Clause 1.—(CHARGES FOR CERTAIN DRUGS, MEDICINES AND APPLIANCES.)

HC Deb 03 April 1952 vol 498 cc1938-2042

4.45 p.m.

Dr. A. D. D. Broughton (Batley and Morley)

On a point of order. May I draw your attention, Sir Charles, very briefly, to three facts before we proceed with the actual Committee stage, and ask that in the light of those facts you will be good enough to give a Ruling? The first fact is that this Bill is one of the utmost importance, affecting the health and the happiness of many of Her Majesty's most loyal subjects.

The second fact is that the Government allowed only one day for the debate on Second Reading. That meant that we were allowed a debate for only six hours, and in the course of that debate no more than six of my right hon. and hon. Friends were able to speak.

The third and last fact to which I should like to draw your attention is that here on these Labour benches we have a wealth of knowledge and practical experience of the National Health Service. In the light of those three facts, may I ask you to give a Ruling that as long as valuable contributions are being made to the debate you will not accept a Motion of Closure from the Government on any Clause or any Amendment which you have selected for consideration.

The Chairman

I am indebted to the hon. Member for Batley and Morley (Dr. Broughton), for he did me the kindness, not only to see me on this subject, but to send me in writing what he proposed to raise. Of course, the acceptance or rejection of the Closure is really governed by what the position is at the time when it is moved, and one could not give any guarantee either to accept or refuse it. One must judge on each case as it comes along. I have to act on what is meant by the Standing Order, and I shall do it according to the best of my judgment.

I agree with the hon. Member in what he said about the number who spoke on Second Reading. During the time I was in the Chair I took a note of 34 Members who wanted to speak, and only 13 Members were called. It seems to me that when we get on to the Committee stage of the Bill it might be for the convenience of the Committee to take together the Amendment to Clause 1, page 1, line 9 and all the subsequent 14 Amendments which deal with charges being excluded from the Bill. If we could discuss them together, there would be ample opportunity for a wide debate, and at the end, if necessary, the Committee could divide on them one by one. That might give Members more freedom.

Mr. Hector McNeil (Greenock)

I think it will be found that in the Amendments put down by my right hon. and hon. Friends there is a very great range of argument and that very different circumstances apply to each Amendment. In some cases there is a matter of principle which can be argued, and in others there are specific reasons why the Amendment should be accepted. It would be of no assistance to the Committee to take them altogether and it might even be a considerable embarrassment to us.

The Chairman

Perhaps I went rather ahead of time, but I thought the suggestion that I was going to make would be helpful. I was hoping to meet the views of the Committee, but if that is not for their convenience I will not pursue the matter, and retain my right of selection.

Mr. H. A. Marquand (Middlesbrough, East)

I think it would be for the convenience of the Committee if we took together with the first Amendment on the Paper, which I propose to move shortly, the one which is down to Clause 1, page 1, line 9. Perhaps it would be for the convenience of myself and my hon. Friends if they were taken together.

The Chairman

I do not quite understand. This first Amendment I thought was very similar to the first Amendment to Clause 2, also standing in the name of the right hon. Gentleman the Member for Middlesbrough, East (Mr. Marquand), and that it might be for the convenience of the Committee if those two were taken together.

Mr. A. Blenkinsop (Newcastle-upon-Tyne, East)

I think it might be for the convenience of the House if we took the first Amendment on the Order Paper and then the Amendment at the top of page 329, which is a proviso which goes with it. I do not know about the other.

The Chairman

They go together, but if the Amendment is defeated the proviso of course will fall.

Mr. Bevan

I wish to put a point arising out of your first statement, Sir Charles, when you said that it would be convenient to take these various charges together in a general debate and then subsequently you said that if that did not commend itself to the Committee you would continue to exercise your right of selection.

May I put it to you, in view of the fact that the whole essence of this legislation is discrimination as to what particular service there should be charges on, each Amendment should be taken separately, because the Minister himself has pointed out that, whereas it might have been in their minds to do it, the Government have now decided not to make regulations naming charges for aural aids and also not to charge for dental examination for those under 21?

Therefore, we have a Bill, the essence of which is that the charges are not all on certain services. In my respectful submission, it would be entirely inconsistent with the spirit of the Bill if the Chairman found himself unable to select an Amendment which left out a charge on a specific service.

The Chairman

I only suggested that they might be taken together in view of the fact that so many disappointed Members on the Second Reading did not have a chance to speak, and I thought that if we widened the debate a little they would be able to take part. It was only my suggestion, and I withdraw it now. We can take the Amendments one by one, I keeping my right to select Amendments under the Standing Order.

Mr. Marquand

I hope I did not make an error in the proviso to which I intended to refer as being something which could be taken with the first Amendment on the Order Paper. I thought it was not unreasonable that those two should be taken together.

The Chairman

I thought I made it clear that what I was pointing out was that the proviso will fall if the Amendment is defeated.

Mr. Edward Evans (Lowestoft)

Sir Charles, you referred to your right of selection of specific Amendments. Would it be in order for you to indicate to us what you are proposing to disallow, in order that we may be able to bring together those Amendments standing in the names of my hon. Friends and myself so as to get them in proper focus in the debate.

The Chairman

No, it would not, because I have not yet made up my mind. My offer, which has now been refused by the Committee, was to take the lot together. As we go along I have to decide what Amendments to call and what not to select.

Mr. Marquand

I beg to move, in page 1, line 6, after "making," to insert: before the first day of April, nineteen hundred and fifty-four. This Amendment is put down at the earliest point of the Committee stage to give the right hon. Gentleman the first available opportunity to remove what we regard as the most objectionable feature of the Bill. Picking it out as the most objectionable does not mean we do not regard this Bill as very objectionable indeed, and the acceptance of this Amendment would not remove our objections to the Bill, but it might help to remove the feeling which exists throughout the country that it is the Government's intention in this Measure to deal a body blow at the National Health Service.

The Bill proposes far reaching changes in the National Health Service Acts and it sets no term to them. Indeed, so far reaching are these contributions in some respects that not only does the Bill disappoint the expectations of the nation, which was promised a comprehensive National Health Service as long ago as 1944 by the Coalition Government, but it radically changes provisions which have been in existence ever since 1911.

The proposals themselves, when they were put before us by the right hon. Gentleman, were not justified on the ground that far reaching changes were necessary in the National Health Service. The right hon. Gentleman did not come to the House and say, "After a very careful review of the whole of the Service, I find great defects which ought to be rectified." It is true that he referred in a kind of subsidiary form of argument, to the possibility of there being some abuses, but he rested his case on the ground of the national emergency. He said that Government expenditure must be reduced, and the overwhelming need to reduce Government expenditure was put forward as his main justification for the Bill.

I do not accept that argument, and neither do my hon. or right hon. Friends on this side of the Committee. I accept that the right hon. Gentleman feels that it is overwhelmingly necessary to reduce Government expenditure at this time, despite the very large size of the surplus which the Chancellor of the Exchequer expects to get at the end of the year. Even though he may feel that the present situation demands such drastic reductions in Government expenditure and that this Bill is necessary, surely he believes that the Government will eventually surmount those difficulties.

Surely he is confident that the Government, through the wise administration of his right hon. Friends and himself, will eventually find a way through our difficulties so that they will be overcome. Then he will be able to go to the nation and say, "Our difficulties are over. We have rectified the balance of payments and we have abolished internal inflation and all those dangers." We, on this side of the Committee, doubt the course of the policies of the Government, but we hope for the sake of the nation that he is right.

If we assume that the right hon. Gentleman is right, honest and genuine in the belief that he must reduce Government expenditure for the purposes which I have mentioned, surely he looks forward to the time when the emergency will be over, when he can proceed to provide that better service, which, as I have reminded the Committee, was promised in the Conservative Party's Election Manifesto. This Amendment provides the right hon. Gentleman with just that opportunity.

When we have gone through the difficulties which justify the imposition of the charges, let the Government take the opportunity of looking again at the Service to see what effect the charges which he proposes will have. Let him even take the chance of reconsidering the working of the whole Service, to see whether it is really true, as was said in one of the Election Manifestos, that the Service had failed to provide adequately, for example, for the care of mothers and children.

5.0 p.m.

The Bill which was introduced in 1951, and to which a great deal of reference was made during the Second Reading debate on the present Measure, had a definite term to it, though it gave an opportunity for annual renewal if the emergency which justified that Measure had not come to an end. That is precisely what we are now proposing.

The Amendment which I have moved, and the other Amendment to which I have alluded, are designed to provide in the Bill exactly what we provided in the National Health Service Act, 1951—that it should come to an end on 1st April, 1954, so that its effect and the state of the Service in relation to the economy of the nation as a whole might be reviewed.

Perhaps I might be allowed to quote shortly from what I said on the Committee stage of the 1951 Bill. I said: We should afford an opportunity to review the position and to be sure, after a reasonable interval, that the need for the charges still exists. At the same time, we should take the opportunity then to consider questions which ought to be answered. For example, how far have the charges—after this period has elapsed—been beneficial in improving the Service for children. That is one of the arguments used again in regard to the Bill. How far has any reduction taken place in that rather alarming figure of 61 per cent. for dentures which I quoted on the Second Reading of the Bill? Has there been any improvement in the numbers of school dentists? That will be an important question to answer after a period of operation by the Bill in front of us, if it becomes law. Have the charges imposed caused any hardship to anybody? How many persons have received payment from the Assistance Board? That will certainly be a very relevant question to ask after a time, if the Bill goes through. How has the cost of glasses"— but that is irrelevent to the Bill. Has it been possible to vary the charges downwards? Have economies, in the meantime, been worked out to make it unnecessary to continue the charges."—[OFFICIAL REPORT, 2nd May, 1951; Vol. 487, c. 1312.] Those were, I suggested in the debate at that time, some of the questions which would need to be answered after a period.

A good many other questions will have to be asked as well as those, if the Bill goes through. We shall want to know the effect—and the Minister ought to want to know it—at the end of a period. What has been the effect upon the dental health of the population of imposing charges for dental treatment? He will want to know the effect upon disabled persons living in very poor circumstances. Has the charge for appliances led them to put off for too long renewing their appliances?

There may be other questions; and there ought to be an opportunity in the Bill for the House to get the answers and for the Minister to review the whole situation. If, on mature consideration, he then decides that he has made a mistake, or that he and his hon. Friends have been successful in conquering the economic difficulties which now beset us, he can alter the Bill, get rid of it altogether, or allow it to lapse.

The most important question of all was that which I mentioned at the latter part of the extract which I have given from my speech in 1951. The most important sentence is whether other economies have been possible in the meantime which may have reduced the need for savings by the method of charging.

On this side of the Committee nobody has ever advocated an extravagant and wasteful National Health Service. We may have been criticised for making the content of the Service too wide and for not restricting it at some point or other. We may have been generous, but we have never wished to be extravagant. Nobody ever suggested from these benches that there should be a prodigal throwing away of national resources in an unnecessary manner on the Health Service. Indeed, the main burden of the argument of hon. Friends behind me who disagreed with the Bill that I introduced a year ago was that there should be, if possible, a more prudent and economical administration so as to make the charges unnecessary. That has been the standpoint of all of us. Some of my hon. Friends said that there was not enough economy, I said we were making all the economies we could. There was no difference between us on the point.

I listed, in that debate, many economies that had been made, including the reduction of travelling expenses of patients and the appointment of teams of experts who were to visit the hospitals, and have visited them in very large numbers—which I gave at that time—to secure reduction in the size of establishments or to prune, wherever excessive administration expense on staff and the like might have occurred. I talked of the practice of the centralised purchase of hosiptal supplies, by which I was able to say that a saving of at least £2,800,000 had been made as compared with other methods.

Since that time a good deal of progress has been made in that direction, as I have reason to know. I should like to know in particular from the right hon. Gentleman whether the central purchase of all paper for the National Health Service is now in operation. I made plans for it while I was Minister and I would like to know whether it is fully in operation. I hope it is.

I mentioned also the possibility of economy on the drug bill. It was the large size of the drug bill to which the right hon. Gentleman particularly pointed when he was introducing the Bill as one of the reasons for effecting a saving. He said that the drug bill was going up so fast as to make that necessary. I referred to the work of the joint committee on prescribing, which did not consist only of mild recommendations as somebody has been inclined to suggest, but actually achieved reductions in price of quite a number of drugs. The committee published a list of recommendations which went out to doctors all over the country of remedies which ought not to be provided under the National Health Service.

I would like to mention particularly the special investigations into the position in particular areas which have been going on. They went on when I was Minister and during the time of my precedessor as well, I think. I cannot quite remember when they started. They are special investigations in particular areas, and I think they are still in progress, for going through the actual prescriptions of individual practitioners and, after careful scrutiny, drawing the matter to the attention of people who may be thought to be prescribing in an unnecessarily expensive way. Handled properly, this investigation in relation to the reaction of the general medical practitioner—

The Deputy-Chairman (Mr. Hopkin Morris)

The remarks of the right hon. Gentleman seem to be directed not so much to the Amendment as to the Clause. The effect of the Amendment is to limit the duration of the Bill to 1954. It is a strictly limited Amendment.

Mr. Marquand

Thank you, Mr. Hopkin Morris, I am sorry if I have been trespassing. Perhaps I can reserve some of these remarks until we come to the Question that the Clause stand part of the Bill.

Mr. Blenkinsop

On a point of order. It would be for the guidance of many of us, Mr. Hopkin Morris, if you could give us guidance on the following point. Is it not completely valid to the issue as to whether the charges are to be temporary or permanent, that other schemes which will bear full fruition in two or three years should be discussed? Unless we know whether these are practicable schemes, we cannot make any decision in Committee as to whether this should be a temporary or permanent charge.

The Deputy-Chairman

It would be more appropriate on the Question that the Clause stand part than at this stage.

Mr. Bevan

Is not the argument in our debate strictly relevant to the main case made by the Minister for the Bill? The main case was a fiscal case. Indeed, the second speaker for the Government made the statement that the Bill was necessary to increase charges to make people spend more on medicines so that they would spend less on imported goods. That being the case, the reason for the Bill is strictly related to the financial emergency. What is now suggested is that the Bill should end in 1954 because, by that time, the excessive expenditure on arms should have ceased and the emergency therefore, be at an end. So that, on time, the widest debate can take place if the Government observations were relevant.

The Deputy-Chairman

That might be true but, as I understand, the right hon. Gentleman the Member for Middlesbrough, East (Mr. Marquand), was pursuing another argument.

Hon. Members

No.

Mr. Frederick Messer (Tottenham)

May I submit this point? I had it in mind to support this Amendment and, in doing so, to state as a valid argument for it that there is a wide field of economy as yet untapped. If, however, the argument has to be left until we have the Question that the Clause stand part, it will be of no avail because the Amendment will not have been carried.

The Deputy-Chairman

If it is an argument, it appears to me to be in order, but if it is a review of the whole Act it is out of order on this Amendment.

Dr. Stross

Could you help me on this point, Mr. Hopkin Morris? As I see it, not only was a fiscal case made out, but we were given to understand that there had been abuse of the service. Those were the two issues put before us on the Second Reading. Here we are considering putting a term to the charges at a specific date. We have a precedent because it was in a previous debate. I do not see how anyone like myself can argue in favour of this Amendment if I cannot mobilise the reasons why I think there must be a term, and in doing so I have to consider what is happening over the whole field of the service, although as briefly as possible.

If, therefore, I am successful in catching your eye, am I not entitled to argue that this is the wrong way to save the money, that it is fiscally wrong? Other ways have already been suggested by a previous speaker by which we can more effectively save money, and those have not been tapped. Also, it is questionable whether there is any need to do this to prevent abuse.

5.15 p.m.

The Deputy-Chairman

The right hon. Gentleman the Member for Ebbw Vale (Mr. Bevan) put the argument accurately, but I do not think that this Amendment is an opportunity for a general survey of the entire Health Service.

Mr. McNeil

The Bill proposes to make limitations extending over the range of the service, and if we are to advance reasons showing why, in terms of time, a restriction should be placed on the Act, surely it is relevant to consider how the Service is operating. Therefore, the widest debate must be in order now.

The Deputy-Chairman

If the arguments are relevant at this time, certainly.

Mr. Marquand

I remember well that we had a similar query raised a year ago when, Mr. Hopkin Morris, your predecessor in the Chair, after asking me what was the relevance of a discussion of economies to a date, accepted my explanation that I was putting a date into the Bill because I had justified my original request for charges on the ground that I needed urgent economies which I could not at that time make in any other way; but that I was seeking by other methods, which I then outlined briefly, to effect the economies, and that I hoped it might be possible at the end of the period set to that Bill, to come to the House and say that, as those economies had been effective and as the national situation had now so improved, the need for that limit of expenditure no longer remained and we could let the Bill lapse.

I think the right hon. Gentleman is in the same position today as I attempted to argue then. He also would be well advised to set a term in the Bill. He also would be well advised, in the interval between now and that term, to explore vigorously all the possibilities of reducing the abuses, which he says exist, or economising generally in the Service, the need for which we do not deny. He referred particularly to the drug bill and that was why I mentioned, in the most cursory and passing way, the possibility of other economies in the National Health Service and was addressing myself particularly to the possibility of economies in the provision of drugs, which was the main justification for the Bill.

I would like to pursue that point although I have no intention of delaying the Committee long, with these observations. I had hoped to introduce a fairly wide debate on the important principle of whether or not what is now proposed is intended to be a permanent part of the Service, whether it is attempted to be a remedy for existing defects, a provision against certain economic difficulties, with a full and honest intention of going forward again to the development of the Service after the war, or whether it is an attempt to hamstring the Service by imposing permanent charges which I regard as injurious. I said a year ago: I say, in all seriousness, that whatever method anyone can suggest for reducing unnecessary consumption of medicines he must have the co-operation of the medical profession if he is to make it effective."—[OFFICIAL REPORT, 24th April, 1951; Vol. 487, c. 237.] I say that again. Even if the right hon. Gentleman succeeds in persuading Parliament to allow him to make charges for prescriptions, he will still need that co-operation. The charges for prescriptions which he proposes would be ineffective if they should lead to any kind of incentive to doctors to be over-generous in order to shelter their poorer patients from the effect of the charge. That co-operation for which I appealed a year ago has been forthcoming in a growing degree. At all points and in every way it is not as good as one might desire, but it has been improved, and I want to know from the right hon. Gentleman whether the project of a prescriber's bulletin, which was being discussed when I was Minister, has now come to fruition, and whether such a bulletin will shortly be issued.

Mr. Crookshank

I am quite prepared to answer, of course, but I wonder how far this is relevant to the Clause. The Clause deals with prescriptions and appliances as part of the hospital service and with out-patients of hospitals. Therefore, I am not at all sure that questions about prescribers' bulletins come into this. We are not discussing the whole field of medical service, but just a part of it.

Mr. Marquand

The prescribers' bulletin, if it is issued, would be of value to those who prescribe within the hospitals just as much as to those who prescribe outside them. I understand that good progress has been made and I merely wish to know whether we may expect that prescribers' bulletin at an early date.

I am confident that the issue, with the full co-operation of the British Medical Association, of a prescribers' bulletin, guiding doctors through the intermediation of their own professional body, and not merely by what might look like an ipse dixit or dictation from the Ministry of Health, should be a very fruitful means of ensuring the utmost economy without injury to the patient, which, we all know, is possible. That sort of guidance would be going out to the dispensers in the hospitals as well as to the general practitioners.

I certainly think that the opportunity lies ready to the right hon. Gentleman's hand if he will take it. It would be out of order for me to refer in detail now to the discussions which I had with the British Medical Association. I quote, however, from the British Medical Association Journal: The Committee gave an assurance that it would be the aim of its representatives … to work harmoniously with a desire to provide the best possible service for the public and make possible a better and happier atmosphere among the doctors who take part in it. With that went a good understanding between us that there would be a strong effort to reduce the size of the drug bill.

This is the question which I have to put to the right hon. Gentleman. Does he believe that it is still possible, by his methods of co-operation with the medical profession, to reduce the drug bill and to prevent by means of this kind the waste which, he says, exists? Does he intend to pursue these things with vigour? If he does, is he not prepared to say that he will allow the Bill to run for a period of two years, during which he can pursue methods of economy of this kind, and then come back to the House again and render a report of his activities? That is the purpose of the Amendment. It would give him the chance in April, 1954, to report on efforts to economise, as well as on the success or otherwise—the incidence upon the people—of the charges that he proposes in the Bill.

The date we have chosen because it is the one which went with the 1951 Act. If the whole thing came to an end in April, 1954, the nation could hold a grand inquest upon the National Health Service. I use the word "inquest" in the sense of that famous phrase, and not, of course, in the medical or forensic sense. We could hold a great public inquiry into the condition of the Service. A report might, perhaps be published by the right hon. Gentleman, or by whoever is in office at that time, surveying the whole thing.

It would be a good time to look at the Service again. It would be six years old, and it would be reasonable to review it in a comprehensive way and to have a great debate, not merely in Parliament, but in the newspapers, on the radio and by all the methods of modern publicity, so that the whole nation could participate and be better educated in what the Service really does, what it really costs and whether the effect of the various Measures which have been passed amending the Act since it was originally introduced have been good or bad.

Finally, I ask the right hon. Gentleman: Does he believe in a comprehensive Health Service for the whole nation, available in proportion to need and not to private wealth? If so, if he would accept that ideal which we hold on this side of the House, he would be bound to accept the Amendment. In that way he would be publicly declaring that these things are emergency measures, that they are justified by the need to economise in Government expenditure and justified because at present various measures of economy which I have in mind cannot be brought fully into operation and which, in the long run, are not the sort of things that I should like to see.

I should like to put an end to this kind of thing. I should like to go back to the ideal of a comprehensive, widely embracing National Health Service, satisfying the whole people on the basis of their needs. If the right hon. Gentleman will do that, then indeed we may be led to believe what the Conservative Party so frequently said in their Election propaganda about the Health Service.

Mr. Enoch Powell (Wolverhampton, South-West)

The right hon. Member for Middlesbrough, East (Mr. Marquand), who proposed the Amendment, finds himself in a very piquant situation. The wording of the Amendment is almost identical with the operative parts of Section 5 of the National Health Service Act, 1951, the Bill for which he himself presented to the House. The interesting fact is that that Clause was not in the Bill as originally presented by him. It was introduced upon Report stage in deference to views expressed on the benches behind him. Anything, therefore, that he may say regarding my right hon. Friend's doubts for the future, his fear that these charges might have to be permanent, and the doubt whether compensatory economies can in fact be made elsewhere in the Service, recoils upon the right hon. Gentleman.

The right hon. Gentleman came down to the House a year ago and presented a National Health Service Bill in which charges comparable with those in the present Bill were embodied, without any qualification, proviso or terminal date whatsoever. He, therefore, is the last person who ought to get up in the Committee and complain now that there is no proviso in the present Bill.

Mr. Marquand

The hon. Member will, I hope, do me the honour of remarking that in my Second Reading speech, said that the Measure was not intended to be permanent.

Mr. Powell

Of course. No Acts of Parliament can be permanent. There is no such thing. [Interruption.] It may be that hon. Members opposite are not aware of the constitutional principle that Parliament cannot bind itself. Nothing which is written into any Act of Parliament is incapable of revision. The whole question, therefore, as to whether the charges in the Bill are permanent or temporary is a matter of shadow fighting; but if the absence of a terminal date from the Bill implies an intention on the part of the Government to maintain the charges in perpetuity, that complaint falls equally upon the right hon. Gentleman himself.

5.30 p.m.

Mr. Marquand

I am sorry if I did say that the Act was not intended to be permanent. That, of course, would be too obvious to be said at all, but what I did say in introducing the Second Reading of the Bill was that these charges need not be regarded as a permanent part of the National Health Service.

Mr. Powell

If the right hon. Gentleman felt that about the charges he imposed last year and nevertheless did not write a proviso of that sort into his Bill but was only driven to do so by pressure, there is no reason for him to complain of my right hon. Friend not following suit. My right hon. Friend is not in the same kind of difficulty as the right hon. Member for Middlesbrough, East, was.

Dr. Stross

The hon. Member has made a very clear statement as to the effect we on these benches were able to have on our own Minister. We are waiting with great anxiety to see what effect the hon. Member and his colleagues will have on their Minister.

Mr. Powell

I think the hon. Member will be interested if I remind him of what I think was the best comment made upon the proposed Amendment as it stands in the 1951 Act. It was made by the hon. Member for Ayrshire, South (Mr. Emrys Hughes), whose absence from the service of the House we all deplore, although compensatory advantages may be accruing elsewhere. Referring to the provisions it is now proposed to move into this Bill, he said: I am quite convinced that from these benches will come the very definite statement that this Clause was one of the most stupid and badly thought out Clauses ever put into a piece of legislation by a Labour Government. It is that very wording which the right hon. Gentleman is now trying to move into my right hon. Friend's Bill.

The fact is that this Amendment, as my right hon. and gallant Friend the Member for Kelvingrove (Lieut.-Colonel Elliot) remarked last year, does not mean anything one way or the other and might just as well be added to the Bill as left out."—[OFFICIAL REPORT, 7th May, 1951; Vol. 487, c. 1622–7.] Later on I shall show reasons why in the case of the present Bill it would be actually harmful to import these words. The fact that the Amendment then made to the 1951 Bill was nugatory and useless is illustrated by the fact that it is to be removed from the Statute Book by the present Bill. There is no possible point in fixing a period of time in a Bill of this kind when at any time from year to year the Minister of Health can come to Parliament with an amending Bill and, even without coming to Parliament, can modify the regulations he makes, or not make any regulations at all.

Mr. Blenkinsop

Surely the hon. Member will agree that with that provision in the Bill it does at least enforce the reopening of the whole issue at the period stated in the Bill, which is not required of the Minister if that provision is not inserted.

Mr. Powell

On the contrary, the hon. Member knows perfectly well that the Government would have no serious difficulty in obtaining an affirmative Resolution to an extension by Order in Council as provided in an Amendment which perhaps the right hon. Gentleman will be moving at a later stage. There is, in fact, no need under his Amendment for the matter to be reopened. Similarly, there is no reason without this Amendment why the matter should not, if necessary, be reopened sooner.

Mr. Blenkinsop

Surely the hon. Member will agree, as indeed he and many of his hon. Friends have argued in the past, that an affirmative Resolution does provide that there shall be an opportunity of debate in the House which is not available in another way.

Mr. Powell

Certainly, if the modification had not taken place before the date mentioned in the Amendment, then an affirmative Resolution would be necessary; but there is no reasonable doubt that as long as a Government remains in power it can get an affirmative Resolution and therefore the charges, if still desired, can continue.

There is a stronger and slightly different reason why the date should not be inserted to which I now come. I want to emphasise that all the arguments of the right hon. Gentleman to the effect that it might be possible in due course either to dispense with these charges, or to reduce them, or to replace them by others, are irrelevant to the point the Committee are considering.

The Committee are not considering at the moment whether or how soon modifications might be possible. The Committee are only considering the expediency of writing into this Bill what purports to be, although in fact it is not, a terminal date. I believe there are strong reasons of public policy why that date should not be inserted. Last year the right hon. Gentleman was pressed to insert the date 1953 in his Act of 1951, and he objected to doing that because people, believing that the operation of the Act would only be for two years, would hold off from availing themselves of the services.

Exactly the same argument applies against writing the date 1954 into this Bill of 1952. Very harmful consequences would follow to public health from the misunderstanding, which the public would gain and which it is the object of hon. and right hon. Members opposite to instill, of what was meant by the date in the Bill. Patients who required, or thought they required, treatment under the National Health Service would be tempted by such a proviso to hold back from month to month and year to year on the chance that they might thereby eventually escape the incidence of the charge.

Mr. Messer

Does the hon. Member really believe that patients read an Act of Parliament?

Mr. Powell

I can only say that this consideration was in the mind of the Government of last year who declined to write 1953 into their Act a year ago precisely on the ground that it would induce patients to hold off from availing themselves of the Service.

Dr. Horace King (Southampton, Test)

rose—

Mr. Powell

I have given way a great deal. I think that I might be allowed to continue. To hold out at present the suggestion that in two years' time this Measure will come to an end—because that would undoubtedly be the impression which would be given—would be to sabotage many of the benefits of the National Health Service. One of the great features of the National Health Service—and I believe this Bill strengthens instead of weakening that feature—is that it induces the patient to obtain treatment and advice. That effect of the National Health Service would be partially negatived in my submission by writing an assumed terminal date into the Clause. I hope, therefore, that my right hon. Friend will resist this Amendment.

Mr. Messer

I have been very interested in the last speech. It follows so closely speeches we hear to the effect that "This Amendment does not mean anything at all and, therefore, I am going to oppose it for all I am worth." I cannot quite understand that reasoning. If it is true that the Amendment does not mean anything, I take it that the Minister will be prepared to accept it.

I want to put forward some reasons why I support Amendment. To me it is a very sad day when we have to destroy what I believe to be the most important element in the National Health Service. For the National Health Service to be a success, I think it has to have three very important factors. The first is that it has to be comprehensive—that it has to include everybody and that nobody shall be deterred from getting its benefits. It may happen that the cost of the Service is such that the country has to consider just how it can afford to give everyone those benefits and an argument is thought out for temporarily imposing an obligation on the patient. I think that is true.

It is no use our refusing to face the fact that £400 million is a lot of money. Indeed, one of the reasons why I think financing the Service is wrong is that it provides too big a target for any Chancellor, whether he be on this side of the Committee or that. It would be felt that a figure of £400 million must provide means whereby there should be some reduction. Why I support this Amendment is that it does at least tell the world that it is temporary; it is for a period. We are not making permanent, as a feature of this Service, payment by that section of the community which can perhaps least afford it.

Why I believe the period laid down is right is because I think that within those two years there will be given an opportunity for investigating the whole of the Service to see where economies can be effected. I want to be honest. I think there ought to be economies in the Service. There is a measure of irresponsibility. There is no disguising the fact that money is being spent which ought not to be spent. I do not say it is the fault of individuals, in every instance. But I give this fact, and it is a fact, that on the general practitioners' lists in Middlesex there are a larger number of patients than there are people in the county. The lists are in excess of the population.

That is not the fault of the general practitioners. Some of us know the reasons for the double-listing of certain patients. But there is a field there for investigation. The doctors themselves do not want it. They cannot help it. It would be wrong to criticise the general practitioner service because we have instances like that. But in those two years we can have an inquiry into the machine.

Let us take the example of the hospital service. That service costs about £250 million out of the £400 million, and everyone will think at once that here is a field for economy. But where shall we look for the economy? Ought we to look to the patients for it, or ought not we to have some regard to the administration? I am convinced that in the field of administration there is an opportunity for discovering where there is a waste of money.

It is not intentional. Nobody wants it. It is due to the structure of the Service which by its incidence prevents that real economy and the saving of money which could be brought about. May I refer, although I do not want to go too much into what has been done, to the centralisation of buying? May I be forgiven for a personal reference? I was chairman of a very big health committee, and what we did when we wanted to buy was not to go to the dealers. We went to the potteries and got the potteries to make the crockery for our hospital services, which covered a population of two million.

We went into Lancashire and got the textiles we required. We went to Sheffield and got the cutlery. We were able to buy cheaply because we were able to do central buying. I am not saying that some of that is not being done, but it is a very gradual process. As has been stated, the Ministry itself has centralised certain things which have resulted in big economies. Why cannot we go on with that investigation for a period of two years? At the end of that time I am certain that we should be enabled to exercise a measure of control.

We knew from the beginning that this was an experiment. Nothing like it had been attempted before. I remember when a delegation from the United States of America came over here and were inquiring into the working of this Service. They expressed surprise that we should have attempted anything of the sort. It will not be a popular thing to introduce in America. But they were surprised that we had been able to tackle this thing and, in the short period it had existed, to have done as much as we have done.

5.45 p.m.

I do not want to make a Second Reading speech, but I do want to argue in favour of there being a term to this particular aspect of payment by patients. There surely are two things—perhaps one of two things, or perhaps two things—which we have to examine. What is the purpose of the Bill? Is it to deter, or is it to save money? Is there the assumption that there are people getting treatment when they do not want it? People do not go into hospital for fun. People do not go to the doctor just because they like the look of the doctor, or think that the doctor might like the look of them. People do not go for the Service for any other reason than because they need it.

If therefore they are deterred from going to the doctor, that will be attended with very sad consequences for them. In connection with a later Amendment which we have down, I wish to refer to some of the serious aspects of that deterrent. If there is one thing that this Service has done so far, it is to fling wide open the doors which were closed against the wives of insured people. What we are doing in this Bill, and surely we ought not to continue it for more than two years, is to make insured people pay for prescriptions which they never paid for before.

We are going back; for years ago it was laid down that there were certain types of cases which could get their treatment free. We have seen advertised on the hoardings and in our newspapers inducements to people to have treatment, because what they were suffering from was not merely something which was medically wrong with them but something which was a social problem too. We are going back, because we are deterring those very people whom, for their own safety as well as the safety of the community, we want to induce to have treatment.

I suggest that hon. Members opposite, those who are supporting the Government, really want to provide a service that will give all the facilities the rich man can have to those who are not rich. Strangely enough, we shall find that the victims of this penalising will not be the very poor. They will easily be able to get these prescriptions, to get these appliances, paid for by the National Assistance Board. Those who are rich will have no trouble, but there are the people, a very big strata, who will not go to the National Assistance Board, but who cannot afford to pay. They will not get the treatment. They will be deterred.

It may well be inevitable, because the nation comes first, that we may not be able to give treatment to all who need it. If that is the case then let us limit the period to two years; so that at the end of that time, by examination of this service which really needs examination, we shall be able to find a system whereby we can give these people not merely what they need, but what is their due.

Health is not merely a question of the individual. It is not merely a question of one's feelings. It has an economic value, and the nation cannot afford not to give the people the treatment they need at the time when they need it.

Sir Ralph Glyn (Abingdon)

I should like to say something about the speech of the hon. Member for Tottenham (Mr. Messer). The hon. Gentleman and I have been in the House a very long time, and all of us know the great contribution which he has made to the Health Service in the country and the personal efforts which he has made. Therefore, any contribution which the hon. Member makes to a debate of this sort is one to which we should all pay attention.

I want to say one thing about this Bill and what I feel about it. It has been distressing to me to hear from very many hon. Members on the other side that they assume that we on this side are opposed to the National Health Service. We are not, but, as the hon. Gentleman opposite has just said, there are undoubtedly flaws in what was a very great experiment, and it was inevitable that there should have been such flaws.

I do beg the Committee to realise that some of us do not want to make this a party matter. It is a national matter. We are dealing with the health of the whole of the people of the country, and I very much regret that in all these debates the party spirit has been brought in. I certainly do not want to add any fuel to those flames, because I think that we are being judged in the country today in a way that a great many of us do not quite appreciate.

I think that the people up and down the country are watching the House of Commons and wondering what we are doing. I think that our performance is not altogether up to their expectations. [An HON. MEMBER: "You are telling us."] Well, I am telling everybody, and all I want to say about the speech to which we have just listened is that it contained a great deal to which we should pay attention.

My own feeling is that we shall not cure the evils of the Health Service on party lines, and that we are only going to cure them by all working together for the benefit of the country as a whole, and in trying to do something to make this Service better. Some of us, when the Beveridge Report was first published, risked a good deal on our side to support it. We did that in previous Parliaments, and I do not regret it for a moment, but I do regret most bitterly the way in which we seem to be falling down and getting into bitter party controversy on a subject which ought not to be concerned with party at all.

I do not want to say anything more, except that I do plead with both sides not to continue to put party in front of what is a great national necessity. Do not let us run any risks of falling back on what has been a great experiment, which, if we remove its present blemishes, will be supported by everyone, irrespective of party, in the whole country.

Mr. J. Grimond (Orkney and Shetland)

I should like to join in what has just been said by the hon. Baronet the Member for Abingdon (Sir R. Glyn) about the last speech to which we listened from this side of the Committee. The hon. Member for Tottenham (Mr. Messer) speaks with great authority on the social services, and I should like to support his main plea, which, as I understood it, was that the primary task at present was a full review of the National Health Service.

The hon. Member for Wolverhampton, South-West (Mr. Powell) drew attention to two objections which he had to this Amendment. He argued in the first place, that it is nugatory. That is certainly technically true, but I am not certain that it is therefore necessarily useless. Secondly, he referred to a more substantial objection, that it will encourage people to delay necessary treatment. That will only become a serious matter, as I think the hon. Gentleman would agree, in the last few months, when the Act is in danger of running out.

Mr. Powell

If the hon. Gentleman bears in mind that this Clause covers such things as appliances, abdominal trusses and so on, he will realise that a person could go on putting off getting the appliance, not only for weeks but for months, because of the idea that he might eventually get it free or at a much lower charge?

Mr. Grimond

I do not want to labour the point. There are certain appliances the acquisition of which may be put off year after year, but I do not think it likely that people will do that from the majority of cases that will fall under the Act.

What I should like to ask the Minister is whether he can give the Committee some assurance that the Government are going to take steps to put in hand this review, which will, I think, almost inevitably mean a new Act long before 1954. I think that this is the appropriate moment when we are bound to ask the Government for some indication of what their thinking is.

The present position, as I follow it, is that a rough and arbitrary ceiling was imposed on the Health Service and upon other things in the days of Sir Stafford Cripps, and it has often been pointed out that that ceiling came on at a particular moment because of our financial position and that it was fixed with very little relevance to the needs of the Service, or, probably, very little consideration of how much money we might need for health, how much for education and so on.

In the last two years, there have been considerable changes in the form of the Service to keep within that ceiling, and, as was pointed out in the debate last year, it is now no longer a free Service, because there are charges.

Some people think, and with good reason, that that is a very important new principle. I myself feel—and I also agree with the last speaker that this was probably inevitable—that we cannot face the continual rise in the cost of the Service. It would get quite out of proportion with the other social services, and would place a greater burden on the country than it ought to bear.

Charges are being imposed primarily for financial reasons, whether good or bad. I do not want to argue that point at the moment, but these charges are part of the campaign to make the country realise how important it is to take the situation in hand and begin in a new direction in regard to finance. There are other reasons, too. It has been suggested by the hon. Member for Enfield, West (Mr. Iain MacLeod) that certain of the charges will have the effect of helping the school dental service. But the financial argument is paramount.

The fact that we are making these cuts, to some of which I object, nevertheless is no reason for putting off indefinitely the review of this Service. It is not a reason for failing to give attention to what are the real priorities of the Service and considering such matters as capitation fees, rates of contributions and a whole series of other matters which do deserve consideration.

It may be that the Minister objects to putting this date into the Bill. I do not know what he will say about it, but I hope he will give us some idea of what the policy of the Government will be in the next two years, and whether we are to have these reviews of the service as suggested by many hon. Members.

Mr. Blenkinsop

I think we all support the appeal made by my hon. Friend the Member for Tottenham (Mr. Messer), to whom we all listened with great interest, when he asked us to consider this matter dispassionately and weigh up the rights and wrongs of expenditure upon health.

I think it would only be fair to say that the Government must have known that bringing forward a Measure of this character would be bound to arouse very strong feelings indeed, not only on this side but throughout the country. That became evident during the last few weeks in which the proposals of the Government were made manifest. I do not think it lies in the mouth of anyone on the opposite side to complain about what are essentially, in our view, political proposals, which are being attacked for that very reason.

6.0 p.m.

During the course of the Second Reading debate and of this debate we have heard various statements made about these proposals and charges that leave us in a very great deal of doubt whether they are put forward purely or mainly upon temporary financial grounds or whether they are part, as appears to be the view of the hon. Member for Enfield, West (Mr. Iain MacLeod), of that wide review referred to by the hon. Member for Orkney and Shetland (Mr. Grimond). It is of vital importance to us in this Committee that we should know the mind of the Government on this matter.

Obviously we can take one view of these proposals if they are put forward as part of a plan, rightly or wrongly, to deal with a temporary financial difficulty, which we all hope will be of short duration, and to help deal with the problem of the burden of re-armament. But if that is the reason we should know that that is so. If it is for that purpose then surely there can be no possible reason why a date such as is suggested in this Amendment should not be put to the proposal.

On the other hand, we have had both from the Minister of Health and the hon. Member for Enfield, West, arguments which relate to these proposals as part of a permanent new direction, which means nothing less than a revolution, a complete change, not merely in detail but in the scheme as a whole. Surely it means, and I think the hon. Member for Enfield, West, regards it as such, a new direction and a new principle to be established in the Health Service.

The hon. Member for Enfield, West, who spoke on this matter on Second Reading, started by defending the proposals as a temporary financial measure, and he adduced reasons why he thought this charge was necessary, just as it was claimed a year ago that the charges imposed by the then Government were imposed then for the same reason—because of a temporary financial difficulty, which presumably would be covered by putting a term of years to these proposals.

But he went on to argue on wholly different lines. He went on to develop arguments we have read with interest in pamphlets and other documents which he has provided for us—or perhaps not specially for us on this side of the Committee but for hon. Members generally—and which argue the case for a wholly different basis for a Health Service. If it is right that that should be argued, it is important that we should understand that we are taking part in that argument. I believe, with my right hon. Friend the former Minister of Health, that one of the important matters when considering this subject on its temporary financial basis is to see what other action is being taken by the Ministry to try and meet proper complaints of abuse from time to time.

My right hon. Friend has mentioned certain proposals which have been put forward and on which, I understand, action is being taken. In that connection the hon. Member for Enfield, West, said in his previous speech that there was something peculiar in the fact that the Cohen Committee was appointed before proposals for prescription charges were introduced in the House of Commons in 1949. He seemed to claim that that destroyed arguments put from this side. Of course it was appointed before prescription charges were mooted in 1949, but there was some time before one could find whether that Committee was likely to offer some fairly concrete and useful proposals that would help tackle this problem.

It became clear that it might be some considerable time, perhaps two years, before it would be possible to have the benefit of many proposals the Cohen Committee were making. It was evident that they had valuable proposals drawn up which, when fully in operation, would provide enormous benefit in procuring control, in particular over the prescribing field. Surely it is another argument why the proposals in this Bill should be limited to a period of not more than two years that there are these other proposals, which are undoubtedly of long-term consideration and which, in our view, are a much more valuable and much less dangerous way of effecting the economies we all agree to be necessary.

If is, of course, also important that at the same time we should do our best to ensure that the medical practitioners and those who are working in the hospitals to which this Amendment particularly refers should know much more than they appear to do at present about the cost of the prescriptions they prescribe. I am glad that a start has been made in making that information available. It is important that that arrangement should have an opportunity of working. That opportunity will not be granted if this Bill goes forward as it stands.

Mention has been made in the last few speeches of the hopes expressed by the hon. Member for Enfield, West, and the Minister, and others, that these proposals could be argued for on the grounds that they can provide some permanent value by transferring dentists from the treatment of adult persons to the treatment of children in the school clinics and in other ways. But that is a particularly futile suggestion when one remembers that at the same time the Chancellor of the Exchequer is requiring the right hon. Lady the Minister of Education to cut down on the Education Estimates, requiring local authorities, if not actually, to cut down the number of school dentists at least to limit the expansion of their number.

Therefore, it is quite ridiculous to talk as though it were going to be possible to make the transfer that the right hon. Gentleman the Minister of Health and the hon. Member for Enfield, West, talk about. It is quite absurd to talk about it when just a few seats along the Government Front Bench one of the right hon. Gentleman's right hon. Friends is taking measures to ensure that it cannot work.

I challenge the right hon. Gentleman to say whether he has an assurance that his right hon. Friend the Minister of Education can give a guarantee that all the extra places for school dentists can be provided under the financial provisions that are available to her. This is a perfectly valid point if we are discussing here whether these provisions ought to be of a temporary or a permanent character.

Mr. Baird

Does my hon. Friend not also agree that if the Government are to attract dentists from the public service to the school service, they will have to pay them more?

Mr. Blenkinsop

I agree with my hon. Friend. Whichever way one looks at it, the argument is fallacious, because either the transfer will not take place or, if provision is being made for it, there will be no financial saving. But the hon. Member for Enfield, West has put forward the argument that he believes in these charges as a permanent contribution to the re-direction of the Health Service as a whole. I am sure he believes that quite sincerely. He believes it is wrong to have a free Health Service. He thinks it is right to introduce charges of one form or another generally throughout the Service, and indeed throughout other services as well. He is perfectly entitled to put forward that view. We are entitled to know whether the fact that this is a permanent proposal means that he has convinced the Government Front Bench of that point of view. Does this proposal mean that the Minister accepts the view of his hon. Friend the Member for Enfield, West that there should be this comprehensive charge in the whole direction and principle of the Health Service, and that in future it should be a service of which charges are a necessary and a general part?

If so, it makes perfectly clear the division that lies between the two sides of this Committee. It makes it perfectly clear that while a year ago we found it necessary to impose temporary charges where we felt they would have the least evil effect, and on good medical advice, too—but which we always regarded as undesirable except for their temporary nature—now we are presented with proposals which envisage a gradual increase in charges over the whole field of the Health Service. Not only that, it suggests that it is a principle which would be worthy of extension to other fields.

On this side of the Committee we have never taken the view that there is no limit to the expenditure upon the Health Service. There must be. In fact, it is inevitable, if we accept the need for the planning of our economy, that the proportion we can make available to our Health Service must be related to the whole. In my view, however, it must be related to the national income. It cannot be argued about in the void without relation to other factors. It certainly cannot be argued about without relation to the change in the value of money. It certainly cannot be argued about without relation to the gradual increase in our national income which, at any rate, was taking place until a few months ago.

We need to have a general review of our Health Service but, instead of arguing about the extravagance of a specific figure without relating it to any other fact, we should know just what we are relating it to. We must make up our minds what we believe to be the proper proportion of our national income that we can set aside for our Health Service.

We have always accepted that there must be some limitation. That is why we have had to delay many projects which we have all wanted to go forward with in the Service. My hon. Friend the Member for Tottenham knows which they are probably better than anybody else here. He knows how often it has been our unhappy job to hold back on demands made upon us. There are so many services that could be regarded as a useful contribution to the health of the country which we have had to put off because we did not believe we could extend expenditure indefinitely.

6.15 p.m.

Therefore, it is not a question of our suggesting at any time that there was an unlimited field for expansion for the National Health Service against every other service. We must look at this matter on grounds of social need and on medical advice, and not assess our limitations upon an individual financial decision which will inevitably mean leaving out so many of the population whose needs are the greatest of all. When we think in terms of the proportion of our national income, it is wise to remind ourselves that in this country, so far from being extravagant on health, we spend a much much smaller proportion of our national income on health than does the United States. That is the advice of a reasonably authoritative survey reported on in "The Lancet" of an issue or two ago. Therefore, we must get our comparisons right.

As an example of the limitation we have always accepted, we thought it necessary to provide wheel chairs free under the service for those most severely disabled. They are covered in the Clause to which we have moved this Amendment. Cars as well as wheel chairs in some cases are made available free to those most severely disabled. If hon. Members opposite have their way, at a later stage no doubt they will provided for a charge as a proper means of deciding who should have a chair and who should not have one. The right hon. Gentleman says he will not do it at moment, but he is providing for it in the Bill.

The Temporary Chairman (Colonel Sir Leonard Ropier)

Order. A discussion on wheel chairs is already provided for on the Order Paper, since there is an Amendment down later on. I have no desire to curtail discussion, but the hon. Member is getting a little wide of the Amendment at the moment.

Mr. Blenkinsop

I agree it is more desirable that we should discuss it in detail later, but I wanted to emphasise that we accept the need for limitation of expenditure, but that we have tried to limit it by restricting the availability to certain medical categories and not doing it in general by imposing charges. However, I will leave the point there.

We are entitled to a clear statement from the right hon. Gentleman as to whether or not he proposes, by making this a permanent charge, to envisage a change in the basis of our National Health Service. If so, then it makes clear not only the position of my hon. Friends on these benches with regard to all these proposals, but also of masses of our people who, particularly at this time, would regard this as a vicious imposition upon their cost of living, and a vicious change in what they have a right to expect from the Government of this country as a consideration for the most vital and essential needs of their health. If, as a result of this Measure, the Government bring down upon themselves not only the detailed and vigorous opposition of this side of the Committee, as they will, but also a great deal of unrest in the country, they have only themselves to thank.

Mr. Hugh Linstead (Putney)

We can all contribute most to the utility of this discussion if we try to continue it in the spirit introduced by the hon. Member for Tottenham (Mr. Messer) and by my hon. Friend the Member for Abingdon (Sir R. Glyn). The bulk of us here are anxious to make the best possible Health Service we can in the interests of the sick and the poorer classes of the community in this country in the light of our financial responsibilities.

The real difference between, not entirely the two sides of the House, but, unfortunately, virtually that, is that there are some of us who put as the first priority at the present time our re-armament responsibilities, while there are others who, for reasons we can perfectly appreciate, put as the first priority the social services. When there is a clash of those two points of view it is possible for discussion to go on for a very long time without an appearance of the agreement and good will which I believe is present among most of us on both sides of the Committee.

My hon. Friend the Member for Enfield, West (Mr. Iain MacLeod), was charged by the hon. Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop), with having gone too far in his advocacy of some charges being an essential feature of our social services. I am one of those who believe that we should move as and when we can towards the conception of a free Health Service; but I should like to say—though not in defence of my hon. Friend the Member for Enfield, West, who does not need defending by me—that we are in danger, in the Health Service in particular, of forgetting one very fundamental thing. That is, that no State can take away from an individual the responsibility for his own health.

There is a very great danger that in our desire to spread our social services in every quarter we will make that fundamental mistake. I think most of us take it for granted that the State is greatly concerned with the health of the individual and must of necessity be so; but the State may make a great mistake if it so emphasises the freedom and extent of its services as to take away from the individual man that sense of responsibility.

The hon. Member for Newcastle-upon-Tyne, East, urged very strongly that we should declare where we stood on the question of the temporary nature of the various charges of this kind. He and his hon. Friends should bear in mind that there is a very grave danger, which we must all appreciate, of the social services and their benefits becoming bargaining counters in the political game. In the long run, if that does happen, first of all Parliament suffers, and second, the beneficiaries suffer. I think we noticed in the Second Reading debate a tendency for this question to become merely a bargaining counter in the political game. I do not think that the Government would be justified in putting a two-year period into this Clause at the present time. I do not believe that they or anybody else in this Committee is entitled to say "We are certain that in two years' time we shall be out of our financial crisis."

Mr. Turner-Samuels

Would the hon. Gentleman say who are the beneficiaries under this Bill?

Mr. Linstead

That interruption lacks the usual perspicacity which we associate with the hon. and learned Member. I was not referring to the beneficiaries under this Bill. The hon. Gentleman introduced the phrase. I was referring to the beneficiaries under the social services generally.

Mr. Turner-Samuels

The hon. Member did not say so. He said "this Bill" That was the term he used.

Mr. Linstead

If I did I will correct myself. The hon. Gentleman will see it in HANSARD tomorrow. The other point which the Committee needs to bear in mind—because there is a danger of it becoming lost in the discussion—is the fact that this year we are spending on the Health Service £20 million more than we were spending in any previous year. That is one of the substantial justifications for these charges. However much they are disliked, there are, as I pointed out in the Second Reading debate, parts of the Health Service which have a greater need of expenditure than others, and one of the advantages which these charges are going to bring with them, however much we may regret them, is that we can divert some of our resources to the hospital service, which is in greater need of finance than the general practitioners' service.

One of the most important things that the Committee—particularly hon. Members opposite—can do is to try to help those who are responsible for this legislation to make the inevitable incidence of the charges fall where it can best be borne. We shall face that as a very real problem a little later, when we discuss certain classes of beneficiaries whom everybody would like to relieve from the obligation to make these payments.

One of the biggest contributions which could be made by hon. Members opposite is to show how we can, as we put this Bill into operation, ensure that need is the test whereby these charges are remitted and not necessarily the chance of a particular man coming into a particular classification. I should like to see a number of groups of people, such as those suffering from tuberculosis or diabetes, excluded from the incidence of these charges, but I cannot see how that can be done if we are to make the scheme work. If hon. Members opposite can show how that can be done it will be one of the most important contributions that they can make to this Bill.

Dr. King

It must be very difficult to convey to hon. Members of the calibre of the hon. Member for Putney (Mr. Linstead)—of whose excellent and devoted work for the National Health Service every hon. Member knows—just how bitterly we on this side of the Committee are opposed to the proposals contained in this Bill. Listening to the hon. Member for Abingdon (Sir R. Glyn), who lamented that party politics should come into this, it seemed to me that the whole tenor of his appeal for a non-party approach to the Bill was really in support of this Amendment which asks, first, that if the shilling charge and the charge for appliances is a non-party charge, if this is a matter of scientific as opposed to party political opinion, we should try it as an experiment and see at the end of two years what the result has been.

The hon. Member for Putney might very well have ended his speech by pleading with his own Government to accept this Amendment. It is a party decision that we should impose charges on the Health Service as a means of solving some of the problems with which we are confronted. I want to preface my remarks about this Amendment by attempting to convey to Her Majesty's Government something of the spirit in which we are tackling not only this Amendment but every other Amendment to this Bill.

It is a matter of simple fact that 14 million voters are opposed to any tampering with the National Health Service. It is probably true that day by day that number is increasing among people who now realise, after voting for the present Government, that attacks are being made on the Health Service.

6.30 p.m.

We cannot hope in the House of Commons to prevent the Bill being passed, but we shall seek by Amendment after Amendment to limit the extent of the damage which the Bill will do to the National Health Service; and if by this Amendment we can limit it for two years, we shall have done something worth while.

It may be argued by some of my hon. Friends that this Amendment is not necessary. Not only Members on this side of the Committee, but people in the country, are saying that the Government will not last until 1954. Perhaps, even as we are speaking, the first nail has been driven into their coffin in the first instalment of local government elections. Thousands of Londoners are walking into the polling booths to declare their opposition to any tampering with the Health Service. And as the Government may not live until 1954, and as a Labour Government will certainly repeal the Bill if it is passed, it is academic to limit it to two years. I think that such an argument is unsound.

It is possible that the Government may last until after 1954. If we are to overthrow the Government, we depend during the next two years on Members like the hon. Member for Putney becoming alarmed at what happens to the Health Service and on their supporting us in our resistance to further attacks upon it. I am afraid that is not likely.

Defeats in by-elections can only come if by-elections take place in marginal constituencies. Whatever happens to public opinion outside the House of Commons—and it is the belief of many of us that the Government day by day are forfeiting the support of public opinion outside—it is quite possible, it is a grim possibility, that the Government may last beyond 1954.

I want to deal particularly with some of the remarks made on Second Reading by the hon. Member for Enfield, West (Mr. Iain MacLeod) in a speech which was a brilliant and able performance. I do not want to deal with the polemical part of his speech but with an argument which, coming from the hon. Member, must be given serious attention. The hon. Member said that the Bill had social, medical and economic justification. He argued that the making of charges would stop abuses. Then he went on to say—I hope he will stop me if I paraphrase him wrongly—that already the charges made on teeth and spectacles had had a deterrent effect far beyond those which had been anticipated by the last Government.

Let me remind the House that already 1,000 dental mechanics have been dismissed, that opticians are facing something like the slump they experienced in the worst period between the wars. The hon. Member for Enfield, West, suggested in his speech that the deterrent effect of the charges already imposed on the National Health Service had been somewhere about 50 per cent.

He went on to argue that we should watch the deterrent effect of the charges imposed in the Bill and that if, as he feared, the deterrent would be much greater than was imagined by the Government, we should seek at some stage to ease it and to deal with the cases of particular groups of poor people who had been deprived of medical aid. I suggest that the whole of that argument is an argument for putting a period to the Bill; and that at the end of 1954 we shall see, in the light of two years' experience, what many of us are convinced will happen: that the Bill, by imposing charges on medicines, drugs and appliances will deter some people from having medicine or appliances which they ought to have.

Moreover, the practical difficulties of administering the Bill will be very great. As the Bill makes its way through Committee, we shall be considering the difficulties that chemists are going to experience—and chemists have already said what difficulties they have to face. We shall have to examine the practical problem of whether doctors will have to collect the charge that is imposed by the Bill. Indeed, if the Bill gets through the Committee and finally takes its place on the Statute Book, we may find that, as the Labour Government anticipated, the administrative difficulties surrounding this little Bill will make its proposals either unworkable or too costly. Therefore, on that ground also we seek to limit the operation of the Bill to two years.

The Clause gives power to the Minister to make regulations far beyond any of the charges which the Minister has stated he proposes to make under the Bill. As long as the Bill remains part of the law, it will be in order for further Regulations beyond those which the Minister has promised to make to come before the House and to impose higher charges and affect appliances beyond the small list which the right hon. Gentleman has given. A Bill which confers such wide powers upon the Minister should be limited to two years.

In the days when we on this side of the Committee were sitting on the benches opposite, when some of us managed to secure a similar concession from the previous Government, it was argued by the right hon. and gallant Member for Kelvingrove (Lieut.-Colonel Elliot) that this was a concession not of very great moment, that it might just as well be added to the Bill as be left out. But in the last Parliament we took the view, and the then Government accepted our arguments, that it was right to limit the provisions of the Bill to a certain period, so that if the Government wished to continue to impose the charges they would have to come back to the House. It seems to me quite certain that if the Government last until 1954, they will command a much smaller majority in the House and may have to yield far more in the way of concessions to the Opposition.

It is also true that at the end of two years we shall have a mass of evidence, comparable to the evidence which the hon. Member for Enfield, West has produced about the effects of the dental and optical charges, of the deterrent effect of the charges on the use by people of medicine. At the same time, we are quite certain that by the end of another two years the pressure of public opinion, steadily growing against this Bill, will make the Government hesitate to re-impose the charges.

But most important of all of the reasons for this Amendment is that we want to ask the Government tonight about the way they react to this Amendment, and to say whether they believe in a free National Health Service or not. Is it the case of the Government, is it the case of the Minister, that they believe in a free medical service in principle, but not in a time of economic crisis? If so, we believe that the Minister should accept this Amendment.

The economic crisis, we hope, will not last for ever. We believe that the Minister should adopt the method of looking at the Health Service Act that his colleagues have adopted in looking at the 1944 Education Act. There, at least, the Government have said, "We believe in equal opportunity for everybody, even if we do not believe in it just now." The Conservative Party have advanced from 1931, when they opposed secondary education for all children, and when the then Minister of Education said that secondary education for all was providing "an intellectual soup kitchen." They have advanced, so far as education is concerned, in that the Government have given an assurance that they believe in equality of opportunity, and that they are going to advance education as soon as the economic situation permits.

We have the right to ask them tonight, Are they going on record as saying, "We believe in charges for medical services under the National Health Service Act, not for two years but for ever"? If the Government say that, the country has a right to know, that, according to the Minister and according to the Government, it is right to add £10 a week to the income of a doctor and charge an old age pensioner for a bottle of medicine; that it is right, under Tory principles, to charge a millionaire 1s. for expensive drugs and to charge poor children 1s. for a 1s. 1d. bottle of medicine; that it is right to single out the bald, the clubfooted, those with varicose veins, the tuberculous, the diabetics and the gastric, and say to them, "The prestige of this country demands that you should pay a fine for being guilty of the sin of illness in order to relieve the rich taxpayer of £1 a week Income Tax."

I believe—and I speak very sincerely about this, as one, incidentally, who owes his life to the National Health Service—that this is the meanest Bill this Government have brought forward. At least I would ask them to say on this Amendment, "We have put in operation something which may seem mean but is only an expedient. We do not want this to be taken as a principle for all time." If they do not accept this Amendment we have a right to say that the Government believe in the slogan, "A shilling a day keeps the doctor away." We have a right to say that the Government believe that charges under the Health Service are a part of permanent Tory policy.

I would urge the Government to take a very different line—to have some consideration for the thousands of members of their own party who have done invaluable service for the National Health Service up and down the country on hospital committees and health executives, and so on, and to say, "At any rate, if we impose these charges, we impose them for two years only, and at the end of two years we shall look at them again, go to the House of Commons, after two years' extra evidence, and either ask that the charges be re-imposed—when the whole matter can be discussed again—or drop them"—as we believe they ought to drop them.

6.45 p.m.

The Minister of Health (Mr. Harry Crookshank)

The debate has covered a good deal of ground on what, I thought, was really a rather narrow point, because the substance of the Amendment is to put in a period during which this Clause should run. The Amendment suggests that it should be for only two years from 1st April. If the second Amendment which runs with this were carried, too, there would be a possibility of an annual extension. On that comparatively simple question the debate has ranged really very wide, and I have been asked a very great number of detailed questions about the present organisation of the Service, about some of the plans which my predecessor started when he was in office, and how they are getting on—in fact, many things which I should have liked to have been able to answer in far greater detail than I can tonight.

I will answer two questions the right hon. Gentleman asked me, because they were points in which he was personally very much interested. He asked me about the "Prescribers' Bulletin," which was one of the means by which doctors were going to be kept informed of the prices of drugs and appliances, and so on. He asked what had happened about that. I am glad to tell him that the first issue of that is out now. I myself saw the advance copy of it three weeks ago, and now it has gone into distribution. I am sorry that the right hon. Gentleman has not got one yet, but I shall be very glad to send him one, and I am sure that it will be very useful for the purposes which he intended.

Dr. H. Morgan (Warrington)

Why not send every Member one?

Mr. Crookshank

I dare say that there would be no great difficulty about that, but I do not know that all would be interested in it. It is really for the benefit of prescribing doctors, which we do not all aspire to be. The second more specific point put to me was, What has gone on about the centralised purchasing of paper? The answer to that is that the centralised purchasing of certain forms of paper is to start on 1st July.

What does this Amendment seek to do? It seeks, as I say, to put the time limit of two years into this Bill, subject to extension. It is quite true that, if that were put in, it would bring the matter into line with Section 5 of the Act of 1951. But it would not bring it into line with the Act with which it ought to be in line; because, after all, the only reason for this Clause that we have to discuss is that the Government—any Government: the Government composed of right hon. Gentlemen opposite might well have done it, as they took power to do it, as we do it now—the Government found, as any Government which decided to bring in a charge for doctors' prescriptions would have found, that there was no power taken in that Act to do the same thing with regard to out patients. And that is all that this Clause deals with—to bring the two into line.

I have no idea why it was not in the original Act—why this particular section of the patients for whom a charge might have been made were not included in the original Act. The fact remains that they were not. Therefore, any Government, whether of this side or of that side, which decided to put a charge on prescriptions would obviously, at least in our view, have to see that the same charge was put on in the case of prescriptions prescribed at hospitals for out-patients—not in-patients: they are not affected at all—for it would otherwise have been unfair, as between one citizen and another, that one paid and another did not because one went to a general practitioner and another as a hospital outpatient.

Dr. Edith Summerskill (Fulham, West)

That is entirely different, as I shall explain later.

Mr. Crookshank

If we are going to put a charge on general practitioners' prescriptions, then a similar charge must be put on in the case of the out-patients at hospitals.

Mr. Turner-Samuels

Is that not only one element? Is not the issue here that the legislation as it stands without this Bill is comprehensive, and that what this Bill will do is to make it no longer a comprehensive Service? The object of this Amendment is to put on a limit of two years in order that the position can be explored to see whether it is right to have this limitation upon the scheme; and if it is discovered to be working to the prejudice of the people who are intended to be served by the Service, then it will come to an end.

Mr. Crookshank

The usually acute mind of the hon. and learned Gentleman has not quite taken the point I was making. Under the law at present there is power, provided by himself and his hon. and right hon. Friends, by which a charge can be put upon doctors' prescriptions. That is the law now. This Clause seeks to assimilate to the condition of those people out-patients in hospitals. That is all the Clause seeks to do—

Mr. Turner-Samuels

rose—

Mr. Crookshank

Let me finish my sentence. It is true that the Act of 1951, which dealt with certain forms of appliance—that is to say dentures and spectacles—introduced words of this kind, but in the Act of 1949 there is no limit. Therefore we were faced with the problem of which of the two Socialist Acts we should follow. We could not follow both, because one put in the limit and one did not. We came to the conclusion that because this dealt with the same field as the Act of 1949—the power of putting on prescriptions—it was right, reasonable and sensible that the point which emerged during the debates of 1949, that there should be no limitation of time, should come into this Bill. That is what we decided to do, and that is why we did it.

When I am asked, "Does that therefore mean they are permanent and for ever?" I remind the Committee—though I cannot, of course, discuss it—that Clause 3 (1) makes it possible by Order in Council to vary the charges or, indeed, to direct that they should cease altogether. So the power is there, just as it is in the 1949 Act. That is what we are doing in this Clause, and that is all that this Clause and this Amendment are about.

Mr. Turner-Samuels

rose—

Mr. Crookshank

If the hon. and learned Gentleman does not agree with my interpretation of what I have read with my own eyes in this book of Public General Acts, he can expatiate on it afterwards. That is the narrow point with which we are concerned, as to whether the provisions of this Clause—this Clause, Clause 1; that is what it is proposed to amend—should last for two years or, as in the Act of 1949 which dealt with prescriptions, should have no specific time limit in it. I would point out that there is in Clause 3 the power either to vary or to abolish the charge altogether by Order in Council.

That is really all that I think I am called upon to argue on this Amendment. A great many other observations were made at large on the general topic of the Health Service, and if we went on into that field we would very much prolong and extend the scope of the debate.

Mr. Michael Foot (Plymouth, Devonport)

Does the right hon. Gentleman not propose in his reply to answer the questions put by my hon. Friends as to whether he agrees with the whole interpretation placed by the hon. Member for Enfield, West (Mr. Iain MacLeod), on the way in which the Act is to be run in future? It is all very well for the right hon. Gentleman to say that this is a narrow point, but with great respect to him, and with greater respect to the Chair, these questions were allowed to be put from this side. Are we to have no answer from the Minister to these questions?

Mr. Crookshank

It is strange how impatient hon. Gentlemen opposite are. They never allow me to get through more than two sentences of any speech I set out to make, whereas if I ever interrupt one of them there is the most scandalised cry as if I were the most disorderly person in the Committee.

The real question—if I may just be allowed to say this—which Gentlemen opposite have been trying to pose, and trying to put the Government into a real dilemma about, was whether this was a form of permanent charge, and whether it really alters the whole basis of the Service. I do not see why anybody should assume anything of the sort. It was the hon. Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop), who, in asking the question whether we believed the charges were to be permanent, said himself that there must be a limit to the cost of the Health Service. That is the answer. He said it must be related to the national income, and went on to say that his party had always accepted that.

Mr. Blenkinsop

rose—

Mr. Crookshank

The hon. Gentleman has already made a long speech and, as I have said, I should like to have two sentences to myself. According to him, his friends have always accepted that there must be a limit to the cost of the Health Service and that it must be related to the national income. That, if I may say so, is the whole basis of this Bill. We find ourselves in this great national emergency, and the Bill is one of the means by which we are trying to help rectify the home sector of the emergency.

I quite agree with the right hon. Member for Middlesbrough, East (Mr. Marquand), who said that he did not accept the argument of internal finance as affecting this problem, in view of the large surplus at the end of last year; but that is not relevant to the difficulties with which this country was faced in the world situation as it affected the position of sterling. I should be out of order if I went too far along that road, and I have spoken on that subject before. That is the basis upon which we have worked, as the Chancellor has also pointed out.

The fact that we should ask the Committee to put on charges is merely in order to carry out what had, at one time at any rate, been intended by the party opposite. They may have sheered off afterwards, but they had at one time intended it, otherwise they would not have passed legislation empowering them to do so. They changed their minds, as anybody is entitled to do. But when they brought in that Bill they did not insert any provision that it should have any specific limit. The 1949 Act dealt with the prescription charge: we are extending the field of the prescription charge, and in doing so are not proposing, if the Committee accepts our view, to put in a time limit either—although we have put in Clause 3 a provision by which the charges can either be varied or abolished altogether.

Mr. McNeil

I quite agree when the right hon. Gentleman says this is a narrow point, and this might not be the most appropriate or the tidiest place to amend if he were of our mind. I take it he is not complaining about the machinery. He is rejecting completely the proposal that he should write in, wherever it seems appropriate to him, a limit in time to the operation of this charge. Although he skated round it with his usual dexterity, that is really what he is saying to the Committee.

Mr. Crookshank

Yes, I do ask the Committee not to write a date into this Clause. If one wanted to put in a date I cannot see how we could be sure what the right date was. That is part of the difficulty. How are we to say what the position will be on 1st April, 1954?

I understood that the argument of the right hon. Gentleman, and why he was so anxious to have a date put in, was so that it would enable a review of the whole of the Health Service to take place, and would give, so to speak, a target date before which it must be done. Well, he knows as well as I do that it is not really necessary to have a target date for reviewing a great national service. It is obvious that with a new experiment, if you like—as was said by my hon. Friend the Member for Abingdon (Sir R. Glyn) in his speech, which was so much admired—in the experimental period there have to be changes made this way and that way, and investigations take place. But if the object in putting in a two years period is merely to make sure that there is to be a great investigation into the Health Service, I do not think that is a valid reason at all.

7.0 p.m.

Mr. Marquand

I think that the right hon. Gentleman's explanation—and I hope to be brief because there are other hon. Members who wish to speak—is quite unsatisfactory. He based his case largely on what is in Clause 3 of the Bill— Or direct that any such charge shall cease to be payable. He failed completely to meet the point we made, that we required the termination of the Act itself. All that he has pointed out is that it is possible under the Bill to bring to an end any particular charge. This, as he realises I am sure, completely fails to meet the point we made.

The Parliamentary Secretary to the Treasury (Mr. P. G. T. Buchan-Hepburn)

rose in his place, and claimed to move, "That the Question be now put."

Question, "That the Question be now put," put, and agreed to.

Mr. McNeil

On a point of order, Sir Charles. I raised my voice immediately and reached for cover for my head.

The Chairman

I know, but the Question had to be put forthwith.

Mr. McNeil

With the greatest respect, Sir Charles, I suggest to you that immediately the Patronage Secretary saw that I was on my feet he attempted to withdraw the Motion for the Closure. I suggest, therefore, that he did so because it was quite plain, as has happened at an earlier stage in the proceedings on this Bill, that many questions have been put which have not been answered. The other point is that the right hon. Gentleman courteously and, I hope, with appropriateness, did attempt to withdraw the Motion when he saw that a Member on these benches had risen.

The Chairman

I had then put the Question, "That the Question be now put."

Mr. McNeil

I appreciate the difficulty of the Chair, but perhaps you will attempt to find out if my interpretation of the situation is correct.

The Chairman

The Closure was moved and carried. [HON. MEMBERS: "No."] I said that I thought the "Ayes" had it, several times. [HON. MEMBERS: "No."] The Question was put. [HON. MEMBERS: "No."] I said it several times, because I was surprised that nobody said, "No."

Mr. William Ross (Kilmarnock)

We were shouting "No" all the time.

The Chairman

Be calm for a moment. Let us collect ourselves.

Mr. Ross

Let us collect the voices.

The Chairman

I did.

Mr. Ross

You did not, Sir Charles.

The Chairman

I must ask the hon. Member to withdraw that remark.

Mr. Ross

I withdraw, but I called "No" and continued to call "No" all the time. I am surprised that you, Sir Charles, in the Chair, did not hear me.

The Chairman

I did not hear it, and my advisers did not hear it.

Mr. Turner-Samuels

On a point of order.

The Chairman

There is no point of order. The Closure was moved.

Mr. A. C. Manuel (Central Ayrshire)

It was never moved properly.

The Chairman

I am not infallible and I may be wrong. I happen, however, to be Chairman for the time being, and if I am not allowed to conduct things to the best of my ability, someone else had better be appointed. My impression of what happened is that the Chief Whip moved the Closure.

Mr. Manuel

He attempted to do so.

Hon. Members

Ask him.

Mr. Buchan-Hepburn

Yes, Sir. I did move the Closure.

The Chairman

That having been done, I said, "The Question is, 'That the Question be now put.' All those of that opinion say 'Aye'; to the contrary, 'No'." [HON. MEMBERS: "Oh."] May I be allowed to continue? There were no shouts of "No," and I was very much surprised. I said several times, "I think the Ayes have it."

Mr. Ross

I shouted "No."

The Chairman

I did not hear it. I inquired of my advisers if they heard it and they did not. The suggestion has been put to me by the Leader of the House that if there is this difficulty I should put the Question again.

Question put, "That the Question be now put."

The Committee proceeded to a Division; but no Member being willing to act as Teller for the Ayes, The CHAIRMAN declared that the Noes had it.

Original Question again proposed.

Mr. McNeil

I am most grateful to the Minister of Health for taking this very unusual but highly ingenious method of correcting what was a complete misunderstanding. I should, however, be disloyal to my hon. and right hon. Friends if I did not say that, while I appreciate the courtesy and ingenuity of the right hon. Gentleman, we deeply regret that the Patronage Secretary found it necessary to move a Motion of this kind so soon. After all, Sir Charles, we are here discussing a very essential part of the provisions of the Bill, and my recollection is that our discussion had not continued more than two hours. If we are to dispose of the Bill at that rate, then, from my limited experience, I suggest, with all respect, that it is unlikely that the Committee will be completely calm during the deliberations.

I am not clear whether I correctly follow the remarks of the Minister. If he is arguing that this is an inappropriate instrument into which to write a date then, of course, that can be met quite easily. An undertaking by the right hon. Gentleman to address himself to what he considers to be the appropriate instrument to meet the substance of our point would, of course, result immediately in our withdrawing the Amendment. If he means that at a later stage—on Clause 3 (1)—we should design an Amendment for that, then we shall be delighted to meet him.

But I and my hon. and right hon. Friends think that what this means is that the Government have determined that they will not in any way seek to meet our basic objections to the range and character of these impositions and restrictions upon the National Health Service. It has been said in answer to the arguments we have advanced that no one can say that two years from now will be an appropriate point at which to make this easement, since no one can say with certainty that our economic situation will be relieved by that time. That is true, but the Minister knows perfectly well that, if these were the conditions, any Committee would be bound to listen to his arguments and to take note of the facts which he then offered.

The right hon. Gentleman must understand that, by that very argument, some part of this Committee might be willing to abandon a scheme because of the existing economic conditions and, for the very same reason, would not be prepared to accede to there being no term to these impositions and restrictions. Many points were put relevant to the operation of the scheme, particularly by my hon. Friend the Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop), and the right hon. Gentleman has only addressed himself to two. We are grateful for that part of his answer.

I plead with him to face the fact that people who are jealous to protect the operation of this scheme cannot be expected to accept this Clause which is undated—which has no period of time set to it—when no reasons are offered for that. If it is that economic conditions make these restrictions necessary, then obviously there is no need for this Clause to be undated.

But if the right hon. Gentleman and his hon. Friends have some other reason, as we suspect—as we are bound to suspect because of their opposition to this reasonable Amendment—then it would be better that he should be frank with

the Committee and tell us that the intention is to change the character of the Health Service which my right hon. and hon. Friends created and which we intend to defend.

Mr. Buchan-Hepburn

rose in his place, and claimed to move, "That the Question be now put."

Question put, "That the Question be now put."

The Committee divided: Ayes, 275; Noes, 262.

Division No. 60.]	AYES	[7.15 p.m.
Aitken, W. T.	Crouch, R. F.	Hope, Lord John
Allan, R. A. (Paddington, S.)	Crowder, John E. (Finchley)	Hornsby-Smith, Miss M. P.
Alpert, C. J. M.	Crowder, Petre (Ruislip—Northwood)	Horsbrugh, Rt. Hon. Florence
Amery, Julian (Preston, N.)	Darling, Sir William (Edinburgh, S.)	Howard, Gerald (Cambridgeshire)
Amery, Heathcoat (Tiverton)	Davidson, Viscountess	Hudson, Sir Austin (Lewisham, N.)
Anstruther-Gray, Major W. J.	Deedes, W. F.	Hudson, W. R. A. (Hull, N.)
Arbuthnot, John	Digby, S. Wingfield	Hulbert, Wing Comdr. N. J.
Ashton, H. (Chelmsford)	Dodds-Parker, A. D.	Hurd, A. R.
Astor, Hon. J. J. (Plymouth, Sutton)	Donaldson, Comdr. C. E. McA	Hutchinson, Sir Geoffrey (Ilford, N.)
Astor, Hon. W. W. (Bucks, Wycombe)	Donner, P. W.	Hutchison, Lt.-Com. Clark (E'b'rgh, W.)
Baker, P. A. D.	Doughty, C. J. A.	Hutchison, James (Scotstoun)
Baldock, Lt.-Cmdr. J. M.	Dugdale, Maj. Rt. Hn. Sir T. (Richmond)	Hylton-Foster, H. B. H.
Baldwin, A. E.	Duncan, Capt. J. A. L.	Jenkins, R. C. D. (Dulwich)
Banks, Col. C.	Duthie, W. S.	Johnson, Howard (Kemptown)
Barber, A. P. L.	Elliot, Rt. Hon. W. E.	Jones, A. (Hall Green)
Barlow, Sir John	Erroll, F. J.	Joynson-Hicks, Hon. L. W.
Baxter, A. B.	Fell, A.	Kaberry, D.
Beach, Maj. Hicks	Finlay, Graeme	Kerr, H. W. (Cambridge)
Beamish, Maj. Tufton	Fisher, Nigel	Lambert, Hon. G.
Bell, Philip (Bolton, E.)	Fleetwood-Hesketh, R. F.	Lambton, Viscount
Bell, Ronald (Bucks, S.)	Fletcher, Walter (Bury)	Lancaster, Col. C. G.
Bennett, F. M. (Reading, N.)	Fletcher-Cooke, C.	Law, Rt. Hon. R. K.
Bennett, Sir Peter (Edgbaston)	Fort, R.	Legge-Bourke, Maj. E. A. H.
Bennett, Dr. Reginald (Gosport)	Foster, John	Legh, P. R. (Petersfield)
Bennett, William (Woodside)	Fraser, Hon. Hugh (Stone)	Lindsay, Martin
Bevins, J. R. (Toxteth)	Fraser, Sir Ian (Morecambe & Lonsdale)	Linstead, H. N.
Birch, Nigel	Fyfe Rt. Hon. Sir David Maxwell	Llewellyn, D. T.
Bishop, F. P.	Gage, C. H.	Lloyd, Maj. Guy (Renfrew, E.)
Black, C. W.	Galbraith, Cmdr. T. D. (Pollok)	Lloyd, Rt. Hon. Selwyn (Wirral)
Boothby, R. J. G.	Galbraith, T. G. D. (Hillhead)	Lockwood, Lt.-Col. J. C.
Bossom, A. C.	Gammans, L. D.	Longden, Gilbert (Herbs, S. W.)
Boyd-Carpenter, J. A.	Garner-Evans, E. H.	Low, A. R. W.
Boyle, Sir Edward	George, Rt. Hon. Maj. G. Lloyd	Lucas, Sir Jocelyn (Portsmouth, S.)
Brains, B. R.	Glyn, Sir Ralph	Lucas, P. B. (Brentford)
Braithwaite, Sir Albert (Harrow, W.)	Godber, J. B.	Lucas-Tooth, Sir Hugh
Braithwaite, Lt.-Cdr. G. (Bristol, N. W.)	Gomme-Duncan, Col. A.	Lyttelton, Rt. Hon. O.
Bromley-Davenport, Lt.-Col. W. H.	Gough, C. F. H.	McAdden, S. J.
Brooman-White, R. C.	Gower, H. R.	McCallum, Major D.
Browne, Jack (Govan)	Graham, Sir Fergus	McCorquodale, Rt. Hon. M. S.
Buchan-Hepburn, Rt. Hon. P. G. T.	Gridley, Sir Arnold	Macdonald, Sir Peter (I. of Wight)
Bullard, D. G.	Grimston, Hon. John (St. Albans)	Mackeson, Brig. H. R.
Bullock, Capt. M.	Grimston, Sir Robert (Westbury)	McKibbin, A. J.
Bullus, Wing Commander E. E.	Harden, J. R. E.	McKie, J. H. (Galloway)
Burden, F. F. A.	Harris, Frederic (Croydon, N.)	Maclay, Hon. John
Butcher, H. W.	Harris, Reader (Heston)	Maclean, Fitzroy
Butler, Rt. Hon. R. A. (Saffron Walden)	Harrison, Col. J. H. (Eye)	MacLeod, Iain (Enfield, W.)
Carr, Robert (Mitcham)	Harvey, Air Cdre. A. V. (Macclesfield)	MacLeod, John (Ross and Cromarty)
Carson, Hon. E.	Harvey, Ian (Harrow, E.)	Macmillan, Rt. Hon. Harold (Bromley)
Cary, Sir Robert	Harvie-Watt, Sir George	Macpherson, MacNiall (Dumfries)
Channon, H.	Hay, John	Maitland, Comdr. J. F. W. (Horncastle)
Clarke, Col. Ralph (East Grinstead)	Head, Rt. Hon. A. H.	Maitland, Patrick (Lanark)
Clarke, Brig. Terence (Portsmouth, W.)	Heald, Sir Lionel	Manningham-Buller, Sir R. E.
Clyde, Rt. Hon. J. L.	Heath, Edward	Markham, Major S. F.
Cole, Norman	Henderson, John (Cathcart)	Marlowe, A. A. H.
Colegate, W. A.	Higgs, J. M. C.	Marples, A. E.
Conant, Maj. R. J. E.	Hill, Dr. Charles (Luton)	Marshall, Douglas (Bodmin)
Cooper, Sqn. Ldr. Albert	Hill, Mrs. E. (Wythenshawe)	Marshall, Sidney (Sutton)
Craddock, Beresford (Spelthorne)	Hirst, Geoffrey	Maudling, R.
Cranborne, Viscount	Holland-Martin, C. J.	Maydon, Lt.-Cmdr. S. L. C.
Crookshank, Capt. Rt. Hon. H. F. G.	Hollis, M. C.	Medlicott, Brig. F.
Crosthwaite-Eyre, Col. O. E.	Holmes, Sir Stanley (Harwich)	Mellor, Sir John
Monckton, Rt. Hon. Sir Walter	Roper, Sir Harold	Thomas, Rt. Hon. J. P. L. (Hereford)
Morrison, John (Salisbury)	Russell, R. S.	Thomas, P. J. M. (Conway)
Mott-Radclyffe, C. E.	Ryder, Capt. R. E. D.	Thompson, Kenneth (Walton)
Nabarro, G. D. N.	Salter, Rt. Hon. Sir Arthur	Thompson, Lt.-Cdr. R. (Croydon, W.)
Nicholls, Harmar	Sandys, Rt. Hon. D.	Thornton-Kemsley, Col. C. N.
Nicholson, Godfrey (Farnham)	Schofield, Lt.-Col W. (Rochdale)	Tilney, John
Nicolson, Nigel (Bournemouth, E.)	Scott, R. Donald	Touche, G. C.
Nield, Basil (Chester)	Scott-Miller, Cmdr. R.	Turner, H. F. L.
Noble, Cmdr. A. H. P.	Shepherd, William	Tweedsmuir, Lady
Nugent, G. R. H.	Simon, J. E. S. (Middlesbrough, W.)	Vane, W. M. F.
Nutting, Anthony	Smiles, Lt.-Col. Sir Walter	Vaughan-Morgan, J. K.
Odey, G. W.	Smithers, Peter (Winchester)	Vesper, D. F.
O'Neill, Rt. Hon. Sir H. (Antrim, N.)	Smithers, Sir Waldron (Orpington)	Wakefield, Edward (Derbyshire, W.)
Ormsby-Gore, Hon. W. D.	Smyth, Brig. J. G. (Norwood)	Wakefield, Sir Wavell (Marylebone)
Orr, Capt. L. P. S.	Snadden, W. McN	Walker-Smith, D. C.
Orr-Ewing, Charles Ian (Hendon, N.)	Soames, Capt. C.	Ward, Hon. George (Worcester)
Osborne, C.	Spearman, A. C. M.	Ward, Miss I. (Tynemouth)
Partridge, E.	Speir, R. M.	Waterhouse, Capt Rt. Hon. C.
Perkins, W. R. D.	Spence, H. R. (Aberdeenshire, W.)	Watkinson, H. A.
Peto, Brig. C. H. M.	Spens, Sir Patrick (Kensington, S.)	Wellwood, W.
Peyton, J. W. W.	Stanley, Capt. Hon. Richard	White, Baker (Canterbury)
Pickthorn, K. W. M.	Stevens, G. P.	Williams, Rt. Hon. Charles (Torquay)
Pitman, I. J.	Steward, W. A. (Woolwich, W.)	Williams, Gerald (Tonbridge)
Powell, J. Enoch	Stewart, Henderson (Fife, E.)	Williams, Sir Herbert (Croydon, E.)
Price, Henry (Lewisham, W.)	Stoddart-Scott, Col. M.	Williams, R. Dudley (Exeter)
Profumo, J. D.	Strauss, Henry (Norwich, S.)	Wills, G.
Raikes, H. V.	Stuart, Rt. Hon. James (Moray)	Wilson, Geoffrey (Truro)
Rayner, Brig. R.	Studholme, H. G.	York, C.
Redmayne, M.	Summers, G. S.
Remnant, Hon. P.	Sutcliffe, H.	TELLERS FOR THE AYES:
Renton, D. L. M.	Taylor, William (Bradford, N.)	Mr. Drewe and Mr. Oakshott
Robinson, Roland (Blackpool, S.)	Teeling, W.
NOES
Acland, Sir Richard	Cullen, Mrs. A.	Harrison, J. (Nottingham, E.)
Albu, A. H.	Daines, P.	Hastings, S.
Allen, Arthur (Bosworth)	Davies, A. Edward (Stoke N.)	Hayman, F. H.
Allen, Scholefield (Crewe)	Davies, Ernest (Enfield, E.)	Healey, Denis (Leeds, S. E.)
Anderson, Alexander (Motherwell)	Davies, Stephen (Merthyr)	Henderson, Rt. Hon. A. (Rowley Regis)
Anderson, Frank (Whitehaven)	de Freitas, Geoffrey	Herbison, Miss M.
Attlee, Rt. Hon. C. R.	Deer, G.	Hobson, C. R.
Awbery, S. S.	Delargy, H. J.	Holman, P.
Ayles, W. H.	Dodds, N. N.	Holmes, Horace (Hemsworth)
Bacon, Miss Alice	Donnelly, D. L.	Holt, A. F.
Baird, J.	Driberg, T. E. N.	Houghton, Douglas
Balfour, A.	Dugdale, Rt. Hon. John (W. Bromwich)	Hey, J. H.
Barnes, Rt. Hon. A. J.	Ede, Rt. Hon. J. C.	Hudson, James (Ealing, N.)
Bellenger, Rt. Hon. F. J.	Edelman, M.	Hughes, Cledwyn (Anglesey)
Bence, C. R.	Edwards, John (Brighouse)	Hughes, Hector (Aberdeen, N.)
Benn, Wedgwood	Edwards, Rt. Hon. Ness (Caerphilly)	Hynd, H. (Accrington)
Benson, G.	Edwards, W. J. (Stepney)	Hynd, J. B. (Attercliffe)
Beswick, F.	Evans, Albert (Islington, S. W.)	Irvine, A. J. (Edge Hill)
Bevan, Rt. Hon. A. (Ebbw Vale)	Evans, Edward (Lowestoft)	Irving, W. J. (Wood Green)
Bing, G. H. C.	Evans, Stanley (Wednesbury)	Janner, B.
Blackburn, F.	Ewart, R.	Jay, Rt. Hon. D. P. T.
Blenkinsop, A.	Fernyhough, E.	Jeger, George (Goole)
Blyton, W. R.	Field, W. J.	Jenkins, R. H. (Stechford)
Boardman, H.	Fienburgh, W.	Johnston, Douglas (Paisley)
Bottomley, Rt. Hon. A. G.	Finch, H. J.	Jones, David (Hartlepool)
Bowden, H. W.	Fletcher, Eric (Islington, E.)	Jones, Jack (Rotherham)
Bowles, F. G.	Follick, M.	Jones, T. W. (Merioneth)
Braddock, Mrs. Elizabeth	Foot, M. M.	Keenan, W.
Brockway, A. F.	Forman, J. C.	Kenyon, C.
Brook, Dryden (Halifax)	Fraser, Thomas (Hamilton)	Key, Rt. Hon. C. W.
Broughton, Dr. A. D. D.	Freeman, John (Watford)	King, Dr. H. M.
Brown, Rt. Hon. George (Belper)	Freeman, Peter (Newport)	Lee, Miss Jennie (Cannock)
Brown, Thomas (Ince)	Gaitskell, Rt. Hon. H. T. N.	Lever, Harold (Cheetham)
Burke, W. A.	Glanville, James	Lever, Leslie (Ardwick)
Burton, Miss F. E.	Gooch, E. G.	Lewis, Arthur
Butler, Herbert (Hackney, S.)	Gordon Walker, Rt. Hon. P. C.	Lindgren, G. S.
Callaghan, L. J.	Greenwood, Anthony (Rossendale)	Lipton, Lt.-Col. M.
Carmichael, J.	Greenwood, Rt. Hon. Arthur (Wakefield)	Logan, D. G.
Castle, Mrs. B. A.	Grenfell, Rt. Hon. D. R.	Longden, Fred (Small Heath)
Champion, A. J.	Grey, C. F.	MacColl, J. E.
Chapman, W. D.	Griffiths, David (Rother Valley)	McGhee, H. G.
Chetwynd, G. R.	Griffiths, Rt. Hon. James (Llanelly)	McGovern, J.
Clunie, J.	Griffiths, William (Exchange)	McInnes, J.
Coldrick, W.	Grimond, J.	McKay, John (Wallsend)
Collick, P. H.	Hale, Leslie (Oldham, W.)	McLeavy, F.
Cook, T. F.	Hall, Rt. Hon. Glenvil (Colne Valley)	MacMillan, M. K. (Western Isles)
Cove, W. G.	Hall, John (Gateshead, W.)	MacPherson, Malcolm (Stirling)
Craddock, George (Bradford, S.)	Hamilton, W. W.	Mainwaring, W. H.
Crosland, C. A. R.	Hardy, E. A.	Mallalieu, E. L. (Brigg)
Crossman, R. H. S.	Hargreaves, A.	Mallalieu, J. P. W. (Huddersfield, E.)

Mann, Mrs. Jean	Price, Philips (Gloucestershire, W.)	Taylor, John (West Lothian)
Manuel, A. C.	Proctor, W. T.	Taylor, Rt. Hon. Robert (Morpeth)
Marquand, Rt. Hon H. A.	Pryde, D. J.	Thomas, David (Aberdare)
Mayhew, C. P.	Pursey, Cmdr. H.	Thomas, Iorwerth (Rhondda, W.)
Mellish, R. J.	Rankin, John	Thomas, Ivor Owen (Wrekin)
Messer, F.	Reeves, J.	Timmons, A.
Mikardo, Ian	Reid, Thomas (Swindon)	Turner-Samuels, M.
Mitchison, G. R.	Reid, William (Camlachie)	Ungoed-Thomas, Sir Lynn
Monslow, W.	Rhodes, H.	Viant, S. P.
Moody, A. S.	Robens, Rt. Hon. A.	Wallace, H. W.
Morgan, Dr. H. B. W.	Roberts, Albert (Normanton)	Watkins, T. E.
Morley, R.	Rogers, George (Kensington, N.)	Webb, Rt. Hon M. (Bradford C.)
Morris, Percy (Swansea, W.)	Ross, William	Weitzman, D.
Morrison, Rt. Hon H. (Lewisham, S.)	Royle, C.	Wells, Percy (Faversham)
Mort, D. L.	Schofield, S. (Barnsley)	Wells, William (Walsall)
Moyle, A.	Shackleton, E. A. A.	West, D. G.
Mulley, F. W.	Shawcross, Rt. Hon. Sir Hartley	Wheatley, Rt. Hon John
Murray, J. D.	Shinwell, Rt. Hon. E.	White, Mrs. Eirene (E. Flint)
Nally, W.	Short, E. W.	White, Henry (Derbyshire. N. E.)
Neal, Harold (Bolsover)	Shurmer, P. L. E.	Whiteley, Rt. Hon. W.
Noel-Baker, Rt. Hon. P. J.	Silverman, Julius (Erdington)	Wigg, George
Oldfield, W. H.	Simmons, C. J. (Brierley Hill)	Wilcock, Group Capt. C. A. B.
Oliver, G. H.	Slater, J.	Willey, Frederick (Sunderland, N.)
Orbach, M.	Smith, Ellis (Stoke, S.)	Willey, Octavius (Cleveland)
Oswald, T.	Smith, Norman (Nottingham, S.)	Williams, David (Neath)
Padley, W. E.	Snow, J. W.	Williams, Rev. Llywelyn (Abertillery)
Paget, R. T.	Sorensen, R. W.	Williams, Ronald (Wigan)
Paling, Rt. Hon. W. (Dearne Valley)	Soskice, Rt. Hon Sir Frank	Williams, Rt. Hon Thomas (Don V'll'y)
Paling, Will T. (Dewsbury)	Sparks, J. A.	Williams, W. R. (Droylsden)
Pannell, Charles	Steele, T.	Williams, W. T. (Hammersmith, S.)
Parker, J.	Stewart, Michael (Fulham, E.)	Wilson, Rt. Hon Harold (Huyton)
Paton, J.	Strachey, Rt. Hon. J.	Winterbottom, Richard (Brightside)
Pearson, A.	Strauss, Rt. Hon. George (Vauxhall)	Woodburn, Rt. Hon. A.
Peart, T. F.	Stross, Dr. Barnett	Wyatt, W. L.
Plummer, Sir Leslie	Summerskill, Rt. Hon. E.	Yates, V. F.
Popplewell, E.	Swingler, S. T.	Younger, Rt. Hon. K.
Porter, G.	Sylvester, G. O.
Price, Joseph T. (Westhoughton)	Taylor, Bernard (Mansfield)	TELLERS FOR THE NOES:
		Mr. Wilkins and Mr. Hannan.

While the Division was in progress—

Mr. James Carmichael (Glasgow. Bridgeton)

(seated and covered): On a point of order. I want to submit to you, Sir Charles, a point about the Closure. A few seconds ago an hon. Member moved the Closure, but the unanimous opinion of the Committee was against the Motion and the debate continued. As far as I can gather, the question of putting the Closure rests with the Chair, and the Chairman admits the Motion if he feels that the Committee and himself are satisfied that the debate has been completed. In this case, after the entire Committee had opposed the Motion, one speaker made some comments from the Box and immediately afterwards you applied the Closure. I submit to you that, with the knowledge that the Committee was against the Closure, you applied the Motion most speedily when, according to all precedents, it should not have operated at all.

The Chairman

The only charge of which I am guilty is speed, and I agree that I move quickly, but otherwise I was carrying out Standing Orders. It is my right to accept the Closure, and I think it ought to have been accepted in this case. There can be no debate about it and there is no point of order.

Mr. Carmichael

I put this to you, Sir Charles—and it is the last point I will make. Surely, if the entire Committee unanimously agrees that the Closure should not be put, it is stretching Standing Orders for you to apply it three minutes afterwards.

The Chairman

I do not think so. These were exceptional circumstances. I still hold the view that the voices were collected and the Closure Motion properly moved in the first instance, but, owing to exceptional circumstances, I was quite happy to allow another speaker to take part in the debate and then to accept the Closure Motion.

Question put accordingly, "That the proposed words be there inserted."

The Committee divided: Ayes, 263; Noes, 276

Division No. 61.]	AYES	[7.25 p.m.
Acland, Sir Richard	Freeman, John (Watford)	Morrison, Rt. Hon H. (Lewisham, S.)
Adams, Richard	Freeman, Peter (Newport)	Mort, D. L.
Albu, A. H.	Gaitskell, Rt. Hon. H. T. N.	Moyle, A.
Allen, Arthur (Bosworth)	Glanville, James	Mulley, F. W.
Allen, Scholefield (Crewe)	Gooch, E. G.	Murray, J. D.
Anderson, Alexander (Motherwell)	Gordon-Walker, Rt. Hon. P. C.	Nally, W.
Anderson, Frank (Whitehaven)	Greenwood, Anthony (Rossendale)	Neal, Harold (Bolsover)
Attlee, Rt. Hon. C. R.	Greenwood, Rt. Hon. Arthur (Wakefield)	Noel-Baker, Rt. Hon. P. J.
Awbery, S. S.	Grenfell, Rt. Hon. D. R.	Oldfield, W. H.
Ayles, W. H.	Grey, C. F.	Oliver, G. H.
Bacon, Miss Alice	Griffiths, David (Rother Valley)	Orbach, M.
Baird, J.	Griffiths, Rt. Hon. James (Llanelly)	Oswald, T.
Balfour, A.	Griffiths, William (Exchange)	Padley, W. E.
Barnes, Rt. Hon A. J.	Grimond, J.	Paget, R. T.
Bellenger, Rt. Hon. F. J.	Hale, Leslie (Oldham, W.)	Paling, Rt. Hon. W. (Dearne Valley)
Bence, C. R.	Hall, Rt. Hon. Glenvil (Colne Valley)	Paling, Will T. (Dewsbury)
Benn, Wedgwood	Hall, John (Gateshead, W.)	Pannell, Charles
Benson, G.	Hamilton, W. W.	Parker, J.
Beswick, F.	Hardy, E. A.	Paton, J.
Bevan, Rt. Hon. A. (Ebbw Vale)	Hargreaves, A.	Pearson, A.
Bing, G. H. C.	Harrison, J. (Nottingham, E.)	Peart, T. F.
Blackburn, F.	Hastings, S.	Plummer, Sir Leslie
Blenkinsop, A.	Hayman, F. H.	Popplewell, E.
Blyton, W. R.	Healey, Denis (Leeds, S. E.)	Porter, G.
Boardman, H.	Henderson, Rt. Hon. A. (Rowley Regis)	Price, Joseph T. (Westhoughton)
Bottomley, Rt. Hon. A. G.	Herbison, Miss M.	Price, Philips (Gloucestershire, W.)
Bowden, H. W.	Hobson, C. R.	Proctor, W. T.
Bowles, F. G.	Holman, P.	Pryde, D. J.
Braddock, Mrs. Elizabeth	Holmes, Horace (Hemsworth)	Pursey, Cmdr. H.
Brockway, A. F.	Holt, A. F.	Rankin, John
Brook, Dryden (Halifax)	Houghton, Douglas	Reeves, J.
Broughton, Dr. A. D. D.	Hoy, J. H.	Reid, Thomas (Swindon)
Brown, Rt. Hon. George (Belper)	Hudson, James (Ealing, N.)	Reid, William (Camlachie)
Brown, Thomas (Ince)	Hughes, Cledwyn (Anglesey)	Rhodes, H.
Burke, W. A.	Hughes, Hector (Aberdeen, N.)	Robens, Rt. Hon. A.
Burton, Miss F. E.	Hynd, H. (Accrington)	Roberts, Albert (Normanton)
Butler, Herbert (Hackney, S.)	Hynd, J. B. (Attercliffe)	Rogers, George (Kensington, N.)
Callaghan, L. J.	Irvine, A. J. (Edge Hill)	Ross, William
Carmichael, J.	Irving, W. J. (Wood Green)	Royle, C.
Castle, Mrs. B. A.	Janner, B.	Schofield, S. (Barnsley)
Champion, A. J.	Jay, Rt. Hon. D. P. T.	Shackleton, E. A. A.
Chapman, W. D.	Jeger, George (Goole)	Shawcross, Rt. Hon. Sir Hartley
Chetwynd, G. R.	Jenkins, R. H. (Stechford)	Shinwell, Rt. Hon. E.
Clunie, J.	Johnston, Douglas (Paisley)	Short, E. W.
Cocks, F. S.	Jones, David (Hartlepool)	Shurmer, P. L. E.
Coldrick, W.	Jones, Jack (Rotherham)	Silverman, Julius (Erdington)
Collick, P. H.	Jones, T. W. (Merioneth)	Simmons, C. J. (Brierley Hill)
Cook, T. F.	Keenan, W.	Slater, J.
Cove, W. G.	Kenyon, C.	Smith, Ellis (Stoke, S.)
Craddock, George (Bradford, S.)	Key, Rt. Hon. C. W.	Smith, Norman (Nottingham, S.)
Crosland, C. A. R.	King, Dr. H. M.	Snow, J. W.
Crossman, R. H. S.	Lee, Miss Jennie (Cannock)	Sorensen, R. W.
Cullen, Mrs. A.	Lever, Harold (Cheatham)	Soskice, Rt. Hon Sir Frank
Daines, P.	Lever, Leslie (Ardwick)	Sparks, J. A.
Davies, A. Edward (Stoke, N.)	Lewis, Arthur	Steele, T.
Davies, Ernest (Enfield, E.)	Lindgren, G. S.	Stewart, Michael (Fulham, E.)
Davies, Stephen (Merthyr)	Lipton, Lt.-Col. M.	Strachey, Rt. Hon. J.
de Freitas, Geoffrey	Logan, D. G.	Strauss, Rt. Hon. George (Vauxhall)
Deer, G.	Longden, Fred (Small Heath)	Stross, Dr. Barnett
Delargy, H. J.	MacColl, J. E.	Summerekill, Rt. Hon. E.
Dodds, N. N.	McGhee, H. G.	Swingler, S. T.
Donnelly, D. L.	McGovern, J.	Sylvester, G. O.
Driberg, T. E. N.	McInnes, J.	Taylor, Bernard (Mansfield)
Dugdale, Rt. Hon. John (W. Bromwich)	McKay, John (Wallsend)	Taylor, John (West Lothian)
Ede, Rt. Hon. J. C.	McLeavy, F.	Taylor, Rt. Hon. Robert (Morpeth)
Edelman, M.	MacMillan, M. K. (Western Isles)	Thomas, David (Aberdare)
Edwards, John (Brighouse)	MacPherson, Malcolm (Stirling)	Thomas, Iorwerth (Rhondda, W.)
Edwards, Rt. Hon. Ness (Caerphilly)	Mallalieu, E. L. (Brigg)	Thomas, Ivor Owen (Wrekin)
Edwards, W. J. (Stepney)	Mallalieu, J. P. W. (Huddersfield, E.)	Timmons, J.
Evans, Albert (Islington, S. W.)	Mann, Mrs. Jean	Turner-Samuels, M.
Evans, Edward (Lowestoft)	Manuel, A. C.	Ungoed-Thomas, Sir Lynn
Evans, Stanley (Wednesbury)	Marquand, Rt. Hon. H. A.	Viant, S. P.
Ewart, R.	Mayhew, C. P.	Wallace, H. W.
Fernyhough, E.	Mellish, R. J.	Watkins, T. E.
Field, W. J.	Messer, F.	Webb, Rt. Hon. M. (Bradford, C.)
Fienburgh, W.	Mikardo, Ian	Weitzman, D.
Finch, H. J.	Mitchison, G. R.	Wells, Percy (Faversham)
Fletcher, Eric (Islington, E.)	Monslow, W.	Wells, William (Walsall)
Follick, M.	Moody, A. S.	West, D. G.
Foot, M. M.	Morgan, Dr. H. B. W.	Wheatley, Rt. Hon. John
Forman, J. C.	Morley, R.	White, Mrs. Eirene (E. Flint)
Fraser, Thomas (Hamilton)	Morris, Percy (Swansea, W.)	White, Henry (Derbyshire, N. E.)

Whiteley, Rt. Hon. W.	Williams, Ronald (Wigan)	Wyatt, W. L.
Wigg, George	Williams, Rt. Hon. Thomas (Don V'll'y)	Yates, V. F.
Wilcock, Group Capt. C. A. B.	Williams, W. R. (Droylsden)	Younger, Rt. Hon. K.
Willey, Frederick (Sunderland, N.)	Williams, W. T. (Hammersmith, S.)
Willey, Octavius (Cleveland)	Wilson, Rt. Hon. Harold (Huyton)	TELLERS FOR THE AYES:
Williams, David (Neath)	Winterbottom, Richard (Brightside)	Mr. Wilkins and Mr. Hannan.
Williams, Rev. Llywelyn (Abertillery)	Woodburn, Rt. Hon. A.

NOES
Aitken, W. T.	Elliot, Rt. Hon. W. E.	Lloyd, Rt. Hon. Selwyn (Wirral)
Allan, R. A. (Paddington, S.)	Erroll, F. J.	Lockwood, Lt.-Col. J. C.
Alport, C. J. M.	Fell, A.	Longden, Gilbert (Herts, S. W.)
Amery, Julian (Preston, N.)	Finlay, Graeme	Low, A. R. W.
Amory, Heathcoat (Tiverton)	Fisher, Nigel	Lucas, Sir Jocelyn (Portsmouth, S.)
Anstruther-Gray, Major W. J.	Fleetwood-Hesketh, R. F.	Lucas, P. B. (Brentford)
Arbuthnot, John	Fletcher, Walter (Bury)	Lucas-Tooth, Sir Hugh
Ashton, H. (Chelmsford)	Fletcher-Cooke, C.	Lyttelton, Rt. Hon. O.
Astor, Hon. J. J. (Plymouth, Sutton)	Fort, R.	McAdden, S. J.
Astor, Hon. W. W. (Bucks, Wycombe)	Foster, John	McCallum, Major D.
Baker, P. A. D.	Fraser, Hon. Hugh (Stone)	McCorquodale, Rt. Hon. M. S.
Baldock, Lt.-Cmdr J. M.	Fraser, Sir Ian (Morecambe & Lonsdale)	Macdonald, Sir Peter (I. of Wight)
Baldwin, A. E.	Fyfe, Rt. Hon. Sir David Maxwell	Mackeson, Brig. H. R.
Banks, Col. C.	Gage, C. H.	McKibbin, A. J.
Barber, A. P. L.	Galbraith, Cmdr. T. D. (Pollok)	McKie, J. H. (Galloway)
Barlow, Sir John	Galbraith, T. G. D. (Hillhead)	Maclay, Hon. John
Beach, Maj. Hicks	Gammons, L. D.	Maclean, Fitzroy
Beamish, Maj. Tufton	Garner-Evans, E. H.	MacLeod, Iain (Enfield, W.)
Bell, Philip (Bolton, E.)	George, Rt. Hon. Maj. G. Lloyd	MacLeod, John (Ross and Cromarty)
Bell, Ronald (Bucks, S.)	Glyn, Sir Ralph	Macmillan Rt. Hon. Harold (Bromley)
Bennett, F. M. (Reading, N.)	Godber, J. B.	Macpherson, Maj. Niall (Dumfries)
Bennett, Sir Peter (Edgbaston)	Gomme-Duncan, Col. A.	Maitland, Comdr. J. F. W. (Horncastle)
Bennett, Dr. Reginald (Gosport)	Gough, C. F. H.	Maitland, Patrick, (Lanark)
Bennett, William (Woodside)	Gower, H. R.	Manningham-Buller, Sir R. E.
Bevins, J. R. (Toxteth)	Graham, Sir Fergus	Markham, Major S. F.
Birch, Nigel	Gridley, Sir Arnold	Marlowe, A. A. H.
Bishop, F. P.	Grimston, Hon. John (St. Albans)	Marples, A. E.
Black, C. W.	Grimston, Sir Robert (Westbury)	Marshall, Douglas (Bodmin)
Boothby, R. J. G.	Harden, J. R. E.	Marshall, Sidney (Sutton)
Bossom, A. C.	Harris, Frederic (Croydon, N.)	Maudling, R.
Boyd-Carpenter, J. A.	Harris, Reader (Heston)	Maydon, Lt.-Cmdr. S. L. C.
Boyle, Sir Edward	Harrison, Col. Harwood (Eye)	Medlicott, Brig, F.
Braine, B. R.	Harvey, Air Cdre. A. V. (Macclesfield)	Mellor, Sir John
Braithwaite, Sir Albert (Harrow, W.)	Harvey, Ian (Harrow, E.)	Monckton, Rt. Hon. Sir Walter
Braithwaite, Lt.-Cdr. G. (Bristol, N. W.)	Harvie-Watt, Sir George	Morrison, John (Salisbury)
Bromley-Davenport, Lt. Col. W. H.	Hay, John	Mott-Radclyffe, C. E.
Brooman-White, R. C.	Head, Rt. Hon. A. H.	Nabarro, G. D. N.
Browne, Jack (Govan)	Heald, Sir Lionel	Nicholls, Harmar
Buchan-Hepburn, Rt. Hon. P. G. T.	Heath, Edward	Nicholson, Godfrey (Farnham)
Bullard, D. G.	Henderson, John (Cathcart)	Nicolson, Nigel (Bournemouth, E.)
Bullock, Capt. M.	Higgs, J. M. C.	Nield, Basil (Chester)
Bullus, Wing Commander E. E.	Hill, Dr. Charles (Luton)	Noble, Cmdr. A. H. P.
Burden, F. F. A.	Hill, Mrs. E. (Wythenshawe)	Nugent, G. R. H.
Butcher, H. W.	Hinchingbrooke, Viscount	Nutting, Anthony
Butler, Rt. Hon. R. A. (Saffron Walden)	Hirst, Geoffrey	Odey, G. W.
Carr, Robert (Mitcham)	Holland-Martin, C. J.	O'Neill, Rt. Hon. Sir H. (Antrim, N.)
Carson, Hon. E.	Hollis, M. C.	Ormsby-Gore, Hon. W. D.
Cary, Sir Robert	Holmes, Sir Stanley (Harwich)	Orr, Capt. L. P. S.
Channon, H.	Hope, Lord John	Orr-Ewing, Charles Ian (Hendon, N.)
Clarke, Col. Ralph (East Grinstead)	Horsnby-Smith, Miss M. P.	Osborne, C.
Clarke, Brig. Terence (Portsmouth, W.)	Horsbrugh, Rt. Hon. Florence	Partridge, E.
Clyde, Rt. Hon. J. L.	Howard, Gerald (Cambridgeshire)	Perkins, W. R. D.
Cole, Norman	Hudson, Sir Austin (Lewisham, N.)	Peto, Brig. C. H. M.
Colegate, W. A.	Hudson, W. R. A. (Hull, N.)	Peyton, J. W. W.
Conant, Maj. R. J. E.	Hulbert, Wing Cmdr. N. J.	Pickthorn, K. W. M.
Cooper, Sqn. Ldr. Albert	Hurd, A. R.	Pitman, I. J.
Craddock, Beresford (Spelthorne)	Hutchinson, Sir Geoffrey (Ilford, N.)	Powell, J. Enoch
Cranborne, Viscount	Hutchison, Lt.-Com Clark (E'b'rgh, W.)	Price, Henry (Lewisham, W.)
Crookshank, Capt. Rt. Hon H. F. C.	Hutchison, James (Scotstoun)	Profumo, J. D.
Crosthwaite-Eyre, Col. O. E.	Hylton-Foster, H. B. H.	Raikes, H. V.
Crouch, R. F.	Jenkins, R. C. D. (Dulwich)	Rayner, Brig. R.
Crowder, John E. (Finchley)	Johnson, Howard (Keptown)	Redmayne, M.
Crowder, Petre (Ruislip—Northwood)	Jones, A. (Hall Green)	Remnant, Hon. P.
Darling, Sir William (Edinburgh, S.)	Joynson-Hicks, Hon. L. W.	Renton, D. L. M.
Davidson, Viscountess	Kaberry, D.	Robinson, Roland (Blackpool, S.)
Deedes, W. F.	Kerr, H. W. (Cambridge)	Roper, Sir Harold
Digby, S. Wingfield	Lambton, Viscount	Russell, R. S.
Dodds-Parker, A. D.	Lancaster, Col. C. G.	Ryder, Capt R. E. D.
Donaldson, Comdr. C. E. McA	Law, Rt. Hon. R. K.	Salter, Rt. Hon. Sir Arthur
Donner, P. W.	Legge-Bourke, Maj. E. A. H.	Sandys, Rt. Hon. D.
Doughty, C. J. A.	Legh, P. R. (Petersfield)	Schofield, Lt. Col. W. (Rochdale)
Douglas-Hamilton, Lord Malcolm	Lindsay, Martin	Scott, R. Donald
Dugdale, Maj. Rt. Hn. Sir T. (Richmond)	Linstead, H. N.	Scott-Miller, Cmdr. R.
Duncan, Capt. J. A. L.	Llewellyn, D. T.	Shepherd, William
Duthie, W. S.	Lloyd, Maj. Guy (Renfrew, E.)	Simon, J. E. S. (Middlesbrough, W.)

Smiles, Lt.-Col. Sir Walter	Summers, G. S.	Walker-Smith, D. C.
Smithers, Peter (Winchester)	Sutcliffe, H.	Ward, Hon. George (Worcester)
Smithers, Sir Waldron (Orpington)	Taylor, William (Bradford, N.)	Ward, Miss I. (Tynemouth)
Smyth, Brig. J. G. (Norwood)	Teeling, W.	Waterhouse, Capt. Rt. Hon. C.
Snadden, W. McN	Thomas, Rt. Hon. J. P. L. (Hereford)	Watkinson, H. A.
Soames, Capt. C.	Thomas, P. J. M. (Conway)	Wellwood, W.
Spearman, A. C. M.	Thompson, Kenneth (Walton)	White, Baker (Canterbury)
Speir, R. M.	Thompson, Lt.-Cdr. R. (Croydon, W.)	Williams, Rt. Hon Charles (Torquay)
Spence, H. R. (Aberdeenshire, W.)	Thornton-Kemsley, Col. C. N.	Williams, Gerald (Tonbridge)
Spens, Sir Patrick (Kensington, S.)	Tilney, John	Williams, Sir Herbert (Croydon, E.)
Stanley, Capt. Hon. Richard	Touche, G. C.	Williams, R. Dudley (Exeter)
Stevens, G. P.	Turner, H. F. L.	Wills, G.
Steward, W. A. (Woolwich, W.)	Tweedsmuir, Lady	Wilson, Geoffrey (Truro)
Stewart, Henderson (Fife, E.)	Vane, W. M. F.	York, C.
Stoddart-Scott, col. M.	Vaughan-Morgan, J. K.
Strauss, Henry (Norwich, S.)	Vosper, D. F.	TELLERS FOR THE NOES:
Stuart, Rt. Hon. James (Moray)	Wakefield, Edward (Derbyshire, W.)	Mr. Drewe and Mr. Oakshott.
Studholme, H. G.	Wakefield, Sir Wavell (Marylebone)

The Chairman

The next Amendment, in the name of the hon. Member for Pembroke (Mr. Donnelly), to page 1, line 8, is one which I do not select.

Mr. Desmond Donnelly (Pembroke)

On a point of order. The Amendment standing in my name was originally put down in my name and that of my hon. Friend the Member for Liverpool, Exchange (Mrs. Braddock), but her name was omitted from the Order Paper while mine was left on. I put it to you, Sir Charles, that this is an Amendment of substance, because it deals with the whole question of out-patients attending hospital, which is a totally different matter from specialists' services. I and my hon. Friend have given a great deal of thought to it, and we both think that it is in the interests of the satisfactory working of the National Health Service that the particular service given to outpatients in hospital should be excluded as a totally different service from that which is given by specialists under the National Health Service.

The Chairman

I thank the hon. Member for the courteous way in which he has put his point of order. I, of course, have to take advice from my advisers, and I went very carefully into the matter. This is one of the Amendments which I decided not to select.

Mrs. Braddock

With great respect, I think you ought to ask for some further advice on this matter, Sir Charles.

The Chairman

I think I have been very good to allow a point of order to be raised on this matter, because really it should not be discussed.

Mrs. Braddock

I want to press you, Sir Charles, on that point of order.

The Chairman

I will not have a point of order on my selection, which is not open to be queried by hon. Members.

Mrs. Braddock

I wanted to argue why it was in order.

The Chairman

Perhaps I should be allowed to explain that the selection of Amendments is one of the powers which the House gives to the Chair. It is not something which can be questioned, but I did allow the hon. Gentleman the Member for Pembroke to deal with it. To be absolutely accurate, there can be no point of order and no one is allowed to discuss my selection.

Mrs. Braddock

May I ask why it is out of order?

The Chairman

I did not say it was out of order. I said I did not select it.

Mrs. Braddock

Can I ask why it was not selected?

The Chairman

After careful consideration I decided not to select it.

Mrs. Braddock

I should like to press this matter. I should like to know why the Amendment was not selected. There must be a reason why. If you were advised that it should not be called because there is some similarity between medicines for the out-patients department and specialists' services, then I humbly submit you have been wrongly advised, Sir Charles.

The Chairman

I thank the hon. Lady for the courteous way in which she put the question to me, and if I answered her and gave my reasons for not selecting it, it would take up a long time. As it is, it cannot be discussed, and we had better keep to the Standing Order.

Mr. Manuel

Seeing that this Amendment has been ruled out of order, Sir Charles, could you indicate if there is any other Amendment on the Order Paper whereby those of us interested in the outpatients attending hospital could raise the particular issue indicated by this Amendment.

The Chairman

Amendments can be put on the Paper and as we come to them I call them, do not select them, or rule them out of order, as the case may be. That is the procedure. I do not think there is anything more to be said.

Mrs. Braddock

Can it be discussed and argued on the Motion, "That the Clause stand part of the Bill"? If you do not call the Amendment for some reason, can the reason for the Amendment being put on the Order Paper be discussed when we come to consider the Clause as a whole?

The Chairman

The hon. Lady knows that when we come to the Motion "That the Clause stand part of the Bill" we cannot discuss an Amendment that has not been selected, but only what is in the Clause. It would not, therefore, be in order to discuss the reasons for putting this Amendment on the Order Paper.

Mrs. Braddock

Can we discuss why it should be out of order?

Dr. Stross

Further to that point of order. Is it not true that the Amendment which appears below this one, namely, in page 1, line 9, to leave out "drugs, medicines or," plus the one after that, which in the same line would leave out "or appliances," between them cover entirely the point made by the hon. Lady, and the whole of the point regarding outpatients?

The Chairman

The hon. Gentleman is clever. He is trying to get me to give my reasons for not selecting an Amendment, which I shall not do.

Dr. Summerskill

I beg to move, in page 1, line 9, to leave out "drugs, medicines or."

The purpose of the Amendment is to exempt the out-patient at a hospital from the charge which it is proposed to make on drugs, medicines, etc. I was surprised to hear the Minister express himself as surprised, when he spoke on the previous Amendment, that these words had been omitted from the last Bill, and I hope that the hon. Lady the Parliamentary Secretary to the Ministry of Health will convey to him the views which I hold on this Amendment. The position of the out-patient is entirely different from that of the ordinary patient.

The Minister said that the Bill had been introduced because there had been an abuse of the Service. He said that the drug bill was out of control, and he implied that many people were enjoying prescriptions which were too expensive. From that I did not dissent. He said that prescribing was not as careful as it might be. Hon. Gentlemen on both sides of the Committee would agree that the drug bill is excessive.

But nobody can charge the out-patient at a hospital with abusing the Service or can say that the out-patient at a hospital might be a malingerer, a hypochondriac or a medicine addict. If he was any one of those, he would never arrive at the hospital in the first place. He is there because he has been sent by his general practitioner, who is anxious that his patient should have specialist treatment.

If it is found on his first visit to hospital that there is no need for him to make a subsequent visit, he is discharged and is sent back to his own doctor who, in his turn, will prescribe medicine for him. The patient will have the prescription made up by a local chemist. If, however, a course of treatment is advised for the patient at the hospital, and it is decided that he must return on subsequent occasions, he obtains his medicine from the hospital dispensary.

It is for these patients I am now pleading. The patient who obtains his medicine from the hospital dispensary should be exempt from this charge. Many of us are familiar with the out-patient's department of a big hospital.

Mr. Messer

Does my right hon. Friend know that there are certain hospitals which do not dispense but give prescriptions which are dispensed by a local chemist? She would not exclude those, would she?

Dr. Summerskill

I think my hon. Friend would agree with me that the Clause deals particularly with the outpatient at the hospital.

Mr. Messer

Yes.

Dr. Summerskill

It may be unusual for one to address oneself specifically to the Clause, but that is the category which is mentioned in this Clause. The hon. Gentleman will find that his point will be covered by the provision which is made in another part of the Bill dealing with patients who obtain their medicine from chemists. We are now dealing with the out-patient who obtains his medicine from the dispensary.

The out-patient at the hospital is, for the most part, a poor person. Some hon. Members may dissent from that statement, but my experience is that the patient who is fairly well-to-do is anxious to avoid spending time in the out-patients' department and prefers his general practitioner to send him straight to a specialist. Therefore, in the first place, these people are poor. The procedure which is indicated to them is not very welcome. They are told on their first visit that they must return again. Perhaps they have to return again twice in the same week, or for many months they may have to make weekly visits to the hospital.

7.45 p.m.

What does this involve for a poor person? If he is a man, he has to lose time at work. He may be compensated in some cases but not in all cases. If the out-patient is a married woman she may find the making of these visits a little difficult because she has to make arrangements at home. If the patient is an old age pensioner there is the exhaustion involved. For them all, there is involved the payment of the fare to the hospital.

So, there are certain expenses. It is suggested that on top of them a charge should be made to these people. This demonstrates again how far removed the Government are from the lives of the people. I could hardly believe my ears when the Minister said he could not understand why a distinction had been made between the hospital out-patient and the ordinary patient.

If the right hon. Gentleman were a poor person he would know that hospital treatment is something which has to be endured. Not for one moment would he think of undertaking that journey to get medicine and so abuse the scheme because that medicine might not really be needed. If the charge is put on the prescriptions of out-patients it will almost certainly deter them from con- tinuing treatment. I want to stress that point.

A hospital is not prepared to give treatment to a patient unless it is necessary, and generally the treatment has to be continued. Let us think of the people who have to have continuing treatment in a hospital. I will begin with a child in a children's hospital, going, say to Great Ormond Street week after week. That means that it must be accompanied. Its mother or a friend of hers will probably accompany it, and that means double fares. Furthermore, the working-class woman has to make arrangements at home, which may mean paying a few shillings to a neighbour to look after her other children. On top of all this there is to be this iniquitous charge. One can understand the mother saying that she will not continue the treatment, although it might be of vital importance for the child.

Take next the group of adolescents. The adolescent is generally in the lowest wage group. Regular attendance at a hospital may determine his or her whole future but boys or girls of 18, 19 or 20 need only a little discouragement to make them voluntarily terminate the treatment. The parents and the doctor have to persuade this kind of patient to continue at hospital. If the adolescent is to be charged, he will be reluctant to continue, and will be tempted to stop the treatment.

Mr. Powell

I am much obliged to the right hon. Lady for giving way. She is constantly using the term "treatment." To avoid misunderstanding, I am sure she will make it clear that the Clause is applicable only where the treatment involves repeated prescriptions of drugs or medicines.

Dr. Summerskill

Surely, the hon. Member is not going to quibble in that fashion. I certainly understand that, and I have already made it quite clear that I am talking about prescriptions. Does he realise that it is quite common for the categories I have mentioned to go to hospital and have a prescription made up every time?

Mr. Powell

Not the majority.

Dr. Summerskill

I am afraid the hon. Member is not familiar, perhaps, with hospital life, or as familiar as I am with it, and I could not agree with him. I would also remind the Committee that sometimes when a patient goes for physiotherapy and complains of something else the hospital authorities, quite rightly, do not always say, "You must go back and get another letter from your doctor," but will be prepared to send him to another department. The hon. Member must not try to ride away on that.

I now come to another category, the chronics. It may be asked, why are patients suffering from chronic disease attending a hospital at all? I would put this point to the Committee, which I think is an important point. In the first place, the person with a chronic disease has been rendered poor by his very disease. He may have had it over a period of years and found life very difficult, but very often he is encouraged by a physician or surgeon to continue to attend the hospital because he is most anxious to watch the progress of the disease. It is very important in these cases that a complete record should be taken in order that this record can be consulted later, perhaps long after the person being treated has died, when a patient who suffers from a similar condition comes to the hospital. Therefore, do not let us ignore the fact that a large number of people suffering from chronic diseases visit the hospitals at the request of physicians or surgeons.

I do not want to weary the Committee because I am sure the human aspect of this is known to all hon. Members. I ask that this category of out-patients in hospitals, who are there because they are suffering, or have been suffering, from very serious diseases—or if the disease is not so serious it is still necessary for them to go frequently for treatment and medicine—shall be exempted from the charge.

Mr. Powell

I would not quarrel with the general picture which the right hon. Lady the Member for Fulham, West (Dr. Summerskill) has drawn of the suffering and need which is associated in the great majority of cases with attendance at the out-patient department of a hospital. Also, I willingly concede that by her professional qualifications she necessarily has more acquaintance than I can claim with the working of a hospital. Nevertheless, my acquaintance with the working of hospitals is not small, and it grows weekly and monthly.

I believe that the right hon. Lady was mistaken in denying that there is an essential connection between the imposition of charges upon prescriptions made by a general practitioner and the imposition of charges upon prescriptions made for out-patients at hospitals. Already, in the course of this stage of the Bill, reference has repeatedly been made to the two causes for which the Bill is before the House.

Those two causes are not mutually exclusive, but they reinforce one another. I will only indicate their nature briefly as they are in the recollection of the Committee, I am sure. There is the financial motive, namely, that it is recognised by all but a small minority that there must be a limit to the amount which in total can be expended on the Health Service. But, secondly, and by no means in conflict with that reason, is the consideration that even if we could take the ceiling off altogether and spend £600 million, there might nevertheless be very good reasons for taking measures of the same, or a similar, kind to some of those in this Bill.

I believe the charges imposed upon prescriptions both for out-patients and for the patients of general practitioners fall into that class. It is generally recognised that the overcrowding—in many cases hopeless overcrowding—of the surgeries of general practitioners has, since the Act came into force, prevented the full value of the skill of the medical profession reaching the patients who really need it. There is a close and intimate connection between the queue in the general practitioner's surgery and the queue in the out-patients department at the hospital.

The hospital service was examined at great length and with great care by the Select Committee on Estimates last year. I should like to remind the House of some of the evidence which they produced in their 11th Report. In reference to out-patients they said: the most substantial increases have taken place in the services rendered to out-patients, and the great increase everywhere in the number of out-patients was confirmed by the witness who gave evidence before Your Committee. Then there comes this important observation: This increase is, to a considerable extent, due to general practitioners sending to hospitals patients who formerly they would themselves have treated in their own surgeries. An eminent medical man who gave evidence before the Committee was asked by an hon. Member opposite: Why do they go to the out-patients department if there is nothing wrong with them? He replied, I do not say there is nothing wrong with them, but I say they are such minor things that they could be dealt with by the general practitioner if he had time to examine them and make the diagnosis. The excessive pressure upon the general practitioner and the excessive pressure upon the out-patients departments of our hospitals hang together. If we attempt to relieve the pressure on the one without taking corresponding measures in respect of the other, we shall only make bad worse in the out-patients departments of the hospitals. In the most real sense—and not merely the technical, legal sense—Clause 1 of the Bill is a corollary of Section 16 of the 1949 Act which right hon. Gentlemen opposite, as late as 1951, still contemplated implementing.

The right hon. Lady has laid great stress upon the problem of the recurrent prescription of the patient attending at an out-patients department, who will need frequent and recurrent prescriptions and who may thereby not merely be deterred from going there, but involved in financial hardship if he continues to attend. It will be noticed that that problem is not peculiar to the out-patient, but is equally a problem which arises out of the charge on prescriptions written by the general practitioner.

That point is one of the big questions which arises on this Bill—the chronic sick and recurrent prescriptions. What are we to do about them? I believe the answer is that we must deal with the problem not by attempting to classify the sickness or the resorts to which the patient goes for treatment but by attempting to concentrate on need. If we can associate with this Bill—and I believe several further steps will be needed before this is achieved—an effective machinery for dealing with cases of hardship and need arising under it, then we shall have dealt with the problem of the chronic sick and the recurrent prescript- tion whether in out-patients departments, or elsewhere.

Before we leave the Clause now before us we shall have further opportunities of concentrating our attention more on the question of how need and hardship are to be dealt with. So I will merely say that the National Assistance Board were selected for the purpose and commended for the purpose, by the great majority of right hon. and hon. Members opposite.

Mr. Blenkinsop

indicated dissent—

Mr. Powell

I notice that the hon. Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop) shakes his head—

8.0 p.m.

Mr. Blenkinsop

The hon. Member will appreciate that there is a great difference indeed between references to the National Assistance Board in cases which arise very rarely in the lifetime of a person, and cases like this, which will arise continually in the lifetime of a person.

Mr. Powell

That does not affect the point. I am speaking on the assessment and relief of need, and the views of the hon. Gentleman on that subject are that … we regard them"— that is the National Assistance Board— as a very suitable means to meet the cases of hardship which may arise."—[OFFICIAL REPORT, 2nd May, 1951; Vol. 487, c. 1219.] I am far from satisfied that, working under their present Regulations and without any further direction or Regulations, the National Assistance Board can fully meet that need. But I do believe it is in the direction of improving them, rather than by attempting to exclude this or that class of patient, that we must seek a solution to the very real problem to which the right hon. Lady has drawn attention.

Mr. Manuel

As I understand it, one of the main reasons for the Government, and the people who control its destiny, wanting to bring in a Bill such as we have before us, is because they are convinced that there is a great deal of waste in connection with the prescription of drugs and medicines. I feel that if this Bill becomes an Act in its present form it will impinge very severely on the con ception which we on this side of the Committee had of what a National Health Service ought to be.

All of us on this side of the Committee feel that the Act which brought the Service into being was the finest piece of legislation put on the Statute Book by the Labour Government when they were in power. Accordingly, I wish it to be fully understood that many of us on this side of the Committee had very heavy hearts at what is happening today. Even last year, when there was a minor attempt at enacting this particular piece of legislation, some of us felt so keenly about it that we had to go as far against it as we could. But at that time there was at any rate the definite guarantee that the legislation was not of a permanent character. However it was felt at that time that there should be, for a period, until 1954, a saving effected in some manner.

This attempt to impose charges for drugs and medicines is not new to right hon. and hon. Members opposite. Those of us who have had long experience in the administration of hospitals in the local authority service know that we had, through the years while advocating the National Health Service, continually to fight against the friends of right hon. and hon. Gentlemen opposite who were Tory county councillors and councillors in these local authorities. And against the intention of these representatives we built up the health and hospital services under the local authorities.

When the Act came into force local authority power was handed to the regional—

The Temporary Chairman (Mr. George Thomas)

I hardly think that that applies to this Amendment. Perhaps the hon. Gentleman would come to the question of payment for drugs and medicines.

Mr. Manuel

With respect, I thought that if I was talking about the deterrents of which charges for drugs and medicines are part, I was dealing with something relating to out-patients attending hospital.

The Temporary Chairman

I am not proposing to argue with the hon. Gentleman, but I thought he was beginning to make a Second Reading speech on the Health Service rather than addressing himself to this Amendment.

Mr. Manuel

I did notice that the hon. Member for Wolverhampton, South-West (Mr. Powell), made certain points of a Second Reading nature without curb—in fact it has been happening during the whole of the Committee discussions—[Interruption.]—with the exception, of course, of my right hon. Friend, who never goes wrong—

The Temporary Chairman

I think we must get on.

Mr. Manuel

The hon. Member for Enfield, West (Mr. Iain MacLeod), talked at length about deterrents. He indicated that because the charges had been operated in a modified form the Service had been reduced in certain respects during the course of the past year. That is one way to save on the Service. But if the main argument is that there has been waste there are two ways in which this waste can be tackled.

I am not prepared to take the view that because those who control the Service—and the doctors and others who issue certificates and sign prescriptions are virtually in control of this Service—are lending themselves to abuses, a deterrent ought to be placed on the patients. The way in which we should tackle this problem is by disciplining those who are causing the abuses. We should try to evolve some way of applying discipline within this Service in order that in the first place the person in control will not issue a certificate causing the so-called abuse. That would be much more preferable than cutting down expenditure on the Health Service.

There is something morally wrong with those in charge of the Government of this country who take this weak-kneed way out of this particular impasse of ever-growing expenditure which they think they must control. They indicate that there is to be a ceiling. In fact certain hon. Members opposite have claimed that because the ceiling is not being reduced this year they are immune from criticism. At the same time all of us know that costs in this country are climbing rapidly—

The Temporary Chairman

The hon. Member really is leaving the Amendment far behind. Perhaps he will discuss the Amendment itself.

Mr. Manuel

I should like to ask for a Ruling upon the point with which I was dealing. If certain out-patients attending hospital are to be asked to pay for all drugs and medicines at the same time as the policies of the Government are causing the cost of living to rise generally, is not it a proper point to put that there should be some easement over the payment for drugs and medicines?

The Temporary Chairman

As I followed his argument, the hon. Member was dealing with the general ceiling for health charges. When I rose he had not related it to the question of drugs or medicines, and that was why I called him to order.

Mr. Manuel

I am very sorry, Mr. Thomas, and I will try to keep within your Ruling, though now that I have elaborated my point a little I think you have agreed that I was really in order.

However, I will come directly to the charges on out-patients attending hospital. On the question of their being asked to pay for the drugs or medicines being used, I want to say that those of us who have had something to do with hospital administration know that there are many people attending the out-patients' departments of hospitals, where they are being subjected to having to wait many long weary hours before they even get treatment, and many are making two or three visits a week. If there were sufficient hospital beds available up and down the country, many of these patients would be in hospital and not attending an outpatients' department.

Therefore, I think that these people should not be penalised when they go to the out-patients' department of a hospital because of the fact that there is a shortage of hospital beds and we are not able to deal with that shortage because of restrictions on building. I am sure that the hon. Lady the Parliamentary Secretary, who is looking so nicely at me, will agree with what I say.

There are also many chronic cases and people whose ailments do not prevent them going to the out-patients' department, and who prefer to be at home. Is the party opposite saying that they will penalise these people still further by the imposition of a charge for the drugs or medicines utilised? I think it is grossly unfair. The same thing applies to many appliances that are supplied in connection with attendance at the out-patients' department of a general hospital. These people are to be charged for these appliances—I had better keep to drugs and medicines, I think—because of their unfortunate position in being covered by this particular proviso in this Clause.

I think this Tory Government are taking a most retrograde step. I think their policy in connection with the payment for drugs and medicines will have a very damaging effect on our vital health statistics next year and in each succeeding year, and that it will clearly do great damage to the health of the people of this country. I hope we shall see a recognition in the country that, when people return a Tory Government, they are taking a very serious step towards weakening all the good social services which have been built up by the Labour Government before them.

8.15 p.m.

Dr. Stross

The whole of this question of charging for drugs and medicines for out-patients is linked, I understand, with the Minister's desire to save a sum of money, and it is interesting to see how much money the Minister hopes to save. It has been estimated—and I think that the Parliamentary Secretary would not deny this—that the sum total that can possibly be obtained in this direction is about £500,000.

This sum is to be obtained, I presume—we all believe this, although it is not mentioned in the Bill—by a charge of a fixed specific sum. I wonder if we might accept it as 1s., and not as a proportion of the cost of the drugs or medicines supplied? I think that must be assumed. One must, therefore, ask some further questions.

We know, indeed, that some prescriptions are very expensive, and that those for certain drugs cost several pounds. The time may well come when the cost of such prescriptions as aureomycin and cortisone will go up to £10 or £15. Towards the cost of such a prescription, a patient would presumably pay 1s., but, against that, there are other prescriptions which are much cheaper than those expensive ones, in the ratio of perhaps 100—1.

In most cases of those which are much cheaper, the cost is only a percentage of 1s. For example, a prescription for 12 tablets of phenol-barbitone would cost about 1¾d. Would the Parliamentary Secretary say whether the patient in such a case would be asked to pay 1s. towards the cost of the prescription which is about 2d. or less? I do not know whether the Parliamentary Secretary would care to nod her head, or disagree with what I am saying.

The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)

My right hon. Friend has already explained that it will be for the patient to pay less if it is less than a shilling charge.

Dr. Stross

I am delighted to hear that, if it is less than a shilling charge, the prescription will cost less, but if the cost is more the payment will be 1s. towards that cost.

Mr. Blenkinsop

This is of some importance, because I thought I understood earlier that the position was that, if a prescription was made up, the charge would be a shilling, irrespective of whatever the actual cost was. I understood quite clearly that that was the position, and it is important that we should be clear about it.

Miss Hornsby-Smith

If the patient handed in the actual prescription to go forward under the National Health Service, he would pay the 1s. charge. If the chemist knows that that item costs a matter of a few pence, the patient can pay the charge direct, in which case the claim will not go forward.

Dr. Stross

Really, this is new to us. I hope the Parliamentary Secretary will not be embarrassed for anything she has just told us, but we shall certainly support her if her right hon. Friend takes umbrage at what she has said. If what she has said be true, will it be the case that the chemist will be able to suggest to the patients that they should pay for the medicines themselves because they are not worth a shilling? We do not want to create tension between the patient, the chemist and the doctor, and so on. I therefore welcome what the Parliamentary Secretary said, and we shall certainly hold her right hon. Friend to it.

Miss Jennie Lee (Cannock)

Is the Committee quite clear on what we are discussing? Is it the case that a patient may go to a chemist with a doctor's prescription, and that the chemist may say, "This costs less than 1s., and I will not accept the doctor's prescription." Is it being left to the discretion of the chemist to make that decision, or at what stage is it made?

Mr. Blenkinsop

If I might follow up that very point, we are dealing here with the hospital and the out-patient, and we want to know whose job it would be to decide what the value of the medicine was—if it is not 1s., and so on. As prescriptions are made up in hospital, is it going to be the job of someone in the hospital to say that the medicine costs less than 1s. and that the patient will therefore pay less? But I understand that the National Assistance Board are making arrangements for refunds of 1s. and not anything less.

Mr. Turner-Samuels

Is there to be a uniformity of charge? Will there be a list that will apply universally? If a charge is to be 2½d., will it be universally and uniformally 2½d.? If so, how and by whom is it to be operated?

Dr. Stross

I am grateful for being allowed to continue. May I point out to the Parliamentary Secretary that we are getting into very deep waters on this subject. If what we are now told is correct—and it really ought to be correct—namely, that if a prescription is not worth 1s. the patient should not pay more than it is worth, what is the technique and procedure for those exempted by poverty need? Are we to assume that they may have a receipt for 2d. or 3d.? It would be invidious if they had a return of 1s. for an expenditure of 2d. After all, we are very concerned with the Health Service as well as with the injury done to poor folk. Therefore, I hope the Parliamentary Secretary or her right hon. Friend will make this matter clear when replying to the debate on this Amendment.

Secondly, are we certain who are outpatients and who are not? Are people who attend a T.B. dispensary considered to be out-patients? When people are sent by the doctor to the out-patient department they are to be charged, or if they are sent as in-patients and then released and told to attend as out-patients they are to be charged. On the other hand, am I correct in assuming that when people are sent to a sanitorium they are not to be charged when they are inside?

Miss Hornsby-Smith

indicated assent.

Dr. Stross

Are they to be charged when they are out and they attend a clinic?

Miss Hornsby-Smith

indicated assent.

Dr. Stross

Well, there we come up against the serious problem of people suffering from a chronic disease and who will be fortunate if they live for the full expectation of life. Many will not, and they will suffer and will not be able to work.

Mr. Ellis Smith (Stoke-on-Trent, South)

My hon. Friend will be aware that there is a great friend of both of us who has just come out of hospital and who is having to receive continuous treatment of the same kind as he received when he was an in-patient.

Dr. Stross

That is the point I am making. I am grateful to my hon. Friend who, quite rightly, will always come to my rescue. He is referring to an important citizen, an alderman in his constituency. Let us assume that a man falls sick from tuberculosis and is put to bed because he is no longer fit to be ambulant. If he is put in a sanatorium there will be no charge. Some people will be lucky and will get in soon, and therefore the time for extortion will be short. Others in other areas where the situation is more difficult and beds are far too few will have to wait a long time on their bed of sickness, and all that time they will have to pay these charges. Is that reasonable or right?

If the Minister were on the Front Bench and not the Parliamentary Secretary, I would be tempted to ask, "How many bloodstained shillings does he want?" It is a bad business; and it is well known that a great many hon. and right hon. Members on both sides of the Committee do not want it. It is a great pity that it has been brought forward.

We are discussing £500,000, representing money extracted from about four million people. I estimate that roughly as the movement to and from the outpatient departments. It is really not worth it. These patients differ from most people because they are most grievously assaulted by disease. That is why they are sent to out-patient departments and told to attend clinics or become patients at out-patient departments after being in hospital. Surely they should not be mulcted of this miserable shilling. Obviously the same applies to the diabetics.

Mr. Messer

We have Amendments on the Order Paper dealing with those.

Dr. Stross

I am glad, and I hope I shall be able to make these comments at greater length on those Amendments. Instead of obtaining £500,000 to relieve the Exchequer, we shall find that the tendency among those who prescribe will be to save the cost for their patients. Again and again the Minister has told us that he does not intend to tell the doctors what they should put on these forms. He does not propose to suggest that there should be any attempt to prescribe larger amounts of drugs and medicines to save patients going to the doctor so often and paying so frequently.

But what will be the result? There will be over-prescribing on the individual forms. The chemist will be hardly able to read the writing on the forms, so crowded will they be. As it is, we define a chemist as the only person who can read a doctor's handwriting. When these proposals come into force the chemist will not be able to read anything at all on the form.

As soon as the threat of these charges came to public knowledge, a chemist explained to me what happened. For 15 years he had prescribed to the same patient each fortnight two oz. of cotton wool, one oz. of pink lint and one 2½ inch bandage. Then, after the threat of these charges, a change came over Form E.C.10. The prescription was four oz. cotton wool, one pound of pink lint and 12 bandages 2½ inches wide.

I have had experience of these things over many years when I was in practice, and the Parliamentary Secretary can take it from me that the tendency will be towards great waste. I do not think we shall raise £500,000. I doubt whether the figure will be £50,000, and we may even make a loss as a result of these proposals; and that hardly commends them to this side of the Committee.

I was very disturbed to note with what equanimity it is accepted on the benches opposite that all one has to do is to use this deterrent selectively, that there is nothing wrong in using a fiscal deterrent to stop people having the treatment they require, and that all that one has to do if one finds it working too harshly is to temper the wind to the shorn lamb. We all know what these charges have already done to dentists and dentists' technicians and therefore to the people.

8.30 p.m.

I am delighted to see that the Minister is now back in the Chamber, because I can be more vigorous with him than with the Parliamentary Secretary. I tell him that the £500,000 he hopes to get he will not obtain at all. If he is not going to get it all, why should be persist with something that, we know, he finds so distasteful that he made a thoroughly bad Second Reading speech? Everyone can see that he thinks this is a bad Bill. He does not like a single provision in it. We who have watched him for six or seven years and know how thoroughly able and progressive a master of the House he can be when he wishes, now see him showing himself, because of his dislike for the Bill, quite inept at the matter. All those who sit behind the right hon. Gentleman would be only too happy if he would say that he would give way, not only on this but on many other matters.

We have been told that there has been great abuse, that cascades of medicine have been poured out and that the cost has been very excessive. Let me offer one or two facts on the cost of drugs and medicine. For the whole of the country the bill has been said to be £50 million. The costs for out-patients are approximately £2 million. One-quarter of that is to be saved—that is the £500,000 that the Minister wishes to get back.

We can guess roughly the cost of medicine and drugs before the war. In a typical year—say, 1935—it was estimated that self-medication, drugs and medicines bought directly from the chemists, ran at about £30 million a year. To that must be added the cost of advertisements in the Press—about £4 million—making £34 million. Panel medicine was about £4 million, bringing the figure to £38 million. That left only private medicine, medicine prescribed by consultants and by private doctors in general practice. Obviously, the over-all sum was over £40 million.

Today, the Health Service figure is £50 million. Chemists, however, say that business over the counter is still at about £30 million, which makes £80 million a year. That is the total cost from every source. In other words, in comparison with pre-war, it has doubled.

What hon. Members opposite have not taken into account in discussing this matter is the fall in self-medication, the turning away by the people who previously bought their medicines at the chemists' shop and have now come into the Service.

Mr. Ellis Smith

It is more reliable, too.

Dr. Stross

I do not say that there are not isolated cases of abuse. I fear that my own colleagues—by which I mean people like myself, and I include myself—can be accused, perhaps, more than the patients.

Dr. Morgan

Keep me out of this.

Dr. Stross

By and large, there is no case made out for serious abuse.

If the right hon. Gentleman would continue what he has begun to do and what his predecessors planned should be done—that is, to send out periodic notes of advice on prescribing to general practitioners—he would find that they would respond. He does not have to do this thing, and I beg him to withdraw it and give us our way on this small but very important Amendment.

Colonel Malcolm Stoddart-Scott (Ripon)

I am not sure that I quite understand the intention of the part of the Clause to which the Amendment relates. One understands that if an outpatient is treated at a hospital and as he leaves is given medicine or drugs to take home with him, he should be charged for them just as a patient goes to his doctor and receives drugs and medicine.

But what is the position regarding medicine and drugs that are given to the out-patient while he is still in hospital in the form of treatment while he is there or is being prepared for investigation? Would a charge be made for them? It is foreseeable that a man who has an accident and goes to an out-patient department might have to have morphia or some other drug to relieve pain or to prevent sepsis. A man who goes to the hospital for treatment for venereal disease might have to receive penicillin and expensive arsenical drugs for his treatment. Is he to be charged for the treatment he receives in the out-patient department of the hospital? It is not clear from the Clause whether that sort of treatment is to be paid for, or whether only the drugs and medicine that a patient takes away from the hospital are affected.

Mr. Ellis Smith

I have a friend whose case is one of the cruellest I know. He suffers from having been gassed in the First World War. In addition, he suffers from asthma, and at various times has to be an in-patient under the treatment of one of the country's finest specialists. The hospital cannot keep him in bed as long as they would like because of the shortage of beds. He then has to go home and to be treated as an out-patient. That man, we understand, will continuously be having to make a payment for the rest of his life.

Colonel Stoddart-Scott

There may be isolated cases like that, but I am not impressed with that argument because the majority of people who are treated in hospital out-patient departments are people who can go for their treatment and can return home after they have had it. What I am not satisfied about is whether the treatment they are having whilst at hospital—the drugs and the medicines—has to be paid for.

Mr. Turner-Samuels

rose—

Colonel Stoddart-Scott

With regard to venereal disease, for over 40 years all cases have been treated free in this country. Indeed, we have entered into a Brussels agreement with 40 other countries whereby we give free treatment to foreign sailors coming to this country on condition that our sailors are treated free in those other countries. I should like my right hon. Friend to say whether it is intended to exclude this type of outpatient treatment from any charges. If not, we shall have the extraordinary position of having British sailors paying for their treatment while foreign sailors get their treatment free.

Miss Lee

If the Committee reject the Amendment, we may be adding to the cost of medicines instead of saving. We all know perfectly well that there was a considerable number of doctors—some, out of antagonism to the Labour Government's free Health Service—who over-prescribed. No one can have an intimate knowledge of his or her constituency and of the nurses and doctors in it without being able to give many instances of waste, and, of course, it is the duty of the House of Commons to try to frame legislation that will end the waste. But if any sane person came among us who had not been living with the question of the shilling prescription charge as long as the House has done, he would find it incredible that we were seeking to introduce legislation which did not even attempt to reach the culprit. The culprit goes free.

Mr. Baird

The doctors are getting another £40 million.

Miss Lee

As my hon. Friend reminds me, the doctors are to have £40 million more—and not just the good doctors and the scrupulous doctors. No matter what the record of a doctor may be, no matter how wasteful he is, we are doing nothing to see that he exercises a proper discretion when issuing prescriptions.

Do we not realise that this Measure is an incitement to the best type of doctor to be unscrupulous? I am going to make a charge against my doctor colleagues on this side of the Committee and I am willing to widen it to those on the other side. Suppose any one of them were dealing with one of the hundreds of thousands or, indeed, millions of families that were not entitled to recover their shilling—families that were just above that level? What would he do? If until the present time he had been entirely scrupulous and had given only the necessary drugs and medicines, would he not be tempted—and fall to the temptation—to give them far more? I would; would not they? I do not think there is any doubt about it. This is something we really must take into consideration. It is one of the sources from which we are really inviting abuse.

But there is another source. Suppose one is dealing with the poorest people of all, who are entitled to recover their shillings. One is not going to write out a prescription that is less than a shilling. I should like an assurance from the Minister or the Under-Secretary that if the prescription costs 10d. or 6d. or 4d. the poor persons will be able to recover the money. But if they are going to be able to recover those various sums we are going to be spending more than we are saving on the administration of this scheme. I suggest to hon. Members opposite that, both on the highest grounds of common decency and on the lowest grounds of sheer electoral expediency, they should agree to this Amendment.

How many of them think that they can live against the real experience of real people, once we find in every constituency in Great Britain the torment of poor folks trying to pay those prescriptions? I do not know who wrote the editorial in "The Times" this morning. I can only say that I did not write it, and the right hon. Member for Ebbw Vale (Mr. Bevan) has assured me that he did not write it. Nevertheless, there is at least one seditious statement in that leader. It says that the Government has been rushed into this whole Bill by pressure from the Treasury. Either that is true or it is not true; but on all the evidence we have got that is precisely the case. The best I can say about hon. Members opposite is that they must have been rushed into it—that they must have refused to learn from the experience we had when we were on those Government benches.

There were some who thought for a short time that the shilling prescription might be a good idea. Why does the Government reject all the evidence and experience that it would be an irritant and not a real saving? Why do we not get down to the proper job? Why do we not start a campaign against fake patent medicines? Why do not we stand behind the great majority of doctors, and not behind a miserable prescription charge of this nature, to prevent the abuse by the medical profession of deliberately wasting drugs and medicines?

I agree with what has already been said, that we are not going to get even a saving of half a million pounds under this Bill unless still further cruelties are introduced. Instead of that, in the long run, it might be found that with the additional abuses—from the highest of motives, this time—and with the additional administration costs, we are spending all this time and causing so much heartbreak and anxiety and it is not even worth a penny to the stony-hearted Treasury.

Mr. Somerville Hastings (Barking)

I was very interested to hear what the Parliamentary Secretary told us when she interrupted, namely, that when the cost of drugs prescribed in hospital was less than 1s. the patient would be charged that lesser sum. I happen to be chairman of one of the post-graduate teaching hospitals in London, and some of the staff are good supporters of the Government. We got busy directly we heard of this proposed charge on prescriptions to try to find out how it could be best carried out in our hospital. After a good deal of thought, we came to the conclusion that it would be best for the patient to go first to the almoner and pay the shilling to her and then take the receipt to the dispensary, or, if the patient was not subject to the charge, he would take a frank instead.

Now that there is this proposal that there should be a differential charge of a sum less than a shilling if the cost of drugs or medicines are less than a shilling, this proposed scheme cannot be carried out. It is only the dispenser who will be able to say what is the cost of the drugs. The almoner cannot do it. I should like to know what extra charge the dispenser is going to add for dispensing. It seems that our carefully worked out scheme will have to go for naught. The patient will have to go first to the dispenser and find out the cost of drugs and dispensing. After that, is the individual to pay the dispenser or how is the money to be collected? There will be a great deal of difficulty if the dispenser has not only to estimate the charges but collect the money afterwards.

8.45 p.m.

Dr. Stross

Is it not a fact that at present in the Health Service there is not a dispensing fee but an on-cost on the original cost of drugs? I do not think there are dispensing fees at present; so the patient would know the cost of the drug the doctor had given him. If it were 2d., the patient would feel that he had been at the doctor's for two hours and had had 2d. worth of treatment.

Mr. Hastings

As I understand it there must be some charge, whether direct or indirect, for dispensing. As the law stands at present the dispenser does not charge the Government merely the cost of the drugs dispensed but also for dispensing. If the matter is to be fair between the private chemist and the dispenser in hospital, some charge for dispensing at the hospital must also be made.

I should like to raise the very strongest objections to these charges to hospital patients for medicines. As I see it, any barrier, real or imaginary, which tends to prevent the patient from being treated at the earliest possible moment must be wrong, because everyone will agree that it is a fundamental principle of medicine that the earlier the case is seen the more can be done for it. I do not want to give examples, but it would surprise hon. Members if I told them that I myself have twice had what used to be considered the most dread disease in medicine—cancer; but nowadays, cancer, if it is recognised early and treated early, can be dealt with successfully—but only if it is recognised early.

There are, too, all these new drugs called the anti-biotics. How many hon. Members have suffered from pneumonia and been cured and brought back to useful life by these medicines? These drugs have changed the whole outlook in sickness so that, while at all times it has been desirable that patients should seek advice at the earliest possible moment, this is now even more abundantly necessary. I wonder if right hon. and hon. Gentlemen opposite realise how even a shilling may prevent a patient from attending hospital.

That seems almost incredible to some of us, but may I give an example of the sort of thing which is happening every day? Supposing there is a mother with young children, and one of the children gets earache. If it is neglected the trouble may become chronic, it may make the child deaf, it may lead to mastoid disease, it may lead to abscess in the brain, not usually in childhood but in after-life. On the other hand, if the child is taken to hospital and treated with one of these anti-biotics, such as one of the sulphonamides, the earache clears up. Surely it must be a mistake to impose a charge which may just tip the balance and decide whether a busy mother, with young children, will take her child to the hospital or whether she will let the matter wait.

Some years ago, just after the Health Bill became law, a mother of a young family said to me, "I no longer dread Thursdays." I could not understand what she meant until I asked her to explain. She said, "By Thursdays the housekeeping money has gone and I dreaded the thought of the child having anything the matter with her and having to be taken to the doctor."

The imposition of these charges is bad for everyone, but it is particularly bad in the case of children and of young people. A young person who has just left school represents a very heavy capital expenditure by the nation. That child has been fed and clothed for 16 years or so, and educated at very considerable cost; and it seems to me to be wrong for us to put anything in the way which would interfere with that child making his full contribution to the nation after so much has been spent on him. As has been said by my hon. Friend, a young person is an investment by the nation. We want to preserve that investment because it is the most precious investment that the country can make.

Mr. Donnelly

After listening to the very moving speech by my hon. Friend the Member for Barking (Mr. Hastings), I do not know how the Minister can sit there and still permit the Committee to discuss this Clause and Amendment instead of accepting the Amendment forthwith. A large number of arguments have already been deployed in favour of the Amendment, but there are one or two points which have not yet been made, and one of them, Mr. Hopkin Morris, affects your constituency and mine; and if you were not in the Chair, we could both raise this point.

There are a large number of minor hospitals in West Wales and other parts of Britain from where, very often, a patient has to go by ambulance to a major hospital such as that at Swansea. If they go to that major hospital they are outpatients for one day in that major hospital. What I should like to ask the Parliamentary Secretary to say when she replies is, what is the position of those people when they have to go long journeys to be out-patients, technically, for one day at a major hospital a long way off simply because proper medical facilities do not exist where they live?

I should like to say one word about the whole question of the prescribing of drugs in out-patients' departments. It seems to me that the right hon. Gentleman and those who helped him draft the Bill seem to imagine that the people who go to out-patents' departments are just casual visitors. Very frequently they are people who cannot go into hospital because of the lack of facilities in the hospitals—a lack of facilities caused by the gross neglect of the right hon. Gentleman's party in five years between the wars. The right hon. Gentleman and those of his colleagues who helped draft this particular Clause seem to me to be people who really have little or no idea of the difficulties of people who go to out-patients' departments. Theirs is the mentality—it is the mentality of the Clause—of those people who simply go to Harley Street whenever they have anything wrong with them.

The whole basis of this Bill and of this particular Clause, which is one which this Amendment would help to nullify, is that life should be made as difficult as possible for people when they are suffering through no fault of their own. In other words, it is based on the principle of kicking a man when he is down. It is a great tragedy, if that is all that the party of the old school tie have to offer to the British people today; and I should like to ask the right hon. Gentleman whether that is what he learned on the playing fields of Eton.

It is monstrous that this charge is put by the Government at this time on people who go to out-patients' departments in circumstances such as these, and who have to pay not only this charge but—very frequently, if they are working people—for loss of time at work as well. It is quite disgusting that the right hon. Gentleman and his colleagues defend this charge in any way at all, and I hope that the right hon. Gentleman will take the consensus of opinion of my hon. Friends on this side of the Committee and forthwith accept the Amendment.

Mr. Carmichael

Earlier in the Committee stage the Member of Abingdon (Sir R. Glyn) made a plea that we should approach this Measure with a touch of humanitarianism and try to avoid clashing on narrow political lines. I do not know if it is possible in any Measure that comes before the House or this Committee to do that, but I do feel that the case for the Amendment has been made, and the Minister would be justified, even in the eyes of the Cabinet, in accepting it. There is a number of reasons for it that have been well ventilated by eminent medical men and by others dealing with the economic side.

One of the reasons for the Bill is said to be the serious economic position of the country, and another is that a charge of this kind will be a deterrent. I have been more than amazed that the hon. Gentleman the Member for Enfield, West (Mr. Iain MacLeod), who made a strong speech on Second Reading about deterrents, has not made a contribution la our discussion on this question of medicines and drugs. Surely he should tell us whether he is backing the Bill on economic grounds, or whether he feels that there is a waste of medicine?

Mr. Iain MacLeod (Enfield, West)

Seeing that the hon. Gentleman has referred to me, let me say that, in my view, that is an entirely unreal distinction. It is not just a black-and-white argument. The Leader of the Opposition, when he introduced, in 1949, in the days of Labour Government, the proposal which is the parent—or the grandparent—of what we are discussing now, put as the main reason that there was an unnecessary waste which it was essential to reduce or eliminate. He put the deterrent charge first. Then he said that there would be a resultant saving to the country of £10 million. He put before Parliament both the medical and the financial grounds, and in this, as in many other health charges, the two are not mutually exclusive.

9.0 p.m.

Mr. Carmichael

I will take up that point. It is quite true that the 1949 Act permits the Government to make a charge for prescriptions, but there has obviously been an examination since then on economic and administrative grounds. It is now admitted that the thing is quite unworkable. We are entitled to assume it is still unworkable, because we have had no evidence from the Government Front Bench, either on Second Reading or at any other stage, that they have some kind of machinery which can be put into operation to save this £500,000 which they say they will save.

If the deterrent, linked with our economic position, is stressed, surely the hon. Member for Enfield, West, who has been congratulated on his brilliant contributions to our debates on this Bill, would not argue that the stability of this country rests on the stealing of 1s. from a tuberculosis patient who cannot get into hospital, because that is what this proposal means. I say that it cannot operate administratively and bring in the money suggested. It has already been admitted that the dispenser will not make the charge to the person getting a prescription; but he must make a charge against somebody, and that charge must be against the authority in some form.

On the medical side it has been continually argued from the other side of the Committee that they were in favour of a national health service. I had grave doubts about that from the time they walked into the Lobby against the Measure. I go further. Suppose I assume that they are in favour of a national health service, and suppose they believe that certain economies can be made, if pressed by the Treasury to make those economies. Surely taking 1s. from the hardest hit of our people is not the way to restore the economy of a great Power.

I speak especially of my own area. In the West of Scotland hundreds of people cannot get into sanitoria because of overcrowding. Although the difficulty is lessening, we have the worst possible tuberculosis cases in the whole country, and in the main people suffering from that dreadful disease come from the poorest parts of the country.

In order to save the country and to achieve something like economic security, a prescription charge is to be made; the Government are taking 1s. off people who are unable to bear that charge. In view of the very able speeches made by medical men in the Committee, including hon. Members opposite, I ask the Minister to look at this proposal again, because, with all due respect to the Parliamentary Secretary, she was not very sure whether he is charging 2½d. or 1s. She is still not very sure about it.

Speaking with all sincerity, I agree with many hon. Members on this side of the Committee that the Minister of Health on many occasions has been very accommodating, both as the Leader of the House and as the Minister. I feel that he is justified in giving this matter further consideration. It may be quite impossible for him tonight to give any assurance, but he might give us some indication that he will look at the matter again, and, if possible, before we reach the Report stage, recognise that, if there is a real clash of political differences between both sides of the House it should not be over a miserable prescription, but over something really worth while, and not on the question of taking a miserable 1s. from the diabetic or the person suffering from tuberculosis. There could be nothing to discredit the Government more in the eyes of decent people.

The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)

The House will he aware that this Clause is part of the general application of a prescription charge, and a very small part, since the bulk of the prescription charge which it is proposed to introduce is already covered by legislation passed by the former Government, under which the saving, as the Committee know, is estimated to be about £12 million.

Having accepted that, and having found, in these difficult times, that it is necessary to implement the legislation passed by the previous Government, we do not accept in justice that it is fair to except those people who get their medicine from the dispensary at an outpatients' department as opposed to going to their general practitioner, obtaining their prescriptions, and getting them dispensed at the chemist's shop.

There is a further difficulty. The point, I think, was made by the hon. Member for Tottenham (Mr. Messer) that there were hospitals and clinics which came under the Health Service where a prescription was given because there was no dispensing service in the hospital or clinic. If this Amendment were accepted we should create an anomaly and an injustice when we want to provide that everyone, from whatever source they obtain their medicine—from the chemist as the result of a general practitioner's prescription or from an out-patients' dispensary—should be charged the same fee.

Mr. Messer

Will the hon. Lady explain this anomaly? Where there is an out-patient department attached to a hospital which has not a dispensary, the patient gets the prescription made up and does not pay. Will the out-patient at the hospital where there is a dispensary also get it free?

Miss Hornsby-Smith

The anomaly arises if we accept this Amendment, while determining to continue with the legislation for 1s. prescription charge to general practitioners. We should then have patients attending a hospital where there was no dispensary, having to take these prescriptions to a chemist, where they would be charged 1s.

The right hon. Lady the Member for Fulham, West (Dr. Summerskill) was very eloquent about the various classifications of the sick, the young and the old who go to out-patient departments. That is certainly true, but it is equally true that the old, the young, the sick and the chronic sick also go to their general medical practitioners. If the principle is accepted that in these difficult times it is necessary to make this charge, it is not fair that there should be exemptions purely as a result of whether or not one's prescription is made up by an outpatients' dispensary or by a dispensing chemist or doctor.

There is the further point that if prescriptions were free in the dispensary of an out-patients' department pressure would be increased because people would know that if they obtained their prescriptions there they would be free, whereas if they got them from a general practitioner and went to a chemist they would have to pay. The hon. Member for Stoke-on-Trent, Central (Dr. Stross) made great play about the saving being only half a million pounds. But we are putting the charge equally on all patients: overall saving is the much larger figure of £12 million.

The hon. Member referred to prescriptions costing less than 1s. I want to go into detail about this because the matter was raised by four other hon. Members opposite. The hon. Member for Stoke-on-Trent, Central, referred to the fact that some prescriptions were very much more costly than others, a matter which received a lot of attention on Second Reading. I am sure he will agree with me that it would certainly not be the wish of hon. Members on either side of the Committee that we should make proportionate charges because the remedy for one complaint was vastly more costly than for others.

At Question time today my right hon. Friend said that the average cost of prescriptions last year was 3s. 8d. There- fore, the 1s. prescription charge is only a moderate proportion of the average cost of all prescriptions. I want to make this point clear, because a number of useful contributions were made in the discussion, and hon. Members generally wanted to find out how this would operate.

If the Health Service is used for the prescription, and the prescription is under this part of the Bill taken to a hospital dispensary, a charge of 1s. is payable. If a patient thinks that the medicine costs less than 1s., or if the chemist dispensing from the general practitioner's prescription advises that it costs less, he can buy it outside the Health Service. [Interruption.]

I think that is fair. Hon. Members may laugh, but it happens to be common sense. It is fair that hon. Members should know that only slightly less than one in every 100 prescriptions costs less than 1s., and the vast majority of that barely 1 per cent. cost between 10d. and 11d. Besides the cost of the actual item, there is the cost of the container and also the dispensing fee. Therefore, a mere fraction of 1 per cent. of prescriptions cost under 10d., and the matter is nothing like so large as some hon. Gentlemen have implied.

Mr. Ness Edwards (Caerphilly)

How will the old-age pensioner who gets his medicine for 10d. recover that 10d.?

Miss Hornsby-Smith

The vast majority of the prescriptions costing less than 1s. are for 10d. The old-age pensioner will pay his 1s. and reclaim it. [HON. MEMBERS: "How?"] I beg the right hon. Gentleman's pardon. I misunderstood him. I was thinking in terms of the old-age pensioner who had a supplementary allowance under the National Assistance Board and would qualify to reclaim. Anyone who qualified to reclaim will have to pay a shilling prescription charge and will be refunded 1s. through the National—

9.15 p.m.

Mrs. Braddock

How?

Miss Margaret Herbison (Lanarkshire, North)

Is the hon. Lady not well aware that many old-age pensioners almost every week, at some time of the week, just have not got one shilling in their pockets to pay this shilling?

Dr. Stross

Is the position this, that it will not be the chemist who will compute the cost of the prescription but that the patient will receive it and it will be at his or her option to price it? If he or she feels from his or her own knowledge that it is less than a shilling in value, can they say to the chemist "I am paying for this in cash. I have priced it and I know that it is less than one shilling"? If that is the situation then the Department is more bankrupt than I thought.

Miss Hornsby-Smith

The hon. Gentleman will agree that the number of people to whom this will apply is small.

Mr. Baird

Five hundred thousand.

Miss Hornsby-Smith

The number of prescriptions which cost less than 10d. or 11d. represent the smallest fraction of 1 per cent. of the total prescriptions.

Mr. Ness Edwards

How does the old age pensioner, who pays 10d. for his medicine to the chemist and who is getting a supplementary pension, recover his money?

Miss Hornsby-Smith

A patient who is getting a supplement from the National Assistance Board, or a war pensioner, who wishes to regain a shilling prescription charge—

Mr. Baird

Tenpence.

Miss Hornsby-Smith

I have already said that if they obtain their prescription through the Health Service they will pay 1s. and they will regain 1s.

Mrs. Braddock

How?

Miss Hornsby Smith

I am answering the right hon. Member for Caerphilly (Mr. Ness Edwards). In reply to his first point they will pay 1s., and the margin between 10d. and 1s. is so small that we cannot vary the 1s. rate. In reply to the hon. Lady the Member for Lanarkshire, North (Miss Herbison), my right hon. Friend in the Second Reading made it plain that those who qualify to regain the 1s. under this Bill will pay a 1s. They will receive a receipt, and when they next go to claim their old age pension and supplementary pension they will receive an extra 1s. when they hand in that receipt at the same time as they apply for—

Mr. Baird

rose—

Miss Hornsby-Smith

No. I have given way a good deal.

My hon. Friend the Member for Ripon (Colonel Stoddart-Scott) raised the question of treatment, medicines and drugs in hospitals.

Mr. Hastings

Can the hon. Lady explain how the people, who are not in receipt of assistance—

Mrs. Braddock

That is what I wanted to know.

Mr. Hastings

—and go to hospital and get a prescription which costs less than 1s., are going to pay for it?

Miss Hornsby-Smith

I have already explained that if a patient feels that the cost of his prescription is well under 1s., the margin between 10d. and 1s.

Mr. Baird

That is 2d.

Miss Hornsby-Smith

The hon. Member knows that the number of prescriptions which cost under 10d., about which hon. Members are trying to make such a vast issue, is very very small indeed.

Mr. Baird

It is not very small. It is 2 million.

Mr. Peter Remnant (Wokingham)

The hon. Gentleman said half a million just now.

Miss Hornsby-Smith

My hon. and gallant Friend the Member for Ripon raised the question of charges for treatment or drugs by patients in hospital. There is no charge of any kind for in-patients.

The hon. Member for Bridgeton (Mr. Carmichael) suggested that the charge would fall most heavily on the poorest people. I reiterate what my right hon. Friend made plain in the Second Reading, that where there is a genuine case of need the patient has the same recourse to the National Assistance Board for meeting the charge—[Interruption.]

Mr. Carmichael

Will the hon. Lady explain "need"?

Miss Hornsby-Smith

That is the function of the National Assistance Board. After all, it was hon. Gentlemen opposite who incorporated a charge for teeth and spectacles as part and parcel of the National Health Service. They established that principle when they sat on these benches and provided us with the legislation.

Mr. G. R. Mitchison (Kettering)

rose—

The Deputy-Chairman

If the hon. Lady does not give way the hon. and learned Member must resume his seat.

Miss Hornsby-Smith

For the general reasons which I have outlined, and because we believe it would be unjust to make this demarcation between people suffering from the same ailment but receiving their medicine from different sources, we do not accept the Amendment.

Mr. Blenkinsop

The important point is how this charge is to operate in the case of out-patients. Who is to collect the money? Is it to be done on the pharmacy side or is it a job for the almoner? If the latter, will it not add to the almoner's staff and take the almoner away from much more important work?

Miss Hornsby-Smith

The hospital will collect the shilling, and it will be for the hospital management committee, or for the superintendent and officers of the hospital, to decide whether the charge will be collected in the dispensary or in the almoner's department.

Dr. Broughton

All I need say about the speech to which we have just listened is that we are very disappointed that the hon. Lady, speaking on behalf of the Government, finds herself unable to accept the Amendment. The Amendment relates to the charges which the Government intend to impose for drugs and medicines issued to patients attending the out-patient departments of hospitals.

Before dealing with that in detail, I feel I must give an answer to a most serious allegation which was made by the hon. Member for Wolverhampton, South-West (Mr. Powell), when he alleged that a number of general medical practitioners were not giving proper attention to patients in their own surgeries and were sending cases to hospital which could well have been examined and treated in the general practitioner's consulting room.

Mr. Powell

The hon. Member is entitled to his own opinions, but I made no allegation at all.

Hon. Members

The hon. Member did.

Dr. Broughton

The hon. Member made a definite statement that that was happening—

Mr. Powell

A quotation.

An Hon. Member

Why did he quote it?

Dr. Broughton

That is an allegation against general medical practitioners that they are not doing their work properly, and I must deny that allegation. The hon. Member may like to know that if general practitioners were guilty of that their professional colleagues on the staffs of hospitals would very quickly protest about it and inform the general practitioners that they would be glad to receive only those cases which are in need of hospital treatment and which cannot receive the necessary examination or treatment in the doctor's consulting room. The hon. Member did say at the outset of his remarks that he did not claim to know a great deal about the National Health Service, but he was learning more and more every day. We hope that he will go on learning more and more every day.

These charges which are being imposed for drugs and medicines issued in outpatients' departments of hospitals have been mentioned in this Bill in order that the Government may give the force of law to those economies which were told to us by the Chancellor of the Exchequer on the first day we returned after the ridiculously long Christmas Recess. They are some of the measures which the Government—[Interruption]

Mr. Ellis Smith

We are not at the Coliseum now.

Dr. Broughton

—consider necessary in order to help us overcome the nation's economic troubles at present. In previous debates that point has been dealt with and we on these benches do not consider that this is the right way to overcome those economic troubles. I am very sorry that the last Amendment was not accepted because I think that within less than two years, if we are still suffering under a Tory Government, even that Government will wish to repeal this Measure because it will probably be found that it is having a serious and deleterious effect upon the health of the nation. I think these charges for drugs and medicines at out-patient departments will act as a deterrent to patients who need to go to hospital, and, therefore, their health will suffer.

9.30 p.m.

The whole truth of the matter is that the Government have found themselves up against the really serious problem of the size, and the growing size, of the drug bill. It is a problem which has to be faced and will have to be solved, but I am quite sure that this Bill is not the correct answer to it. Imposing charges for the drugs and medicines of patients attending the out-patient department of hospitals is not the correct way to solve the problem of the huge amount of money we have to spend on drugs.

These charges recall to mind the National Health Service Bill of 1949, to which so many references have been made. I would remind the Committee that my right hon. Friend the Leader of the Opposition, who was then Prime Minister, stated, on 24th October, 1949: We propose to make a charge of not more than 1s. for each prescription under the National Health Service. The purpose is to reduce excessive and, in some cases, unnecessary, resort to doctors and chemists, of which there is evidence which has for some time troubled my right hon. Friends the Minister of Health and the Secretary of State for Scotland."—[OFFICIAL REPORT, 24th October, 1949; Vol. 468, c. 1019.] The necessary legislation came before us in the form of a Lord's Amendment to the National Health Service Bill on 9th December, 1949. I supported it in the Division Lobby after I had confirmed, by conversations with chemists and doctors, that there was abuse on the part of some patients, and also after I had learned that some doctors were being over-generous in issuing prescriptions.

But when the Labour Government came to consider the necessary regulations for implementing it, they found the charges could not be imposed without inflicting serious financial hardship upon some people and injustice upon a large number of people. The Labour Government had the courage to say that they had found that that Act, hastily passed, I suggest, under Treasury pressure, would not work. [HON. MEMBERS: "Hear, hear."] Yes, the Labour Government had the courage to admit it would not work. I should have thought that the Conservative Government which we now have would have learned something from that experience of the Labour Government. Instead they are allowing themselves to be subjected to the same type of Treasury pressure, and with sheer ridiculous obstinacy are trying to bring these cruel proposals into operation.

I feel that the Minister himself knows that these methods are the wrong ones. We have heard many brilliant speeches from the right hon. Gentleman, but the speech which he made on the Second Reading of this Bill was, in my opinion, the worst I have ever heard him make in this House. The right hon. Gentleman really looked most uncomfortable when making that speech.

I believe that some methods must be devised in the near future to encourage the early recognition and treatment of disease, and, at the same time, they must repress abuse in the prescribing of drugs and medicines. This is the major problem which faces us when we survey the National Health Service. We must find an answer quickly, but, while we are waiting and hoping that the answer will come to us before long, I suggest that people of all political parties, both inside and outside this House, should try to work out a method for improving the nation's health by encouraging early treatment, and, at the same time, for abolishing abuses in the demand for and the prescribing of drugs and medicines.

I wonder if hon. and right hon. Gentlemen opposite who form the present Government realise that attendance at the outpatient department of a hospital causes financial worry to workers, because they have to break their work for short or long periods and suffer a lower income? Many of them who attend the out-patient departments are dependent for their income on National Insurance benefits and National Assistance. When people are ill, that is the time when they can least afford expense, and to impose these charges upon people who are sick and injured is mean and brutal.

People do not attend the out-patient departments of hospitals unless they have something wrong with them. Prescribing for these hospital cases is done by medical men and women who are remunerated by means of salary and not on a capitation basis, and there has been no abuse of prescriptions in the hospital service.

The proposed legislation merely follows typical Tory policy. The present Government are being mean to the extent of being Scroogian. It all amounts to kicking a man when he is down, and I believe that the people of this country will not stand it for long. It is foreign to the British character, and, therefore, intolerable.

Mr. Buchan-Hepburn

rose in his place, and claimed to move, "That the Question be now put."

Question put, "That the Question be now put."

The Committee divided: Ayes, 279; Noes, 269.

Division No 62.]	AYES	[9.42 p.m.
Aitken, W. T.	Donaldson, Comdr, C. E. McA	Johnson, Howard (Kemptown)
Allan, R, A, (Paddington, S.)	Donner, P. W.	Jones, A (Hall Green)
Alport, C. J. M.	Doughty, C. J. A.	Joynson-Hicks, Hon. L. W.
Amery, Julian (Preston, N.)	Douglas-Hamilton, Lord Malcolm	Kaberry, D.
Amory, Heathcoat (Tiverton)	Drewe, C.	Kerr, H. W. (Cambridge)
Anstruther-Gray, Major W. J.	Dugdale, Maj. Rt. Hn. Sir T. (Richmond)	Lambert, Hon. G.
Arbuthnot, John	Duncan, Capt. J. A. L.	Lambton, Viscount
Ashton, H. (Chelmsford)	Duthie, W. S.	Lancaster, Col. C. G.
Astor, Hon. J. J. (Plymouth, Sutton)	Elliot, Rt. Hon. W. E.	Law, Rt. Hon. R. K.
Astor, Hon. W. W. (Bucks, Wycombe)	Erroll, F. J.	Legge-Bourke, Maj. E. A. H.
Baker, P. A. D.	Fell, A.	Legh, P. R. (Petersfield)
Baldock, Lt.-Cmdr J. M.	Finlay, Graeme	Lennox-Boyd, Rt. Hon. A. T.
Baldwin, A. E.	Fisher, Nigel	Lindsay, Martin
Banks, Col C.	Fleetwood-Hesketh, R. F.	Linstead, H. N.
Barber, A. P. L.	Fletcher, Walter (Bury)	Llewellyn, D. T.
Barlow, Sir John	Fletcher-Cooke, C.	Lloyd, Maj. Guy (Renfrew, E.)
Beach, Maj. Hicks	Foot, M. M.	Lockwood, Lt.-Col. J. C.
Beamish, Maj. Tufton.	Foster, John	Longden, Gilbert (Herts, S.W.)
Bell, Philip (Bolton, E.)	Fraser, Hon. Hugh (Stone)	Low, A. R. W.
Bell, Ronald (Bucks, S.)	Fraser, Sir Ian (Morecambe & Lonsdale)	Lucas, Sir Jocelyn (Portsmouth, S)
Bennett, F. M. (Reading, N.)	Fyfe, Rt. Hon. Sir David Maxwell	Lucas, P. B. (Brentford)
Bennett, Sir Peter (Edgbaston)	Gage, C. H.	Lucas-Tooth, Sir Hugh
Bennett, Dr. Reginald (Gosport)	Galbraith, Cmdr. T. D. (Pollok)	McAdden, S. J.
Bennett, William (Woodside)	Galbraith, T. G. D. (Hillhead)	McCallum, Major D.
Bevins, J. R. (Toxteth)	Gammans, L. D.	McCorquodale, Rt. Han. M. S.
Birch, Nigel	Garner-Evans, E. H.	Macdonald, Sir Peter (I. of Wight)
Bishop, F. P.	George, Rt. Hon. Maj. G. Lloyd	Mackesen, Brig. H. R.
Black, C. W.	Glyn, Sir Ralph	McKibbin, A. J.
Boothby, R. J. G.	Godber, J. B.	McKie, J. H. (Galloway)
Bossom, A. C.	Gomme-Duncan, Col A.	Maclay, Hon John
Boyd-Carpenter, J. A.	Gough, C. F. H.	Maclean, Fitzroy
Boyle, Sir Edward	Gower, H. R.	MacLeod, Iain (Enfield, W.)
Braine, B. R.	Graham, Sir Fergus	MacLeod, John (Ross and Cromarty)
Braithwaite, Sir Albert (Harrow, W)	Gridley, Sir Arnold	Macmillan, Rt. Hon. Harold (Bromley)
Braithwaite, Lt.-Cdr. G. (Bristol, N.W.)	Grimston, Hon. John (St. Albans)	Macpherson, Maj. Niall (Dumfries)
Bromley-Davenport, Lt.-Col. W. H.	Grimston, Sir Robert (Westbury)	Maitland, Comdr. J. F. W. (Horncastle)
Brooman-White, R. C.	Harden, J. R. E.	Maitland, Patrick (Lanark)
Browne, Jack (Govan)	Harris, Frederic (Croydon, N.)	Manningham-Buller, Sir R. E.
Buchan-Hepburn, Rt. Hon. P. G. T.	Harris, Reader (Heston)	Markham, Maj. S. F.
Bullard, D. G.	Harrison, Col. J. H. (Eye)	Marlowe, A. A. H.
Bullock, Capt. M.	Harvey, Air Cdre. A. V. (Macclesfield)	Marples, A. E.
Bullus, Wing Commander E. E.	Harvey, Ian (Harrow, E.)	Marshall, Douglas (Bodmin)
Burden, F. F. A.	Harvie-Watt, Sir George	Marshall, Sidney (Sutton)
Butcher, H. W.	Hay, John	Maudling, R.
Butler, Rt. Hon. R. A. (Saffron Walden)	Head, Rt. Hon. A. H.	Maydon, Lt.-Cmdr. S. L. C.
Carr, Robert (Mitcham)	Heald, Sir Lionel	Medlicott, Brig F.
Carson, Hon. E.	Heath, Edward	Mellor, Sir John
Cary, Sir Robert	Henderson, John (Cathcart)	Morrison, John (Salisbury)
Channon, H.	Higgs, J. M. C.	Mott-Radclyffe, C. E.
Churchill, Rt. Hon W. S.	Hill, Dr. Charles (Luton)	Nabarro, G. D. N.
Clarke, Col. Ralph (East Grinstead)	Hill, Mrs. E. (Wythenshawe)	Nicholls, Harmer
Clarke, Brig. Terrance (Portsmouth, W.)	Hinchingbrooke, Viscount	Nicholson, Godfrey (Farnham)
Clyde, Rt. Hon. J. L.	Hirst, Geoffrey	Nicolson, Nigel (Bournemouth, E.)
Cole, Norman	Holland-Martin, C. J.	Nield, Basil (Chester)
Colegate, W. A.	Hollis, M. C.	Noble, Cmdr. A. H. P.
Conant, Maj. R. J. E.	Holmes, Sir Stanley (Harwich)	Nugent, G. R. H.
Cooper, Sqn. Ldr. Albert	Hope, Lord John	Nutting, Anthony
Craddock, Beresford (Spelthorne)	Hornsby-Smith, Miss M. P.	Oakshott, H. D.
Cranborne, Viscount	Horobin, I. M.	Odey, G. W.
Crookshank, Capt. Rt. Hon. H. F. C.	Horsbrugh, Rt. Hon. Florence	O'Neill, Rt. Hon. Sir H. (Antrim, N.)
Crosthwaite-Eyre, Col. O. E.	Howard, Gerald (Cambridgeshire)	Ormsby-Gore, Hon. W. D.
Crouch, R. F.	Hudson, Sir Austin (Lewisham, N.)	Orr, Capt L. P. S.
Crowder, John E. (Finchley)	Hudson, W. R. A. (Hull, N.)	Orr-Ewing, Charles Ian (Hendon, N.)
Crowder, Petre (Ruislip—Northwood)	Hulbert, Wing Cmdr. N. J.	Orr-Ewing, Ian L. (Weston-super-Mare)
Darling, Sir William (Edinburgh, S.)	Hurd, A. R.	Osborne, C.
Davidson, Viscountess	Hutchinson, Sir Geoffrey (Ilford, N.)	Partridge, E.
De la Bère, R.	Hutchison, Lt.-Com. Clark (E'b'rgh W.)	Perkins, W. R. D.
Deedes, W. F.	Hutchison, James (Scotstoun)	Peto, Brig. C. H. M.
Digby, S. Wingfield	Hylton-Foster, H. B. H.	Peyton, J. W. W.
Dodds-Parker, A. D.	Jenkins, R. C. D. (Dulwich)	Pickthorn, K. W. M.
Pilkington, Capt. R. A.	Snadden, W. McN	Tweedsmuir, Lady
Pitman, I. J.	Soames, Capt. C.	Vane, W. M. F.
Powell, J. Enoch	Spearman, A. C. M.	Vaughan-Morgan, J. K.
Price, Henry (Lewisham, W.)	Speir, R. M.	Vosper, D. F.
Profumo, J. D.	Spence, H. R. (Aberdeenshire, W.)	Wakefield, Edward (Derbyshire, W.)
Raikes, H. V.	Spens, Sir Patrick (Kensington, S.)	Wakefield, Sir Wavell (Marylebone)
Rayner, Brig. R.	Stanley, Capt. Hon. Richard	Walker-Smith, D. C.
Remnant, Hon. P.	Stevens, G. P.	Ward, Hon. George (Worcester)
Renton, D. L. M.	Steward, W. A. (Woolwich, W.)	Ward, Miss I. (Tynemouth)
Robinson, Roland (Blackpool, S.)	Stewart, Henderson (Fife, E.)	Waterhouse, Capt. Rt. Hon. C.
Roper, Sir Harold	Stoddart-Scott, Col. M.	Watkinson, H. A.
Russell, R. S.	Strauss, Henry (Norwich, S.)	Wellwood, W.
Ryder, Capt. R. E. D.	Stuart, Rt. Hon. James (Moray)	White, Baker (Canterbury)
Salter, Rt. Hon. Sir Arthur	Summers, G. S.	Williams, Rt. Hon. Charles (Torquay)
Sandys, Rt. Hon. D.	Sutcliffe, H.	Williams, Gerald (Tonbridge)
Schofield, Lt.-Col. W. (Rochdale)	Taylor, William (Bradford, N.)	Williams, Sir Herbert (Croydon, E.)
Scott, R. Donald	Teeling, W.	Williams, R. Dudley (Exeter)
Scott-Miller, Cmdr. R.	Thomas, P. J. M. (Conway)	Wills, G.
Shepherd, William	Thompson, Kenneth (Walton)	Wilson, Geoffrey (Truro)
Simon, J. E. S. (Middlesbrough, W.)	Thompson, Lt.-Cdr. R. (Croydon, W.)	Wood, Hon. R.
Smiles, Lt.-Col. Sir Walter	Thornton-Kemsley, Col. C. N.	York, C.
Smithers, Peter (Winchester)	Tilney, John
Smithers, Sir Waldron (Orpington)	Touche, G. C.	TELLERS FOR THE AYES:
Smyth, Brig J. G. (Norwood)	Turner, H. F. L.	Mr. Studholme and Mr. Redmayne.
NOES
Acland, Sir Richard	de Freitas, Geoffrey	Hudson, James (Ealing, N.)
Adams, Richard	Deer, G.	Hughes, Cledwyn (Anglesey)
Albu, A. H.	Dodds, N. N.	Hughes, Hector (Aberdeen, N.)
Allen, Arthur (Bosworth)	Donnelly, D. L.	Hynd, H. (Accrington)
Allen, Scholefield (Crewe)	Driberg, T. E. N.	Hynd, J. B. (Attercliffe)
Anderson, Alexander (Motherwell)	Dugdale, Rt. Hon. John (W. Bromwich)	Irvine, A. J. (Edge Hill)
Anderson, Frank (Whitehaven)	Ede, Rt. Hon. J. C.	Irving, W. J. (Wood Green)
Attlee, Rt. Hon. C. R.	Edelman, M.	Janner, B.
Awbery, S. S.	Edwards, John (Brighouse)	Jay, Rt. Hon. D. P. T.
Ayles, W. H.	Edwards, Rt. Hon. Ness (Caerphilly)	Jager, George (Goole)
Bacon, Miss Alice	Edwards, W. J. (Stepney)	Jenkins, R. H. (Stechford)
Baird, J.	Evans, Albert (Islington, S.W.)	Johnston, Douglas (Paisley)
Balfour, A.	Evans, Edward (Lowestoft)	Jones, David (Hartlepool)
Barnes, Rt. Hon. A. J.	Evans, Stanley (Wednesbury)	Jones, Frederick Elwyn (West Ham, S.)
Bellenger, Rt. Hon F. J.	Ewart, R.	Jones, Jack (Rotherham)
Bence, C. R.	Fernyhough, E.	Jones, T. W. (Merioneth)
Bann, Wedgwood	Field, W. J.	Keenan, W.
Benson, G.	Fienburgh, W.	Kenyon, C.
Beswick, F.	Finch, H. J.	Key, Rt. Hon. C. W.
Bevan, Rt. Hon. A. (Ebbw Vale)	Fletcher, Eric (Islington, E.)	King, Dr. H. M.
Bing, G. H. C.	Follick, M.	Lee, Miss Jennie (Cannock)
Blackburn, F.	Foot, M. M.	Lever, Harold (Cheatham)
Blenkinsop, A.	Forman, J. C.	Lever, Leslie (Ardwick)
Blyton, W. R.	Fraser, Thomas (Hamilton)	Lewis, Arthur
Boardman, H.	Freeman, John (Watford)	Lindgren, G. S.
Bottomley, Rt. Hon. A. G.	Freeman, Peter (Newport)	Lipton, Lt.-Col. M.
Bowden, H. W.	Gaitskell, Rt. Hon. H. T. N.	Logan, D. G.
Bowles, F. G.	Gibson, C. W.	Longden, Fred (Small Heath)
Braddock, Mrs. Elizabeth	Glanville, James	MacColl, J. E.
Brockway, A. F.	Gooch, E. G.	McGhee, H. G.
Brook, Dryden (Halifax)	Gordon, Walker, Rt. Hon. P. C.	McGovern, J.
Broughton, Dr. A. D. D.	Greenwood, Anthony (Rossendale)	McInnes, J.
Brown, Rt. Hon. George (Belper)	Greenwood, Rt. Hon. Arthur (Wakefield)	McKay, John (Wallsend)
Brown, Thomas (Ince)	Grenfell, Rt. Hon. D. R.	McLeavy, F.
Burke, W. A.	Grey, C. F.	MacMillan, M. K. (Western Isles)
Burton, Miss F. E.	Griffiths, David (Rother Valley)	MacPherson, Malcolm (Stirling)
Butler, Herbert (Hackney, S.)	Griffiths, Rt. Hon. James (Llanelly)	Mallalieu, E. L. (Brigs)
Callaghan, L. J.	Griffiths, William (Exchange)	Mallalieu, J. P. W. (Huddersfield, E.)
Carmichael, J.	Grimond, J.	Mann, Mrs. Jean
Castle, Mrs. B. A.	Hale, Leslie (Oldham, W.)	Manuel, A. C.
Champion, A. J.	Hall, Rt. Hon. Glenvil (Colne Valley)	Marquand, Rt. Hon. H. A.
Chapman, W. D.	Hall, John (Gateshead, W.)	Mayhew, C. P.
Chetwynd, G. R.	Hamilton, W. W.	Mellish, R. J.
Clunie, J.	Hannan, W.	Messer, F.
Cocks, F. S.	Hardy, E. A.	Mikardo, Ian
Coldrick, W.	Hargreaves, A.	Mitchison, G. R.
Collick, P. H.	Harrison, J. (Nottingham, E.)	Monslow, W.
Cook, T. F.	Hastings, S.	Moody, A. S.
Cove, W. G.	Hayman, F. H.	Morgan, Dr. H. B. W.
Craddock, George (Bradford, S)	Healey, Denis (Leeds, S.E.)	Morley, R.
Crossland, C. A. R.	Henderson, Rt. Hon. A. (Rowley Regis)	Morris, Percy (Swansea, W.)
Crossman, R. H. S.	Herbison, Miss M.	Morrison, Rt. Hon. H. (Lewisham, S.)
Cullen, Mrs. A.	Hewitson, Capt. M.	Mort, D. L.
Daines, P.	Hobson, C. R.	Moyle, A.
Dalton, Rt. Hon. H.	Holman, P.	Mulley, F. W.
Davies, A. Edward (Stoke, N.)	Holt, A. F.	Murray, J. D.
Davies, Ernest (Enfield, E.)	Houghton, Douglas	Nally, W.
Davies, Stephen (Merthyr)	Hoy, J. H.	Neal, Harold (Bolsover)

Noel-Baker, Rt. Hon P. J.	Schofield, S. (Barnsley)	Viant, S. P.
O'Brien, T.	Shackleton, E. A. A.	Wallace, H. W.
Oldfield, W. H.	Shawcross, Rt. Hon. Sir Hartley	Watkins, T. E.
Oliver, G. H.	Shinwell, Rt. Hon. E.	Webb, Rt. Hon M. (Bradford C.)
Orbach, M.	Short, E. W.	Weitzman, D.
Oswald, T.	Shurmer, P. L. E.	Wells, Percy (Faversham)
Padley, W. E.	Silverman, Julius (Erdington)	Wells, William (Walsall)
Paget, R. T.	Simmons, C. J. (Brierley Hill)	West, D. G.
Paling, Rt. Hon. W. (Dearne Valley)	Slater, J.	Wheatley, Rt. Hon. John
Paling, Will T. (Dewsbury)	Smith, Ellis (Stoke, S.)	White, Mrs. Eirene (E. Flint)
Pannell, Charles	Smith, Norman (Nottingham, S.)	White, Henry (Derbyshire, N.E.)
Parker, J.	Snow, J. W.	Whiteley, Rt. Hon W.
Paton, J.	Sorensen, R. W.	Wigg, George
Peart, T. F.	Soskice, Rt. Hon Sir Frank	Wilcock, Group Capt. C. A. B.
Plummer, Sir Leslie	Sparks, J. A.	Wilkins, W. A.
Popplewell, E.	Steele, T.	Willey, Frederick (Sunderland, N.)
Porter, G.	Stewart, Michael (Fulham, E.)	Willey, Octavius (Cleveland)
Price, Joseph T. (Westhoughton)	Strachey, Rt. Hon. J.	Williams, David (Neath)
Price, Philips (Gloucestershire, W.)	Strauss, Rt. Hon George (Vauxhall)	Williams, Rev. Llywelyn (Abertillery)
Proctor, W. T.	Stross, Dr. Barnett	Williams, Ronald (Wigan)
Pryde, D. J.	Summerskill, Rt. Hon. E.	Williams, Rt. Hon. Thomas (Don V'll'y)
Pursey, Cmdr H.	Swingler, S. T.	Williams, W. R. (Droylsden)
Rankin, John	Sylvester, G. O.	Williams, W. T. (Hammersmith, S.)
Reeves, J.	Taylor, Bernard (Mansfield)	Wilson, Rt. Hon. Harold (Huyton)
Reid, Thomas (Swindon)	Taylor, John (West Lothian)	Winterbottom, Richard (Brightside)
Reid, William (Camlachie)	Taylor, Rt. Hon. Robert (Morpeth)	Woodburn, Rt. Hon. A.
Rhodes, H.	Thomas, David (Aberdare)	Wyatt, W. L.
Robins, Rt. Hon. A.	Thomas, Iorwerth (Rhondda, W.)	Yates, V. F.
Roberts, Albert (Normanton)	Thomas, Ivor Owen (Wrekin)	Younger, Rt. Hon. K.
Roberts, Goronwy (Caernarvonshire)	Thurtle, Ernest
Rogers, George (Kensington, N.)	Timmons, J.	TELLERS FOR THE NOES:
Ross, William	Turner-Samuels, M.	Mr. Pearson and Mr. Holmes.
Royle, C.	Ungoed-Thomas, Sir Lynn

Question put accordingly, "That the words 'drugs, medicines or' stand part of the Clause."

The Committee divided: Ayes, 281; Noes, 269.

Division No. 63.]	AYES	[9.50 p.m.
Aitken, W. T.	Butcher, H. W.	Fort, R.
Allan, R. A. (Paddington, S.)	Butler, Rt. Hon. R. A. (Saffron Walden)	Foster, John
Alpert, C. J. M.	Carr, Robert (Mitcham)	Fraser, Hon Hugh (Stone)
Amery, Julian (Preston, N.)	Carson, Hon. E.	Fraser, Sir Ian (Morecambe & Lonsdale)
Amory, Heathcoat (Tiverton)	Cary, Sir Robert	Fyfe, Rt. Hon. Sir David Maxwell
Anstruther-Gray, Major W. J.	Channon, H.	Gage, C. H.
Arbuthnot, John	Churchill, Rt. Hon W. S.	Galbraith, Cmdr. T. D. (Pollok)
Ashton, H. (Chelmsford)	Clarke, Col. Ralph (East Grinstead)	Galbraith, T. G. D. (Hillhead)
Astor, Hon. J. J. (Plymouth, Sutton)	Clarke, Brig. Terence (Portsmouth, W.)	Gammans, L. D.
Astor, Hon. W. W. (Bucks, Wycombe)	Clyde, Rt. Hon. J. L.	Garner-Evans, E. H.
Baker, P. A. D.	Cole, Norman	George, Rt. Hon. Maj. G. Lloyd
Baldock, Lt.-Cmdr. J. M.	Colegate, W. A.	Glyn, Sir Ralph
Baldwin, A. E.	Conant, Maj. R. J. E.	Godber, J. B.
Banks, Col. C.	Cooper, Sqn. Ldr Albert	Gomme-Duncan, Col A.
Barber, A. P. L.	Craddock, Beresford (Spelthorne)	Gough, C. F. H.
Barlow, Sir John	Cranborne, Viscount	Gower, H. R.
Beach, Maj. Hicks	Crookshank, Capt Rt. Hon H. F. C.	Graham, Sir Fergus
Beamish, Maj. Tufton	Crosthwaite-Eyre, Col. O. E.	Gridley, Sir Arnold
Bell, Philip (Bolton, E.)	Crouch, R. F.	Grimston, Hon. John (St. Albans)
Bell, Ronald (Bucks, S.)	Crowder, John E. (Finchley)	Grimston, Sir Robert (Westbury)
Bennett, F. M. (Reading, N.)	Crowder, Petra (Ruislip—Northwood)	Harden, J. R. E.
Bennett, Sir Peter (Edgbaston)	Darling, Sir William (Edinburgh, S.)	Hare, Hon. J. H.
Bennett, Dr. Reginald (Gosport)	Davidson, Viscountess	Harris, Frederic (Croydon, N.)
Bennett, William (Woodside)	De la Bère, R.	Harris, Reader (Heston)
Bevins, J. R. (Toxteth)	Deedes, W. F.	Harrison, Col. J. H. (Eye)
Birch, Nigel	Digby, S. Wingfield	Harvey, Air Cdre. A. V. (Macclesfield)
Bishop, F. P.	Dodds-Parker, A. D.	Harvey, Ian (Harow, E.)
Blank, C. W.	Donaldson, Cmdr. C. E. McA.	Harvie-Watt, Sir George
Boothby, R. J. G.	Donner, P. W.	Hay, John
Bossom, A. C.	Doughty, C. J. A.	Head, Rt. Hon. A. H.
Boyd-Carpenter, J. A.	Douglas-Hamilton, Lord Malcolm	Heald, Sir Lionel
Boyle, Sir Edward	Drewe, C.	Heath, Edward
Brains, B. R.	Dugdale, Maj. Rt. Hn. Sir T. (Richmond)	Henderson, John (Cathcart)
Braithwaite, Sir Albert (Harrow, W.)	Duncan, Capt. J. A. L.	Higgs, J. M. C.
Braithwaite, Lt.-Cdr. G. (Bristol, N. W.)	Duthie, W. S.	Hill, Dr. Charles (Luton)
Bromley-Davenport. Lt-Col. W. H.	Elliot, Rt. Hon W. E.	Hill, Mrs. E. (Wythenshawe)
Brooman-White, R. C.	Erroll, F. J.	Hinchingbrooke, Viscount
Browne, Jack (Govan)	Fell, A.	Hirst, Geoffrey
Buchan-Hepburn, Rt. Hon P. G. T.	Finlay, Graeme	Holland-Marlin, C. J.
Bullard, D. G.	Fisher, Nigel	Hollis, M. C.
Bullock, Capt. M.	Fleetwood-Hesketh, R. F.	Holmes, Sir Stanley (Harwich)
Bullus, Wing Commander E. E.	Fletcher, Walter (Bury)	Hope, Lord John
Burden, F. F. A.	Fletcher-Cooke, C.	Hopkinson, Henry
Hornsby-Smith, Miss M. P.	Marlowe, A. A. H.	Smiles, Lt.-Col. Sir Walter
Horobin, I. M.	Marples, A. E.	Smithers, Peter (Winchester)
Horsbrugh, Rt. Hon. Florence	Marshall, Douglas (Bedmin)	Smithers, Sir Waldron (Orpington)
Howard, Gerald (Cambridgeshire)	Marshall, Sidney (Sutton)	Smyth, Brig. J. G. (Norwood)
Hudson, Sir Austin (Lewisham, N.)	Maudling, R.	Snadden, W. McN.
Hudson, W. R. A. (Hull, N.)	Maydon, Lt.-Cmdr. S. L. C.	Soames, Capt. C.
Hulbert, Wing Cmdr. N. J.	Medlicott, Brig. F.	Spearman, A. C. M.
Hurd, A. R.	Mellor, Sir John	Speir, R. M.
Hutchinson, Sir Geoffrey (Ilford, N.)	Morrison John (Salisbury)	Spence, H. R. (Aberdeenshire, W.)
Hutchison, Lt.-Com. Clark (E'b'rgh W.)	Mott-Radclyffe, C. E.	Spens, Sir Patrick (Kensington, S.)
Hutchison, James (Scotstoun)	Nabarro, G. D. N.	Stanley, Capt. Hon. Richard
Hylton-Foster, H. B. H.	Nicholls, Harmar	Stevens, G. P.
Jenkins, R. C. D. (Dulwich)	Nicholson, Godfrey (Farnham)	Steward, W. A. (Woolwich, W.)
Johnson, Howard (Kemptown)	Nicolson, Nigel (Bournemouth, E.)	Stewart, Henderson (Fife, E.)
Jones, A. (Hall Green)	Nield, Basil (Chester)	Stoddart-Scott, Col. M.
Joynson-Hicks, Hon. L. W.	Noble, Cmdr. A. H. P.	Strauss, Henry (Norwich, S.)
Kaberry, D.	Nugent, G. R. H.	Stuart, Rt. Hon. James (Moray)
Kerr, H. W. (Cambridge)	Nutting, Anthony	Summers, G. S.
Lambert, Hon. G.	Oakshott, H. D.	Sutcliffe, H.
Lambton, Viscount	Odey, G. W.	Taylor, William (Bradford, N)
Lancaster, Col. C. G.	O'Neill, Rt. Hon. Sir H. (Antrim, N.)	Teeling, W.
Law, Rt. Hon. R. K.	Ormsby-Gore, Hon. W. D.	Thomas, P. J. M. (Conway)
Legge-Bourke, Maj. E. A. H.	Orr, Capt. L. P. S.	Thompson, Kenneth (Walton)
Legh, P. R. (Petersfield)	Orr-Ewing, Charles Ian (Hendon, N.)	Thompson, Lt.-Cdr. R. (Croydon, W.)
Lennox-Boyd, Rt. Hon. A. T.	Orr-Ewing, Ian L. (Weston-super-Mare)	Tilney, John
Lindsay, Martin	Osborne, C.	Touche, G. C.
Linstead, H. N.	Partridge, E.	Turner, H. F. L.
Llewellyn, D. T.	Perkins, W. R. D.	Tweedsmuir, Lady
Lloyd, Maj. Guy (Renfrew, E.)	Peto, Brig. C. H. M.	Vane, W. M. F.
Lockwood, Lt.-Col. J. C.	Peyton, J. W. W.	Vaughan-Morgan, J. K.
Longden, Gilbert (Herts, S.W.)	Pickthorn, K. W. M.	Vosper, D. F.
Low, A. R. W.	Pilkington, Capt. R. A.	Wakefield, Edward (Derbyshire, W.)
Lucas, Sir Jocelyn (Portsmouth, S.)	Pitman, I. J.	Wakefield, Sir Wavell (Marylebone)
Lucas, P. B. (Brantford)	Powell, J. Enoch	Walker-Smith, D. C.
Lucas-Tooth, Sir Hugh	Price, Henry (Lewisham, W.)	Ward, Hon. George (Worcester)
McAdden, S. J.	Profumo, J. D.	Ward, Miss I. (Tynemouth)
McCallum, Major D.	Raikes, H. V.	Waterhouse, Capt. Rt. Hon. C.
McCorquodale, Rt. Hon. M. S.	Rayner, Brig. R.	Watkinson, H. A.
Macdonald, Sir Peter (I. of Wight)	Remnant, Hon. P.	Wellwood, W.
Mackeson, Brig. H. R.	Renton, D. L. M.	White, Baker (Canterbury)
McKibbin, A. J.	Robinson, Roland (Blackpool, S.)	Williams, Rt. Hon. Charles (Torquay)
McKie, J. H. (Galloway)	Robson-Brown, W.	Williams, Gerald (Tonbridge)
Maclay, Hon. John	Roper, Sir Harold	Williams, Sir Herbert (Croydon, E.)
Maclean, Fitzroy	Russell, R. S.	Williams, R. Dudley (Exeter)
MacLeod, Iain (Enfield, W.)	Ryder, Capt. R. E. D.	Wills, G.
MacLeod, John (Ross and Cromarty)	Salter, Rt. Hon. Sir Arthur	Wilson, Geoffrey (Truro)
Macmillan, Rt. Hon. Harold (Bromley)	Sandys, Rt. Hon D.	Wood, Hon. R.
Macpherson, Maj. Niall (Dumfries)	Schofield, Lt.-Col. W. (Rochdale)	York, C.
Maitland, Comdr. J. F. W. (Horncastle)	Scott, R. Donald
Maitland, Patrick (Lanark)	Scott-Miller, Cmdr. R.	TELLERS FOR THE AYES:
Manningham-Buller, Sir R. E.	Shepherd, William	Mr. Studholme and Mr. Redmayne
Markham, Major S. F.	Simon, J. E. S. (Middlesbrough, W.)
NOES
Acland, Sir Richard	Brook, Dryden (Halifax)	Dodds, N. N.
Adams, Richard	Broughton, Dr. A. D. D.	Donnelly, D. L.
Albu, A. H.	Brown, Rt. Hon. George (Belper)	Driberg, T. E. N.
Allen, Arthur (Bosworth)	Brown, Thomas (Ince)	Dugdale, Rt. Hon John (W. Bromwich)
Allen, Scholefield (Crewe)	Burke, W. A.	Ede, Rt. Hon. J. C.
Anderson, Alexander (Motherwell)	Burton, Miss F. E.	Edelman, M.
Anderson, Frank (Whitehaven)	Butler, Herbert (Hackney, S.)	Edwards, John (Brighouse)
Attlee, Rt. Hon. C. R.	Callaghan, L. J.	Edwards, Rt. Hon. Ness (Caerphilly)
Awbery, S. S.	Carmichael, J.	Edwards, W. J. (Stepney)
Ayles, W. H.	Castle, Mrs. B. A.	Evans, Albert (Islington, S. W.)
Bacon, Miss Alice	Champion, A. J.	Evans, Edward (Lowestoft)
Baird, J.	Chapman, W. D.	Evans, Stanley (Wednesbury)
Balfour, A.	Chetwynd, G. R.	Ewart, R.
Barnes, Rt. Hon. A. J.	Clunie, J.	Fernyhough, E.
Bellenger, Rt. Hon. F. J.	Cocks, F. S.	Field, W. J.
Bence, C. R.	Coldrick, W.	Fienburgh, W.
Benn, Wedgwood	Collick, P. H.	Finch, H. J.
Benson, G.	Cook, T. F.	Fletcher, Eric (Islington. E.)
Beswick, F.	Cove, W. G.	Follick, M.
Bevan, Rt. Hon. A (Ebbw Vale)	Craddock, George (Bradford, S.)	Foot, M. M.
Bing, G. H. C.	Crosland, C. A. R.	Forman, J. C.
Blackburn, F.	Crossman, R. H. S.	Fraser, Thomas (Hamilton)
Blenkinsop, A.	Cullen, Mrs. A.	Freeman, John (Watford)
Blyton, W. R.	Daines, P.	Freeman, Peter (Newport)
Boardman, H.	Dalton, Rt. Hon. H.	Gaitskell, Rt. Hon. H. T. N.
Bottomley, Rt. Hon. A. G.	Davies, A. Edward (Stoke, N.)	Gibson, C. W.
Bowden, H. W.	Davies, Ernest (Enfield, E.)	Glanville, James
Bowles, F. G.	Davies, Stephen (Merthyr)	Gooch, E. G.
Braddock, Mrs. Elizabeth	de Freitas, Geoffrey	Gordon Walker, Rt. Hon. P. C.
Brockway, A. F.	Deer, G.	Greenwood, Anthony (Rossendale)

Greenwood, Rt. Hon. Arthur (Wakefield)	Mallalieu, E. L. (Brigs)	Shurmer, P. L. E.
Grey, C. F.	Mallalieu, J. P. W. (Huddersfield, E.)	Silverman, Julius (Erdington)
Griffiths, David (Rather Valley)	Mann, Mrs. Jean	Simmons, C. J. (Brierley Hill)
Griffiths, Rt. Hon James (Llanelly)	Manuel, A. C.	Slater, J.
Griffiths, William (Exchange)	Marquand, Rt. Hon H. A.	Smith, Ellis (Stoke S.)
Grimond, J.	Mayhew, C. P.	Smith, Norman (Nottingham, S.)
Hale, Leslie (Oldham, W.)	Mellish, R. J.	Snow, J. W.
Hall, Rt. Hon. Glenvil (Colne Valley)	Messer, F.	Sorensen, R. W.
Hall, John (Gateshead, W.)	Mikardo, Ian	Soskice, Rt. Hon Sir Frank
Hamilton, W. W.	Mitchison, G. R.	Sparks, J. A.
Hannan, W.	Monslow, W.	Steele, T.
Hardy, E. A.	Moody, A. S.	Stewart, Michael (Fulham, E.)
Hargreaves, A.	Morgan, Dr. H. B. W.	Strachey, Rt. Hon. J.
Harrison, J. (Nottingham, E.)	Morley, R.	Strauss, Rt. Hon George (Vauxhall)
Hastings, S.	Morris, Percy (Swansea, W.)	Stross, Dr. Barnett
Hayman, F. H.	Morrison, Rt. Hon. H. (Lewisham, S.)	Summerskill, Rt. Hon. E.
Healey, Denis (Leeds, S. E.)	Mort, D. L.	Swingler, S. T.
Henderson, Rt. Hon. A (Rowley Regis)	Moyle, A.	Sylvester, G. O.
Herbison, Miss M.	Mulley, F. W.	Taylor, Bernard (Mansfield)
Hewitson, Capt M.	Murray, J. D.	Taylor, John (West Lothian)
Hobson, C. R.	Nally, W.	Taylor, Rt. Hon. Robert (Morpeth)
Holman, P.	Neal, Harold (Bolsover)	Thomas, David (Aberdare)
Holt, A. F.	Noel-Baker, Rt. Hon P. J.	Thomas, Iorwerth (Rhondda, W.)
Houghton, Douglas	O'Brien, T.	Thomas, Ivor Owen (Wrekin)
Hoy, J. H.	Oldfield, W. H.	Thurtle, Ernest
Hudson, James (Ealing, N.)	Oliver, G. H.	Timmons, J.
Hughes, Cledwyn (Anglesey)	Orbach, M.	Turner-Samuels, M.
Hughes, Hector (Aberdeen, N.)	Oswald, T.	Ungoed-Thomas, Sir Lynn
Hynd, H. (Accrington)	Padley, W. E.	Viant, S. P.
Hynd, J. B. (Attercliffe)	Paget, R. T.	Wallace, H. W.
Irvine, A. J. (Edge Hill)	Paling, Rt. Hon. W. (Dearne Valley)	Watkins, T. E.
Irving, W. J. (Wood Green)	Paling, Will T. (Dewsbury)	Webb, Rt. Hon. M. (Bradforn, G.)
Janner, B.	Pannell, Charles	Weitzman, D.
Jay, Rt. Hon. D. P. T.	Pargiter, G. A.	Wells, Percy (Faversham)
Jager, George (Goole)	Parker, J.	Wells, William (Walsall)
Jenkins, R. H. (Stechford)	Paton, J.	West, D. G.
Johnston, Douglas (Paisley)	Peart, T. F.	Wheatley, Rt. Hon. John
Jones, David (Hartlepool)	Plummer, Sir Leslie	White, Mrs. Eirene (E. Flint)
Jones, Frederick Elwyn (West Ham, S.)	Popplewell, E.	White, Henry (Derbyshire, N.E.)
Jones, Jack (Rotherham)	Porter, G.	Whiteley, Rt. Hon. W.
Jones, T. W. (Merioneth)	Price, Joseph T. (Westhoughton)	Wigg, George
Keenan, W.	Price, Philips (Gloucestershire, W.)	Wilcock, Group Capt. C. A. B.
Kenyon, C.	Proctor, W. T.	Wilkins, W. A.
Key, Rt. Hon. C. W.	Pryde, D. J.	Willey, Frederick (Sunderland, N.)
King, Dr. H. M.	Pursey, Cmdr. H.	Willey, Octavius (Cleveland)
Lee, Miss Jennie (Cannock)	Rankin, John	Williams, David (Neath)
Lever, Harold (Cheetham)	Reeves, J.	Williams, Rev. Llywelyn (Abertillery)
Lever, Leslie (Ardwick)	Reid, Thomas (Swindon)	Williams, Ronald (Wigan)
Lewis, Arthur	Reid, William (Camlachie)	Williams, Rt. Hon. Thomas (Don V'll'ry)
Lindgren, G. S.	Rhodes, H.	Williams, W. R. (Droylsden)
Lipton, Lt.-Col. M.	Roberts, Rt. Hon. A.	Williams, W. T. (Hammersmith, S.)
Logan, D. G.	Roberts, Albert (Normanton)	Wilson, Rt. Hon. Harold (Huyton)
Longden, Fred (Small Heath)	Roberts, Goronwy (Caernarvonshire)	Winterbottom, Richard (Brightside)
MacColl, J. E.	Rogers, George (Kensington, N.)	Woodburn, Rt. Hon. A.
McGhee, H. G.	Ross, William	Wyatt, W. L.
McGovern, J.	Royle, C.	Yates, V. F.
McInnes, J.	Schofield, S. (Barnsley)	Younger, Rt. Hon K.
McKay, John (Wallsend)	Shackleton, E. A. A.
McLeavy, F.	Shawcross, Rt. Hon. Sir Hartley	TELLERS FOR THE NOES:
MacMillan, M. K. (Western Isles)	Shinwell, Rt. Hon. E.	Mr. Pearson and Mr. Holmes.
MacPherson, Malcolm (Stirling)	Short, E. W.

Bill read the Third time, and passed.

To report Progress, and ask leave to sit again.—[Mr. Redmayne.]

Committee report Progress; to sit again Tomorrow.