Exchange)
The Minister said that 61 per cent. of the cases were for dentures, not that 61 per cent. of the time of the dentists was occupied with dentures. Would the hon. Member tell the House how on earth imposing a charge for dentures is going to help the school dental service?
§ Sir H. Lucas-Tooth
If imposing a charge will not reduce the number of dentures supplied to people, the whole of the case of hon. Members opposite falls to the ground. If it will bring a reduction, 1661 it will relieve a certain number of dentists to do the other more urgent work.
A Bill in some way to impose a limit on the Health Service has been inevitable for a long time past. In his Budget speech two years ago Sir Stafford Cripps indicated that it was essential that there should be no further Supplementary Estimates. That represented the first rumblings of the storm from the Treasury. A year ago Sir Stafford Cripps, in a passage which has been referred to a great many times in our debates on this Bill, laid down quite definitely that there was to be no further increase in the cost of the Health Service. In spite of the Chancellor's firmly declared policy and in spite of the power that the Treasury has over the other Departments, it has not been possible to check in any way the growth in cost of the Health Service——
§ Mr. Aneurin Bevan (Ebbw Vale)
I am quite sure that the hon. Gentleman would not wish to misrepresent the situation. The expenditure on the National Health Service for the year 1950–51 was the first year's expenditure based upon the first year's estimates of the first year's full experience of the Service, and in 1950–51 the expenditure was not only within the estimate but was actually very nearly £11 million less than the original estimate. Therefore, it is quite wrong to say that the finances of the Health Service were out of control. They were kept within the limit—well within it—in the first full year's experience of the Service.
§ Sir H. Lucas-Tooth
The estimates cover the whole range of the Service and during the course of last year a number of things were done within the Health Service which effected economies in certain directions——
§ Sir H. Lucas-Tooth
But reduced for this reason, that in each of those services very heavy cuts were made during the course of the years in question, cuts in the emoluments of those concerned——
§ Sir H. Lucas-Tooth
—but it was beginning to be apparent that the real trouble was not essentially the overpayment of the professions concerned by the right hon. Gentleman but that the scheme itself was wrong in giving the wrong emphasis to the patients' demand for the treatment provided.
§ Mr. Bevan
I do not wish to interrupt the hon. Gentleman again, but he is inaccurate. From last year's use of the optical side of the service it was quite clear that the demand for spectacles in Great Britain was beginning to reach the level of the pre-Health Service demand. In the case of the dentists, in some parts of the country dental technicians have been put off because the demand for dentures has been falling. The fact of the matter is that hon. Gentlemen opposite have not had enough faith in the service to nurse it through its initial period.
§ Sir H. Lucas-Tooth
I hope very much that the right hon. Gentleman will develop these lines of argument in a speech after I have sat down. To return to the point at which I was interrupted, in spite of all the efforts of the Chancellor of the Exchequer and the Treasury it has not been possible to control the great increase in the cost of the service. I do not wish to go into details, but the rise in cost in the last year, as stated by the Chancellor of the Exchequer, was of the order of £30 million, apart from economies to be effected by this Bill. That was the situation, and something had to be done about it, and that is the reason why the Government introduced the Bill.
I want to say straight away that, although the Bill represents a reversal of policy, I regard a reversal of policy in this connection as a bad thing in itself. The one thing we want in the Health Service is a continuous policy so that the professional men, the hospital administrators and the others concerned will know where they stand. I do not wish to use this as an opportunity for attacking the right hon. Member for Ebbw Vale (Mr. Bevan), but I believe that the scheme was fundamentally at fault because it contained in itself the seeds of a great many reversals of policy.
§ Sir H. Lucas-Tooth
My complaint about the Bill is that it is a "hit and miss" affair which deals with only two branches of the Service which are not the largest branches, and I believe that there will inevitably be other Measures of this kind whoever is sitting on the benches opposite. I am quite certain that under the policy as laid down by the right hon. Member for Ebbw Vale the increasing demands will inevitably drive any Government to take steps to see that the Service is not abused and not over-used.
Mr. Frederick Elwyn Jones
Will the hon. Gentleman give an indication of the other Measures he has in mind? We are most anxious to know what he is contemplating.
§ Sir H. Lucas-Tooth
I am afraid that the hon. Member is inviting me to go outside the bounds of order. When an opportunity for this kind of argument occurred on Second Reading, the hon. Member did not make points of this sort. As I see it, the objections are that the Bill is piece-meal legislation, that it does not deal with the problem as a whole and that it is in its nature something of a temporary one. Although it is part of an inevitable process, it is only a small part, and sooner or later some Government will have to consider the problem as a whole, and until we get it reviewed as a whole we shall find constant difficulty over the Health Service.
§ 7.17 p.m.
§ Mr. Messer (Tottenham)
I feel sure that every hon. Member sitting on this side will have listened with very great care to what has been said by the hon. Member for Hendon, South (Sir H. Lucas-Tooth), for, if anything, he has confirmed some of us about the dangers that the Bill exhibits. What it does is to open a door.
I admit right away that when at some future date, if they care to do so, hon. and right hon. Gentlemen opposite come along and say, "We have reached a ceiling, and within that ceiling we shall have to spend just what we can afford, which means that we shall have to make charges," that will be quite logical. They may ask what the difference is between glasses and glass eyes; what the difference is between false teeth and false hair; if it is true that dentures are a form of 1664 treatment, what the difference is between that form of treatment and a surgical boot; and what the difference is between a calliper splint and any other form of splint.
If that principle is accepted, we shall have two types of patient, those who can make a contribution to the Health Service and those who are unable to do so. If there was any merit in the Service at all it lay in the fact that everybody was treated alike, whether he was a duke or a dustman, a bank clerk or a road sweeper. No matter what his social position was, everybody could come through the wide open door of the National Health Service. It is impossible for us to accept the statements made that this is not any infringement of principle. When once we single out any section of the service for payment, we destroy the Socialist basis of the Service. In the past, under the old educational service, we differentiated between those who were unable to afford to pay for a real education and those who could. We have got away from that. We have evolved a Health Service where everybody whatever they were suffering from, could get treatment without any question as to whether they could afford to pay. No longer was there a premium placed on human suffering. Now there is.
We cannot accept everything that is said unless we accept the fact that a charge on dentures means that fewer dentures will be supplied. That can only mean that people who otherwise would have dentures, will no longer be able to get them. Indeed, the hon. Member for Hendon, South, referred to the alarming situation which arose on the destruction of the priority dental service. I agree with him. Everybody deplores the fact that the basis of payment attracted dentists away from the school dental service and from the maternity dental service.
I am not sure that we shall get what we want by this method. During the Second Reading debate the Minister of Health referred to the advice given by the Dental Advisory Committee to the effect that by some means there should be a reduction in the supply of dentures. The actual wording of the advice did not mention a charge, although they meant that. They referred to payment. What assurance is there that in making a charge we shall divert dentists to the priority 1665 dental services? The hon. Member said that because there are not sufficient dentists to go round, let them go where people can afford to pay for the services of a dentist. Is there not some other way? Is it not possible for even that highly specialised profession to be diluted? Cannot some attention be given to the oral hygienists? I know that some are employed; but cannot there be investigation with a view to seeing how much of the dentist's job can be done by somebody not so skilled as the dentist?
§ Mr. Messer
Yes, but cannot steps be taken to expand that service so as to make available a larger number of people? Recognising that there is a limited number of dentists, would it not be possible to control the dentists so that they will be used where they are most needed? Perhaps we have given too great a freedom to those who have gone out of a full time service into a service which pays them better.
I hope that my forebodings will not be realised, but I know that a service representing £400 million is the finest target that any Chancellor of the Exchequer can have. Looking to the future, I cannot fail to see that that target will be always there for any Chancellor, and the sooner we take it out of the hands of the Treasury and finance it by other means, the better. I think there is the possibility of that being done. When we can do it, we shall be able to organise this service without always being faced with the fact that here is a ready pool from which the Chancellor can draw.
We have been told that £500 million is the ceiling of the service, as though that was a completely new charge. It is not. We forget what the local authorities used to pay before this became a national service. We do not subtract from that £400 million the amount which would be paid if it went back to the local authorities. I am not suggesting that it should, but we must not let it go out that this is £400 million of the taxpayers' money which, if it were not paid for by the taxpayer, would have to be paid by the community in any event. There are considerations which rise superior to the economics of the situation. Those considerations are the well-being of the people. I hope that 1666 the principle of a completely free service which this Bill is undermining will be restored.
With regard to tuberculosis, my hon. Friend the Member for Stoke-on-Trent, Central (Dr. Stross) referred to treatment that can be obtained abroad. I am glad to have that Clause in the Bill and that we have been able to take advantage of what is offered abroad, but I have no illusions about the extent to which we shall be able to take advantage of it. I realise some of the difficulties. I realise, too, that limiting it, as the Bill does, to pulmonary tuberculosis in not making the best use of those facilities. It would be wrong of me on Third Reading to go outside the terms of the Bill. I hope that if there is one thing we have started in this Bill which is bad, that there is another which is good, and we should expand that which is good in the interests of the people who can take advantage of it.
§ 7.27 p.m.
§ Mr. Angus Maude
I do not wish to detain the House longer than is necessary to comment briefly on one or two points raised by hon. Members opposite. The hon. Member for Tottenham (Mr. Messer) said one thing which I thought was significant, namely, that once we admit the principle of charges in the National Health Service, we at once eliminate the Socialist basis of the scheme. That is perfectly true. It is precisely the reason why the Government have been forced now to make this charge. At last it has become apparent to them what I always knew, that a scheme based upon a purely Socialist theory would never work.
The hon. Member for Tottenham said he wanted to see a wide open door through which duke and dustman alike could enter into the Health Service. I do not. I have never done so. I want to see a door which will be wide open to the dustman but, when the duke comes along, I want to see a turnstile with an admission charge. I will tell the hon. Member why. It is because, until we are prepared to recognise that under the present financial system we cannot conceivably provide a decent service for the dustman if we are to provide a free service for everyone else as well, we shall never get a decent free service for the dustman.
1667 Surely it must be realised at this stage by all hon. Members that we must face the principle which this Bill introduces. I have never accepted the assurance of the Minister that it did not introduce a new principle. The new principle is a recognition of the fact that the resources available will not provide a proper service for everyone. The hon. and learned Member for Hornchurch (Mr. Bing), in applying himself to the provisions of the Bill, said it was rendered necessary, in the submission of the Minister, by the fact that the resources available could not be increased any further, but the hon. and learned Member said that that could not be true because the resources were only £8 per head of the population.
§ Mr. Speaker
I have been doing my best to keep the debate within some kind of bounds. The Bill deals, as I said before, with teeth, spectacles and sanatoria. Its general principles are really Second Reading points and not Third Reading points.
§ Mr. Maude
I appreciate that, Mr. Speaker. I will therefore remove myself from the border line of the rules of order and confine myself simply to observations on the Bill as it has been amended.
In my submission, right from the beginning of the service the Bill was bound to come, in view of the principles on which the right hon. Member for Ebbw Vale (Mr. A. Bevan) started the service. The rate at which the increases went on made it inevitable. This new principle is dangerous in many ways, and we shall have to watch very carefully to see where it takes us. I do not believe that it makes any particular difference to the sheer financial necessity with which the Minister will be faced, whichever party is in power next year, the year after or in five years' time. The way things are going at present, this problem will face a Chancellor of the Exchequer and a Minister of any party which is in office.
1668 This is a belated recognition of necessity. I think it has been introduced without due regard to the merits and needs of the Health Service as a whole. I think it is a money-saving measure, and it ought to have been something much more. It ought to have been something deliberately and precisely conceived to ensure the best Health Service for the people who need it most. I hope that if hon. and right hon. Gentlemen opposite find themselves in power long enough to have to face this question again, as I think they will, they will bear in mind when that occasion arises that the only reason for departing from their principle is to make the Health Service better. They may do so this time by accident. Next time, I hope they will do so on purpose.
§ 7.33 p.m.
§ Mr. Michael Foot (Plymouth, Devonport)
Before the Bill goes through, it is worth recognising that the debate which we are having on the Third Reading today is a somewhat different kind of debate, and conducted in a somewhat different atmosphere, to a previous debate in the House on a National Health Service Bill. In this debate we have been spared the reasoned Amendment which was put down by the party opposite when we were discussing the previous Bill, and we have been spared the violent speeches which we had from hon. Members opposite when the original Bill went through.
Although we have had no reasoned Amendment from hon. Members opposite, however, it is only fair to say that we have had a number of reasoned speeches from them. They have argued very powerfully that they are strongly in favour of the Bill precisely because they strongly opposed the original Bill when it went through the House. Nobody could say that that is an unfair interpretation of at least the last two speeches we have had from the opposite side of the House, because both hon. Members who have spoken on behalf of the Opposition in the last two speeches have emphasised that they regard the Bill as a first taste, which merely whets their appetite; they are expecting something much bigger and better in the future.
I was particularly interested in the speech of the hon. Baronet the Member for Hendon, South (Sir H. Lucas-Tooth), because we have a right to recall that he 1669 speaks officially on behalf of the Conservative Party on this matter. On the Second Reading of the Bill, he was put up on the Front Bench to speak officially on behalf of his party. I presume, therefore, that when he was speaking today he was again speaking officially and giving us some indication of what would be Conservative policy on these matters. I was particularly interested also because I remembered that at the time of the last General Election, the hon. Member's leader, the right hon. Member for Wood-ford (Mr. Churchill), came to my constituency, when we asked the right hon. Member precisely what kind of National Health Service Measure he would favour. We did so because the right hon. Member had sought to give the impression to my constituents that the National Health Service Act had been brought into operation by himself in the face of rigid and stubborn opposition from my right hon. Friend the Member for Ebbw Vale (Mr. A. Bevan). We were particularly eager, therefore, to know exactly the sort of National Health Service of which the Conservative Party would be in favour. We did not get an answer from him.
We owe a debt of gratitude to the hon. Member for Hendon, South, who has given us some indication of the answer. He said quite clearly that he thinks that if some people can afford to pay for spectacles and teeth, they ought to pay for them. That is the principle in which he believes. Of course, he would apply the same principle to Medresco aids, hospital services, and all the other services which are applied under the National Health Service Act. We are grateful to the hon. Member, because he said that in his view the Bill was only a piecemeal and temporary Measure. He made it quite clear that the official policy of the party for whom he was speaking officially was that they would extend these charges very much further and would apply the same principle to other parts of the Service as the hon. Member, in his argument, applied them to spectacles and teeth.
§ Sir H. Lucas-Tooth
In case the hon. Member should think I am agreeing with what he says, may I say that I totally disagree with the views he has taken of my speech? If he reads it carefully, he will see that I said nothing of the kind whatsoever.
§ Mr. Foot
Everyone listened to what the hon. Member said. He said that he thought it was quite right that people should pay for spectacles and teeth if they could afford to do so. If that principle is applied to the rest of the Health Service, we arrive at exactly the same point which I have been making. My complaint against the Government is that they have given hon. Members opposite the opportunity for the first time of supporting a National Health Service Bill going through the House. This is the first main Bill which hon. Members opposite have ever plucked up courage to support, and they do so for the principles which the hon. Member for Hendon, South, has outlined.
The hon. Member made another interesting point when he based a large part of his support of the Bill on grounds which, I admit, have never been advanced as the main arguments by the Government Front Bench: that is, the ground of abuse. The hon. Member made some of this argument during the Second Reading and has continued it on the Third Reading, in which he has claimed that these charges are necessary in order to prevent some form of abuse, although when he is cross-examined from this side of the House he cannot explain how the abuses arise. But the Government have never based their main case on that point.
My right hon. Friend the Minister of Health, on Second Reading and when describing very clearly the Clauses which we have been discussing, gave as the main reason for introducing the Bill the fact that he was presented by the Chancellor of the Exchequer with a demand that a ceiling must be provided for National Health Service expenditure. The story, however, was finished too early, because when my right hon. Friend discovered that the ceiling involved what my hon. Friend the Member for Tottenham (Mr. Messer) described as the destruction of the principle of the Health Service, why did my right hon. Friend not go back to the Chancellor of the Exchequer and say, "There is a conflict. You say I must apply a ceiling to the Service. This means that I must depart from the principle for which this party stood at the General Election and ever since the Bill was introduced"? If on previous occasions we had had a Minister of Health who never wished to argue with the Chancellor of 1671 the Exchequer on these matters, we would not have had the National Health Service introduced in the last Parliament and an Act which we could defend on every platform in the country at the last election.
I do not believe that the explanation which has been given for the introduction of this Bill by the Government holds any water at all. The only explanations for the introduction of the Bill which would hold any water at all have been given to us by the Opposition. They are enthusiastically in favour of this Bill for precisely the same reason that they were enthusiastically opposed to the National Health Service Act when it was originally introduced.
When the Government introduced the Bill they had to put some proposal into it which, they hoped, would mitigate the opposition which might arise. We have had one Amendment since. I do not quite agree with my hon. Friend who seems to imagine that the Amendment makes a great deal of difference to the Bill. It apparently proposes that in three years' time when, according to the Government's estimate, expenditure on armaments will be at its greatest, the whole of our expenditure on the Health Service shall be reviewed. I would not call that a cast iron guarantee that we are to get back to the full principles of the National Health Service and I am not very much enamoured of the new Amendment we obtained.
There was one Clause put into the original Bill obviously to mitigate such opposition as might be certain to arise. It was put into the Bill in order that the Chancellor of the Exchequer might be able to say in his Budget speech and the Minister of Health could say in his Second Reading speech that despite the imposition of these charges there was going to be no real hardship or distress imposed. That is Clause 4 and in particular as it relates to the possibility that the National Assistance Board might be able to give assistance to people who need spectacles or artificial teeth, even people in full employment.
I believe the explanation of this Clause which we have had so far from the Government in the Second Reading and the Committee stage is totally inadequate, for the reason that if the Bill 1672 goes through the House of Commons today, as it probably will, no hon. Member will be able to tell his constituents at the week-end whether they will be able to get assistance from the National Assistance Board or not. No one will know. What about my constituents, a large number of whom get about £5 a week, even after a recent wage increase? They are getting nothing else out of the Budget, indeed they are getting further hardships in my view. What am I to say to them supposing they ask, "Am I allowed to go to the Assistance Board and get assistance?" I shall not be able to tell them as the Minister has not yet told us.
Regulations are to be issued to safeguard people who might have hardship or distress imposed on them because of these charges, but when the Bill goes through the House of Commons not one hon. Member will be able to say how it applies to his constituents earning £5 a week.
§ Mrs. Jean Mann (Coatbridge and Airdrie)
May I quote from HANSARD a statement by my right hon. Friend the Secretary of State for Scotland:A married man with two children, earning around five guineas a week, would not be expected to make any contribution to the cost of dentures."—[OFFICIAL REPORT, 2nd May. 1951; Vol. 487, c. 1353.]
§ Mr. Foot
That is the one statement we have had. I went through the Committee stage debate very carefully. What about my constituents earning £5 a week with one child or with no child? We cannot answer such persons yes or no. I say it is a miserable way to bring in a miserable Bill to bring it in in such a manner that we are to vote on it on Third Reading without being able to tell our constituents how it applies to them and how the regulations are to operate. Why was that necessary?
Would it have hurt the Government so much to have waited two or three weeks to work out the regulations so that we could have had an idea on Third Reading what the regulations were about? If the Secretary of State for Scotland is able to raise one corner of the veil and give half a hint of how the regulations are to apply, would it not have been possible for us all to know how they were to apply to a man earning £5 with one child, or with no child? Today no hon. Member will 1673 know exactly for what he is voting, and on Clause 4 we are asked to go into the Lobby and vote for the Government in this respect and wait very kindly to see what regulations they will bring in later on.
In fact Clause 4 introduces an entirely new and entirely dangerous principle. It introduces the principle of subsidising wages according to particular needs. This is something we have not had in our legislation for many years. It is something which we have under the old Elizabethan Poor Law and under the Speenhamland system. But it is not a principle we have or expect in our social legislation in this House of Commons or a principle we would have expected when we were debating the National Assistance Act in the House of Commons.
Supposing someone had said then, "We will have a new special provision whereby subsidies can be given to people whose wages fall below a certain level." Every trade unionist would have got up and protested and said, "This is a scandalous situation and is not what the National Assistance Board is meant for at all. The Board is there to protect the people who are not protected properly by the system of general insurance." The idea that we should protect the wages of people by a subsidy and say whether they should be penalised or not is a principle which this House——
§ Lieut.-Colonel Elliot
The hon. Member is developing an argument and I take it he will say why he supported this principle in the last Parliament on the question of legal aid?
§ Mr. Foot
I think that a very valid point. I am against the National Health Service of this country being run on the same principle as the legal aid service, and certainly every hon. Member on this side of the House would be opposed to that as well. I think it is a perfectly valid interruption. Therefore, if the right hon. and gallant Gentleman's defence of what the Government are doing—and I know he has been passionately supporting the Government throughout the whole Bill—is that he does not mind if this transforms the situation into the same as that of the legal aid service, it is the most damning attack on the Government even from the right hon. and gallant Gentleman.
§ Lieut.-Colonel Elliot
Of course we do not mind. The hon. Member does not know the arguments. He was not in the discussions on legal aid in Committee upstairs and did not hear us protesting against this principle in legal aid, but if he consults with his hon. Friend the Member for West Ham, South (Mr. Frederick Elwyn Jones), next to him and if he intervenes he will be——
§ Mr. Deputy-Speaker (Colonel Sir Charles MacAndrew)
Perhaps before discussing legal aid further, I should remind the House that the discussion must be concerned with matters in the Bill.
§ Mr. Foot
I have not discussed the matter of legal aid, although I am perfectly prepared to pursue it. But I do not imagine that the right hon. and gallant Member for Kelvingrove (Lieut.-Colonel Elliot) is trying to persuade us that upstairs, or here, he was arguing for a full legal aid service provided free for everyone, or there would be some point in his interruption. Without that I cannot see the point at all.
§ Lieut.-Colonel Elliot
Of course, I should be perfectly willing to continue the argument, but I would be ruled out of order, and therefore I say that until the hon. Gentleman reads the debate he is not entitled to say any of these things because he will find he is totally in error in the assumptions he is making.
§ Mr. Foot
If the right hon. and gallant Gentleman is able to make interruptions which are out of order, I am entitled to make replies which are out of order. We will leave it there, but I notice that the interruption, irrelevant or not, came from the right hon. and gallant Gentleman and not from the Government Front Bench.
§ Mr. Blenkinsop
If my hon. Friend will allow me, perhaps I might put a relevant point. What was his attitude to the same principle in regard to the National Assistance Board determining need cases on travelling allowances within the National Health Service?
§ Mr. Foot
I do not think the same principle applies at all. The hon. Gentleman is proposing under this Bill that there should be subsidies from the National Assistance Board for low wages, and he is proposing that on terms which he is not even prepared to explain to the House of Commons before the Bill goes through.
§ Mr. Blenkinsop
The same question of payments to those who may be employed arises in connection with travelling allowances.
§ Mr. Foot
It may be that the hon. Gentleman has a valid point and a valid statement there, but it does not alter the fact, which he will surely recognise, that it would be a highly dangerous principle to have the National Assistance Board coming along at a whole series of points in our economy and saying, "We will subsidise wages, here, there and at some other point." That is what is being proposed under this Bill. It is that the National Assistance Board should give subsidies to people who happen to suffer from particularly low wages. But nobody knows how the test of low wages is to be applied. The hon. Gentleman is still working out the regulations. If the Government knew what the regulations were, they could tell us, but they do not know what they are.
It is not only that we are to vote for this Measure without knowing how it is going to work out; the Government do not know either. The reason that the Government have got into this difficulty is that it is a terribly difficult thing, once they start injuring and breaking the mechanism of a free Health Service, to know where they get to next. That is the difficulty in which the Government are at the present time. They are in a particular difficulty because when they decided to embark upon a new principle in relation to this service which involved them in complicated difficulties about the National Assistance Board they decided that not merely would they do that but that they would do it with all possible speed for purely political reasons.
That is why they have got themselves in difficulty today. So we shall have to wait to see what these new regulations are to discover whether a man getting £5 per week will have to pay or not, or whether it depends on whether he is to have a child next month or next year as to whether he gets his dentures free. That is a miserable Clause in a miserable Bill, and it should not be introduced in that fashion.
The main objection to the Measure, which has been voiced by my hon. Friend the Member for Tottenham (Mr. Messer) and which has come from almost every 1676 hon. Member who has spoken on this side of the House during Second Reading, the Committee stage and Third Reading, and a view which has been confirmed by the attitude taken by hon. Gentlemen opposite, is that of course once we have started and put these Measures into operation we do not know how far we shall go in the future. My hon. Friend the Member for Tottenham used a very significant phrase when he spoke of what a target this would be for a Chancellor of the Exchequer who next year and the year after will be faced with possibly greater economic difficulties than those which the Chancellor is facing today: what a target to enable him to say, "If we can tax spectacles and teeth, why cannot we next year tax Medresco aids, etc.?"
A Chancellor of the Exchequer, looking at this situation without any principle to guide him as to how to deal with it might, looking at the National Health Service in future, state as General Blücher said, when he looked at London, "What a city to sack." But at least we can say this. The protest that has been made about this Bill on Second Reading, on the Committee stage and on the Third Reading, and which will no doubt be continued when the Government have thought out the regulations under which they are to operate the Bill, may at least be sufficient to protect the Health Service from further inroads being made in future years.
§ 7.55 p.m.
I cannot and will not attempt to compete with the vehemence of the hon. Member for Devonport in attacking His Majesty's Government. It fills me with astonishment that he did not find it possible to join that small group of bandits who during the Committee stage voted against Clause 1. It astonishes me also that there is no reasonable expectation of the hon. Member being found in the Lobby against the Government on the Third Reading of the Bill.
In the main part of his speech, he attacked the association of the Bill with National Assistance. He might, with charitable intent to the Opposition, if he can find such charity in his heart, have said that that issue was raised by my hon. Friends on this side of the House. Although I do not find myself in agreement with their conclusion, it is right that 1677 we should pay tribute to them for drawing attention to that very important element in the proposals.
When he referred to the hon. Member for Tottenham (Mr. Messer) the hon. Member for Devonport supported him in his assertion that a big principle is involved here, that a door is opened. But when one of my hon. Friends says the same thing, virtue becomes vicious. What for the other side of the House is a revelation and an astonishment becomes a wickedness when the same words are used and the same significance is attached to them on this side of the House.
I wish to refer to one aspect of the Bill, namely, that of the expected saving or income from these proposals. I should welcome an intervention from the Minister or the Parliamentary Secretary early in my remarks, so that I shall not waste the time of the House. I should like to know at the outset whether the estimate—contained in the Civil Estimates published on 16th February—for the expenditure on the dental services in 1951–52 takes account of the economies or savings which are alleged to be made. I hope that it will be found possible to save me from error or the House from unnecessary words, if I could be told now, in the form of an intervention, whether that published estimate takes into account the economies or savings under this Bill.
§ Mr. Blenkinsop
As has been said before, if I am not mistaken, the Chancellor made it quite clear in his Budget speech that account was taken of these savings.
I am grateful for the intervention. I am about to develop my point, arising from that answer, despite any visible discomfort to the hon. Gentleman, that so early as February the calculation was made of the savings from this service.
I noticed that as between 1950–51 and 1951–52 a saving of approximately £8 million for England, Wales and Scotland is shown. Part of that saving is due to something quite different—the cutting of the remuneration of the dentists. Am I then told that although in the financial memorandum it is estimated that in the current financial year, the saving will be of the order of £8½ million, that adding up the 1678 savings by the cuts in dental remuneration, and the £8½ million calculated in the Financial Memorandum, the total saving from the lot is in the region of £8 million?
It seems to me that something has gone wrong in this calculation. If it be true that allowance has been made in the £38 million estimate for the £8½ million saving referred to in the Financial Memorandum, then it was expected that next year there would be an expenditure of £46½ million. If the expenditure on the dental service be estimated at £46½ million the 60 per cent. to be devoted to dentures would amount to £28 million. A half of £28 million, if the repayment is to be approximately half, is £14 million. Yet the money to be saved in a full year is £17 million, a difference of £3 million.
I suggest that we are now coming to the measure of the saving or the repayment to be effected by the deterrent effect of the charges. I do not pretend to any accomplishment in mathematics, but I think that the House should be told to what extent that calculation is wrong and what is the accurate calculation, for as matters now stand, it seems that, taking a full year, the savings will be considerably less, and are calculated to be considerably less, than the £17 million contained in the Financial Memorandum to the Bill. I would ask that that matter be resolved.
§ Mr. Ellis Smith
I cannot see how the hon. Member can estimate accurately, because there may be increased expenditure by the National Assistance Board, which may affect the figures.
I appreciate that point. I have made allowances on the basis of the payments amounting to half, but to the extent to which the saving turns out to be less than half it becomes difficult to understand. I knew that one half would be recovered, and I knew that I was ignoring mothers and children and the repayments that will go elsewhere as a result of National Assistance.
The hon. Member for Devonport spoke of the enthusiasm on these benches. I suspect that he was counterfeiting an enthusiasm which he purported to see for his own political purposes. The principle involved here is that of a ceiling on National Health Service expenditure. I will not weary the House by repeating what I said on Second Reading, but I am 1679 convinced that unless other social services are to suffer it is absolutely essential to create a ceiling related to what the nation can afford on this form of social service. If that principle of a ceiling be accepted, it then becomes necessary, if the scope of the service is not to be touched, to impose charges. But that is no justification, as I said earlier, for any particular set of charges imposed in a slap-dash financial way unrelated to the needs of the service and to the defects of the service.
I shall not weary the House by going over the dental field once again, but I wish to thank the hon. Member for Tottenham for the candour with which he faces the dental position. I agree with him that on the one hand there is the method of imposing barriers between the dental service and some sections of the population in order to secure it for others. On the other hand there is, apart from the training of new dentists, the problem of dilution of the dental service. I offer no comment on that now, but I would say that no financial proposal should be put forward without being related to the need so to recast and reorganise the dental service in order to secure once more priority for children and for expectant and nursing mothers.
I believe that this proposal goes some way, in a rough and ready way, to do this. What I regret is that it seems to me that the Government have taken hasty decisions and selected two places in the service to slap on a charge in what seems to me to be a Bill put forward by the Chancellor of the Exchequer rather than out of a steady desire, if charges must be made, so to apply them as to secure the best possible service.
§ 8.5 p.m.
§ Mr. E. Fletcher
I will not follow the argument of the hon. Member for Luton (Dr. Hill), although I agree with very much of what he has said. I hope that the Minister will deal with his argument tonight. I want to return to the speech of my hon. Friend the Member for Devon-port (Mr. Foot). In my opinion, the position is far worse than he indicated. He assumed that some new Regulations would be made by the National Assistance Board. I do not know why he assumed that. There is nothing in Clause 4 which indicates that any new Regulations are authorised or will be made and nothing 1680 has been said since the inception of this Bill to suggest that any new Regulations will be made by the National Assistance Board.
I agree that this is an important point. It is most unsatisfactory that, as a result of the almost indecent haste with which this Bill has been rushed through the House we are in complete ignorance of what the true position will be in this respect. I agree with everything said by my hon. Friend the Member for Tottenham (Mr. Messer) about the real objections to this miserable Bill, which in my opinion is totally unnecessary and need never have been introduced. The real objections to it are, of course, that it violates the whole conception of a free National Health Service. But it is justified by hon. Members opposite on the ground that there are some people benefiting from the National Health Service who can afford to pay and who can therefore make a contribution to the Exchequer. That is not a reason acceptable to many hon. Members on this side of the House.
I return to the other and equally serious criticism of the Bill. I would remind the House that, both in the Budget Speech of the Chancellor of the Exchequer and in the speech of the right hon. Gentleman the Minister of Health on Second Reading, the Ministers sought to make the Bill palatable to the House by saying specifically that it would create no hardship. These were the words of the Chancellor of the Exchequer in his Budget statement:Those for whom the charge involves hardship will receive reimbursement, in whole or in part, from the National Assistance Board in the ordinary way."—[OFFICIAL REPORT, 10th April, 1951; Vol. 486, c. 852.]On Second Reading the Minister of Health said much the same thing. He said:Finally—and this is important—to safeguard against the imposition of any hardship upon any deserving person, the National Assistance Board is to be empowered to make grants towards meeting these charges to any person who suffers hardship thereby, even though such a person is in work. This may be particularly valuable to lower paid workers who have a number of children."—[OFFICIAL REPORT, 24th April, 1951; Vol. 487, c. 244.]The principle on which it was sought to justify this Bill was that there would be no hardship, and certainly no hardship to the lower paid workers.
When we came to the Committee stage of the Bill, and my right hon. Friend the 1681 Secretary of State for Scotland was here, we were told a different story. He at any rate had the merit of candour. He said:I am not saying to the Committee that there will be no hardship. That is nonsense….That is very different from what the Chancellor of the Exchequer and the Minister of Health said. I welcome the presence of the Secretary of State for Scotland on the Front Bench, because we have come in this House to admire the great candour and honesty with which he treats us. He recognised that the Bill would create hardship. I think he was rather optimistic at one stage when he said:There will not be any kind of hardship visited upon the most hard-up of the community."—[OFFICIAL REPORT, 2nd May, 1951; Vol. 487, c. 1312.]Then at a later stage, in the early hours of last Thursday morning, the Secretary of State was pressed a little more about this, but not at any great length. He was asked why the position about National Assistance appeared still so obscure. Part of what the right hon. Gentleman said has just been quoted by my hon. Friend the Member for Coat-bridge and Airdrie (Mrs. Mann), but not all of it. This is what he said:I cannot be expected to answer for the Assistance Board—and I have no right to do so—but I ask the Committee to believe that we have looked at this very carefully, and where National Assistance scales are involved, and hardship is caused, there will be no charge.What are the facts about this mysterious Clause 4 from which it was assumed by my hon. Friend the Member for Devon-port that some entirely new scales would be introduced? As I read it, there will be no new scales. All Clause 4 does is to deal merely with people who are at present in receipt of National Assistance benefits, because they come within the existing scales. Hitherto, those people getting assistance from the National Assistance Board have not been able to get any additional assistance because they required any medical necessities. There is a provision in the National Assistance Act excluding from the operation of the relief given by the National Assistance Board financial assistance for medical requirements. When there was a free National Health Service, no such assistance was required.
1682 Now that these 50 per cent. charges for spectacles and false teeth are to be imposed, it follows as a corollary that those who are in receipt of National Assistance benefit are entitled to get reimbursement for the 50 per cent. charges which they would have to pay and which obviously they cannot afford. In addition, Clause 4 does one other thing. If I am wrong I hope the Minister of Health or the Secretary of State for Scotland will correct me, because this is essentially a matter on which constituents not only in Islington and Devonport but everywhere throughout the country, will want guidance. Unless satisfaction is given by the Front Bench on this matter, I fail to see how they will be able to redeem the condition on which the Bill was introduced—that it did not impose any hardship.
As I understand Clause 4, it does one other thing. It brings within the class of recipients of National Assistance people who are working full time. Those people who cannot have assistance in the ordinary way can get reimbursement for the half charges for their teeth and spectacles. But it seems abundantly clear to me that the existing scales will apply, and it only means that, whereas at present only people out of work, whether temporarily or permanently, can get relief, in the case of these half charges, people who are within the existing scales, although in full time occupation, will also be able to get this kind of relief.
I invite the Minister of Health or the Secretary of State for Scotland to correct me if I am wrong, but there is nothing whatever in the Bill, or in any statement yet made, to suggest that any new special or specific scale will be laid down by the National Assistance Board to deal with the charges imposed by this Bill. If corroboration of that is required, I think that it is to be found in a further sentence which I wish to quote from what the Secretary of State for Scotland said in answer to a question by an hon. Member for one of the Glasgow constituencies. The hon. Member put this pertinent question when asking where the scales started. He said:Does it start with the railway porter earning £4 15s.?The Secretary of State for Scotland said:Let me give my hon. Friend an approximate example.1683 The right hon. Gentleman was careful to repeat what he said earlier. He said:I have no right to speak for the Assistance Board, but I offer the example in good faith"—I do not challenge his good faith. The right hon. Gentleman said:A married man with two children, earning around five guineas a week, would not be expected to make any contribution to the cost of dentures."—[OFFICIAL REPORT, 2nd May, 1951; Vol. 487, c. 1353.]That was the guess of the right hon. Gentleman who had no right to speak for the Assistance Board.
Since the right hon. Gentleman made that statement, I have taken the trouble to verify the facts from the Assistance Board to find out what they think about the matter. It is most unfortunate, but they do not share the view of the Secretary of State for Scotland. I am told on the highest authority that a married man with two children, paying an average amount of rent and earning £4 15s. a week, will not get any benefit under this Bill but will himself either have to pay the half charges for teeth and spectacles or—which, of course, is much more likely—go without them.
§ Mr. Ellis Smith
Does this mean that the Ministry have been in touch with the Assistance Board and that the Assistance Board have given consideration to the question? If so, have they replied to the Ministry, and why has not an announcement been made in this House?
§ Mr. Fletcher
I cannot answer that. I do not know whether the Ministry have been in touch with the Assistance Board or not. All I know is that the Secretary of State for Scotland attempted to deal with this matter in Committee and, from his own words, I do not think he had been in touch with the Assistance Board. He went out of his way to repeat to the Committee that he could not be expected to answer for the Assistance Board.
As far as I know, there has been no consultation about this subject between the Ministry and the Assistance Board. That may be a good thing or it may be a bad thing, but the result is that this House is left in complete ignorance and complete mystery about the matter. Perhaps we shall be told before this debate concludes. Apart from the abrogation, the departure, from the principle of a free 1684 National Health Service, what worries me is that unless we can get some more satisfaction about this before the Third Reading is concluded, I shall not be satisfied that there has been any fulfilment of the specific promise given both by the Chancellor of the Exchequer and the Minister of Health that these charges will not create any hardship.
As I understand it, under the Bill as it stands, a person in work earning £4 15s. a week with two children, and paying a normal rent, will not get any benefit at all if he has to have spectacles and dentures. He will be required either to pay the charges under the Bill or go without the spectacles and teeth. It is obvious that he will go without, because a person in that position cannot be expected to make—either for himself or for his family—the sacrifices that he would otherwise have to make in order to get the spectacles and the teeth which he requires. Therefore, there will be no gain to the Revenue. It is for that reason that I am so strongly opposed to this Bill. I think that it will defeat the only object which it has really put forward. It is put forward as part of the general budgetary provisions for raising further money.
We all know that the whole framework of the Budget depends on the basic assumption that we have, if we can, to increase our national production by 4 per cent. this year. We can do that only if the people of this country have the best possible health, which includes, where necessary, the best possible sight and best possible teeth. If people have need of spectacles we cannot expect them to do a proper day's work without spectacles. It is obvious that, as matters stand, in view of this provision in the Bill, that a number of people who are expected to do a full day's work with the maximum efficiency and contribute to the national productivity effort which we are trying to increase by 4 per cent. will not be able to do so, because they will go without spectacles.
Although I am not qualified, like the hon. Member for Luton, to speak on medical matters, I know from experience that to a person in need of spectacles they are not a luxury. If a person has bad sight spectacles are a necessity.
§ Mr. Fletcher
They are a necessity for his work, which is of national importance, and not a mere matter of luxury or convenience to himself. I have every reason to believe that what is true of spectacles is equally true of teeth. If a person has bad teeth and is entitled to have them out free, as he is entitled to have them out under this Bill, I believe that the best medical advice is that it is much better for him to have a new set of dentures than to do without teeth; although I am quite sure that, as things stand, a lot of people will go without teeth and spectacles.
I beg, whichever Minister is to reply, to do the House the courtesy of giving us the most detailed information as to precisely what provision will be made, if this Bill is enacted, to relieve the very real hardship which will be imposed on people of the class I have mentioned—the lowest paid workers earning £5 a week, or thereabouts—who will be faced with the miserable choice either of having to do without something and make sacrifices from other sources which they cannot afford, or of being deprived of spectacles and dentures which they need.
§ 8.23 p.m.
§ Mr. Iain MacLeod
I think the main point which concerned the hon. Member for Islington, East (Mr. E. Fletcher) was the amount of hardship this Bill would cause. Of course, no precise answer can be given to that, but I suggest that there is a clue in the figures put forward more than once from this side of the House on the question of the deterrent effect. The figures show that the difference is between £14 million and £17 million.
There is therefore, calculated by the Government a deterrent effect of £3 million. That £3 million appears to compare with the twice £14 million—£28 million—and is therefore something rather more than 10 per cent. So the Government are calculating that the deterrent effect of this Measure is about 10 per cent., and hon. Members should make their own calculations within that figure of £3 million as to how much hardship there will be. I think that is probably the only guide we have, unless some more intricate calculation is to be presented later for deciding the very important question on which the hon. Member for Islington, East, has been addressing the House.
This Bill is of great importance, apart from the civil war which it has caused on 1686 the benches opposite. I have no doubt at all that the main importance of this Bill was indicated quite clearly on Second Reading by my hon. Friend the Member for Wolverhampton, South-West (Mr. Powell). What really matters is that a new principle—I believe it to be that—puts the National Health Service Bill for the first time into the category of a means test social service. I think that is the essential point, and almost everybody who has spoken took up that point, including the hon. and learned Member for Horn-church (Mr. Bing), the hon. Member for Devonport (Mr. Foot) and many others.
The hon. Member for Tottenham (Mr. Messer) said that this Measure would destroy Socialism or the Socialist basis of the Social Services. I think that he is quite right. Some hon. Members on this side of the House tried to remove—although the hon. Member for Devon-port did not seem to be aware of it—the National Assistance Board from the Bill, but we have it in the Bill in Clause 4, and I am not going over those arguments again.
It may be right to have the National Assistance Board in the Bill if it is to be a very temporary Measure—to be torn up soon and forgotten. But is it so temporary? The Government Front Bench have indicated that it should be reviewed again, in so far as one can bind Parliament in these matters, in 1954. I would have thought it surely wrong, if it is to go on for that length of time, or even longer as it may well be, that we should not seek to find an alternative method. I believe the logic to be unanswerable, that while re-armament, or any other such special strain on our resources remains, this Bill has come to stay.
Once we accept the ceiling—I think this is the real point—then the Bill follows. I know perfectly well that what one might call the "Opposition" to the Bill from the Government back benches does not accept the ceiling at all. But once that point is given up; once we accept a ceiling for the National Health Service, beyond the slightest doubt this sort of Bill follows absolutely automatically. The hon. Member for Reading, South (Mr. Mikardo), either on Second Reading or during the Committee stage, and many other hon. Members have recognised that.
This discussion touched off last Wednesday in Committee as joyous a 1687 piece of political "nuts in May" as we have ever seen from those benches opposite. Let me say quite frankly that I believe that those on the other side of the House who object to a ceiling in this Measure are putting forward a genuine Socialist point of view, with which I completely disagree. But let us remember that this ceiling to which so many references have been made—why it should be £400 million——
§ Mr. Deputy-Speaker (Colonel Sir Charles MacAndrew)
References may have been made, but they were all out of order.
§ Mr. MacLeod
I am sorry. In that case I will not pursue this question of the ceiling, except to say that it is not a new matter which is now being introduced. It has been said of this Bill that it is a Tory Bill. Let me say quite frankly that I do not consider that an unfair description at all. It may be that some of us think it incoherent and muddled, but still a Tory Bill. That is why so many hon. Members opposite hate it so much. It is not surprising that some of us on this side of the House heard with a modified degree of hilarity the declarations of indestructible party unity alternating with fierce denunciation of the Front Bench, sometimes above and sometimes below the Gangway.
Of course we on this side of the House want to see the Bill on the Statute Book. Of course we are delighted that the Chancellor of the Exchequer and the Minister of Health and the Secretary of State for Scotland are at last plodding down the right road. Of course we are quite prepared, now we have them on that road, to urge them on.
§ Mr. MacLeod
If the hon. Member has not read any of the earlier proceedings of the Bill, he should consult my Second Reading speech, if he can bear to do so, where he will find that point dealt with. Let me say, quite frankly, that I think the Bill is full of anomalies. 1688 In many ways its approach is quite wrong. I think it is ill-considered. As hon. Members have said, I welcome these charges; I have pressed for them for a long time. [HON. MEMBERS: "And written about them."] Yes, I have even written about them. If these charges can be the means of taking money from less urgent sectors of the National Health Service to reinforce and renew the fight against ill-health in the most important sectors of the Health Service, then I not only welcome the charges but also welcome the Bill. It is only on those grounds that the Government Front Bench can justify seeking a Third Reading today.
§ 8.32 p.m.
§ Mr. Crossman (Coventry, East)
I think those of us sitting below the Gangway will be more grateful for the speech of the hon. Member for Enfield, West (Mr. Iain MacLeod) than will those sitting on the Government Front Bench. One might almost describe the hon. Member as an agent provocateur from the Left Wing of the Socialist Party, for he has put the real facts about the Bill with an extraordinary clarity. The difference is that the Government Front Bench are seeking to disguise the implications of the Measure whereas he has sought to bring them out in the fullest possible way.
I must say I was surprised to hear my hon. Friend the Member for Stoke-on-Trent, Central (Dr. Stross), say that in his view the back benchers on this side of the House have done a great deal to improve the Measure on the Committee stage. If we are frank with ourselves, all we have achieved is a Clause which limits the duration of the Bill to the next three years. It is not an accident that the next three years are the three years of the rearmament plan. What it comes to is that in this Clause, with a candour unusual in the Front Bench on this Bill, the Bill has now been re-named the Rearmament Bill. It is the Bill which openly cuts the social services for the duration of the re-armament programme. To have achieved a certain candour from the Front Bench is, of course, some advantage to one's knowledge but not, I think, anything to the credit of the party to which all of us belong. We now know that for the length of the re-armament period people will pay for dentures and spectacles, as a first instalment.
1689 We shall face the Budget of next year very much dependent upon the attitude which the House takes to the debate on this Bill. Many hon. Members opposite and a few poor Front Bench speakers from this side of the House have tried to defend the Bill as a Measure to curb extravagance in the Health Service. I have been very strongly in favour of some sort of Measure for curbing what undoubtedly exists—extravagance in the Health Service; but this Bill, as defended by the Minister, has not been introduced, as some hon. Members suggest, to curb extravagance in the Health Service. There would be quite a different Bill for that purpose. This is openly a money-raising Bill and not an extravagance-curbing Bill.
That is precisely the reason why we have so passionately objected to the Bill from below the Gangway. There might have been a case for a Bill to introduce measures of economy into the Health Service. Indeed, I myself have often wondered whether a small token payment has not a great deal to be said for it as a way to encourage people to think twice before they let a dentist take out their teeth. But a 50 per cent. charge is something totally different from a charge designed to discourage extravagance.
A 50 per cent. charge has one purpose and one purpose only—to obtain money for re-armament, as we now know from the new Clause, which tells us openly that for the three years of re-armament the money will be taken out of dentures and out of spectacles. If we want to have it confirmed we find it in the Clause dealing with spectacles, as was pointed out by my hon. Friend the Member for Manchester, Exchange (Mr. W. Griffiths), who has great experience of this and whose speech I checked over the week-end. If this was an economy measure, would the Front Bench have decided to make those who need spectacles pay more than the full cost of the lens which will be used? That is not a measure of economy; that is even making a profit out of the unfortunate people.
If I calculate correctly, a large number of those who pay what is called a 50 per cent. charge will, in fact, be paying for the cost of the lens, the cost of the frames and the cost of the testing as well. That is not an economy measure; that is a charge designed to make as much money 1690 as possible in the easiest possible way out of the most vulnerable section of the Health Service. It is not the best way of curbing extravagance in the Health Service, as the hon. Member for Luton (Dr. Hill) has already very cogently argued. To make a savage charge for the sole purpose of raising money to pay for the rearmament programme is not the best way to get economy or wise spending.
I want now to turn to Clause 4. I think the House should be deeply grateful to my hon. Friend the Member for Islington, East (Mr. E. Fletcher) for being the first fully to ventilate what I also regard as a scandal. We are passing the Bill without knowing clearly what we mean. An hon. Member opposite pointed out that we have a precedent already in that the National Assistance Board are responsible for giving free what otherwise people would have to pay for; they provide travelling expenses to hospitals. I understand the Minister has also said that. Let us assume that we can take that as a precedent and that people will be given free dentures and spectacles in the same way as they are given free journeys to a hospital.
How does the free journey to the hospital work? There is no special scale as my hon. Friend the Member for Devon-port (Mr. Foot) seemed to think necessary. National Assistance is provided under the subsistence level. It is based on a calculation that if a man's or a family's standard of living sinks below a certain level, that man or that family are destitute, and, therefore, in order to bring the family's income up to that level the Assistance Board is empowered, and entitled, indeed, to pay the amount which is necessary to bring the family's income up to a certain basic minimum below which people starve.
In the case of travel to hospitals—the Minister will correct me if I am wrong—unless a man can prove that with his weekly wage, when the charge for the journey to the hospital is added to his other expenses, he will be destitute, he gets not a penny—not a penny. He must prove destitution by National Assistance standards.
§ Mr. Crossman
With great respect, Sir, Clause 4 is concerned with the National Assistance Board and its being entitled on certain occasions to relieve hardship by providing free spectacles. I am providing the only instance we know of. My hon. Friend the Member for Coatbridge and Airdrie (Mrs. Mann) asked me who introduced it. I think it is perfectly correct in the case of travelling expenses, because I doubt whether we should have allowed travelling expenses to be paid in the Health Service. This was an abuse in the Service before this provision was introduced. But it is the only precedent we have got. If it is true we have got one case where the National Assistance Board is entitled to pay, and to enable people to have the service free, I am concluding—unless the Minister tells me no—that in the case of men in factories, for instance, it means that a means test will be applied to know whether somebody is indigent or not—which is already provided for to obtain free travelling expenses to hospital.
§ Mr. McAllister (Rutherglen)
I am sure my hon. Friend does not want it to get on the record that it is his view that to obtain assistance from the National Assistance Board one has got to prove destitution.
§ Mr. Crossman
I am very sorry. We are dealing with the problem of the subsistence level; but do not let us pretend that the subsistence level we have achieved in this country is very elevated with the present cost of living. I accept my hon. Friend's correction. I should have said, "minimum subsistence level." It is unfair to the Board not to make that correction. But what I am pointing out is that one will have to prove that one's income falls below the minimum subsistence level in order to obtain free dentures and free spectacles, and it seems to me grievous that we have to do this because we shall have two scales—National Assistance for the old age pensioners and another for those in work.
It is clear that no Assistance Board could produce a new scale and say, "This is for those in work, and the standard of minimum subsistence, where a man is 1692 working in a factory, shall be a bad weekly wage; and somebody who is an old age pensioner or a widower with children shall have something else." Only one subsistence level can be applied in the country. This means that if, having to pay this charge, a man's total income falls below that under which one is entitled, if he is out of work or aged, to National Assistance, an employed man may, in those circumstances, receive National Assistance. On this point I agree with my hon. Friend the Member for Devon-port.
This, of course, is subsidising low wages. [Interruption.] Of course it is. If we say that this will be the basic minimum that we provide for men in work, then, of course, we are subsidising those who pay insufficient wages to people to enable them to earn their living. We have the food subsidies, of course, but they are subsidies for everybody; but in this particular case we are saying that somebody who is not earning sufficient wages is able to pay for his spectacles and keep on the subsistence level shall have assistance.
I am sorry that capitalists should be subsidised in that way. It is a very striking thing that we do that. In my experience people are still—I think, rightly—reluctant to rely on National Assistance. By and large the scrounger will go to get it. [HON. MEMBERS: "Oh."] Thousands of decent people will not. [Interruption.] I am very sorry, but I would point out that there are many people who will not, in fact, get what they are entitled to under this Bill because they are too proud to do so. I still think it is a grave mistake to impose a means test on men at work before they can get—[HON. MEMBERS: "It is not a means test."] But it is a means test. They will have to submit to a national means test in order to be able to get free spectacles and free service.
I say with great respect that this means test exists—but, of course, we have to have it—in National Assistance. What we are doing here is to extend the principle to men in work, and that seems to me a grievous violation of principle. I agree with hon. Gentlemen opposite that this is, in fact, having two health services, one for the top level, and one for the others, and I think that having two services is fundamentally a bad thing even in this beginning with teeth and spectacles.
1693 The last point I want to make is this. I cannot believe that many people on this side of the House are proud of this Bill. The only argument in favour of it—the only argument—is that we must have this Bill as a help towards payment for re-armament. It is the only argument that can be introduced, now that we have this new Clause saying that the period shall be at least three years. I do not believe that there was no other way of paying for it. I do not believe that this Bill, enthusiastically received by the other side, is a precedent. I do not pretend that this is what the other side would have done. I say that it is a small example of what they would have done on an enormous scale.
Because I do not like our Front Bench doing on a small scale what the other side would do on a big scale, I do not happen to like this Bill. I do not think that anyone else does. If the Bill is a precedent for what might happen in future legislation, a much healthier precedent is the reaction of the benches on this side of the House. I hope that in future it will not be the actions of the Front Bench but the reactions of the Labour back benchers which will be the precedent for future Socialist policy.
§ 8.47 p.m.
§ Mrs. Mann
I have listened with very great interest to the contributions made in this Debate, and I cannot profess to have the intellectual training of the hon. Member for Coventry, East (Mr. Crossman), as an economist who bestrides the world like a Colossus. I wish I were as cocksure of anything as he happens to be of everything. I read his contributions to various journals, and I read in regard to re-armament—and I introduce this, Sir Charles, because the hon. Member has talked very much about it—a contribution which went like this—of course, he was writing for the popular Press: "If we can afford to spend £800 million this year on re-armament, therefore, I say that we can afford to give £50 million to the railways for subsidies." I confess I would have taken an entirely opposite view. If we are thinking of increasing the amount of re-armament, that, I think, would be one reason why we cannot afford this other service.
I should like also to follow up the hon. Member's remarks on re-armament because he said that the amount in the 1694 Bill is being taken from the people who need dentures and spectacles to pay for re-armament. Last year without gasping he swallowed the bottles of prescriptions that "cascaded" down the throats of the patients, and he did not protest about the terrific hardship to many of my constituents and others which caused them to pay for travel across Lanarkshire—one woman paying 6s. each visit, three times a week. He and the others swallowed that without a word of protest.
In my opinion, they swallowed the camel and strained at the gnat because they have only now raised their objection to something which, I would remind the hon. Member for Islington, East (Mr. E. Fletcher), the Minister himself admitted was a hardship. When the hon. Member for Islington, East, was reading the Secretary of State's remarks that a married man with two children earning about £5 5s. a week would not be expected to make any contribution to the cost of dentures, he stopped there, and he omitted to read on:Let me take this argument a stage further. I have previously admitted that this scheme does mean hardship for some people. It is bound to."—[OFFICIAL REPORT, 2nd May, 1951; Vol. 487, c. 1353.]We are all agreed that it means hardship for some people but we disagree very much on the degree of hardship of the measures introduced last year without a murmur of dissent and the ceiling accepted last year without a murmur of dissent and without there being a Bill of £1,400 million for armaments that year. Why was that accepted? Was it because this poor body in my constituency had no Colossus on the Front Bench to lead a revolt? If he had led it, would we have had all these speeches made about the prescriptions, because when we swallowed the camel last year instead of the gnat this year we were hitting every family and every mother whose child in the middle of the night took a pain. We did not think then of the difficulty of getting public assistance lines. Why did nobody get up then? All that was swallowed last year, is rejected this year because of a certain type of leadership.
It is said that this BUI is for the first time introducing an appeal to the Public Assistance Committee. It is nothing of the kind. It was introduced last year with complete silence on the part of those 1695 Members who have so much to say about it today. It is also said that this is opening the way to the Tories. Do hon. Members on this side of the House never listen to the party political broadcasts? Do they not realise that the Tories had their policy on this formulated years ago? Only little more than a year ago there was a party political broadcast made by the right hon. Lady the Member for Moss Side (Miss Horsbrugh), who is not in her place tonight. She frankly admitted to the people of Britain that it was the Tory policy only to give dentures and spectacles to mothers and children. It is utter nonsense to say that the Tory Party were waiting on this lead. I wish they were as frank about the other items of their policy as they are about this.
I deplore this charge. I deplore much more the principle fixed last year without the excuse of our re-armament commitments and which imposed hardship on the people in my constituency. I deplore and regret that no one then had the courage to stop it, or to say where in the Health Service we should fix a ceiling. The sky is not the limit. Do not let us be hypocrites about that. If someone said, "Where can we introduce economy?" I could think of no one on whom it would fall less hard than on the people who have to wait at least nine months for their gums to harden before they get new teeth. We are fixing a limit of 10s. per lens and 7s. 6d. for the frames, a sum of £1 7s. 6d., and we should compare that with what we know is charged for testing alone without glasses, namely, a minimum of £2 2s. The Government Front Bench deplore that there should be a limit, but if there have to be charges I know of nowhere where they would fall less harshly than they do under these proposals.
§ 8.55 p.m.
§ Mr. Dye (Norfolk, South-West)
I do not wish to say very much in this debate. I have listened to most of it with a very great deal of interest, and to some of it with utter amazement. I heard my hon. Friend the Member for Coventry, East (Mr. Crossman) say when he was referring to the manner in which there will be a means test for the new spectacles or false teeth, that this Bill will subsidise wages. He can only justify some such statement if he knows of any body of 1696 workers in the country whose normal wages are on the level of the National Assistance Board scale. If he does not know of any body of workers whose wages are as low as that, he cannot make such a statement and get away with it. Such statements do harm to the party to which he belongs and do no justice to the people who sent him here.
I am amazed, too, that my hon. Friends the Members for Islington, East (Mr. E. Fletcher) and Devonport (Mr. Foot) should make the statement that the Bill introduces the principle of payment in relation to the National Health Service. Why was it that last year there was stopped the payment of travelling expenses for people in rural areas who had to go to hospital to get specialist treatment? If the question of principle depends upon the amount that it costs the patient, why is it that £2 breaks the principle when the wife of an agricultural labourer in my constituency has to pay £2 each time to go to the hospital for treatment? She has had to go many times.
For one single payment of £2 patients will be able to get false teeth, or glasses for a less amount. Why is that breaking the principle, when it was not breaking the principle in the case in which it was vital to a woman's continued existence that she should be treated for something wrong internally which, if not treated, would bring her to her deathbed? Why did not hon. Members who represent industrial areas and have hospitals on their doorsteps, protest against the breaking of the principle last year? It is quite untrue to say that we are breaking the principle now.
It is true, as the hon. Member for Coatbridge and Airdrie (Mrs. Mann) has said, that when the principle was broken last year we had not before us the great cost of armaments which we have for this year and next year. I fail to see why hon. Friends of mine on this side of the House are making such an attack upon the Government as they are doing today, giving hon. Gentlemen in the party opposite a stick with which to beat us in the country.
§ Mr. Dye
My hon. Friends should consider very carefully before they use such 1697 extravagant statements as they have used. After all, at rock bottom, in spite of the Bill more will be spent on the National Health Service in the coming year than was spent last year. That is essentially true. Of all the services which are of importance to our people the greatest is the hospital service, rather than those which provide teeth and spectacles.
Therefore, while I should be only too glad if the country was in a position to implement in full the principle of a free National Health Service, as long as we are faced with other financial burdens, which it is vital to the defence and welfare of our country that we should meet, I believe that the Government have been wise in limiting some aspects of the Health Service so that others, which I believe to be of vital importance to many of our people, may be extended.
§ 9.0 p.m.
§ Dr. Broughton (Batley and Morley)
There is an angle from which this embarrassing problem may be viewed which has been neglected in the debate so far, and I wish to draw the attention of the House to it. The Schedule to the Bill lays down the scale of charges for dental and optical appliances, and we have been told that these contributions towards the cost of the National Health Service will provide about £13 million this year. We heard previously from the Chancellor of the Exchequer that he would furnish £400 million. Therefore, with the aid of the Bill, £413 million will be spent on the service this year. Each successive year the National Health Service has shown a considerable rise in cost. If we take into account the £13 million to be raised by the contributions detailed in the Schedule we find that this year we shall be spending at a rate approximately 50 per cent. above that when the service began.
This afternoon the House accepted a new Clause laying down that the provisions in the Bill shall continue in force until 1954 and that they shall then expire unless the House passes an affirmative Resolution that their operation shall be prolonged. I am pleased that the House accepted that Clause because I believe it is wise that the measures contained in the Bill should be reviewed within a reasonably short time. But when the House comes to reconsider the matter in 1954 I hope that the Chancellor of the Exchequer will find himself able to offer 1698 more money towards the cost of the Health Service. If he is unable to do that the measures in the Bill will have to continue in operation, or else alternative economy methods will be required because I am sure that the Minister of Health will be asking for not less but more money for the Service. I believe that next year the Minister of Health will go to the Chancellor of the Exchequer and plead for more money and the year after for still more, and I believe that that will be so no matter who is Minister of Health and no matter which political party is in power.
§ Mr. Ellis Smith
Is it not possible to reduce costs by increasing efficiency? Has not my hon. Friend read the Civil Appropriations Account and the Report of the Comptroller and Auditor-General in which it is suggested that economies and increased efficiency will reduce costs?
§ Dr. Broughton
I am sure all hon. Members deplore waste in the National Health Service, and wish to have brought into operation all reasonable and possible economies. My hon. Friend intervened a little prematurely because I had not reached the point I desired particularly to stress. I was about to say that my hon. Friend the Member for Tottenham (Mr. Messer) said this evening that he wished the finances of the National Health Service could be divorced from the Treasury, and he considered that this was a possibility. It would have been out of order for him to give us the details on the Third Reading of this Bill, but I hope we shall have an opportunity before long of hearing his views.
Perhaps, Mr. Deputy-Speaker, I may be permitted to mention that there is a school of thought which hopes that rising national production and increasing national income will keep pace with expanding social services and allow the full cost of the service to be borne by the Exchequer. I know that those high hopes spring from faith in the British people and confidence in the future of Great Britain.
There is one factor that has not sufficiently been taken into account and it is the point I wish to stress, namely, the accelerating rate of progress in the science of medicine. Recent new discoveries are likely to be followed by others giving more efficient treatment for a number of diseases. 1699 We cannot abstain from giving patients the benefits of new aids to diagnosis, new drugs, new methods of treatment. Many of these are expensive. For some time I have held the view, shared by others, that the cost of the National Health Service would rise to such a height that sooner or later a ceiling figure for expenditure would have to be imposed. The moment that a financial limit is fixed we are faced with the disagreeable problem of arranging a system of priorities.
We have reached that stage now. A ceiling has been fixed and this Bill is consequential upon that. The Bill allows more money to be spent on cases of respiratory tuberculosis and it cuts down on dentures and spectacles. If this Bill were now to be rejected this House would not have maintained a free for all health service for all time. The House would merely have deferred the issue; it would only have postponed the unpleasant hour.
§ Mr. Manuel
Would my hon. Friend give way? Does he not agree that, taking a long view of the National Health Service, ultimately there is bound to be an immense saving because of its curative nature?
§ Dr. Broughton
We should all like to believe that is correct, and we hope it is correct that ultimately a considerable saving will be effected in this way. That is a very long way ahead, however, and in the meantime new treatments are coming along, many of which are expensive, and the cost has to be met. The Chancellor of the Exchequer has not got a bottomless pocket and a ceiling has to be fixed sooner or later. A ceiling may vary from year to year, depending on the state of the national finances.
I believe that the question we have to ask ourselves now is not whether we shall accept the Bill, but when shall we accept it. The Government hold the view that we should accept it now, and I think they are right. The Chancellor of the Exchequer is making a generous contribution towards the cost of the service. His contribution will include the cost of the life-saving measures, which are mentioned in the Bill, for sending persons suffering from respiratory tuberculosis to Switzerland for treatment. That is a progressive step which we all welcome. The provisions in the Bill for imposing charges for 1700 dentures and spectacles are forced upon us by the steeply rising cost of the service.
§ Mr. Ellis Smith
Would the charges stop it? I do not speak of my own personal experience, which has resulted in medical science saving my life, but yesterday afternoon I was sitting in a bedroom in my constituency where it was a treat to see all that medical science could place at our disposal in order to save a man's life. What concerns me is where this thing will stop.
§ Dr. Broughton
This is a difficult problem which the House will have to consider most carefully each financial year. It will have to look carefully upon the amount of money which the Minister of Health desires to have for the Service, and into the amount of money which the Chancellor of the Exchequer offers. If the Chancellor of the Exchequer is able to provide the amount which the Minister of Health feels that he needs, the problem that is worrying my hon. Friend does not arise. On the other hand, if the Chancellor feels that he cannot meet the full demand of the Minister of Health, some economies will have to be effected. The Bill is considering those priorities consequential upon a ceiling having been fixed to the expenditure this year for the National Health Service. I think that the Government are acting wisely, for if I had the misfortune to be edentulous, myopic and tuberculous, I should regard the eradication of the tuberculosis as of much more importance than the provision of dentures and spectacles.
We all dislike the provisions of the Bill for the charges for dentures and spectacles, but I think we have reached a stage in the rapid development of the National Health Service when they have become necessary. We must face up to the fact that the service is costing more than the Exchequer can at present afford. This medicine is bitter to swallow, but I think it is right that the Bill should be given its Third Reading.
§ 9.13 p.m.
§ Lieut.-Colonel Elliot (Glasgow, Kelvingrove)
We have had a long debate, in which, contrary to usual experience, there has been an approximation of views towards its end. I do not think any of us could have listened to the speech which has just been delivered by the hon. Member for Batley and Morley (Dr. Broughton) 1701 without realising that he was a man, not grappling with the Opposition—which, Heavens above, is easy enough to do—grappling with the other side of the House, or even grappling with his own Front Bench, which in this debate has taken the part of an unhappy row of Aunt Sallies, subject to slings and arrows of every kind of outrageous fortune. Instead, the hon. Member was grappling with himself, and with the facts of the situation, which is much the most difficult thing to do. One of our poets wrote that:Because that two and two make fourAnd neither five nor three,The heart of man has long been soreAnd long is like to be.That is the position in which the House finds itself tonight. We have been entertained by the interlude of a special party meeting staged apparently for the benefit of the public and of His Majesty's Opposition, in which we have been most interested. We have had the vitriolic incursion of the hon. Member for Devonport (Mr. Foot), who came amongst us like Satan in great fury knowing his time was but short.
We suffer from shortage of sulphuric acid, but I never understand why. If some one would only bottle the hon. Member for Devonport we could export enormous quantities all over the world. He spent a certain amount of time in inventing a speech for my hon. Friend the Member for Hendon, South (Sir H. Lucas-Tooth), and denouncing it, but he rapidly got on to the much more congenial topic of denouncing his own Front Bench. I will not go into details on that. It is neither desirable nor, indeed, is it necessary when every so often they produce this vitriolic and very valuable publication the "Tribune," of which I have no doubt people in future years will say that it must have been produced by the Woolton Fund, because no other source of quotations half so valuable has been discovered by us at any time.
He did not address himself to the question at all, nor indeed did the hon. Member for Coventry, East (Mr. Crossman), as the hon. Member for Coat-bridge and Airdrie (Mrs. Mann) said in the robust fashion in which love talk is begun north of the Border. There were denunciations, for instance, against the introduction of the Assistance Board into our social system at all, which was 1702 described by these hon. Members as if it were an unheard of crime. Yet, if the hon. Member for Devonport had listened to the debate and had been here on 2nd May, he would have heard the hon. Member for Widnes (Mr. MacColl) attacking those of us on this side of the House who proposed that the Assistance Board should be taken out, on the ground that it was a very mischievous Amendment and that the older generation had these prejudices but the younger generation had adopted a more sensible attitude in this matter.
The fact is that either side of the House finds it easy enough to hurl denunciations at the other. I do not propose to do that at this stage of this long, difficult and painful debate. It is nonsense and ridiculous to say that this Bill has been accepted with enthusiasm by hon. and right hon. Members on this side. Not at all, hon. Member after hon. Member on this side has pointed out with what reluctance we accept it. Of course we would all prefer that these disagreeable decisions did not have to be made; but they have to be made; and the necessity for these decisions—and it is not necessary to do more than mention it, though it has to be mentioned again and again—was accepted before the intensified re-armament drive began, and before the Korean War.
It was then that the Chancellor of the Exchequer said that a ceiling would have to be put on, and the Prime Minister said that the late Minister of Health and the Secretary of State for Scotland had been troubled in their minds because of the abuses of the Health Service, "the cascades of medicine," as the Minister of Health put it in his picturesque way, "pouring down the throats of the British public" which he "shuddered to think about." The Government introduced the charge of 1s. per prescription which was accepted by all hon. Members on the other side of the House, including the Minister of Health who commended it to the House.
The fact is that it is useless for some hon. Members below the Gangway to try to score points off hon. Members on this side of the House about the Measure. It was the Secretary of State for Scotland who said, tonight, "These are His Majesty's Government proposals"—so they are—and "we shall defend them. 1703 We shall operate them." There is a declaration of paternity pretty solid and difficult to get away from; there is a declaration of paternity which is uncompromising.
Nor is it true, as the hon. Lady the Member for Coatbridge and Airdrie said, that these matters have been adumbrated with even greater ferocity by hon. and right hon. Gentlemen on this side of the side of the House. She contended that my right hon. Friend the Member for Moss Side (Miss Horsbrugh) had said in a broadcast that dentures ought to be confined to expectant mothers. If the hon. Lady looks up what my right hon. Friend said, she will find that my right hon. Friend pointed out that the Coalition Government, of which most of the Members of the hon. Lady's Front Bench were members, brought out a White Paper in which it was stated that dentures should go to expectant mothers and that dental care should be given to children, and that these should be the first priorities.
The difficulty in all this is the question of priority. My complaint against the approach which the Government have made to this problem is that they have tried to drive three buses abreast through Temple Bar, and now that they are banging and scratching the paint off each other, the Government feel upset and unhappy. Many mistakes were made in the introduction of the National Health Service. I think, and I am sure that the hon. Lady the Member for Coat-bridge and Airdrie would agree with me, that, for instance, to snatch all the hospitals in Glasgow and elsewhere away from the local authorities who were managing them very well and economically was a step that was altogether premature, which has led to an exaggeration of the charges and the expenses in the hospital service, of which this Bill is a direct result.
I am sure that far more than £13 million has gone in expenditure which was not really necessary. Had the problem been approached step by step, and not with this desire to produce the whole thing at one blow and hand it out to the nation, and indeed to the world, as the great achievement of Socialist Britain before which all other nations should bow down. These are difficult 1704 matters and they cannot be taken at the pace at which Ministers and hon. Members have tried to take them. When the Secretary of State for Scotland was defending the proposals, he used an argument which struck near to my heart. He was asked what we would get out of the Bill. He replied that the money would pay for 50,000 hospital beds.
That is a great and important consideration, and it cannot be brushed away merely by saying that these matters will be difficult to administer, which they will be, that they will lead to anomalies, which they will, and that they will lead to hardships, which they may very well do. I say that the first requirement for a sick man or woman is a bed on which to lie, and until beds can be provided freely for all comers, without their waiting, I do not believe that other priorities really count in comparison.
I am sure that many of the arguments which have been brought forward by Ministers will not commend themselves to Members in all parts of the House. Their actual proposals certainly do not commend themselves to us on this side of the House. This is certainly no Tory Bill in the sense that if the Tories had been responsible we should have introduced a very different and we believe a much better Bill. [Laughter.] Hon. Members need not laugh. I have had the responsibility for bringing in a medical service, the Emergency Medical Service, a universal medical service which had nearly 50,000 more beds in it than has the present service.
§ Mr. Manuel
Does not the right hon. and gallant Gentleman think it complete nonsense to talk about an extra 50,000 beds when we cannot staff the beds we have with the number of nurses we have today? How then would we provide the 50,000 beds?
§ Lieut.-Colonel Elliot
If that is true, that is a counsel of despair—that we shall never get these extra beds. That is not so. Ministers say, and rightly, that the number of nurses is increasing. Steps can be taken, and some have been. I think that more imagination could be shown. There are ways in which that process could be speeded up.
§ Lieut.-Colonel Elliot
Does the hon. Gentleman expect anybody will now work for the payment they received when the pound was worth double what it is worth today?
§ Lieut.-Colonel Elliot
The difficulty now, as the hon. Member for Batley and Morley said, is the rising cost of living; and there is also the falling value of the pound. Everyone knows that to be true. That is another problem which the Government will have to face but I do not want to embark on its discussion today.
I say that there is a shortage of staffed beds and that if the weight of administration, thought and finance of this country were concentrated more on that problem, we could speed up a solution of that problem. The Government are taking one step towards speeding it up in this Bill by the removal of the weight of tubercular patients, not merely from the sanatoria but from the general hospitals, because the weight of that list extends to the general hospitals. Even if it is only by 150 in the case of Scotland and 150 in the case of England, that contribution will at all events diminish the waiting list by that number.
I am sure that if imagination and thought were devoted to these matters, something more rapid could be done than is now being done. But first it is necessary to get away from the taboo which the late Minister of Health placed on the Health Service. The Health Service is sacrosanct; it cannot be touched; anyone touching it is committing a crime against humanity, a crime against Socialism and a crime against the Labour Party—to put it in an ascending scale of horror. These seemed to him terrible and unthinkable ideas.
Of course we must adopt a more realistic attitude towards the Health Service. We must see where the resources of the country can best be expended. Even in this Bill we must see how we can rebuild again the shattered school dental service. Nothing could be worse than finding that we were providing the raw material for the future by producing dentures for the grandmothers and grandfathers of the present. This is not the last word.
1706 This is a reform in a service to which the whole country contributed many years of thought and hard work, to which all parties have contributed a certain amount of thought and to which, however, there has now come a need for revision and reform. Here is a step in revision and reform. To that extent it is desirable. It is certainly necessary that some reform and revision should be carried out and that a start should be made. We do not welcome this particular start. We are reluctant to accept the Bill and the specific steps proposed here, but I am sure that the whole House is agreed on the necessity for a review of the Health Service on a realistic basis and without regarding it as sacrosanct. For that reason we certainly shall not divide against the Bill.
I shall be very surprised if the hon. Member for Devonport divides against the Bill. I shall be surprised if he finds it possible to go down to his constituency and denounce the Tory Party in the unbridled terms which he would like to use. If he did so, his opponent would be able to say, "The hon. Member for the Devonport Division did not divide against the Second Reading, against the operative Clause or against the suspension of the Ten o'Clock Rule on the first occasion or the second occasion. He protested on all these occasions. He said that there was undue haste and that the matter was being rushed, but he confined himself to protests." I am neither a prophet nor the son of a prophet, but it may well be that this remarkable consistency will be exemplified again when, in a short time, Mr. Speaker puts the Question to the House.
§ Lieut.-Colonel Elliot
I do not think that the hon. Gentleman will be able to escape in that way. If he tries, he will find it most difficult to explain why another course of action commended itself to his hon. Friend the Member for Shettleston (Mr. McGovern), and to his hon. Friend the Member for South Ayrshire (Mr. Emrys Hughes), unless his contention is that they love the Tory Party really, and that he, and he alone, is the man who dislikes it and who is really 1707 willing to go to the stake against it. But his way of going to the stake showed itself by his remaining in his seat when the other hon. Members to whom I have referred went through the Division Lobby.
He may be able to explain that to the constituents of the Devonport division of Plymouth. Plymouth is, I believe, inhabited by a great number of marines. They are supposed, perhaps, unjustly, to be credulous folk, and he may get away with it there. I would not recommend him to try that line of argument in Shettleston or in South Ayrshire. But I only turned aside to reason with the brethren in the shape of the hon. Member for Devonport, because he is a bonny fighter and a skilled fencer, and I should not like him to think that his remarks had gone unnoticed on this side of the House.
What we have to say, and what, it seems to me, is the view that we all have to take, is bound up in the question whether we believed, with Sir Stafford Cripps, with the present Chancellor of the Exchequer, with the late Minister of Health and with the present Minister of Health, that a ceiling will have to be put upon expenditure on the Health Service. If we do, then I do not see how we can escape from the logic that something must be done to implement that view. Something is being done here. We may not like it. We may think that we would tackle the matter in another way. But that at some time, somewhere, in some measure, some step will have to be taken of some kind, is an absolutely inescapable conclusion. That being so, neither I nor my hon. and right hon. Friends will divide against the Third Reading of this Bill.
§ 9.34 p.m.
§ Mr. Marquand
I think that all hon. Members who have taken part in this debate have found it a little difficult to keep within our rules and yet to discuss all the aspects of this matter which they would have liked to discuss. I think this is because essentially it is a machinery Bill. It is a Bill which provides rather distasteful machinery to accomplish a useful purpose. The right hon. and gallant Member for Glasgow, Kelvingrove (Lieut.-Colonel Elliot) said it has been a difficult and painful debate and in those words I feel sure he commanded the assent of everyone in the House. It is a distasteful 1708 piece of machinery, of which we have been obliged to make use in very difficult circumstances indeed, in order to save money from one side of our National Health Service, so as to spend it on a much more important side.
My hon. and learned Friend the Member for Hornchurch (Mr. Bing) referred—and I was glad he did so; I think it was right to do so—to the other very important parts of our National Health Service. It is with those other parts of our service in mind, although I know it is out of order to talk about them too much, that we have to approach this discussion tonight; not only the treatment of tuberculosis, which is provided for in this Bill in a new way not hitherto provided, but all the hospital services generally. I wish I could be permitted to make a speech entirely on hospitals, because I think hon. Members might have been surprised at some of the information which I could have given them. It is perfectly true, as the right hon. and gallant Gentleman has just said, that we needed the money which will be saved by this Bill in order, not to open 50,000 new beds, but to keep open 50,000 beds which are open now.
If my right hon. Friend and I could have cut hospital estimates for this year by £23 million there would have been no necessity to bring forward this Bill at all. We could not do so. We considered as carefully as we possibly could what less essential parts of the hospital service might be postponed in the current year in order to see us through a difficult period, but we could not recommend a reduction of so large an amount in the estimates presented to us by the regional hospital boards. We could, if we had the money, spend very much more than we are budgeting to spend this year on the hospitals—yes, and the year after—without waste at all.
Sometimes perhaps the seriousness of the hospital position may be overestimated. I think it has perhaps been done in the last couple of days since in answer to a Question on Thursday of last week I said that the waiting list was 550,000. The number of beds appropriate to the waiting list is 440,000 in round figures. That means the situation is perhaps not quite so serious as some might imagine by the use of large figures like 550,000. But when we come to specific waiting lists, the aged and chronic sick, 1709 the tuberculosis patients and other groups of that kind, it is a serious position; and it is our duty to ensure, not for this year only but for the next year, the possibility of keeping up with the additional recruitment of nurses, which will enable us to open beds as we go along to reduce these waiting lists.
Much of the argument in this debate, rightly or wrongly, was directed against placing a ceiling at all on the National Health Service. I cannot enter into that argument. I feel it would be out of order, and in any case this is hardly the point at which to discuss it. All I would say is that in my view the only hon. Members who can logically take the view that no ceiling at all should have been placed at this time on the National Health Service are those who both voted against and objected to the Budget last year, which imposed a ceiling on the Health Service, and those who have resisted rearmament this year. If there be any hon. Members, and I believe there are one or two who sincerely held that point of view on both occasions, I admit that they are in a logical position to use this argument, but nobody else is.
It was suggested again, as I knew it would be when I made my Second Reading speech, that in some way or other, by other sorts of economy not involving charges on anybody, we could have made the savings which are necessary to keep hospital beds open. But that sort of argument ignores altogether the very substantial economies in the service which have already been made during the past three years. It under-estimates the value of the economies and the searching scrutiny which my right hon. Friend who preceded me has undertaken in the National Health Service.
My right hon. Friend the Secretary of State for Scotland and I were faced with the necessity of finding £23 million, somehow or another, out of an expenditure in round figures of £98 million on sections of the service outside the hospital and general practitioner service. In such a situation it would not be prudent to say, "We will take a gamble on making that amount of economies by a further scrutiny of methods of administration and expenditure." We could not safely undertake to find that amount of money out of the very small total available to us. It would not have been honest to pretend 1710 that within nine or ten months we could in that way find economies which have not been found within three years.
Had we decided to do that, we should have found ourselves, before long, closing beds in the hospitals—and that we were not prepared to do. Of course, during the year we will scrutinise our expenditure and our administration wherever we can. An immense amount of scrutiny of this kind is going on, with the help of very valuable bodies like the King Edward Hospital Fund and with the help of skilled accountants and other professional experts who are reviewing hospital expenditure at the moment. We need all the economies we can prudently and reasonably make without sacrificing the quality of the service, and in making our calculations we reckoned on some revenue from that source.
So much for the general need for saving money from other parts of the service to make possible the continuation of the hospital service. We have been asked, quite reasonably, why, if we found that we could not get the saving we needed from economies in the existing administration, and if we concluded that we must have charges, did we choose to levy those charges in the way announced. I thought I had explained that carefully and thoroughly when I introduced the Bill and I certainly do not want to qualify or alter the explanation which I gave at that time. Hon. Members who did not notice it or have forgotten it may like to read it again.
I do not agree for one moment with the criticism of the hon. Member for Luton (Dr. Hill) who said we have done this in a slap-dash manner. In fact, we used the four criteria which I set out in my Second Reading speech and we came to the conclusion that the points we have chosen would inflict less hardship than others, consistently with making the savings large enough for the purpose we had in mind. I thought my hon. Friend the Member for Coatbridge and Airdrie (Mrs. Mann) made some very wise remarks, based on her wide experience of the way in which the ordinary people of this country live and work, about the wisdom of the choice which has been made.
I could not help feeling that far too many of my hon. Friends, both in Committee and on Third Reading, have 1711 spoken as though the charges for teeth and spectacles were to be frequent and recurrent, as though people were for ever—once a week or once a month—requiring this type of appliance. They might reflect that, after all, these things are not so frequently required as all that. Indeed, that was one of the main reasons why we rejected the idea of resurrecting the charge on prescriptions, which would have fallen at frequent intervals upon people who were sick and ill. We have tried in the Bill, for example by the subsection concerning in-patients, to shield from hardship, so far as we possibly can those who are sick and ill. In discussing hardship I do not think we should allow ourselves to get the thing completely out of proportion. I think that my hon. Friend the Member for Stoke-on-Trent, Central (Dr. Stross)—and if I am right in my interpretation of his speech I agree with him—felt that the discussion was getting a little out of proportion because of the very fact that these are not appliances frequently needed even by poor people.
To complete our protection of the poor and needy from hardship we put into the Bill not merely that the Assistance Board might help those who might suffer hardship through these charges but that they should be empowered for the first time, exceptionally, to give assistance to persons in full-time employment. There has been a good deal of discussion tonight about precisely how those arrangements will work. It is a little late in the day to raise the question, for we had a very long discussion in the Committee stage about the arrangements which the Assistance Board would make for this purpose and my hon. Friend the Parliamentary Secretary to the Ministry of National Insurance attended to deal with any questions that might be raised. Those questions were not put to him at the time and it is a little late in the day to raise them now.
It is a little difficult for me, not having a special responsibility for the Assistance Board, to go into a lengthy discussion as to how they will carry on their operations under the powers given by the Bill. But I can say that of course—and I think this has already been mentioned by the Parliamentary Secretary—there will be no special regulations needed under the Bill to enable the Assistance Board to do this work. Its assessment of hardship will be determined by the application of its 1712 existing methods, to which, after all, on numerous occasions in this House and on the platform hon. Members on my own side of the House as well as opposite have paid tribute for their kindness, their humanity, their understanding. The Board will apply its regulations to people whether in work or out of it who go to the Board and say that a payment of this magnitude, whichever it may be—27s. for spectacles, or it may be as high as £4 5s. for dentures—will involve hardship.
I do not wish to seem to be evading anything when I say it is very difficult, possibly even misleading, in this matter to go into a whole lot of hypothetical examples, because the assessment made by the Board's officers of the circumstances of an individual or of a family does depend upon a great variety of factors—the age of the children and the rent to be paid, and so on; and it has power in reserve—discretionary power—to make an adjustment even beyond the scales specifically laid down. I would say to my hon. Friends, "Do not cry havoc about this. Do not go about the country persuading people they are never going to get any help from the Assistance Board in this way." Let us wait and see what the Board does.
I believe that the Minister of National Insurance—I have been so pre-occupied with this particular Bill that I did not have the time to do my other work at the same time and did not have the pleasure of hearing her speech on the National Insurance Bill—did indicate that certain adjustments or changes might take place in the future in regard to the Assistance Board. Without saying anything more than that—and I hope I have not said anything indiscreet in saying that—I would say that the figure which the Secretary of State for Scotland gave, having in mind a charge of £4 5s. for dentures, having in mind a man and wife and two children, having in mind a reasonable sort of rent, will not prove to be so very wide of the mark. When we come to the working out of the proposals themselves it will, of course, be open to my hon. Friends, when the charges come into operation, to put Questions, and so on, and get some further elucidation from the Minister of National Insurance and from the Board itself, if there are further doubts about the matter.
1713 There was some talk during the Debate about the make-up of the charges themselves. As to the amount of the charges stated in the Schedule to the Bill, I will say in passing, since some doubt has been thrown upon these estimates, that, after all, my right hon. Friend and I get our estimates in the same way as every Minister standing at this Box ever has received estimates, and that, in general, these estimates made by the Departments do not normally turn out to be so very far wrong. [Interruption.] Well, these are estimates of savings and not of expenditure, and perhaps that may make a little difference.
The charges have been reckoned so as to give an immediate saving thought to be necessary to allow the necessary expansion of the hospital services. They have not been calculated on the principle of trying to ensure rigidly that they never exceed 50 per cent. of the cost to the Exchequer. In the case of the spectacles charge, for instance, it happens to be roughly half of the total cost to the Exchequer of supplying the spectacles, including the sight testing that goes with supplying spectacles; and similarly with the charge for the dentures. They have been so calculated not because we thought there was something magical about 50 per cent. but because we thought a charge of this amount should not be too heavy to be borne at the very infrequent rate it has normally to be borne, and because we were satisfied on the estimates presented to us that it would yield the necessary saving which we needed to make.
Will the right hon. Gentleman permit me? I want to get this quite clear. Did I understand him to say that a proportion of the charge is in respect of sight testing as distinct from the appliances?
§ Mr. Marquand
When we say that the charge for spectacles is approximately half the cost to the Exchequer of supplying them we are taking into account the payment of 14s. for the test as well; but it does not alter the fact that the total payment by the patient does not exceed the cost of the dispensing fee and the appliance itself.
I am grateful to the right hon. Gentleman, because I understood that what was being done here was merely to 1714 charge for the appliances, and not to open the door for the charging for items of professional services. I now appreciate that I was wrong.
§ Mr. Marquand
There will be, of course, no charge for examinations when they result in no provision of spectacles, and there will be, as we have said—all too frequently, perhaps—no charge for treatment for dental caries, no charge for filling teeth, no charge for the extraction of teeth, no charge for children's spectacles, and so on.
Reference has been made during this debate to an event that took place in 1931. There has been a suggestion that the Government in deciding——
§ Mr. Powell
This is a very important point that the Minister has just disclosed, I think for the first time to the House. [HON. MEMBERS: "No."] May I ask him how he reconciles the statement which he has just made with the Financial Memorandum presented with the Bill, which states in paragraph 3,In the ophthalmic service the charges proposed are 10s. for each lens plus the actual cost of spectacle frames. There will be no charge for testing sight…?Are we to understand that means that there will only be charges for testing sight that result in the supply of spectacles?
§ Mr. Marquand
If a person goes to an optician and after his sight is tested is found to need spectacles, he will be asked to pay the charges laid down in the Schedule. That is stated in the Bill. If a person goes to an optician and is found not to be in need of spectacles, he will pay nothing. That is also provided for in the instructions and notices which will be put up in the opticians' consulting rooms and in the dentists' waiting rooms.
I was going to say, in attempting to sum up the position, that those hon. Friends of mine who have referred to the events of 1931, which so many of us remember with distaste and horror, seem to have forgotten that there are in the Government men who at that time refused to follow MacDonald, Snowden, and Thomas into the adventure of 1931. Do they really believe that my right hon. Friend the Prime Minister and other colleagues of mine are suggesting now to the House anything comparable to the events of 1931?
1715 I myself—if I may allude to myself for a moment, because the hon. and learned Member for Hornchurch (Mr. Bing) very kindly referred to the work which I did as Minister of Pensions, and I would be ungracious if I did not acknowledge that kindly reference—in 1931 was a person of no importance. I was at that period out canvassing and working for my local Labour candidate. We are not going back on what we always believed in by introducing this Bill to the House. We introduce it because we believe that, in the emergency that confronts us, it is necessary that there should be a re-adjustment within the service because of the immediate necessity of the moment, and because we accept our responsibility in these difficult times to shoulder the burden of Government and not to shrink from difficult decisions merely because they are unpopular.
That is the reason why I ask my hon. Friends and the House to support us tonight, not because we want to betray Socialism, not because we are planning a desertion or betrayal of our party, but because we believe that the people of this country will respond to a Labour Party which can prove that it is not afraid of responsibility, and is not afraid to make awkward and difficult decisions merely because they are unpopular. It is in that spirit that I ask my hon. Friends behind me and the rest of the House to give this Bill a Third Reading tonight.
I well understand the misgiving that this proposal has aroused, and so do my colleagues in the Government. We have shown, I think, our understanding of these misgivings and our appreciation of the feelings that inspired them at this time by the adjustments which we have made in the Bill during its passage through the House. We have made it absolutely clear that the charges now to be imposed are to be maximum charges. We have arranged that the Bill shall expire in 1954 unless the circumstances of the moment make the Government of the moment ask the House for fresh powers; they will have to ask the House. I am sorry that I did not hear the speech of my hon. Friend the Member for Devonport (Mr. Foot) and I apologise, but it was due to the necessity of having refreshment that I happened to be out of the House when his name was called in the debate. I 1716 believe that my hon. Friend—or was it my hon. Friend the Member for Coventry, East (Mr. Crossman)—said that this would expire just as the bill for re-armament was at its height. That may be, but it will expire, I hope and trust, just as the Chancellor of the Exchequer of the day is able to see the clouds breaking on the horizon and the possibility of removing these burdens from the body politic and going forward again to an improvement and expansion of our National Health Service.
I ask my hon. Friends to take no notice of the fly so skilfully cast by the right hon. and gallant Member for Kelvingrove (Lieut.-Colonel Elliot) and his hon. Friends today. Let them not believe that we are retreating or betraying the cause in which we have so often proclaimed our trust. I ask my hon. Friends to look forward with some confidence to the end of the three years and the possibility, if our policy is successful, that a more peaceful world will confront us at that time, that the great burden may be lessened and that we may be able to go forward to an improvement and expansion of our great National Health Service.
§ Question put, and agreed to.
§ Bill accordingly read the Third time, and passed.