HC Deb 01 April 1953 vol 513 cc1228-35
The Minister of Health (Mr. Iain Macleod)

With your permission, Mr. Speaker, and that of the House, I should like to make a statement on the cost of the National Health Service.

With my right hon. Friend the Secretary of State for Scotland, I have had under close review—

Mr. S. Silverman

On a point of order, Mr. Speaker. I apologise to the right hon. Gentleman for interrupting, but it is now 50 minutes since the end of Questions. It has usually been thought not quite appropriate to have too many Ministerial statements on the same day interfering with normal business. Is there anything so very urgent in the statement now being made that it could not have waited until tomorrow?

Mr. Speaker

It is my experience—and it may be that of the hon. Member—that when a vacation is approaching there is always a sudden rush of statements to be made in the House, but the sooner we can complete them the better.

Mr. Macleod

With my right hon. Friend the Secretary of State for Scotland, I have had under close review the whole problem of the present and future cost of maintaining a proper and adequate National Health Service. We have, as the House is aware, already initiated a number of administrative and other measures designed to alleviate, as far as possible, the considerable cost to the taxpayer without impairing the quality of the service provided. But these are, inevitably, measures of detail and the general long-term problem remains essentially unsolved.

After a great deal of thought, the Secretary of State and I both feel that the many issues involved in this problem are so complex that the wisest course will be to refer the whole matter for an independent and objective inquiry by a committee. We therefore propose to appoint a small committee with the following terms of reference: To review (he present and prospective cost of the National Health Service; to suggest means, whether by modifications in organisation or otherwise, of ensuring the most effective control and efficient use of such Exchequer funds as may be made available; to advise how, in view of the burdens on the Exchequer, a rising charge upon it can be avoided, while providing for the maintenance of an adequate Service; and to make recommendations. I am glad to say that Mr. C. W. Guillebaud, the Cambridge economist, has accepted our invitation to be chairman of the new committee. I will inform the House as soon as possible of the names of the other members.

Mr. Bevan

May I, with your permission, Mr. Speaker, protest at this practice of making very important statements immediately before a Parliamentary Recess? Furthermore, may I respectfully submit that this, in particular, is an abuse of Parliamentary procedure, because immediately after the Recess we are to have a Budget statement which necessarily bears upon the cost of the National Health Service, and the appropriate time to make a statement of this sort—if, indeed, it should be made at all—would be in the course of the Budget statement. In spite of that, it is being made today, when we are rising tomorrow; and I suggest to you, as I did at the beginning, that this is a serious abuse of the procedure of the House. It is similar to what occurred before the Christmas Recess, and we ought not to have any more of it.

Next, I would ask the right hon. Gentleman whether the Cabinet, as a whole, seriously decided that this was an issue that should be remitted to a committee of inquiry. Is it not in fact a matter primarily for the House of Commons, for political decision, and is it not an act of the most unprecedented political cowardice to send to a committee a matter which is at the centre of British politics?

I am sorry to have to trespass upon the time of the House in this way, but I would ask the right hon. Gentleman whether he will give his attention to the fact that not only modifications to the organisation are to be discussed but, in the words of the terms of reference, "or otherwise." In other words, the whole central question whether there should be any longer a free health service in Great Britain is to be remitted to a committee of inquiry.

If the right hon. Gentleman is going to have advice upon the question whether any modifications in the organisation of the Health Service ought to be made, why does he not ask for the views of the Central Health Service Council, which is exactly suited to that purpose, and which is a repository of expert knowledge on this subject? Is it not a fact that what he is doing, as a consequence of struggles between himself and the Treasury, is seeking another instrument by which he might mutilate the National Health Service? Everybody knows that he is the avowed enemy of the Service, as he has publicly declared, and in his own hands it has already received many grievous blows. The best service he could render it would be to resign.

Mr. Macleod

First, on the question of the timing of this statement, which was the first of the points made by the right hon. Gentleman, I saw Mr. Guillebaud yesterday afternoon and thought it my duty to inform the House as soon as possible.

On the second point, of course it is true that this matter has been considered at the highest levels of Government, but we consider—and it is possible to disagree on this—that it is essentially a Departmental matter and, therefore, that this announcement should be made by myself and not by the Chancellor of the Exchequer as part of the Budget speech. This is a long-term problem which, in the view of most people- as I said in my statement—remains essentially unsolved.

When the right hon. Gentleman suggests that we should remit this question to the Central Health Service Council—or that we should take account of their views on this kind of matter— I entirely disagree. It is because the Central Health Service Council are representative of wide interests within the Health Service that I do not consider them to be the proper body for an inquiry of this nature. In my view, what is needed is an entirely independent inquiry. It should not in any sense be a political one, nor one which is linked in any way, through the membership of the committee, to any of the professions concerned in the Health Service.

With regard to the accusations that the right hon. Gentleman was good enough to end his speech with, in the first place I should not have agreed to a committee—nor would Mr. Guillebaud have accepted the chairmanship of a committee—which was designed to mutilate the National Health Service. I know perfectly well that on a matter that so deeply concerns the finances of the Health Service the House will give the very fullest value to the views of a Minister of Health who never got his Estimates within £100 million of the right figure.

Mr. Bevan

May I call the right hon. Gentleman's attention to the first error that he made in the course of his statement? I never suggested that these terms of reference should be sent to the Central Health Service Council. I suggested that they might be asked for their advice about any organisational modifications.

With regard to the last point made by the right hon. Gentleman, he might again seek the advice of his officials, because he will find that my last Estimate was £14 million underspent.

I would ask the right hon. Gentleman whether an expenditure equal to £400 million in the National Budget, and which concerns the welfare of all the citizens of Great Britain, is a fit subject to be remitted to a committee of inquiry. If so, why does not the Chancellor of the Exchequer remit to a committee of inquiry the question whether taxes should be lower or higher. That is the question which the Minister has re-mitted to the committee. Why does not the Chancellor of the Exchequer hand his Budget to a committee of inquiry? Is not it a fact that what the right hon. Gentleman is really doing is to seek the most respectable way—

Mr. Alport

On a point of order. We have already had a number of statements. Hon. Members opposite drew attention to the way in which they had eaten into the time allowed for the business of the House. May I have your guidance as to whether, subsequent to a statement, the matter should develop into a debate and a vicious personal attack upon the Minister?

Mr. Speaker

It is customary after a statement to ask questions in elucidation. I think that some of the statements made on both sides of the House have been more in the nature of debate. I understood the Minister's statement to mean that he is appointing a committee. Presumably the report of that committee will come before us at some time and we can debate it. Certainly, the legislative provisions of the National Health Service Act cannot be altered without the approval of this House. Perhaps we could draw our preliminary investigation to a close.

Mr. S. Silvernsan

While it is true that I drew your attention to the number of statements that had already been made and invited you to say whether or not this additional one should be made, may I now submit, Mr. Speaker, that the character of the statement that has been made amply justifies my raising the original point and amply demonstrates that the making of such a statement at such a time is an abuse of the procedure of the House? What the right hon. Gentleman the Minister of Health has done has been to take one large chunk of public expenditure and propose an entirely revolutionary and unconstitutional method of dealing with it. If he had made the same proposal with regard to the Defence Services nobody in this House would have had any doubt about its impropriety.

Mr. Speaker

I must appeal to the House on this matter. I do not think that there is any point of order in what the hon. Member for Nelson and Colne (Mr. S. Silverman) has put to me. I did not gather from the statement of the Minister that it was proposed that the authority of this House should be superseded by that of the committee.

Mr. Bevan

Further to that point of order. Immediately after the Recess we are to consider the Budget. An essential feature of the Budget is the expenditure on the National Health Service. When any reference is made in the course of the Budget or the Budget debate to such an expenditure, mention will be made of the setting up of this committee. Therefore, the House will be expected to be abortive in its decision on the National Health Service. I submit that my hon. Friend the Member for Nelson and Colne (Mr. S. Silverman) was right. If this had been the Defence Services, its impropriety would have been obvious. In my submission the right hon. Gentleman, immediately before the Easter Recess and the Budget, has made a statement the purpose of which is to nullify a great deal of the discussion on the Budget.

Mr. Speaker

I do not agree with that. I do not think that any point of order arises.

Mr. Fort

Is my right hon. Friend aware that many inside this House and many outside will welcome the statement and the opportunity to have a large amount of information about costs and expenditure brought together in a form in which we can really appreciate its value? In putting this matter before the committee, will he ask their opinion about the effect of making block grants to the hospitals, which would give regional boards greater independence than they have enjoyed under the organisation originated by the right hon. Gentleman the Member for Ebbw Vale (Mr. Bevan)?

Mr. Macleod

On the general question, of course it is true that a vast number of people in all political parties have thought for a long time that this matter should be inquired into. On the specific question about block grants, of course they come within the terms of reference. That is a subject on which people hold strong views and on which there may conceivably be considerable saving. I have no doubt that the points of view for and against block grants will be put to the Committee.

Mr. Woodburn

May I ask the Minister—

Mr. Nabarro

On a point of order. May I inquire whether or not it is customary for the Ballot for Notices of Motions to be taken after Questions. We have now spent 67 minutes since the end of Questions, with the result that grave inconvenience is being caused to private Members who have remained in their places to take part in the ballot.

Mr. Speaker

I am fully aware of that. We have had an hour of Questions followed by Private Notice Questions and statements. I am sure that the right hon. Gentleman the Member for Clackmannan and East Stirlingshire (Mr. Woodburn) will be as brief as possible.

Mr. Woodburn

May I ask the Minister whether he is aware that a reading of the terms of reference creates the impression that they are tendentious and that they are suggesting to the committee what the committee should report? Since an economist is being put in charge of the committee, is it its purpose to find out, as the Organisation and Methods Department of the Treasury might find out, whether the existing service can be more economically worked? Is the Minister aware that there is a Select Committee of this House which inquires into these matters and which may have been examining this question already? Has he considered that this may be a reflection upon them?

If this committee is to give a balanced report to the House, will it be called upon to find out what was the cost of preventable disease in this country before the Health Service was introduced? If my memory is correct, before the war the right hon. Gentleman's Department estimated it at £350 million a year. May I ask him whether he will broaden the terms of reference so that if the committee is to report on the economics of the Health Service it will report on them comprehensively as they affect the whole country?

Mr. Macleod

I do not agree with the right hon. Gentleman in his reading of the terms of reference. This is a general inquiry into the function, structure and policy of the service and not an economy cuts committee. It is true that the Select Committee have done admirable work in this field, but that touches only the fringe of the very much bigger problem. Many countries have made experiments in social welfare, and we ourselves have had this spendid experiment going on now for five years. But not everybody is satisfied that we and other countries have found the ideal way of running the service and the ideal way of financing it. We can honestly differ about this, but in my view a committee not tied to any profession in the Health Service or to any political party is the best way in which we can seek answers to these difficult questions. This is a very long-term business. It will take many months and perhaps a year.

Mr. Bowles

On a point of order. The Minister has said that the inquiry will last a long time. May I ask whether you, Mr. Speaker, knew, when you were asked to allow the statement to be made this afternoon, that only the chairman of the committee had been selected and not the other people? It seems clear now that the committee will not start work for some time yet.

Mr. Speaker

That appears to be so. I heard the Minister say that it would take a long time. It has already taken a long time.

Several Hon. Members rose—

Mr. Speaker

Order. We will now proceed with the Ballot for Notices of Motions.