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

HC Deb 01 May 1952 vol 499 cc1668-726

3.53 p.m.

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

I beg to move, in page 1, line 10, at the end, to insert: drugs, medicines or appliances authorised to be supplied before the commencement of this Act, or in respect of. This Amendment has been put down in order to draw attention to a circular which has been issued by the Minister of Health to the hospital authorities instructing them to warn patients for whom appliances are being supplied that, in view of legislation now going through Parliament, they may, when those appliances are actually delivered, have to pay for them. We take the view that it is rather extraordinary that before this House has parted with a Bill and before Parliament has passed it into law, steps should be taken to inform people for whom appliances were thought to be necessary several weeks ago—in many cases, several months ago—that they will have to pay for them.

This House has not yet approved the principle—or at least not the detail—that there should be a charge for appliances, and even if and when the House does that, the Bill will have to go to another place and receive the Royal Assent before it becomes law. These appliances very frequently take a long time to make even after the specialist at the hospital has decided that they are necessary for certain disabilities. It takes a considerable time to measure the patient, to make the appliance and then to fit it, and perhaps to alter it until it is entirely suitable. The manufacturers of these appliances are highly specialised people producing a made-to-measure article. In the nature of things, they cannot produce these appliances very rapidly, and because of that reason they have long waiting lists.

In any case there are waiting lists at the hospitals, so that we have the position in which patients who may already have been waiting some weeks or months for an appliance considered to be absolutely necessary for their condition will not have it supplied until after this Bill may become an Act, and will then have to pay for it. We think it an unwarrantable presumption on the part of the right hon. Gentleman to assume that the Bill now before the House is going to become an Act and that, in so far as there is a deterrent effect in the levying of charges of this kind, he should try to produce that effect before the Bill becomes law. We believe that hardship may be inflicted by this procedure.

I think that I have said sufficient to indicate the general lines of the argument, and I will now leave it to some of my hon. Friends to place before the House evidence in their possession in order that we may make progress in the discussion of the other Amendments which stand on the Order Paper in our names. I know that my hon. Friends will produce very interesting and valuable evidence in support of this Amendment.

Mrs. E. M. Braddock (Liverpool, Exchange)

I wish to support this Amendment because there is very definite evidence that the hospitals have been contacting those people who will be receiving some sort of surgical or other appliance asking them to sign forms undertaking to make the payment laid down in the Bill, which has not yet become law.

As no doubt the Minister of Health knows, there are a number of questions on the Order Paper from hon. Members representing different parts of the country commenting on this request to people to sign forms undertaking to make such a payment. Apart from the fact that people are resenting this and are finding that it is putting them in a very difficult position, I think it wrong that advance administrative arrangements should be made and that people should be asked to sign such forms.

There is another point with reference to this matter. I do not know exactly what has happened in the matter, but only this weekend I heard of a case where the parents of a child of three-and-a-half years had been informed by the hospital in which the child had been that, owing to a very grave deficiency of calcium, it would never be able to grow a proper set of teeth. The child was sent to hospital and all its teeth were extracted. It was then sent home and soon afterwards was sent to one of the dental hospitals in Liverpool, where a complete set of false teeth was made for it. The child is only three-and-a-half years old, and I was informed that this was the smallest set of dentures ever made in the history of the dental profession.

4.0 p.m.

Last Friday when the father and mother appeared at the hospital to obtain the dentures, they were told they could not have them unless they made an immediate payment of £4 5s. They were unable to pay that sum and they asked to be allowed to make a weekly contribution because the child needed the appliance immediately. They were told they could not make any weekly payment and that, although the teeth were available in the department, they could not be supplied until payment of £4 5s. was made. The parents who are working-class people, had to go home and find some means of borrowing the money, and until yesterday I had the receipt for £4 5s. in my possession.

It is obvious that something has happened in the hospital service to compel a dental department to insist upon immediate payment of that kind. I have since taken steps to see that a refund was made through the maternity and child welfare department. When I asked about this matter I was told that things were in such a difficult administrative state that the people concerned did not know exactly what was happening and that they had instructions to do certain things in relation to payments.

These matters should be straightened out to ensure that this kind of thing does not happen. It causes great difficulty to people requiring these appliances, and any amount of evidence can be supplied to show that people are asked to sign certificates that, as soon as this Bill comes into operation, they will pay for these appliances.

Mr. Hylton-Foster (York)

Can the hon. Lady indicate under which Statute this charge was made?

Mrs. Braddock

I could not say; but the charge was made and it should not have been made. This was a child of three and a half years. I understood that children of school age or below school age were exempt from payments of this kind. This is the first time that I have had any intimation or anybody has come to me to say that a request has been made for immediate payment in respect of a child. Obviously there is something wrong administratively which should be straightened out. The Minister should give a guarantee that no charge will be demanded in advance of this Bill becoming operative. As far as I understand the position it is quite unusual to ask for payment in advance of a Bill coming into force.

Mr. Iain MacLeod (Enfield, West)

It is true that children's glasses were exempt. Children's dentures are obviously extremely rare and this case apparently was not so exempt. But the hon. Lady is clearly arguing, not for an amendment of this Bill, but for an amendment of the 1951 Act.

Mrs. Braddock

No. The whole matter is being dealt with at the moment by running the previous Act into the present Bill. But what I was just saying was that the Minister should declare that nobody should be asked to sign in advance a statement undertaking to pay after the date when the Bill comes into operation. Anything that is needed between now and that date comes under the old Act which prescribes no charge, and we should not presuppose that all the Clauses of this Bill will be put into operation.

Mr. George Jeger (Goole)

I want to support the argument put forward by my right hon. Friend the Member for Middlesbrough, East (Mr. Marquand), and my hon. Friend the Member for Liverpool, Exchange (Mrs. Braddock), in support of this Amendment. I want to refer to cases brought to my attention in my constituency in Goole, during the past weekend, when three people came to see me bearing notices making a request from the Bartholomew Hospital. The notices were headed, "Surgical Appliances," and were worded in this way: This is to inform you that it is possible that, as a result of measures now under consideration by Parliament, you may be charged the sum of £3 for the surgical boots ordered for you. Would you therefore sign and return to the hospital the enclosed statement to show that yon understand the position. That reinforces the argument of my hon. Friend the Member for Liverpool, Exchange, that people are being asked to agree to pay, in anticipation of the Bill now before the House becoming an Act of Parliament. We on this side of the House believe that this Bill contains many measures which are harmful and mean and which should never be there at all. Once the Bill becomes an Act of Parliament, we have to accept its provisions, but surely it is going a long way to expect people to accept responsibility for payment before those payments have been approved by this House or by another place.

I urge upon the Minister that he should mitigate hardships imposed upon people by this Bill by saying that nothing in it shall take effect until the Bill actually has been passed. In the cases I have quoted, the surgical boots were ordered last August, under the administration of a different Government, when there was no question of payment being made and in circumstances where it cannot be said that these three patients were anticipating that a charge would be levied on the boots and were therefore seeking to evade that charge. Of course they were not.

Because of the delay, for which they have not been responsible, in making and fitting the boots to their satisfaction, they are being asked to agree to a payment under a Bill which has not yet become an Act of Parliament. I do not know whether it is legal to expect them to agree to that. I believe an hon. Member opposite was so moved by the remarks of my hon. Friend the Member for Liverpool, Exchange that even he questioned whether it was legal.

Dr. H. Morgan (Warrington)

It is not legal.

Mr. Jeger

Whether it is legal or not, it is imposing on the goodwill of the poor patients concerned to ask them to agree in anticipation, and it is mean. I advise the Minister not to lose what little goodwill he has in the country and to accept this Amendment and advice, actuated by a good deal of humanitarian feeling on both sides of the House. I ask him to say that no charge will be levied until the Bill becomes an Act.

Mr. George Chetwynd (Stockton-on-Tees)

It seems to me that there are constitutional, legal and social issues involved here and that the Minister should give a full explanation of what is taking place. We are entitled to know on whose authority this kind of instruction has been sent to the people concerned. Has there been a central directive from the Minister in anticipation of the Bill becoming an Act? If there has, the Minister must believe that we are wasting our time here in deliberating on this Bill. There was an Amendment down to deal with this subject and no one could anticipate what the result of it would be. To send this note round a week or a fortnight, or whatever it was, before the Bill became an Act seems to be a grave constitutional impropriety.

Secondly, there is the point of its legality. A contract has been entered into, and when people first ordered the boots the suppliers were acting on the understanding that they would receive payment from the Ministry and none would be made by the patient. Now it seems that they have to have a payment from the recipient as well, and if the recipient refuses or fails to take up the article when he is faced with a charge, it seems to me that there would be a case for a breach of contract between the maker and the Ministry to cover any cost involved.

Thirdly, we have the important social point—that these patients undertook their action on the understanding that they would receive the appliances free of charge, whereas now they find that they must pay. What we want to know, and what we are entitled to know, is this: exactly how many of these four appliances have been ordered to date and not supplied? How long is the waiting list in each case? I understand that one of the major reasons why the charge for hearing aids was not proceeded with was that there is a long waiting list which cannot be worked off under, perhaps, one or two years.

If it was right to drop charges in that case because people who had already ordered could not be exempted, then there is a very strong case, if the charges for appliances ordered in future cannot be dropped, why the Minister should accept the Amendment and relieve from payment those who have already applied and been examined. We should also like some assurance that there is no holdup in the immediate supply of these appliances owing to the fact that in a few weeks' time people will have to pay for them. There should be no delay of that kind. I hope the Minister will accept the Amendment.

Mr. A. C. Manuel (Central Ayrshire)

I shall be very brief, but I think we should probe this position a little further. It is quite reprehensible that people should be asked to sign these contract forms, binding them to pay varying amounts in connection with the supply of certain appliances. As an hon. Member who previously was a member of a regional hospital board, I am certain that the regional board did not issue these instructions to the hospitals under their command on their own initiative. I am equally certain that the boards of management of the respective hospitals or groups of hospitals are not acting on their own initiative.

I think the Minister should tell the House how this has happened and what directive has been issued from his Department anticipating an Act of Parliament. Or does he not believe any longer in democracy? Does he believe that directives should be issued anticipating what is going to happen in an Act of Parliament—issued at a time when the Measure is still a Bill before the House? Surely such action is entirely wrong. [Interruption.] I can believe that the hon. Gentleman would take that sort of Hitlerite action and anticipate legislation in order to get the cuts in the Health Service which he wants, but we certainly do not agree with that idea and we do not believe that it is democracy.

I hope the Minister will follow the principle which last year's Act indicated quite clearly—that where treatment or appliances were authorised in hospitals before the Act came into force, there would be no charge. That was quite clear. In hospitals, where dentures were to be supplied but could not be supplied until after the Act came into force, they were nevertheless supplied free.

Mr. Iain MacLeod

rose—

Mr. Manuel

The hon. Gentleman will have a full opportunity to vote for this Amendment and to strengthen our hands. I hope the Minister will tell us how this mistake arose—because surely it is a mistake—and how this circular was sent to hospitals indicating to them that they should ask for payment to be contracted under a provision which will become operative only when the Bill becomes law.

4.15 p.m.

The Minister of Health (Mr. Harry Crookshank)

It might perhaps be convenient if I intervened now and explained the situation about this Amendment, but before I do so I should like to clear up a point raised by the hon. Lady the Member for Liverpool, Exchange (Mrs. Braddock), who referred to a case in which a charge was made for a set of dentures for a child. That has nothing to do with the Amendment, which deals with charges under the first Clause. The first Clause has nothing to do with teeth. If, in spite of that, I may answer the hon. Lady, I would point out that any charges which are being levied for a set of dentures are being levied under the Act of 1951 and have nothing to do with what we are discussing today.

Mrs. Braddock

What I was saying was that in this case, where the teeth were taken out in hospital and had to be replaced, there should not have been a charge on this child of three and a half years. I raised the matter because there must have been a mistake somewhere. In ordinary circumstances the parents would have been referred by the hospital to the maternity and child welfare department, who would have dealt with the matter, instead of a request being made for an immediate payment of £4 5s. I suggest that it arises from the issue of a new directive and that the matter should be cleared up.

Mr. Crookshank

The hon. Lady's suggestion is ill-founded. There may or may not have been a mistake in this instance about making a charge; I cannot possibly know offhand; but whether there was or not, it has nothing in the world to do with what we are discussing here. I appreciate that the hon. Lady has made a point, and if there is anything to look into, I will look into it; but it has nothing to do with this Amendment or this Clause or, indeed, the Bill, because it all stems from the 1951 Act under which charges can be made for dentures.

I come to the Amendment. Hon. Gentlemen have asked whether any circular was issued bringing these matters to the notice of hospital patients, and the hon. Member for Ayrshire, Central (Mr. Manuel) made a great attack upon my views on democracy and upon the impropriety of my action, if any, in this matter. I can explain the situation perfectly clearly, and I am really rather surprised that hon. Gentlemen and hon. Ladies have brought the matter up.

When I spoke on the Second Reading on 27th March, I said exactly what I was going to do and exactly what was in my mind. If I may be allowed to quote it, the House will see that I have done nothing contrary to what I said I was going to do. Whether that is right or wrong is another matter, but certainly I have done nothing unusual. I want to be quite fair to the House. Although I have full power, and have had ever since we came into office, as did hon. and right hon. Gentlemen opposite, to impose the major charges under the 1949 Act, it is much more decent and proper, in the Parliamentary sense, so long as we are making amendments and extensions, to wait until the Bill has received the Royal Assent, if so that be. I see the right hon. Gentleman agreeing with that and I hope he will agree with me in this. I think it is only fair now for hospitals to warn people who attend to have appliances prescribed for them to say, This Bill is before Parliament and if it is passed you will have to pay a certain amount towards these appliances if you do not get them before the Bill is enacted. I think that that warning should be given and I hope the House will not think it improper."

As I read it—and it is not within my recollection—I think I must have paused there because the next sentence says: As there is no dissent, I hope the House will think it fair"— certainly there is nothing in the OFFICIAL REPORT in the way of interruptions. I said: As there is no dissent, I hope the House will think it fair to do that as quickly as possible."—[OFFICIAL. REPORT, 27th March, 1952; Vol. 498, c. 857] That is what I said I was going to do—that it was only fair to warn people that the Bill was before the House and that one of the results of it might be that they would have to pay, and to send out the warning as soon as possible.

Mr. Jeger

The point I attempted to make in my few remarks was that this request for payment was being made to patients who had already made their applications, had been measured, and were on the point of being fitted with their appliances. They were not new patients turning up at the hospital for the first time after the right hon. Gentleman had made his statement. If they were, I am prepared to concede that this request would be perfectly fair; but for old patients who had been having treatment for many months—in the cases I have cited, since last August—it is most unfair that they should come under the strictures of the right hon. Gentleman for the continuation of that treatment.

Mr. Crookshank

I was not dealing with that point. I was trying to explain how the position arose. I thought people should be warned. If it had been done the other way round and nothing had been said until the particular day when the Regulation came in, so that nobody knew about it in advance, I am quite sure that people would have been very indignant if they had then been immediately required to pay.

That is why we have asked that the people concerned should be made aware of the situation. There is no question of anticipating legislation. The hon. Member for Ayrshire, Central, said I was anticipating legislation, but I am not doing anything of the sort. I am not anticipating anything. I am giving a warning of what might happen. We have been discussing the Finance Bill. Does the hon. Member not realise that taxes are collected long before the House passes the Finance Act?

Sir Lynn Ungoed-Thomas (Leicester, North-East)

rose—

Mr. Crookshank

The hon. and learned Gentleman the Member for Leicester, North-East (Sir L. Ungoed-Thomas), is not taking exception to what I am saying about the warning?

Sir L. Ungoed-Thomas

No. I gather the right hon. Gentleman will not give way?

Mr. Crookshank

The warning is nothing more than a warning. This is the notice which I suggested should be displayed: A Bill has been introduced in Parliament which, if enacted, may result in certain appliances and repairs being made chargeable.

That is the warning.

Mrs. Braddock

They are asked to sign advance agreements.

Mr. Crookshank

I wish the hon. Lady would allow me to make my speech by taking it in stages. First of all, I told the House I was going to do this, and nobody dissented at the time. I made reference to the matter during the Second Reading debate. The hospital authorities have given the warning that a Bill is before the House and that if it is passed certain charges may be payable. Then, to make quite sure that individuals realised what was going on, they were asked to sign a statement to show that they understood the position. It is perfectly clear. That is all they have been asked to do. It is even underlined in the circular. It is emphasised that none of the charges referred to will be payable unless the necessary Regulations come into operation.

I do not think that the English language could be put more simply to explain what was the position. That is what the Government had in mind. We hope that the Bill will at some time become an Act and, under Regulations made, charges will become payable on a particular date.

Mr. Manuel

rose—

Mr. Crookshank

The hon. Gentleman has made his speech. Let him contain himself. The Government anticipated that the Bill would be enacted. These are all suppositions which it is legitimate for a Government to make—that what the Bill says will be carried out, that Regulations will be introduced and, as a result, charges will be levied—but all that was some time ahead, after 27th March, and we thought it was right and proper to give an immediate warning, as soon as the Bill was introduced, that that might happen.

Dr. Morgan

It was an irregular action.

Mr. Crookshank

I should be interested to know where the hon. Member thinks it is irregular. He can protest against it if he likes, but I am perfectly sure that the ordinary people would prefer to have it done that way rather than to wait until the actual moment the Regulation was introduced and to be told: "As from today, without any warning at all, you have to pay." Other people may have different opinions, but that is the action I took and I warned the House in good time that that was what I was going to do. Nobody protested at the time in any way. All that is happening is that people are being asked to make quite sure that they understand the position—that if the charges come into effect before delivery is made of the appliances for which they are waiting, they will have to pay for them. That is the situation in brief.

I hope that the House will not accept this other arrangement, which has the effect of making some administrative difficulties, not only in trying to track all the people who have ordered these appliances in the past, but discovering when they ordered them. In addition, let us not lose sight of the fact—and I am sorry to have to remind the House of this on the first Amendment on the Report stage—that one of the objects of this Bill is to try to obtain from the Health Service a contribution towards the improvement of our economic and financial situation.

I say that every time because it is one of the important reasons for this Bill and any extra delay, such as would be involved by this Amendment, would pro tanto reduce the amount we hope to get by these efforts. For that reason, having explained how this circular arose, and having satisfied the hon. Lady the Member for Liverpool, Exchange, that her point has nothing to do with this—

Mrs. Braddock

I knew that.

Mr. Crookshank

—I hope the House will not accept the Amendment.

Mr. Manuel

I should like to make one point regarding this retrospective payment—because that is what it is. The Measure of last year did not operate in this way, and where a contract for an appliance had been made before the coming into force of the Act, the appliance was supplied free. There is nothing in this Bill to say that the payment will be retrospective. Will the right hon. Gentleman indicate where this Bill says that retrospective payment will be made for any appliance which was contracted for before the date on which the Act comes into force?

Mr. Crookshank

There is nothing about retrospective payment. The payment will come into effect when the regulation comes into effect.

Mr. Hector McNeil (Greenock)

I hope the right hon. Gentleman will think again about this Amendment. It may be true that we did not object to his precise phrase on Second Reading. We were then arguing about the principle and were hoping that common sense and justice would prevail and that he would revoke the whole principle he was there advocating. The only objections he attempted to raise were, first, the administrative difficulties, and secondly, the cost.

The administrative difficulties are not insuperable, as was pointed out by one of my hon. Friends in an intervention a second or two ago. We had a comparable problem to this and we faced it. I am not objecting in the least to the right hon. Gentleman making reasonable provision to warn the patients of these outdoor clinics what is going to happen; but I suggest that where people have entered into treatment and where agreement in principle—perhaps at the end of a surgical operation—has been made, he might, on the certificate of the consultant, take them inside his scheme.

What is involved? Would the right hon. Gentleman make a guess as to what money would be involved if he gave these poor, distressed and incapacitated people another mite? Surely he is not asking the House to believe that the whole stability of the pound sterling and the economy of this country rest on the question whether he gives £10 million, £20 million, or £50 million?

4.30 p.m.

I have to advise my hon. Friends not to press this Amendment at this time, because we have very serious principles to discuss later and we are working under the Guillotine; but the right hon. Gentleman must understand how the House smarts at this little piece of pin-pricking. I do not ask him more than this. Will he reconsider the administrative arrangements which were made, and which did work, in relation to the provision of dental appliances?

We are not open to abuse here; we have not got people queueing up for this treatment. We are here dealing with people whose treatment is prescribed, and whose appliances are prescribed on the decision of consultants—men of reputation and experience. There can be no possible abuse. Will he not give the House an undertaking that between now and when the Bill leaves the other place he will see whether reasonable administrative arrangements cannot be made so that there will be no retrospective charges?

Mr. S. S. Awbery (Bristol, Central)

Is the Minister aware that the hospital authorities are not only giving information to patients that they may have to pay for their appliances if the Bill becomes an Act, but are also presenting patients with a certificate which the patients must sign to say that they will have to pay for the surgical appliances which will be provided?

Some of these appliances were ordered long before the right hon. Gentleman's speech on 27th March, and because delivery has been delayed, not through any fault on the part of the patient but because of the manufacturers' delay, the patient will now have to pay. If the position were reversed and the charges were being made prior to 27th March, and if under the Bill no charges were to be made, would the Minister refund the money paid by patients because they were charged before 27th March?

I have received several letters from people in my constituency. I have a Question on the Order Paper today which was not reached, so I have not yet received the reply, but I presume that I shall have a written reply later on. There is grave dissatisfaction among the people of Bristol at a charge of £3 for surgical boots, and I ask the Minister to give serious consideration to this matter. This will not save him very much money, and I ask him to withdraw the charge he suggests making in this Bill.

Mr. Iain MacLeod

As I understand it, three points have been put forward by hon. Members opposite in support of this Amendment. One was put forward by the hon. Lady the Member for Liverpool, Exchange (Mrs. Braddock). We need not go any further into that, except to say that I hope it is recorded in HANSARD that with great candour she said in an interjection a short time afterwards that she knew there was nothing in the point she raised.

Mrs. Braddock

I explained the reason why I raised it.

Mr. MacLeod

I understand fully why the point was raised, but it is common ground that there was nothing in it.

The second point was raised by the hon. Member for Ayrshire, Central (Mr. Manuel), who used the most extraordin- ary language about the circular. "Hitlerite," I think, was his phrase.

Mr. Manuel

That was about the hon. Gentleman himself.

Mr. MacLeod

I do not mind that coming from the hon. Gentleman, if he chooses to use that word about me. Perhaps if he were to cast his eye, not towards this side of the House but a few steps further down, he would see sitting together, very uncomfortably, two people who were responsible a year ago for very similar sorts of considerations in regard to another Bill. Perhaps I might be allowed to quote from what the right hon. Member for Greenock (Mr. McNeil) said, speaking about the circular on this year's Bill: I must make it plain that I do not think it was necessarily irregular; I think it would be quite often the case that instructions might be sent out saying, in the event of an enactment taking place, that these administrative arrangements should be made."—[OFFICIAL REPORT, 9th April, 1952; Vol. 498, c. 2889.]

Mr. McNeil

We are talking of quite different things. The hon. Gentleman is usually so fair about these matters. I was conceding that it was obviously reasonable administration that the Minister of Health should consult about the machinery which he would have to employ and the method that would be chosen for use should the Bill become an Act. We are not talking of exactly comparable circumstances.

Mr. MacLeod

I understand that. But I go a great deal further. It would have been criminally negligent of my right hon. Friend not to have sent out the same sort of circular as he did this time warning people that these charges were in contemplation by the House of Commons. That is the position, and that is the difference between the two sides of the House. To use the sort of adjectives that were used by hon. Members opposite about what is not only an ordinary administrative act

Mr. Manuel

A retrospective act.

Mr. MacLeod

—but an act that was essential to the ordinary workings of administration is not only taking language too far, but shows quite clearly that the Opposition are determined to pick on the most trivial, silly and niggling points to oppose this Bill and to support the Amendment, which I hope will be rejected.

Mr. Barnett Janner (Leicester, North-West)

I wish to occupy the time of the House for only two or three minutes to point out one very important fact which the hon. Member for Enfield, West (Mr. Iain MacLeod), and the Minister have overlooked, which is that there was a contract in existence under the present Act whereby certain appliances had been ordered, and the patients had been measured and informed that the contract was in existence. The actual appliances are almost ready and may be supplied before this Bill comes into force, but nevertheless, letters were sent informing people that, although those arrangements had already been made, they might now be called upon to pay for those appliances and for any other commodity being supplied in accordance with the contract.

I wish to bring the Minister's attention back to that point. In view of the promises made, people have allowed themselves to be measured, and have been led into the belief that they would receive these appliances without any payment. They have received letters from those who are making the appliances informing them that, in accordance with their order, which had been accepted, the appliances are almost ready. I appeal to the Minister. He still has time, even if this Amendment is not carried, to carry into effect the purport of the Amendment, and to grant what is a very reasonable request: that those who have already been led to believe that the appliances and the commodities which are being supplied to them would be supplied free shall have the right to receive them.

If charges are to be imposed—although I do not agree that they should be—the right hon. Gentleman was perfectly in order in saying that from the time of the decision to impose the charges people must understand that if they entered into any new arrangement it could not be one which might not call for a charge to be made. But it would be monstrous to call upon those who had already entered into an arrangement, the goods being almost ready, to make a payment, and I hope the House will consider what is proposed by this Amendment to be reasonable.

I had hoped that we would press this Amendment to a Division, but apparently there are differences of view about that in consequence of the time factor. Even if the Amendment is not pressed to a Division, I earnestly hope the Minister will see that this is not a frivolous point. It is not a sentimental point. It is a point of considerable substance and of material value to those who are suffering considerably and who have been led to believe that they will get what they are entitled to get free of charge.

Mr. William Keenan (Liverpool, Kirkdale)

This is about the fiftieth time that I have attempted to speak on this Clause, and I was beginning to wonder if there was some reason why I had not been called.

The Minister seems to assume that he is in a similar position to that of the Chancellor and that when he made an announcement on this Bill everything in that announcement was agreed to in the same way as when the Budget Resolutions were passed. Nobody could assent to that proposition. It is arrogant of the right hon. Gentleman to take that attitude in order to try to justify his administrative blot.

I have listened to many speeches on this Clause, and, as has been said, we are dealing here with people, including inpatients in hospitals, who are among the poorest in the population, and that part of the population who, generally speaking, are unemployed, dependent upon publc assistance, or old-age pensioners, or those who are in receipt of National Assistance. This Clause demands that the people who are least able to pay should pay because they have the misfortune to be in hospital. The Minister has become so arrogant in this matter that he seems to think that he is in the same position as the Chancellor of the Exchequer and can do just as he likes.

Mr. Tudor Watkins (Brecon and Radnor)

I might have intervened with greater authority if I had been fortified with information to Questions 98 and 99 on today's Order Paper relating to the issue of forms to applicants for surgical appliances seeking an undertaking from them to pay charges under the National Health Service Bill. This is very important, because I think the Minister ought not to have sent these circulars to the hospital management committees.

There is supposed to have been a precedent, but I maintain that the Minister ought to have informed applicants for surgical appliances that they could have them free if they were in receipt of National Assistance. It is contended that it will not be possible to find out how many people in that category require these appliances, but I suggest that hospital management committees have records containing this information. Therefore, there is no administrative difficulty at all. I have asked the Minister whether these forms could be withdrawn, but I have not yet had an answer to my question.

A case has been made out to show that it is unfair that these people in need of these appliances should be asked to pay for them. Because they are in receipt of National Assistance and also because of lack of information on the form, many of them have said that they no longer require their appliances, since they are unable to pay for them. I suggest that the Minister should reconsider this matter and accept this Amendment.

4.45 p.m.

Mr. Aneurin Bevan (Ebbw Vale)

I apologise to the House for not being present earlier to hear the Minister's statement; it was impossible for me to be here then. I did, however, hear the speech of the hon. Member for Enfield, West (Mr. Iain MacLeod), and it seemed to me to be a most astonishing statement. I do not think there is any precedent for this proposal at all. It is quite right for the Minister to make certain administrative preparations within his own Department because certain legislation is proposed and there is a likelihood that it will be carried into effect, but there is no precedent for that information reaching individual patients before Parliament has passed the legislation.

The very fact that these patients are being informed—I am not quite certain to what extent Privilege is involved here—that, since certain legislation is being considered by Parliament, they will be called upon to pay, and the fact that they have to sign this undertaking, is evidence that the physical process of attending to their difficulties will already have started.

That being so, I maintain that these are the very kind of persons to whom legislation ought not to be made retrospective. I am quite amazed at this procedure. I have written to the Minister. I have had many letters from different parts of the country from old people and people in various walks of life stating that they have been to the hospital and that the surgeon has told them that they will be called upon to pay something towards their treatment. Why?

No one can suggest that that is administrative efficiency. It is administrative parsimony. I challenge the hon. Member for Enfield, West, on this point. There is nothing wrong in the Minister asking the hospital authorities to make the necessary administrative preparations for applying these charges in the event of Parliament deciding that they are to be imposed, but why should such administrative action go outside the Department itself and reach the patient when the House of Commons is still debating the matter?

We are also assuming the complete docility of the other place. Have we had a guarantee that the other place will agree with what we send them? This is a most amazing business. After all, Parliament considers legislation of this sort in both Houses. It either starts in the other place and comes here, or starts here and goes to the other place. But here we have the Minister telling not only his own officials but citizens of the country that he is practically certain of the complete docility of the other place as well as of this House, and that the individuals must realise that these charges are going to be made.

Mr. Arthur Colegate (Burton)

When the right hon. Gentleman talks about precedents, he seems entirely to have forgotten that Sir Stafford Cripps, before the Budget was passed, repeatedly warned the citizens of this country of what he was going to do.

Mr. Bevan

This is an entirely different matter. If certain legislation is carried, certain classes of citizens will have certain charges imposed upon them, but here we have not classes of citizens but the individual patient.

Mr. Colegate

Sir Stafford Cripps warned two individuals; he warned Mr. Lord and Sir John Black by name.

Mr. Bevan

The hon. Member is seeking to put a poor man who is attending hospital and being measured for an appliance on the same basis as a proposed act to cheat the intention of Parliament. That was the case then. The two cases are not parallel at all. I understand, speaking from memory on the spur of the moment, that it was intended in that other case that certain forms of income should be taxed, and then it was thought that certain firms were going behind that by making payments of another kind to cheat the intention of Parliament. A person going along for a special kind of boot is not cheating Parliament. He is proceeding to exercise his normal legal rights. Here, however, we are hitting at him.

I must say that of all the mean pieces of behaviour, this is about the limit. I challenge the Minister. I have made inquiries to try to find out whether there is any precedent for it, but I can think of no precedent for it at all. I think that for a sheer, downright dog-in-the-manger attitude, this surpasses anything. It is the sheer limit, and ought to make the Minister ashamed of himself.

Mr. J. Enoch Powell (Wolverhampton, South-West)

It seems to me that the House is in danger of confusing two separate questions. The first question is whether the material date of the operation of these charges should be the date of supply or some anterior point such as that of prescription. That is one question. The second question is whether, if the date of supply is the material date, as it is as the Bill now stands, the Minister has acted rightly in the administrative arrangements which he has made. I want to address myself only to the second point, because it is perfectly clear to me that he would have been liable to severe blame if he had not made those arrangements.

I want to read to the House the terms of a typical document which is being issued to patients for signature. The wording is this: I wish to be supplied with"— and then there is a blank for the name of the appliance to be inserted— and I understand"— the patient is signing to the effect that he understands; he is merely saying he understands— that I will have to pay"— that is false English for "I shall have to pay"— the Ministry of Health if charges are authorised by Act of Parliament. "I sign that I understand that, if an Act of Parliament is passed, then such and such effects will follow." That is what he is signing. If he had not had a document for signature, and later the charges were made, he could say, "I did not understand. You did not tell me. It was not made clear to me."

Mr. Keenan

I do not know if the hon. Gentleman knows what he is saying and means what he is saying, but he is agreeing to retrospective paying. So is the patient, if he signs. It is not even as though the patient were signing after the passing of the Act of Parliament. He is signing something two or three months before the Measure is passed. Therefore, it will be retrospective payment, if the patient agrees to pay.

Mr. Powell

The hon. Gentleman has reverted to the first of the two questions. The first question was whether charges should be imposed on persons who were measured for these appliances, or for whom they were prescribed, before the coming into force of the Bill. I am on a quite different point, a point which has been widely canvassed during this debate—which is why I can speak to it—namely, if charges are to be made from the date of supply, if the date of supply is to be the material date, should or should not my right hon. Friend have done what he has. I return to the point I had reached.

It is common knowledge that people are constantly invited to take notice of the effect of legislation while it is passing through Parliament from the date of its first publication. If anyone can overcome the natural nausea which assails anyone reading the Town and Country Planning Act, 1947, he will see that, throughout the Bill which became that Act, it was assumed that the citizens of the country in their transactions would take account of the provisions of that Measure. That left quite open the question whether the Bill would, in fact, reach the Statute Book at all, or whether it would reach it in the form in which the Bill was presented; but the citizens of the country were invited to take note, as they always have been, of what was going through this House of Commons.

The persons affected by these charges are not people having legal advisers watching Parliament for them. They might have remained unaware of the consequences of what was being done. It was right and indispensable that it should be brought personally to their attention, under the guarantee of signature, how they would be affected if—and the word "if" is the material word—such and such legislation reached the Statute Book. Had my right hon. Friend not seen to it that that understanding was secured, he would have been open to and would have been subjected to great criticism.

Amendment negatived.

Mr. Crookshank

I beg to move, in page 1, line 11, to leave out "any services provided," and to insert: (a) the supply of any drug, medicine or appliance. This is a drafting Amendment, in anticipation of the next Amendment.

Amendment agreed to.

Mr. Crookshank

I beg to move, in page 1, line 12, after "hospital," to insert: (b) the supply of any drug or medicine for the treatment of venereal disease; (c)the supply of any appliance for a person who is under sixteen years of age or is undergoing full time instruction in a school within the meaning of the Education Act, 1944, or the Education (Scotland) Act, 1946; or (d) the replacement or repair of any appliance in consequence of a defect in the appliance as supplied. This Amendment carries out and accepts suggestions made on the Committee stage. It relates to the subsection which refers to items on which there will be no charge. The first paragraph, (b), provides that there should be no charge for the supply of drugs and medicines for the treatment of venereal disease. There was an Amendment on that subject down by hon. Gentlemen opposite which I should have accepted, subject to drafting, had it been reached; and the Parliamentary Secretary made it clear on 9th April that we were going to deal with this matter. The only question was whether it should be dealt with by the Regulations or whether it should be in the Bill.

We came to the conclusion that this particular matter should be dealt with in the Bill, because we are signatories to the Brussels Agreement of 1924, under which we are under obligation to provide free treatment of venereal disease and any necessary drugs and medicines for the purpose for foreign merchant seamen; and because we were committed to that extent in this field it seemed wise to put it in the body of the Bill so that it should be quite clear to anybody interested that we were carrying out our obligations. That was the reason for deciding as we have on the question of Bill versus Regulation.

The second point on which I should say, perhaps, a word, is the reason why venereal disease should be brought in and other diseases not specifically mentioned. Apart from the international effects of the Brussels Agreement, the reason is that, of course, this particular disease, since 1916, has been in a very special position, and is one of those in which the spread of infection can be prevented by prompt treatment by drugs; and for that reason it is distinguished from some of the other illnesses and diseases which were mentioned in the general debate which we had earlier on. That is the position about paragraph (b).

Now, as to paragraph (c) about the children. There again, I think, there was an Amendment down. Anyhow, it was always the intention that the appliances here should be exempted, both as regards supply and repair, because in the case of children—of growing children—there are obviously rather different considerations from those which apply in the case of adults. It was always the intention that they should be exempted, and the question was whether we should do it by Regulation or by Bill. There was an Amendment down and, therefore, I gave the matter further consideration, and in view of the fact that we had also amended Clause 2 by bringing adults into the exemptions provided in that Clause, I thought it more tidy and right to put this in here. That is the explanation of paragraph (c).

5.0 p.m.

As to paragraph (d), there was again an Amendment put down, I think, by the hon. Member for Tottenham (Mr. Messer), which was not moved, but with which I was ready to deal. I have, therefore, brought before the House this suggestion, that we should make this Amendment now, so that there can be no charge for either replacing or repairing an appliance in consequence of a defect in the appliance itself when supplied. As it is an Amendment which was suggested by the hon. Member for Tottenham, perhaps I ought to leave it to him to amplify any further point which he thinks ought to be within the knowledge of the House.

This Amendment thus brings in three quite different matters, all of which, I think, in view of the Amendments on the Order Paper in previous discussions, will be acceptable to the House.

Mr. McNeil

I shall leave to my hon. Friend the Member for Tottenham (Mr. Messer) any elaboration of paragraph (d) and, at a later stage, we shall have some elaboration to make on paragraph (b). That is not to say that neither I nor my hon. Friends do not greatly welcome these concessions which the Minister has offered. I intervene to plead with the Minister to go a little further than he has done in paragraph (c).

The House will have noticed that some of my hon. Friends and I, at an earlier stage, had down an Amendment to which, I suppose, I must not make any reference since it was not called. The first Amendment on the Order Paper has not been called, and I am not grumbling about that. It would, however, be convenient for the House to consider now the principle which was embodied in that Amendment which was not called.

That Amendment proposed to exempt children under the age of 16 from this shilling charge. It will be quite appropriate to discuss it now because there has been called, and the House is discussing, an Amendment under which the Government are doing exactly the same thing in relation to appliances as we propose to do in relation to drugs and medicine. So perhaps the right hon. Gentleman will permit me to say that as he has admitted the principle in relation to the supply of appliances, the provision of free dental treatment and the provision of free dental examination by these concessions, which are concessions to the conception that good hygiene habits are of great importance to the nation, that, similarly, drugs and medicine should be made available without charge of any kind at least to children under 16.

The case obviously could be elaborated at some length. There is a most excellent compassionate case to be made. In our country, as in most other Western countries, we naturally tend to see that children and infants are the first to be relieved of any distress or pain. There is also a very good public health case to be made. If we are really permitting any barrier to be put between the mother and the doctor, then we are running the risk of spreading infection. The right hon. Gentleman cannot really believe, even if he is highly successful in the collection of his miserable shillings from these children, that there will be any saving to the nation if there is an increase of even 1 per cent. in the infectious hospital population in the year. It would be a complete waste in terms of national economy.

It is, no doubt, very difficult for many of us to appreciate that there are women in this country, good, frugal housewives, who count their income in shillings, and whose income, when it comes to a Thursday or Friday, is confined exclusively to shillings. It is very difficult perhaps to believe that is so, but it is so. They "manage," as they say in my part of the world, and they manage with great pride and do not want any assistance but when it comes to Thursday or Friday, every shilling in the woman's purse is counted, earmarked and apportioned.

When we get to the stage when a woman has to decide to call in a doctor, who is freely available, but knowing that he will prescribe and that she will have to find a shilling, it means literally—the right hon. Gentleman seems a little puzzled as to how this creeps in. I appreciate that it is difficult for him to understand everything that is happening in this House, but I have pointed out to the Chair, and the Chair has not disproved me, that since the Government Amendment deals in one case with making appliances available for children and, in another case, drugs and medicines being available to adults, it is scarcely irrelevant that drugs and medicines should be made available freely to children. That is what I am arguing.

I know that it must be very unpleasant for the right hon. Gentleman. We do not want, in this distinguished House, to have to think of anything so unpleasant as a mother having to forgo a meal in order to find a shilling for a child's prescription. That is one of the subjects we have been discussing, and which I plead with the right hon. Gentleman to consider again before this Bill comes back from another place.

I do not want to be sharp or angry about this business. We have objected to many of the provisions of the Bill, but there is none more mean, and none, I think, more short-sighted than this one, that we should exact a shilling for an infant's prescription.

Mr. Iain MacLeod

It is not in the Bill.

Mr. McNeil

The hon. Gentleman is leaving himself wide open. Of course it is in the Bill. He forgets that we are suggesting a charge for a prescription for an infant or child or for anyone else from out-patients' department or consultant is in the Bill. The hon. Member for Enfield, West said that it was not in the Bill. He was referring to the general practitioner's prescription. The Minister told us that he is going to do that by Regulation, and it needs no stretch of imagination to believe that what he does in regard to prescriptions for out-patients' departments he will do under the Act in relation to the general practitioner. That is the end of the speech I wanted to make, and that is why I place the Amendment which was not called at the top of the paper.

Mr. Frederick Messer (Tottenham)

I beg to move, as an Amendment to the proposed Amendment, in paragraph (b), after "disease," to insert "or tuberculosis."

I should like first to express my appreciation of the Minister's action in accepting the Amendments, all of which were inspired by me. The right hon. Gentleman does not get many bouquets, but I am very glad to be in the position of expressing my gratitude to him. I feel sure that when I have finished by speech on tuberculosis, he will be as generous on this Amendment as he has been on the others.

The Minister said that the reason that he has accepted the Amendment on venereal disease arises from the Convention of 1924, when we in company with 40 other nations agreed that we would treat each other's nationals quite free. Obviously, however, the reason for that international agreement was because it was recognised that venereal disease had a certain special position which did not apply to ordinary diseases. It stood in a class almost by itself. The reason that motivated that Convention can, perhaps, be used in connection with tuberculosis too.

There are two diseases that might be said to be something more than merely a medical problem—they are social problems. What we did in reference to venereal disease was to attempt to protect the community. The same thing, surely, must be agreed in regard to tuberculosis. Respiratory tuberculosis is infective. It is not merely in the interests of the individual, but in the interests of the community, that we should take every step possible to minimise the number of those who contract it.

I am bound to say that the steps which have been taken within recent years have been successful. We have seen a very big reduction in the mortality rates of tuberculosis. But although that is true, and it is very encouraging to see that within the period of the National Health Service the tuberculosis mortality rates have dropped by 2,151 in one year, which is 10 per cent., the morbidity figures do not give so much encouragement.

At the beginning of 1949 there were 261,696 cases. At the end of 1949 that figure went up to 272,040 cases. It will be realised that we shall not be getting on top of this problem unless we continue doing what we have started: that is, to give every encouragement to those who might be suspected of having tuberculosis, to get early treatment.

There are three questions which I might put to the Minister. Does he agree that it would be harmful to discourage patients to have early treatment? Does he agree that a charge for prescriptions is bound to have a deterrent affect? Thirdly, does he agree that the problem is one which affects the community and not the individual?

Whatever may be the Minister's opinion, I feel certain that all those engaged in this service—all authorities, the National Association for the Prevention of Tuberculosis, the Tuberculosis Association and the medical staffs at chest clinics and hospitals—agree that the payment is likely to have a deterrent effect. One cannot measure just the extent of the deterrent, but the point is that we have spent an enormous amount of public money.

5.15 p.m.

We have somewhere in the neighbourhood of 45 to 50 miniature mass-radiography units. We are advertising and asking people to come and have an X-ray. If we discover that there is a shadow on the lung, they are sent to the chest clinic, where sputum tests and blood counts are taken. As the Ministry's report shows, we have now got the waiting lists down to a manageable proportion, and if the tests give a positive result we are able to admit patients at a very early stage. There is not a doctor in the House or anywhere else who would not agree that if one gets that lesion in its early stages, one has a very much better opportunity of preventing the patient from developing a chronic condition or from dying.

I wonder whether we have yet grasped the magnitude of this problem? On the hoardings we read of 100 deaths a week on the roads. The drama and the tragedy of it seizes us, and organisations and associations get together to see what can be done to make the roads safer. But nobody seems to notice that there are 400 deaths a week from tuberculosis. That is not sensational, and it does not capture the headlines.

There is here a double problem. There is, first, the human problem. I repeat that we are dealing not with the individual, but with the community; and every authority agrees that we cannot deal with the individual. When dealing with tuberculosis, we must regard the family as the unit; and we are going back when we now say that the treatment for tuberculosis shall not be free.

That treatment has been free since 1936. Local authorities that were running their hospitals, whilst they assessed a patient or a patient's legally liable relative for ordinary cases, admitted T.B. cases free. Chest clinic treatment was free. But now, in 1952, we are putting the clock back and we are saying that tuberculosis cases must now pay for medicine.

One of the reasons why the mortality figure has gone down is due to the discovery which has been made by our scientists. There are two drugs of comparatively recent discovery. One is streptomycin, and the other is para amyl salycic acid, which is better known as P.A.S. It is widely known—I am giving away no confidence—that the Minister has been approached and that it has been pointed out to him that it is necessary that these drugs should be prescribed.

I say very little about streptomycin beyond the fact that it is a very expensive drug and is usually given by injection. In its early days, it was discovered that if one went beyond a course of about six weeks' treatment, the germ developed a resistance to streptomycin, and so if a patient did not respond within six weeks, the treatment was discontinued. But it was found that when the second drug—P.A.S.—was taken in conjunction with streptomycin, it prevented that resistance.

The point is that if a T.B. patient goes to the doctor the doctor says, "I am sorry, but I can only prescribe P.A.S. in small quantities, the reason being that in solution it deteriorates so rapidly that it will not be very much use. Therefore, I must give it to you in small quantities at a time and you must come frequently as a patient." But every time the patient goes he must pay.

The Minister has been approached and has sent an answer to the query by saying, "Oh, yes, that is true, but this drug can be prescribed in granulated or cachet form, and then it will not deteriorate." There is need for some wider knowledge on this subject, for it does not appear to be known that the drug in granulated or cachet form costs three times as much as any solution. The result is that the Minister tells a doctor to prescribe a drug that will cost so much that it would be cheaper if the prescription were free. We are going to get beyond the field of a 1s. prescription in this particular case.

Every one of us who travels in a crowded tube train is running the risk of infection. Every one of us who has been in the company of someone who has been deterred from getting early treatment is in danger of infection. I want to appeal to the Minister to give greater consideration to this question in another place. There they have numbers of eminent doctors and specialists who can speak with authority on such matters. I have not yet met any of the tuberculosis experts that I have encountered in some of the finest sanatoria in the country, nor have I met any chest physician in the country, who have approved of payment on prescriptions for tuberculosis cases

I have no desire to detain the House this afternoon, but there is a tragic side to this matter. This disease is peculiar. Those who suffer from it have a strange psychology. They have an optimistic outlook and they believe that they are the people who are going to be exceptions to the rule and are going to be cured. There is this danger that when they go to the chest clinic and get a prescription on which they will have to pay, they will not trouble to go and have the prescription made up because of their belief that they are going to get well and, therefore there is no necessity to pay the money. Even if we have got to economise somewhere else, I urge the Minister not to economise at the expense of what is the most tragic section of our community.

In any ward of our tuberculosis establishments there are patients whom the doctors will describe as having to undergo a most difficult form of treatment, and who might have been saved had they had early treatment. A very important point which I should like to put is, why have we been able to reduce the waiting lists in hospitals? Because we have organised the service. Suspect cases at the chest clinics have been given initial treatment. They have been admitted to hospital where they have undergone the treatment known as artificial pneumothorax and pneumoperitoneum, and then they have been sent to their homes for a brief period.

What do we suppose is going to be the attitude of the medical staffs in these hospitals when they know that when the patient is discharged to his home he will now be called upon to pay? They will keep such cases in hospital because there the prescriptions will be free, and that is going to block beds against somebody who might be getting the treatment.

For all these reasons—and there are many others which can be advanced—I want to make an earnest appeal to the Minister to accept this Amendment. I am not attempting to make any party point on this. Some considerations rise above the party line, and even if I were to offend against my own party I would still speak as I am speaking and say that we are doing a great disservice not merely to the few people who suffer but to the community at large, for they will suffer if we do not take these steps. This Amendment surely can be supported on the grounds of humanity and more so on the grounds of materialistic economy, for every patient lying in a bed and so absent from the workshop is a loss to the productive capacity of this country. I hope that the Minister will see that of all the diseases and complaints of which we know there is one which stands out and this is that one.

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

I beg to second the Amendment to the proposed Amendment

My hon. Friend the Member for Tottenham (Mr. Messer), in so ably moving this Amendment appealing to the Government for free treatment for tuberculosis cases, has spoken in his usual way with a deep knowledge of the subject and with profound sincerity. The subject of the treatment of tuberculosis is one upon which I could speak at great length but for the fact that we are having to conduct our debate under the procedure of the Guillotine. The Guillotine will fall before very long, and in the meantime many of my hon. Friends will wish to speak. Also, we have many other subjects that require discussion. I shall, therefore, have to confine myself to a comparatively brief speech.

The Minister of Health a few minutes ago proposed that the treatment of venereal disease shall be free. We agree with him that that should be so but, unless this Amendment is accepted, we are going to find ourselves in the ridiculous position where a person who deliberately leads an immoral life and contracts venereal disease is given free treatment and where a person who, through no fault of his own, has the misfortune to develop tuberculosis has to pay for the treatment.

I am aware that the treatment of tuberculosis in hospitals and sanatoria will be free, but I am thinking of those thousands of people who are awaiting admission to sanatoria. It is not the case that many of these patients require a bottle of medicine which needs refilling only once a week. The drugs and the medicines which are given to patients suffering from tuberculosis are provided mostly for symptomatic treatment. The tuberculosis patient may have a number of symptoms, all of which require treatment in the form of drugs and medicines. It is by no means uncommon for a tuberculosis patient to require several bottles of medicine, several different medicines and several different kinds of tablets.

5.30 p.m.

It is no exaggeration to say that for a severe case of tuberculosis someone must go very frequently to the chemist's shop with a prescription for medicines or tablets. This charge of 1s. will be imposed upon tuberculosis patients with considerable frequency. As everybody knows, as these patients are incapacitated for work their income is low and they cannot afford the expense.

There has been no abuse in the use of medicines and drugs by patients suffering from tuberculosis. I regard it as very wrong indeed that the Minister of Health should be trying to raise revenue by imposing this tax upon the drugs and medicines that are required by patients suffering from tuberculosis. We on this side shall support the Minister of Health in his proposal that patients suffering from venereal disease shall have free treatment. I appeal to him to support our Amendment allowing free treatment for patients suffering from tuberculosis.

Mr. Somerville Hastings (Barking)

I very strongly support the Amendment. There is an increasing tendency in the medical profession to regard tuberculosis of the lung as just as infectious as venereal disease, and to say that unless it is generally so regarded it will never be eliminated. Some people go further and say that nearly all cases of tuberculosis are cases of infection in the earliest years of life, and that it may become quiescent and remain so until later in life. There is very strong support for this view.

May I give a few points in evidence of this infectivity. The disease is five times as common in households in which there is an active case of tuberculosis. There are cases of school teachers who have infected one after another of the pupils in their class at school. My friend Dr. Seta Lumsden, Medical Officer of Health for Southend, has traced as many as 10 cases of direct infection from one individual. Some little time ago I had occasion to write about tuberculosis in one of the Sunday papers. I got a letter from a man saying that he was suffering from tuberculosis and that one after another his five children got the disease. The poor man did not realise it but he was, of course, the source of the infection.

Therefore, we have to make sure that there is no barrier against obtaining the best possible treatment, if we want to eliminate the disease. If we want to prevent tuberculosis, we cannot separate prevention and cure. To prevent this disease, the first principle is to provide easy facilities for cure. This has been recognised in what are known as chest clinics. They were originally called clinics or dispensaries for the prevention of consumption. How did they prevent it? Merely by recognising early cases and treating them. So the way to deal with and prevent tuberculosis is to get it early and treat it. The real difficulty is getting it early, and we must provide every facility for this.

I am attached to one of our hospitals—Hammersmith Hospital—in an administrative capacity. There we have what was called a dispensary for the prevention of tuberculosis, and is now called a chest clinic.

Mr. Messer

I opened it.

Mr. Hastings

I am glad that my hon. Friend the Member for Tottenham (Mr. Messer) has reminded me that he very kindly came down to open it for us. The medical officer in charge of the clinic is a very keen man who has worked out the history of many of his patients. He finds that the average time between the first development of symptoms and coming to his chest clinic is between four and five months. Already there is a long delay. The imposition of a charge for this treatment will make the delay even longer.

I regard it as most unfair that whether a person will have to pay for the treatment or not may be merely a matter of chance. If an individual who develops tuberculosis happens to live in Stepney, he will be able within a few days to get into St. Georges-in-the-East Hospital, where there are tuberculosis wards, because there is practically no waiting list, and the treatment will cost him nothing. If he lives in some other part of the country, he may have to wait four or five months. [HON. MEMBERS: "Or longer."] Yes, longer in some cases.

All that time he will need treatment, and all that time, if this abominable Bill goes through, he will have to pay for it. It is not only a question of the individual concerned, but of the people with whom he lives and the public generally. If he receives treatment, for which he may have to pay, unfortunately, he gets at the same time valuable advice how to protect other people and prevent himself from becoming a public danger. He is given facilities, such as a sputum cup, and all that sort of thing, and disinfectant to disinfect his sputum. It is very strongly to the public advantage that every sufferer from tuberculosis should be encouraged to obtain treatment at the earliest possible moment. I therefore desire strongly to support the Amendment.

The Joint Under-Secretary of State for Scotland (Commander T. D. Galbraith)

The whole House listened to the hon. Member for Tottenham (Mr. Messer) with the greatest possible respect, in view of the moderation and the great sincerity with which he put his points before us, and also to those other hon. Gentlemen, both members of the medical profession, who have given us the benefit of their experience and advice this afternoon.

I want to remind the House of the essential difference which there would appear to be between the venereal diseases and tuberculosis, as referred to by my right hon. Friend when dealing with the original Amendment. Perhaps in their anxiety, those hon. Members who have spoken in support of this Amendment have in some measure exaggerated their case, because it is the fact that the treatment of tuberculosis is undertaken to far the greater extent either in hospitals or in clinics, and that the proportion who receive medicine which is prescribed, and will therefore be subject to the 1s. charge, is really a very small proportion. [HON. MEMBERS: "Oh."] I am stating my case, hon. Gentlemen may state their own. That is my impression.

Mr. Bevan

If the hon. and gallant Member will allow me to interrupt on that point, he said that a large proportion are treated in clinics or as outpatients. Will they therefore have drugs free?

Commander Galbraith

As the right hon. Gentleman is well aware, we are dealing only with prescriptions in out-patients departments. I was dealing with the general arguments which have been put forward in the course of this debate. I thought the hon. Member for Barking (Mr. Hastings) gave the impression that those who are suffering from this disease will have to pay for treatment, whereas, as I have just said, it is only where there is a pre- scription for use in the home and not in the clinic. After all, those of us who are not experts on the subject are rather inclined to get this muddled. Surely treatment in the majority of cases means treatment either in hospitals or clinics.

Mr. Hastings

Then am I right in asuming that when a patient in a chest clinic—some, but not all of which, are associated with hospitals—is ordered medicine, in future he will not have to pay for it? Will the hon. and gallant Gentleman make that clear?

Commander Galbraith

Where the treatment is given in the clinic, he will not have to pay for it. [HON. MEMBERS: "Oh."] Where it is a case of getting a prescription, the shilling charge will be payable. [An HON. MEMBER: "If he is an out-patient."] I hope that is clear to the House. We have had a good many statements as to the great hardship which this would inflict on those who find themselves unable to meet the charge, but the Bill has made provision—

Mr. Percy Shurmer (Birmingham. Sparkbrook)

No.

Commander Galbraith

I contend that it has. There is the provision there. The National Assistance Board is always available—

Mr. Shurmer

But what is the position of a person drawing his Assistance Board money on a Monday if on a Friday he wants a prescription and has not the money to pay? Has he to wait over the week-end and get worse until he can afford to pay?

Commander Galbraith

I rather think that in such a case application would be made to the Assistance Board prior to that. [HON. MEMBERS: "No."] Oh, yes.

An Hon. Member

In anticipation?

Mr. Shurmer

There are hundreds of thousands of people like it.

Commander Galbraith

It is perfectly open to people to take advantage of it. I have as much sympathy with tuberculosis—

Mr. Jack Jones (Rotherham)

Show it—

5.45 p.m.

Commander Galbraith

—as anyone in this House. I have shown my interest in it since I assumed the office which I hold—[An HON. MEMBER: "Sympathy is not enough"]—by visiting both clinics and hospitals. I intend to go on visiting them, because it is not only interesting but advisable that one should know everything possible about this disease. Yet I feel that the speeches may have over-emphasised the position, and I much regret that I cannot accept the Amendment.

Mr. Messer

Before the hon. and gallant Gentleman sits down, may I ask him a question? First, I agree with him that the majority of cases are the chronic domiciliary ones and are not affected by this Bill, but that does not mean we ought not to do what we can for them. Second, it is not merely a question of hardship. I never made that point. My point was that it is a deterrent factor in the early cases. Will the hon. and gallant Gentleman answer the question I posed? Is it not a fact that every authority agrees that it is wrong to deter people from having early treatment and that if a prescription is imposed it will deter them and, therefore, is that not against the public interest?

Commander Galbraith

When this Bill becomes an Act and the position is really understood by the public—[An HON. MEMBER: "You do not understand it now"]—I think it will be made clear, particularly at the clinics, that such a deterrent factor will not really exist.

Mr. Marquand

The reply of the hon. and gallant Gentleman to the case which has been put before him so sincerely, so movingly and with so much expert knowledge, is deplorably disappointing. When we on this side of the House occupied the seats opposite, we said that we wanted to mobilise all the resources of the nation in a war against tuberculosis. I had hoped that the hon. and gallant Gentleman would have said this evening, "We want to continue that war and we will use every weapon, however small, in the fight." He has refused to do so. Nevertheless, I hope that my hon. Friends will decide not to pursue the discussion now, but to register their opinion of the refusal in the Division Lobby so that we can get on to other points of great importance which we want to discuss.

Mr. C. J. M. Alport (Colchester)

I am certain that all those who have followed the steady growth of tuberculosis over the last 20 years and more will have listened with the greatest sympathy to the point raised by the hon. Member for Tottenham (Mr. Messer). As we have heard many times in this House that it is a scourge against which everyone in all parties wishes to take whatever measures are possible in order to end it. What we are really considering in this Amendment is a much wider problem than that of tuberculosis alone.

After all, there is no special case, on a morbidity basis, for treating tuberculosis any differently from any of the other great killing diseases. If it were taken on a question of statistics, one might say that there was more reason for providing relief for those suffering from heart disease, which is a far greater killing disease than tuberculosis. As I see it, we are really considering whether tuberculosis, like venereal disease, because it is possible to communicate it to other people, deserves special treatment in the interests not merely of the patient but even more in the interests of those who have not so far been unfortunate enough to contract it.

I should have thought that, if my right hon. Friend were to consider the point further, he should consider it on those grounds and not specially in respect of any particular communicable disease. But we have the evidence of the right hon. Member for Ebbw Vale (Mr. Bevan), when speaking in the debate on the 1949 Bill on an Amendment received from another place, about the impossibility of making any exceptions to the general application of the charges that he was supporting at that time. We should be clear that the principle of the charges has been approved, whether or not there has since been a change of mind on the part of hon. Members opposite, and also that there has since been no evidence to confute the statement of the right hon. Member for Ebbw Vale that he could see no administrative way of making distinctions of this sort.

One can take a particular example of a disease like venereal disease, which, after all, has a very special form of treatment, but, in dealing with a different problem such as communicable diseases generally, I believe that the principle raised by the right hon. Gentleman would apply. However, if my right hon. Friend is able to consider the point further—no doubt it is one which will be considered—I feel that, whatever arguments may be raised in favour of it, from the point of view of the evidence given by the right hon. Member for Ebbw Vale on a previous occasion one is unable to support the Amendment.

Mr. Bevan

It is essential that I should answer that last point. The argument of the hon. Member for Colchester (Mr. Alport) is a simple one. He says that in 1949 I said that discrimination was difficult. Consequently I proceeded to make no charges whatsoever. In this case the hon. Member says, "Because discrimination is difficult, we will charge everybody." I should have thought that there was a slight difference between the two forms of approach.

When moving the Second Reading of the Bill on that occasion, and during its Committee stage, I pointed out that I anticipated very considerable difficulty in framing Regulations, and I warned the House that that would probably be so. No one could have had stronger hints about administrative difficulty in applying the charges than I gave at that time. Therefore, we did not proceed.

What the hon. Member and the Minister have not done today is to answer the very powerful case of my hon. Friend the Member for Tottenham (Mr. Messer). My hon. Friend said that the case for exempting venereal disease from charges is the same as that for exempting tuberculous patients—the social incidence of the disease. It is a curious fact that a disease which was in the first place contracted by a voluntary act is going to be exempted and one contracted as the result of an involuntary association is not. I do not believe that hon. Members can defend this on any platform in the country. It really is monstrous.

If there is one disease, however, that it is administratively possible to separate from the others, it is this one, first, because, as my hon. Friends have pointed out, it is highly infectious, and secondly, because the susceptibility to the disease depends on the resistance factor of the patient.

Commander Galbraith

Can the right hon. Gentleman tell us of any course of treatment whatsoever which can possibly banish infection from T.B, in anything like the same period as infection from venereal disease can be banished?

Mr. Bevan

That point is really not germane to what I am saying. The hon. and gallant Gentleman should address questions of that sort to members of the medical profession; it is not for me to answer that question. I am dealing with the medical consequences of certain legislation. The hon. and gallant Gentleman said that patients could have Assistance Board help in order to pay these charges. It is precisely people in that category, who have reached the income level which attracts assistance from the Assistance Board, whose resistance to infection is the lowest.

Indeed, as unemployment rears its head in different parts of the country, the incidence of tuberculosis is likely to rise. One of the most heartening things I experienced at the Ministry of Health was to see the death rate of tuberculosis falling, and then—of course, hon. Members opposite made the most of it—notifications rising. But hon. Members opposite did not seem to be able to see the connection between the two. The death rate was falling because the notifications were increasing, and in the latter stages of the Labour Government the actual notifications themselves were falling.

Mr. William Ross (Kilmarnock)

. Even in Scotland.

Mr. Bevan

We were beating back the white scourge. We were defeating it.

I say that it is administratively easier to separate tuberculosis from the pharmaceutical field just because it is easy to diagnose. Members of the medical profession are not exact scientists, and they sometimes issue very peculiar certificates, such as in the whole field of rheumatism. Fibrositis is sometimes certified as arthritis—I have seen that done very frequently—and all kinds of bronchial troubles are certified in a most peculiar fashion. The point about tuberculosis is that it is identifiable. As a result of modern diagnostic methods, there is no doubt at all whether a patient is suffering from tuberculosis or not.

Dr. Morgan

Sometimes there is.

Mr. Bevan

Do not let us raise all these marginal points, "… for the letter killeth, the Spirit giveth life." It is a fact that this group of patients can be identified, and no doctor will certify his patient as suffering from tuberculosis in order to get free medicine for him, if the Amendment is carried.

The hon. and gallant Gentleman has made no case at all. I hope that when this provision comes to be examined in another place, the eminent members of the medical profession there who have for many years, notwithstanding the political parties to which they may have belonged, conducted a sustained attack upon this disease will rebuke, reprimand, and chastise the Government for daring to resist so humanitarian an Amendment as this.

Mr. Manuel

Some reply ought to be made to the Joint Under-Secretary of State for Scotland. He knows the position about tuberculosis in Scotland, and he knows the shortage of beds there. He knows that, because of the shortage of beds, many hundreds of Scottish tuberculosis sufferers who ought to be in hospital are being treated as out-patients. What in effect the Government are saying in the Bill is that these people have to continue paying.

6.0 p.m.

Commander Galbraith

A fair description was given by the hon. Member for Tottenham (Mr. Messer), who knows something about this, and has told the House that I am right in the suggestion that this is a very small proportion.

Mr. Manuel

I want to repudiate that completely. Hundreds of patients who are not in-patients of hospitals are getting treatment and repeatedly having prescriptions issued for them for which they will have to pay.

There is another facet of this problem of which the hon. and gallant Gentleman should be aware, if he is not. Owing to the shortage of beds and the many hundreds on the waiting lists in Scotland, in certain areas, deliberately as a principle, they are taking into hospitals as patients persons whom they think they can cure while the chronic tuberculosis patient is left at home. By this Measure we are saying that to the end of his life he has to keep paying, week in and week out, for the prescriptions given him by his family doctor to keep him alive. That is the position in Scotland, and the hon. and gallant Gentleman should know it.

Most hon. Members know that treatment of this disease is a lengthy matter. Patients may be in hospital and sanatoria for 18 months or two years, and very often after the treatment there is follow-up treatment, pneumo-thorax refills, and people go regularly every fortnight or month to get those refills. They have still to be charged.

Sir Edward Boyle (Birmingham, Handsworth)

No.

Mr. Manuel

They are out-patients. If there is to be repudiation of the statement that an out-patient having follow-up treatment has to pay, we should get the hon. and gallant Gentleman to answer, as he is dealing with the debate. In Scotland we shall regard very seriously the irresponsible speech we had from the Under-Secretary of State about tuberculosis patients.

Commander Galbraith

I want to make it clear to the hon. Member that treatment at the clinic does not come into this matter at all, but it is only where a prescription is given to be taken away from the clinic that the charge is made. The hon. Member continues saying that patients will have to pay for treatment at a clinic; they will not.

Mr. Manuel

I wish to underline the point that in Scotland we are peculiarly placed in this matter. The hon. and gallant Gentleman knows that we have many hundreds who cannot get into hospital because of shortage of beds and the family doctor, week in and week out, is treating that type of patient in the home. Many of the chronic cases are not being taken in at all, as they take in patients in whom it is thought a cure may be effected. Therefore, the person who is suffering chronically from tuberculosis is continuing at home and paying for prescriptions and will do so until he dies. It is in connection with that kind of case that relief should be given.

Mr. Edward Short (Newcastle-upon-Tyne, Central)

Some time ago the Parliamentary Secretary gave an undertaking to this House that the Government would do all in their power to try to reduce the incidence of tuberculosis on Clyde-side, a movement which was started so successfully under my right hon. Friend. The incidence there is the highest of any in England and Wales and very nearly the highest in Scotland. How does the Minister square that undertaking given to me across the Floor of the House with the imposition of these charges, which

will act as a tremendous deterrent to early diagnosis of the disease?

Question put. "That those words be there inserted in the proposed Amendment."

The House divided: Ayes, 258 Noes, 278.

Division No. 111.]	AYES	[6.5 p.m.
Acland, Sir Richard	Fletcher, Eric (Islington. E.)	McNeil, Rt. Hon. H.
Adams, Richard	Follick, M.	MacPherson, Malcolm (Stirling)
Allen, Arthur (Bosworth)	Foot, M. M.	Mainwaring, W. H.
Anderson, Frank (Whitehaven)	Forman, J. C.	Mallalieu, E. L. (Brigg)
Attlee, Rt. Hon. C. R.	Fraser, Thomas (Hamilton)	Mallalieu, J. P. W. (Huddersfield, E.)
Awbery, S. S.	Freeman, John (Watford)	Manuel, A. C.
Ayles, W. H.	Freeman, Peter (Newport)	Marquand, Rt. Hon. H. A.
Bacon, Miss Alice	Gaitskell, Rt. Hon. H. T. N.	Mayhew, C. P.
Baird, J.	Gibson, C. W.	Mellish, R. J.
Balfour, A.	Glanville, James	Messer, F.
Barnes, Rt. Hon. A. J.	Gooch, E. G.	Mikardo, Ian
Bartley, P.	Gordon Walker, Rt. Hon. P. C.	Mitchison, G. R.
Ballenger, Rt. Hon. F. J.	Greenwood, Rt. Hon. Arthur (Wakefield)	Monslow, W.
Bence, C. R.	Grenfell, Rt. Hon. D. R.	Moody, A. S.
Benson, G.	Grey, C. F.	Morgan, Dr. H. B. W.
Beswick, F.	Griffiths, David (Rother Valley)	Morley, R.
Bevan, Rt. Hon. A (Ebbw Vale)	Griffiths, William (Exchange)	Morris, Percy (Swansea, W.)
Bing, G. H. C.	Hale, Leslie (Oldham, W.)	Morrison, Rt. Hon. H. (Lewisham, S.)
Blackburn, F.	Hall, Rt. Hon. Glenvil (Colne Valley)	Moyle, A.
Blyton, W. R.	Hall, John (Gateshead, W.)	Mulley, F. W.
Boardman, H.	Hamilton, W. W.	Murray, J. D.
Bottomley, Rt. Hon. A. G.	Hannan, W.	Neal, Harold (Bolsover)
Bowden, H. W.	Hardy, E. A.	Noel-Baker, Rt. Hon. P. J.
Bowles, F. G.	Hargreaves, A.	Oldfield, W. H.
Braddock, Mrs. Elizabeth	Harrison, J. (Nottingham, E.)	Orbach, M.
Brockway, A. F.	Hastings, S.	Oswald, T.
Brook, Dryden (Halifax)	Hayman, F. H.	Padley, W. E.
Broughton, Dr. A. D. D.	Healey, Denis (Leeds, S.E.)	Paling, Rt. Hon. W. (Dearne Valley)
Brown, Rt. Hon. George (Belper)	Henderson, Rt. Hon. A. (Rowley Regis)	Paling, Will T. (Dewsbury)
Brown, Thomas (Ince)	Hewitson, Capt. M.	Pannell, Charles
Burke, W. A.	Hobson, C. R.	Pargiter, G. A.
Burton, Miss F. E.	Holman, P.	Parker, J.
Callaghan, L. J.	Holmes, Horace (Hemsworth)	Paton, J.
Carmichael, J.	Holt, A. F.	Pearson, A.
Castle, Mrs. B. A.	Houghton, Douglas	Peart, T. F.
Champion, A. J.	Hoy, J. H.	Plummer, Sir Leslie
Chetwynd, G. R.	Hubbard, T. F.	Poole, C. C.
Clunie, J.	Hudson, James (Ealing, N.)	Porter, G.
Cocks, F. S.	Hughes, Cledwyn (Anglesey)	Price, Joseph T. (Westhoughton)
Coldrick, W.	Hughes, Emrys (S. Ayrshire)	Price, Philips (Gloucestershire, W.)
Collick, P. H.	Hughes, Hector (Aberdeen, N.)	Proctor, W. T.
Cook, T. F.	Hynd, H. (Accrington)	Pryde, D. J.
Corbet, Mrs. Freda	Hynd, J. B. (Attercliffe)	Rankin, John
Cove, W. G.	Irvine, A. J. (Edge Hill)	Reeves, J.
Craddock, George (Bradford, S.)	Irving, W. J. (Wood Green)	Reid, Thomas (Swindon)
Crosland, C. A. R.	Isaacs, Rt. Hon. G. A.	Reid, William (Camlachie)
Crossman, R. H. S.	Janner, B.	Rhodes, H.
Cullen, Mrs. A.	Jay, Rt. Hon. D. P. T.	Richards, R.
Daines, P.	Jeger, George (Goole)	Roberts, Rt. Hon. A.
Dalton, Rt. Hon. H.	Jenkins, R. H. (Stechford)	Roberts, Albert (Normanton)
Darling, George (Hillsborough)	Johnson, James (Rugby)	Roberts, Goronwy (Caernarvonshire)
Davies, A. Edward (Stoke, N.)	Johnston, Douglas (Paisley)	Rogers, George (Kensington, N.)
Davies, Ernest (Enfield, E.)	Jones, David (Hartlepool)	Ross, William
Davies, Harold (Leek)	Jones, Frederick Elwyn (West Ham, S.)	Royle, C.
Davies, Stephen (Merthyr)	Jones, Jack (Rotherham)	Schofield, S. (Barnsley)
Deer, G.	Jones, T. W. (Merioneth)	Shackleton, E. A. A.
Dodds, N. N.	Keenan, W.	Shawcross, Rt. Hon. Sir Hartley
Donnelly, D. L.	Key, Rt. Hon. C. W.	Shinwell, Rt. Hon. E.
Driberg, T. E. N.	King, Dr. H. M.	Short, E. W.
Dugdale, Rt. Hon. John (W. Bromwich)	Kinley, J.	Shurmer, P. L. E.
Ede, Rt. Hon. J. C.	Lee, Frederick (Newton)	Silverman, Julius (Erdington)
Edelman, M.	Lee, Miss Jennie (Cannock)	Silverman, Sydney (Nelson)
Edwards, John (Brighouse)	Lever, Harold (Cheetham)	Simmons, C. J. (Brierley Hill)
Edwards, Rt. Hon. Ness (Caerphilly)	Lever, Leslie (Ardwick)	Slater, J.
Edwards, W. J. (Stepney)	Lewis, Arthur	Smith, Ellis (Stoke, S.)
Evans, Albert (Islington, S.W.)	Lindgren, G. S.	Smith, Norman (Nottingham, S.)
Evans, Edward (Lowestoft)	Lipton, Lt.-Col. M.	Snow, J. W.
Evans, Stanley (Wednesbury)	Logan, D. G.	Sorensen, R. W.
Ewart, R.	McGhee, H. G.	Soskice, Rt. Hon. Sir Frank
Fernyhough, E.	McInnes, J.	Sparks, J. A.
Field, W. J.	McKay, John (Wallsend)	Steele, T.
Finch, H. J.	McLeavy, F.	Stewart, Michael (Fulham, E.)
Stokes, Rt. Hon. R. R.	Ungoed-Thomas, Sir Lynn	Willey, Octavius (Cleveland)
Strachey, Rt. Hon. J.	Usborne, H. C.	Williams, David (Neath)
Strauss, Rt. Hon. George (Vauxhall)	Viant, S. P.	Williams, Rev. Llywelyn (Abertillery)
Swingler, S. T.	Wade, D. W.	Williams, Ronald (Wigan)
Sylvester, G. O.	Wallace, H. W.	Williams, W. R. (Droylsden)
Taylor, Bernard (Mansfield)	Watkins, T. E.	Williams, W. T. (Hammersmith, S.)
Taylor, John (West Lothian)	Webb, Rt. Hon. M. (Bradford, C.)	Wilson, Rt. Hon. Harold (Huyton)
Taylor, Rt. Hon. Robert (Morpeth)	Weitzman, D.	Winterbottom, Ian (Nottingham, C.)
Thomas, David (Aberdare)	Wells, Percy (Faversham)	Winterbottom, Richard (Brightside)
Thomas, George (Cardiff)	Wells, William (Walsall)	Wyatt, W. L.
Thomas, Iorwerth (Rhondda, W.)	West, D. G.	Yates, V. F.
Thomas, Ivor Owen (Wrekin)	White, Mrs. Eirens (E. Flint)	Younger, Rt. Hon. K.
Thorneycroft, Harry (Clayton)	White, Henry (Derbyshire, N.E.)
Tomney, F.	Whiteley, Rt. Hon. W.	TELLERS FOR THE AYES:
Turner-Samuels, M.	Willey, Frederick (Sunderland, N.)	Mr. Wilkins and Mr. Wigg.
NOES
Aitken, W. T.	Donner, P. W.	Johnson, Eric (Blackley)
Allan, R. A. (Paddington, S.)	Doughty, C. J. A.	Jones, A. (Hall Green)
Alport, C. J. M.	Douglas-Hamilton, Lord Malcolm	Joynson-Hicks, Hon. L. W.
Amery, Julian (Preston, N.)	Drayson, G. B.	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.
Assheton, Rt. Hon. R. (Blackburn, W.)	Eden, Rt. Hon. A.	Langford-Holt, J. A.
Astor, Hon. J. J. (Plymouth, Sutton)	Erroll, F. J.	Law, Rt. Hon. R. K.
Astor, Hon. W. W. (Bucks, Wycombe)	Fell, A.	Legge-Bourke, Maj. E. A. H.
Baker, P. A. D.	Finlay, Graeme	Legh, P. R. (Petersfield)
Baldock, Lt.-Cmdr. J. M.	Fisher, Nigel	Lennox-Boyd, Rt. Hon. A. T.
Baldwin, A. E.	Fleetwood-Hesketh, R. F.	Lindsay, Martin
Banks, Col. C.	Fletcher, Walter (Bury)	Linstead, H. N.
Barber, A. P. L.	Fletcher-Cooke, C.	Lloyd, Rt. Hon. G. (King's Norton)
Baxter, A. B.	Fort, R.	Lloyd, Maj. Guy (Renfrew, E.)
Beach, Maj. Hicks	Fraser, Hon. Hugh (Stone)	Lloyd, Rt. Hon. Selwyn (Wirral)
Beamish, Maj. Tufton	Fraser, Sir Ian (Morecambe & Lonsdale)	Lockwood, Lt.-Col. J. C.
Bell, Philip (Bolton, E.)	Gage, C. H.	Longden, Gilbert (Herts, S.W.)
Bell, Ronald (Bucks, S.)	Galbraith, Cmdr. T. D. (Pollok)	Low, A. R. W.
Bennett, F. M. (Reading, N.)	Galbraith, T. G. D. (Hillhead)	Lucas, P. B. (Brentford)
Bennett, Dr. Reginald (Gosport)	Gammans, L. D.	Lucas-Tooth, Sir Hugh
Bevins, J. R. (Toxteth)	Garner-Evans, E. H.	McAdden, S. J.
Bishop, F. P.	George, Rt. Hon. Maj. G. Lloyd	McCorquodale, Rt. Hon. M. S.
Black, C. W.	Godber, J. B.	Macdonald, Sir Peter (I. of Wight)
Bossom, A. C.	Gomme-Duncan, Col. A.	Mackeson, Brig. H. R.
Boyd-Carpenter, J. A.	Gough, C. F. H.	McKibbin, A. J.
Boyle, Sir Edward	Gower, H. R.	McKie, J. H. (Galloway)
Braine, B. R.	Graham, Sir Fergus	Maclean, Fitzroy
Braithwaite, Sir Albert (Harrow, W.)	Gridley, Sir Arnold	MacLeod, Iain (Enfield, W.)
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)
Brooke, Henry (Hampstead)	Hare, Hon. J. H.	Maitland, Patrick (Lanark)
Brooman-White, R. C.	Harris, Frederic (Croydon, N.)	Markham, Major S. F.
Browne, Jack (Govan)	Harris, Reader (Heston)	Marples, A. E.
Buchan-Hepburn, Rt. Hon. P. G. T.	Harrison, Col. J. H. (Eye)	Marshall, Douglas (Bodmin)
Bullard, D. G.	Harvey, Air Cdre. A. V. (Macclesfield)	Maude, Angus
Bullock, Capt. M.	Harvey, Ian (Harrow, E.)	Maudling, R.
Bullus, Wing Commander E. E.	Harvie-Watt, Sir George	Maydon, Lt.-Comdr. S. L. C.
Burden, F. F. A.	Hay, John	Medlicott, Brig. F.
Butler, Rt. Hon. R. A. (Saffron Walden)	Head, Rt. Hon. A. H.	Mellor, Sir John
Carr, Robert (Mitcham)	Heald, Sir Lionel	Molson, A. H. E.
Carson, Hon. E.	Heath, Edward	Moore, Lt.-Col. Sir Thomas
Cary, Sir Robert	Higgs, J. M. C.	Morrison, John (Salisbury)
Channon, H.	Hill, Dr. Charles (Luton)	Mott-Radclyffe, C. E.
Clarke, Col. Ralph (East Grinstead)	Hinchingbrooke, Viscount	Nabarro, G. D. N.
Clarke, Brig. Terence (Portsmouth, W.)	Hirst, Geoffrey	Nicholls, Harmar
Cole, Norman	Holland-Martin, C. J.	Nicholson, Godfrey (Farnham)
Colegate, W. A.	Holmes, Sir Stanley (Harwich)	Nicolson, Nigel (Bournemouth, E.)
Conant, Maj. R. J. E.	Hopkinson, Henry	Nield, Basil (Chester)
Cooper, Sqn. Ldr. Albert	Hornsby-Smith, Miss M. P.	Noble, Cmdr. A. H. P.
Cooper-Key, E. M.	Horobin, I. M.	Nugent, G. R. H.
Craddock, Beresford (Spelthorne)	Horsbrugh, Rt. Hon. Florence	Nutting, Anthony
Cranborne, Viscount	Howard, Gerald (Cambridgeshire)	Oakshott, H. D.
Crookshank, Capt. Rt. Hon. H. F. C.	Howard, Greville (St. Ives)	Odey, G. W.
Crosthwaite-Eyre, Col. O. E.	Hudson, Sir Austin (Lewisham, N.)	O'Neill, Rt. Hon. Sir H. (Antrim, N.)
Crouch, R. F.	Hudson, W. R. A. (Hull, N.)	Ormsby-Gore, Hon. W. D.
Crowder, John E. (Finchley)	Hulbert, Wing Cmdr. N. J.	Orr, Capt. L. P. S.
Crowder, Petre (Ruislip—Northwood)	Hurd, A. R.	Orr-Ewing, Charles Ian (Hendon, N.)
Cuthbert, W. N.	Hutchinson, Sir Geoffrey (Ilford, N.)	Osborne, C.
Darling, Sir William, (Edinburgh, S.)	Hutchison, Lt.-Com. Clark (E'b'rgh W.)	Partridge, E.
Davidson, Viscountess	Hutchison, James (Scotstoun)	Peaks, Rt. Hon. O.
Deedes, W. F.	Hyde, Lt.-Col. H. M.	Perkins, W. R. D.
Digby, S. Wingfield	Hylton-Foster, H. B. H.	Peto, Brig. C. H. M.
Dodds-Parker, A. D.	Jenkins, R. C. D. (Dulwich)	Peyton, J. W. W.
Donaldson, Cmdr. C. E. McA.	Jennings, R.	Pickthorn, K. W. M.

Pilkington, Capt. R. A.	Simon, J. E. S. (Middlesbrough, W.)	Thornton-Kemsley, Col. C. N.
Pitman, I. J.	Smiles, Lt. Col. Sir Walter	Tilney, John
Powell, J. Enoch	Smithers, Peter (Winchester)	Turner, H. F. L.
Price, Henry (Lewisham, W.)	Smithers, Sir Waldron (Orpington)	Turton, R. H.
Prior-Palmer, Brig. O. L.	Smyth, Brig. J. G. (Norwood)	Vane, W. M. F.
Profumo, J. D.	Snadden, W. McN.	Vaughan-Morgan, J. K.
Raikes, H. V.	Soames, Capt. C.	Wakefield, Edward (Derbyshire, W.)
Rayner, Brig. R.	Spearman, A. C. M.	Wakefield, Sir Wavell (Marylebone)
Redmayne, E.	Spence, H. R. (Aberdeenshire, W.)	Walker-Smith, D. C.
Remnant, Hon. P.	Spens, Sir Patrick (Kensington, S.)	Ward, Hon. George (Worcester)
Renton, D. L. M.	Stanley, Capt. Hon. Richard	Ward, Miss I. (Tynemouth)
Roberts, Peter (Heeley)	Stevens, G. P.	Waterhouse, Capt. Rt. Hon. C.
Robertson, Sir David	Steward, W. A. (Woolwich, W.)	Watkinson, H. A.
Robinson, Roland (Blackpool, S.)	Stewart, Henderson (Fife, E.)	Webbe, Sir H. (London & Westminster)
Robson-Brown, W.	Stoddart-Scott, Col. M.	Wellwood, W.
Rodgers, John (Sevenoaks)	Storey, S.	White, Baker (Canterbury)
Roper, Sir Harold	Strauss, Henry (Norwich, S.)	Williams, Rt. Hon. Charles (Torquay)
Ropner, Col. Sir Leonard	Studholme, H. G.	Williams, Gerald (Tonbridge)
Russell, R. S.	Sutcliffe, H.	Williams, Sir Herbert (Croydon, E.)
Ryder, Capt. R. E. D.	Taylor, Charles (Eastbourne)	Wills, G.
Salter, Rt. Hon. Sir Arthur	Taylor, William (Bradford, N.)	Wilson, Geoffrey (Truro)
Sandys, Rt. Hon. D.	Teeling, W.	Wood, Hon. R.
Savory, Pref. Sir Douglas	Thomas, Rt. Hon. J. P. L. (Hereford)	York, C.
Schofield, Lt.-Col. W. (Rochdale)	Thomas, P. J. M. (Conway)
Scott, R. Donald	Thompson, Kenneth (Walton)	TELLERS FOR THE NOES:
Scott-Miller, Cmdr. R.	Thompson, Lt.-Cdr. R. (Croydon, W.)	Mr. Butcher and Mr. Vosper.
Shepherd, William	Thorneycroft, R. Hn. Peter (Monmouth)

6.15 p.m.

Mr. James Simmons (Brierley Hill)

I beg to move, as an Amendment to the proposed Amendment, in line 5, to leave out from "appliance," to the end of line 6. The effect of this Amendment will be to leave out the words in consequence of a defect in the appliance as supplied. So that as many Members as possible may take part in this debate I shall devote my attention to the question of surgical boots, about which I had considerable experience at the Ministry of Pensions. The charge for the replacement and repair of surgical appliances will fall very heavily on sick and crippled people. It will be a continual drain on their resources. Some indication of the magnitude of the problem can be gained from the figures for the past three years, which relate to civilian patients and not ex-Service disability claims. New boots, in 1949, numbered 20,711. This figure rose to 45,502 in 1950; and to 52,785 in 1951. Repairs have gone up from 11,000 in 1949 to 18,000 in 1950, and to 33,000 in 1951. Adaptations have gone up from 102,000 in 1949 to 186,000 in 1950 and to 204,000 in 1951.

It will be seen, therefore, that there are an increasing number of people who will be affected by this charge. Have the Minister and his Department considered the position which will arise when this charge becomes operative? The person with the surgical boot will go on wearing it long after it has ceased to be effective and, consequently, the medical and surgical attention which he has received from the State will be nullified.

I know from personal experience that an artificial limb may be worn for a certain time, and it then needs readjustment. The same applies to surgical boots. If an artificial limb is worn too long it becomes ineffective and serious repercussions on the general bodily condition follow. That is also the case regarding boots. The Ministry of Pensions were coping with this problem very well. When they took over responsibility as agents for the Ministry of Health, a very big effort was required at first to cope with the accumulated misery of so many people by supplying these appliances.

This Bill will undoubtedly place an intolerable burden upon the already overworked staff of the Ministry of Pensions, and I think the Minister ought to consider this effect very carefully, because the Ministry of Pensions has done a very good job for his Department, and the right hon. Gentleman ought not to overburden the staff when they have done so well.

I quote from the 25th Annual Report of the Ministry of Pensions for 1949–50, paragraph 107 of which states: National Health Service patients whose disabilities are stabilised and who require renewal of their surgical footwear may now apply direct to the local offices of the Ministry instead of to the hospitals. So the scheme works, but, when a charge becomes applicable, what will happen? Will the Minister ask the Ministry of Pensions to be responsible for collecting that charge? Has he consulted the Ministry of Pensions to see whether it is administratively possible to collect the charge?

If the Ministry of Pensions will not collect the charge, and the patients have to go back to the hospitals, as they did before the Ministry of Pensions made these remarkably smooth working arrangements for both Departments, has the Minister considered the position of the ex-Service man and the civilian, both of whom are needing surgical boots and both going to the offices of the Ministry at the same time, when one is charged and the other is not?

Has he considered the jealousy and friction which this may cause? The civilian will say, with a certain amount of justification, "Why should I be called upon to pay for my surgical boot when a man suffering from the same disability and needing the same treatment is not being charged?" As an ex-Service man myself, I regard these disability cases in the battle of industry as just as deserving of the sympathy and respect of the community as those disabilities suffered by soldiers on the field of battle.

This matter requires very careful investigation. I could go over a much wider field of appliances, but I have confined myself to this question of surgical boots because it is a subject which I know from fairly close experience. The Government are throwing a spanner into the work of the Ministry of Pensions, which has done such a good job for the past three or four years in assisting the Ministry of Health.

I think it is a good thing that two Government Departments can co-operate together for the good of the people they serve, and I am sorry that the Conservative Party and Government are destroying the marvellous co-operation which we carried on, under a Labour Government, for three or four years, to serve the needs of disabled people.

Mr. Tom Brown (Ince)

I beg to second the Amendment.

It has become clear, certainly to hon. Members on this side of the House who have attended these debates, and to the country at large, that the Bill now under discussion is a bad and mean Bill, and that, if the right hon. Gentleman does not accept this Amendment, its badness and meanness will be intensified.

Perhaps I may be permitted to put a point of view for a class of workers among whom the incidence of accidents is greater than that in any other industry. I am not claiming that I should be allowed to speak because I represent a mining constituency, but I claim a right to say a word or two on the effect which this Bill will have on those unfortunate men in the mining and other industries who suffer accidents which compel them to wear appliances.

I wonder whether the right hon. Gentleman and officials of his Department can visualise the effect which the Bill will have upon those who have had the misfortune to meet with an accident in the pit. I do not think they can. I remember the right hon. Gentleman being at the Ministry of Mines. When I spoke on 8th April I said that he would recall the representations made to him at that time because of the high incidence of accidents in the industry, and that he had had to try in every conceivable way to bring down the number of those accidents to the lowest possible figure. Despite all the attempts which he made, and all that have been made since—and they are many—we still have a very high incidence of accidents in the mines, and will have until the end of time.

On 8th April, before the Guillotine fell upon us, I quoted the case of a man who has to buy three appliances. Many men have to buy three appliances of one kind. They need one to wear when engaged in their occupation, one which is worn at home, and a third which is held in readiness for use when either of the others is in need of repair. Such a man will have to pay for three appliances.

Since that debate on 8th April, I have found not one man within the field of the mining industry who has to buy three appliances, but one case where a man has to wear five appliances, and has to wear them all at once, because his body has been so broken and bruised by accidents that, in order that he may get out into the sunlight when the opportunity presents itself, he must be fastened up with five appliances.

What is to be the position of that man, if he is on a low income, and is compelled to wear these five appliances? I sometimes wish that I possessed a fairy wand, by a wave of which I could transfer the right hon. Gentleman and some officials of his Department into the mining villages in the coalfields, where they would see for themselves crippled men who have been broken and bruised on the wheels of industry and are now compelled to wear appliances so that they may visit their friends or attend a social at their club. I ask the Minister seriously to consider the effect of this Bill upon that particular section of the community.

My hon. Friend who moved the Amendment referred to the wonderful work done by the Ministry of Pensions and to the number of surgical boots issued. It is interesting to find in the Report of the Ministry of Pensions for 1949–50 the increase in the number of appliances which have been provided by the Ministry. It is surprising to find that the increase began immediately after the operation of the main Act. In 1949, 129,530 appliances were supplied by the Ministry of Pensions acting as agents for the Ministry of Health; in 1950, the number had gone up to 232,278; in 1951, it was 208,232.

Practically every one of these appliances and adaptations have to be specially made to suit individual requirements, so far be it from hon. and right hon. Gentlemen opposite to say that there have been abuses. Every one of those requiring an appliance had to be examined by a highly qualified specialist before they got the appliances. If the right hon. Gentleman refuses to accept our Amendment he will affect the lives of these people in a manner which he will regret until the end of time. I appeal to him to accept our Amendment so that these men, who have been broken and bruised in industry, shall not have the unhappy experience of having to pay for something due to an accident they sustained when getting the coal we so badly need.

6.30 p.m.

Oft-times in this House when we discuss humanitarian questions we take the liberty of quoting from the Old Book. There are some things in the Old Book which hon. Gentlemen opposite ought to read and practice. I recall reading in my younger days a passage about a prophet who was in difficulty with his people; he was frustrated and handicapped; he did not know which way to turn, and the record tells us that he went to the Lord, who advised him what to do.

The Lord said, "If you are troubled about the conditions of your people, if you fail to understand what they require, sit where they are sitting, and then come back and make up your mind what to do." The Old Book continues to tell how he sat where they sat and how, having passed through the experiences of his people, he came back with an entirely different attitude and approach to the questions troubling him. If the right hon. Gentleman will take his Parliamentary Secretary with him and sit where these people are sitting, he will have no hesitation in accepting our Amendment when he comes back.

Mr. Crookshank

We have heard two very eloquent and sincere speeches, as we always do from the two hon. Gentlemen, for which we respect them, particularly when they are dealing with sections of the community which they personally understand, the one as a result of his own personal sufferings and the other because of his long association with the people about whom he speaks. We all recognise that.

Unfortunately, I find it very difficult to reconcile what they were saying on the larger issue with the very small point of their Amendment. I should like to explain that the reason I cannot accept their Amendment is not because I do not accept what they have said or admire the spirit in which they have offered their observations. They were really trying to go back to the whole issue of whether or not appliances should be charged for. In some of his remarks the hon. Member for Ince (Mr. T. Brown) overlooked the very small field of appliances with which we are intending to deal. However, he put over his points.

Mr. Simmons

I am sure the right hon. Gentleman does not desire to misrepresent the meaning of our Amendment. It refers not to new appliances but to replacements and repairs.

Mr. Crookshank

Exactly, but the speeches did not go into the Amendment very much, and I thought I would just explain why I did not think the Amendment was acceptable.

Mr. T. Brown

Time does not permit us to go into it. The Guillotine is on.

Mr. Crookshank

The time is at the hon. Gentleman's disposal until the end of the debate if he likes to continue on this Amendment.

Let us understand where we are. My Amendment is intended to classify, in this rather tidier way, what is to be exempted from the charges and to make some additions to the list. The subsection begins by saying that no charge shall be made on these things, and says that there shall be no charge for the replacement or repair of any appliance when the replacement or repair is due to some defect in the appliance when supplied. That is to say, when it was initially a bad appliance. In that case they take back the appliance and say, "This is a bad one; the repair will be made, or it will be changed and replaced by another, and for that there will be no charge."

The fundamental point of the whole Clause is that there shall be a charge for certain appliances. That is the point from which we start, and we merely say that if, unfortunately, the appliance supplied is found to be defective from the beginning, then it is replaced without charge. That had to be made clear in the Bill, and to that extent this Amendment is a drafting Amendment. Hon. Members opposite wish to extend that and to say that the non-payment of charge should apply not only when replacing or repairing an initially defective appliance but in all cases.

For example, if the appliance were defective because of misuse or lack of proper care by the patient and had to be repaired or replaced, according to the Bill that would be the same as a new appliance, and would, therefore, be subject to a charge. Again, if, in due course, the appliance wears out and has to be replaced, according to the Bill and our Amendment the new appliance would be subject to a charge in the same way as the original. But under the hon. Gentleman's Amendment, while an originally supplied pair of surgical boots would be charged for, in the case of repair or replacement there would never again be a charge for those boots. That is the effect of it, as was quite clear from their speeches.

Mr. T. Brown

Suppose that after the appliance has been made, according to the measurements and recommendations of the highly qualified specialist, the broken part of the body to which the appliance has to be applied changes and the appliance has to go back—not because the appliance is a misfit, but because the body has taken a turn for the worse. What would be the position in a case like that?

Mr. Crookshank

The hon. Gentleman is talking about the body. We are talking about feet. Do not let us be confused. At the moment I am talking about surgical boots.

The hon. Gentleman's Amendment would mean that if once a charge is made for a pair of surgical boots they would be repaired and replaced for the rest of the man's life without there ever being a charge. Well, that is not our view of what should be charged, any more than it was the view of hon. and right hon. Gentlemen opposite with regard to either spectacles or dentures, which, under the 1951 Act, continue to be charged for when renewed or replaced. We are doing exactly the same thing as they did in the last Act with regard to spectacles and dentures. We are now doing it with regard to wigs, surgical boots, abdominal belts and elastic stockings, and that is all there is to it.

Now that I have explained what the Amendment means, I do not think that, on consideration, the House will think it a reasonable proposition, although I am sure we are all agreed that if the defect is an initial defect when the appliance is supplied there should not be a second charge for a replacement.

Mr. Brown

The right hon. Gentleman has concentrated his reply on surgical boots, but our Amendment refers to appliances generally. He has not referred to abdominal belts and other appliances which these men have to use. If I may say so, I speak with a great deal of experience with dealing with this type of case. What is to be the position of men who have to wear appliances other than surgical boots? Will the Minister reply to that?

Mr. Crookshank

Exactly the same applies. The Amendment covers the whole field we have in mind.

Mr. McNeil

I wonder whether the Minister would not agree that he is straining his case very much. No one in this House will believe that a man who is compelled to make another payment for a set of dentures is comparable to the kind of man my hon. Friend the Member for Ince (Mr. T. Brown) described, who depends for his uprightness and ability to move on surgical appliances. We have reached a stage in this matter where we are begging for crumbs.

Mr. F. M. Bennett (Reading, North)

Even if the right hon. Member makes play with dentures, surely there is no great difference between a half-blind man who needs glasses and the person who needs surgical boots?

Mr. McNeil

I am willing to accept that point, but the half-blind person will be provided for under another Act. I agree that if a man has a serious defect of vision it is a hardship. The Minister raised the question of dentures. I am not making a large-scale matter of this or trying to make any political capital. I am pleading for consideration for a small group of most unfortunate people.

The right hon. Gentleman knows that he makes no concession in the Amendment. If there is a contract between the State and the individual and the State completely fails to fulfil its part of the contract—that is, to supply a sound piece of apparatus—then there is cause for redress in the civil courts and the right hon. Gentleman makes plain that in that case he does not intend to ask for a charge for repair or replacement. As he says, this is a tiny matter. What is the cost? We have been at a disadvantage in discussing all these things because we have been sticking a pin to find information. We have no real figures. Would the Minister tell us what he guesses it will cost? Let us have a little compassion for the type of people for whom my hon. Friends plead.

Mr. T. Brown

I must put a question to the right hon. Gentleman. Like my hon. Friends, I am not satisfied with the reply.

Mr. Speaker

I should like to point out that we are on Report and we cannot have unlimited contributions from the same hon. Member. If he wishes to ask a question, I hope that in doing so he will confine himself to it.

Mr. T. Brown

Thank you, Mr. Speaker. In view of the fact that the Minister has refused to accept this Amendment, will he co-operate with the Ministry of National Insurance to put into operation Section 75 of the National Insurance (Industrial Injuries) Act, 1946, which will help us?

Dr. Horace King (Southampton, Test)

It would be tedious repetition if I were to say that the Minister's reply to the discussion on this Amendment has been disappointing. In reply to what he said, I merely want to say that nobody supporting this Amendment was anxious to protect those who abuse any surgical appliances they may have in operation. If the Minister would only say that he would look at that part of the Amendment and himself devise an Amendment to give us what we want, we should be very happy indeed.

I want to speak about surgical boots for two reasons. The first is that the cost of repairing surgical boots is constant and is a far more onerous burden than is the repair of any other appliance for which a charge is to be made. The other reason is that many hon. Members have already come into real contact with the effect of charges for repairs for surgical boots proposed in this Bill.

6.45 p.m.

Last weekend the husband of a cripple came to see me. He had received one of the disgusting circulars issued under the authorisation of the Minster of Health, pointing out that in future his wife would have to pay 7s. 6d. every time her surgical boots were repaired and asking her to sign at the bottom of the circular to show that she had understood what she had read. I consider that to be insult added to injury, and it was in that spirit that the husband took the circular.

On making inquiries about this case, I find there is already uncertainty among all the people who have to handle repairs to surgical boots and collect the money. A surgical boot manufacturer tells me that the scheme is in an "infernal mess," if I may paraphrase his more simple and homely English. He has already tackled the Ministry of Pensions, who are grappling with the problem of collecting money for boot repairs when they should be doing something far more important. The manufacturer tells me that the schedules are inadequate and do not cover many of the repairs which have to be made. Although the Chancellor said that nobody would have to pay more than half the cost of repairs, the manufacturer says that some will have to pay as much as five-eighths.

The boot repairer has no directive to collect the money and the local branch of the Ministry of Pensions has no directive. If the surgical boots have to be repaired, they have to be sent by the repairer to a regional central office to be checked and have then to be sent back to an agent or branch office. This means postage and a waste of time which is very serious. Application for the boots will have to be made at the local branch. We are dealing with cripples who are often very poor people, and this means expense in transport.

The crippled wife of the man who came to see me at the weekend has to have her surgical boots repaired every five weeks. Therefore, this imposes a tax of 7s. 6d. a week on a working man merely because he is unfortunate enough to have a crippled wife. Yesterday we were discussing the Petrol Duty and talking about the last straw that breaks the camel's back. Charges of this kind will indeed be the last straw in many working-class homes.

But the serious point I want to put on repairs is that when people have to pay £3 for surgical boots, they will do what many people did in the years before we had the free National Health Service—they will buy one pair of surgical boots. They will have to wait at home while that pair is being repaired before they can go out again. There are constituents of mine who had to do that. The imposition of this charge and the delay caused to these people by linking repairing with the collecting of the money will constitute a very severe handicap.

How will the Minister collect the money for repairs from the cripples? Will repaired boots be handled by the Ministry of Pensions nationally, regionally or locally? Will the boot repairer collect the money, or will the Ministry of Pensions do so, or will a crippled collector be appointed? Whichever Department has to collect the money, I estimate that the cost of administering this part of the scheme will offset a lot of the little gain that the Minister hopes to get. I urge him to remove a little of the meanness of the Bill by accepting the Amendment or promising to look at the matter further.

Mr. F. M. Bennett

I should like to make clear the point of my remark just now when I spoke quickly about half-blind people. I meant not someone dealt with under the Act but somebody with seriously defective vision. My interjection represented what the Minister had said earlier, that the principle involved in the payment on secondary occasions when boots need to be re-made because of some physical change is no different from the principle applied by the Labour Government in respect of dentures and spectacles.

Amendment to the proposed Amendment negatived.

Mr. Alport

During our discussions this afternoon, many allusions have been made to the meanness of the Bill and various demands have been made about amending it. In view of the remarks of the right hon. Gentleman the Member for Greenock (Mr. McNeil) at the beginning of the discussion, this is an opportunity to ask exactly where the Opposition stand on the matter.

On many occasions we have tried to ensure that this type of legislation is as fair and equitable as a Parliamentary Statute can be. Why is it that these objections and adjectives have appeared for the first time during the course of the Bill? Why is it that, all of a sudden, the attitude of the party opposite has changed from what it was last year and three years ago?

How does the right hon. Gentleman take up the attitude which he adopted when he referred to an Amendment which was not called because it was out of order? How is he able to make such remarks and still claim any form of continuity with the attitude of the Labour Government in the last two Parliaments? During the remaining discussions on this subject and in future, it will be important to know whether the Labour Party entirely repudiate the principles which they supported in 1949 and 1951.

Mr. Speaker

The hon. Member appears to be speaking to the Amendment to the Amendment, which we have just disposed of. There is nothing in the Minister's Amendment to justify the argument he is putting.

Mr. Alport

I was merely following the argument made by the right hon. Member for Greenock earlier. As the point that he made was allowed, I thought it would be possible for me to take it up now that we have disposed of the two Amendments to the Minister's Amendment and are now considering the Amendment.

Mr. Speaker

That is not so. When he made those remarks, the right hon. Member for Greenock was speaking to another Amendment which is not before the House.

Mr. Alport

The right hon. Gentleman made those allusions and argued that point at some length while you were out of the Chamber, and I felt it was right that one should be able to answer the point that he made, because it seemed to be of substance in regard to the general subject which we are discussing.

Mr. Speaker

I should explain that, first of all, the Amendment by the Minister was called, and immediately after that the House proceeded to deal with the two Amendments to the Minister's Amendment.

Mr. Powell

Further to that point of order. The first speech by the right hon. Member for Greenock was made on the main question concerning the Minister's Amendment and before either of the Amendments to his Amendment was moved.

Mr. Alport

It is to that point that I am trying to direct the attention of the House.

The issue raised by the right hon. Gentleman seems to be clear. I want to know whether it is now the intention of his party to repudiate their policy of previous years. It would help us in discussing the Amendment if we knew where the Labour Party stand. Is it true, as is becoming rapidly apparent to us, that the right hon. Member for Ebbw Vale (Mr. Bevan) has won and that he is now able to impress on the rest of his party his policy which repudiates the action taken on two occasions by the Labour Government? If that is the case, we can be quite clear—we ought to have it made clear at this point—that the official leadership of the Socialist Party is on the bandwagon of the right hon. Member for Ebbw Vale.

Mr. McNeil

I do not want to pursue the point at all—

Dr. Morgan

I should not answer it.

Mr. McNeil

—because I had some difficulty in following the hon. Member for Colchester (Mr. Alport).

Mr. Crookshank

The right hon. Gentleman has spoken already.

Mr. McNeil

I am grateful to the right hon. Gentleman. Might I, with the leave of the House, have indulgence to utter two sentences? If the hon. Member for Colchester is talking about the 1951 Act, it did not apply to these things. If he is talking about the 1949 Act, that was a temporary provision, and if he wants to follow that we shall be glad of his support.

Amendment agreed to.

Further Amendments made: In page 1, line 14, leave out "the case of such other persons," and insert "such other cases."

In line 15 leave out first "The," and insert "Any."—[Mr. Crookshank.]