National Health Service, Scotland (Hansard, 16 February 1955)

The Joint Under-Secretary of State for Scotland (Commander T. D. Galbraith)
This Supplementary Estimate seeks additional provision under four heads only. These are the running costs of hospital and specialist services, for which almost £1 million extra is sought; the general dental service, requiring an extra £200,000; the pharmaceutical service, with £250,000 more; and the supplementary ophthalmic service—sight-testing and the supply of spectacles—with a smaller item of £45,000. Relatively small savings under two other heads, and an increase in certain items of income appropriated in aid of the Vote, offset these additional costs by £249,000 in all, leaving the additional sum asked for at just under £1¼ million.
For the dental and optical services, the extra expenditure simply reflects the fact that the public are making more use of these services than was expected when the Estimates were framed.
The extra cost of the pharmaceutical service is due to the fact that more prescriptions are being dispensed, and at a higher average cost, than was expected when the Estimate was prepared. The increase in average cost represents an increased proportion of proprietaries and other expensive drugs, rather than an increase in the prices of individual drugs. The increased number of prescriptions reflects a rather high level of sickness at the beginning of 1954, and also the recent influenza epidemic.

Mr. Hector McNeil (Greenock)
What is the increased number?

Commander Galbraith
I can give that to the right hon. Gentleman when I reply to questions, if that satisfies him.
The largest item in the Estimate is the additional £987,000 for hospital running costs. This sum is needed for a variety of reasons. To begin with, when the final accounts for 1953–4 became available, we found that assumptions made this time last year relating to the course of expenditure in 1953–54 had resulted in under-provision to the extent of some £175,000 in the 1954–55 Estimate. At the same time hospital authorities had run down their stocks in 1953–54 to a level of £160,000 below the target we had set them, and thus we have to reduce the further call on stocks to be made in the 460 present year. Then, during 1954–55, it happens that weekly paid wages and salaries have to be met on 53 occasions, there being 53 pay-days in this particular financial year. That means an extra £160,000.
Events which could not have been foreseen in framing the original Estimate were further wage and salary awards made by Whitley Councils, which are costing nearly £100,000 more than the sum provided in the Estimate, and also rises in prices—especially prices of fuel, of surgical dressings and of provisions—which we now expect to absorb £230,000 in the current year. These items do not quite account for the whole of the Supplementary Estimate, the balance reflecting the fact that hospital authorities are unlikely to achieve economies—by that I mean savings without detriment to the treatment of patients—quite on the scale we had hoped.
I should like to make it clear to the Committee that if we provide hospital authorities with the additional sum now sought, they will be able to maintain their programme of expansions and improvements in the service at the level authorised at the beginning of the present financial year.
I would remind hon. Members that, as I explained when the Estimates were considered by the Scottish Standing Committee last summer, the sum allowed for additional running costs arising in this way was designed to enable boards to bring into operation in 1954–55 improvements and expansions that would cost £700,000 to run in a full year. This the Supplementary Estimate will still leave hospital authorities in a position to do, despite the increased expenditure resulting from Whitley awards and higher prices over which the authorities have no control.
With this brief explanation, I hope the Committee will see fit to authorise the provision now sought. I will naturally endeavour to answer any questions which may be put to me in the debate.

Mr. McNeil
I will try to emulate the right hon. and gallant Gentleman in his brevity. I am sure the Committee will acknowledge their indebtedness to him for his frankness, some of which perhaps was a little impolitic, if I understood him.
461 I will try to keep my remarks to the two main points of sub-heads H and B.
I hope the right hon. and gallant Gentleman will try to explain to us how it came about that the Scottish Estimates were proportionately wider from the original than the English Estimates. Without elaborating the point, it will be obvious that if the comparative figure is £1.25 million against £4.8 million, there is an unusual disproportion.
The misestimates are surprising. In B, for example, the figure is at least 3 per cent. out, and in H it is nearly 5 per cent. out. It may be that in B, in addition to the explanations which the right hon. and gallant Gentleman offered, they were caught on one leg by the advice of the Public Accounts Committee. I will not attempt here to discuss that, but if it is true, as the Minister of Health told us, that in future Estimates are to be based without any allowance being made for what might reasonably be anticipated in the movements of wages, of prices, of foods, drugs and supplies, as a Committee we shall be left in a very curious position year after year.
The right hon. and gallant Gentleman explained that some of these increases which he has had to meet this year were unpredictable. With great respect, I scarcely think that that is wholly true. The right hon. and gallant Gentleman might plead that with such a wonderful Government, backed up by such wonderful pledges as have been given, there should have been a degree of control in the movement of prices which events subsequently did not display, but, even if that were so, he knew last May that awards would be made. He might not have been able to predict the exact amount but he could not escape from anticipating those awards, nor could he completely escape from anticipating a continued increase in the price of certain drugs, supplies and food.

§ Dr. H. Morgan (Warrington)
This is out of order.

Mr. McNeil
If my hon. Friend wants some help in keeping in order, perhaps he would have a private word with me afterwards.
The right hon. and gallant Gentleman explained, I must say I thought somewhat naively, that these changes were unpredictable, but it is straining the credulity 462 of the Committee to ask us to believe that the fact that there were to be 53 pay days in the year was unpredictable. The right hon. and gallant Gentleman said that.

Commander Galbraith
I did not put that in the unpredictable class.

Mr. McNeil
If the right hon. and gallant Gentleman did not overlook that calculation, then in presenting his original Estimates he misled the Committee. There is no point in shrugging this off.

Commander Galbraith
The right hon. Gentleman did not hear what I said. I said I never put that in the unpredictable class.

Mr. McNeil
Then let me make my point laboriously. If that were indeed predictable and if the right hon. and gallant Gentleman did not include it in his Estimates, then he has misled the Committee. I think the right hon. and gallant Gentleman's Department was caught out in what is a relatively minor matter, but he had better accept it with a little grace and say, "We missed the fact that there were 53 pay days."
I want very quickly to make one or two points about pharmaceutical costs. The right hon. and gallant Gentleman knows that this subject is almost a phobia with me, but I will not attempt to pursue it as emphatically as did my my right hon. Friend the Member for Middlesbrough, East (Mr. Marquand) and other hon. Members concerned with the disturbing costs of proprietary drugs, despite the steps the Government have most properly taken.
I was a little unwilling to accept the explanation offered about the increased prices of the new anti-biotics which are now being used. The Minister of Health said that the increase in the average price was not due so much to a marked increase in the more usual drugs as to the higher prices of the anti-biotics.
The hon. Member for Putney (Sir H. Linstead), who always leaves the Committee in his debt because of his knowledge of these things, quoted figures which I imagine must have been right. They were very disturbing and in conflict with the apparent explanation which the Minister of Health offered. The hon. Member for Putney said that the proportion of proprietary drugs was 463 apparently steadily increasing and that in the last three years it had risen by 9 per cent., from 18 per cent. to 27 per cent. I am not sure that the amounts of the two new drugs, aureomycin and terramycin, would account for 9 per cent. in value in three years. There must be another large factor.
The probability is that if the Scottish figures have followed the English figures, we have had, I am sure to the distress of the whole Committee, another substantial rise in the number of prescriptions which the Minister of Health so cheerfully said was a reflection of the weather. I would not think that we could blame Scottish weather for much and my constituency is frequently blamed more than any other in the community for its weather. I do not think that the increase can be due to Scottish weather conditions.
I believe that the right hon. and gallant Gentleman will later tell the Committee that, despite the intentions of the Government and the claims the Government made for their imposition of the 1s. charge, there has been an increase in the number of prescriptions. I fear that we shall be confronted with Supplementary Estimates for our pharmaceutical services almost annually unless there is a concerted effort to address ourselves, at university level, perhaps at school level, certainly at the Ministry of Health and the Department of Health, to trying to persuade people that their health does not lie in these almost endless prescriptions, some of which are not worthy of the service.
That takes me to my second point, which is to hope that the extension of the hospital pharmacy service will continue. If the hospital pharmacy service had been developed with vigour, we would not have had an estimate of this size for the pharmaceutical service. The hon. Member for Putney was a little cool in saying that he was in favour of the hospital service, but was not at all sure that a patient should be kept at a hospital, instead of being sent out to general practice. But, in constituencies the size of mine, a man could go back to his general practice and have the staffs and facilities available for his dispensing at the hospital and it would be done at a much cheaper rate.
I suspect, although this is a very delicate question, that the dispenser in a hospital 464 is always able to give a little of that positive education which the dispenser at a commercial drug store could not possibly risk. If we continue to be as short as we now are of good men in the Service, then one of the other ways of tackling that problem is to see that more and more qualified pharmacists are provided with whole-time employment, which a hospital affords, rather than continuing to be employed in a shop where much of their time is misspent.
I do not use that argument on a party basis. The right hon. and gallant Gentleman would be the first to admit that all over the country that practice has been adopted by the best of the commercial drug stores. The big drug stores do not have qualified men selling scented soap. That only happens in the little shops, and it is there that there is an extravagant misuse of the qualified pharmacists, and the health of the country cannot afford that kind of extravagance.
I hope that the right hon. and gallant Gentleman will give a few more details about Item B. He explained to us that several hospital authorities had run down stores beyond the anticipation of the Government at the time of the presentation of the Estimates. We ought to know a little more about that. I cannot imagine that any hospital authority took to throwing stuff out of the window or overfeeding its patients. I presume that the real explanation was that the Department under-budgeted for normal consumption over this nine months and that the hospitals were therefore forced in the treatment and feeding of patients to raid those stores and run them down further than was prudent.
I am sure that the right hon. and gallant Gentleman did not want to escape blame for that, that it was an accident of presentation and that he will admit it was a fault of the Government that they forced the hospital authorities to go to those stores and that the hospital authorities were forced so to do by the misestimation of the Government last May. Perhaps he will give us these details so that we can fully value this additional Item B.
What was the value of the run-down in the hospital stores? He might give us a breakdown, even in percentages, and tell us what the increased hospital supplies cost in terms of drugs, medical appliances, 465 food and other commodities. I have no doubt that the other commodities, including bed linen, blankets and so forth will probably show a drop. That is the whole case of the Government about the cost of living. I have no doubt that the other three categories will slightly alarm the Committee and give no promise that next year's Estimates are likely to be correct, unless, of course, there is a change of Government in that period.

§ Mr. A. C. Manuel (Central Ayrshire)
I wish to comment on the pharmaceutical service in hospitals. No one would object to the manner in which the right hon. and gallant Gentleman introduced the Estimate, but I must say that it was rather in contrast with the way that he used to speak when in Opposition during the period of office of the Labour Government. He seemed to be much more forthright and to speak in a much louder voice then. I am pleased to see that he has his right hon. and learned Friend the Lord Advocate to support him tonight. Possibly the right hon. and learned Gentleman has sat on the sidelines for too long. I am very pleased that he decided that he would win quicker advancement if he left Ayrshire and that he would do better in Edinburgh; but that is as may be.
Some useful information could be given by the Joint Under-Secretary about the pharmaceutical services within hospitals or groups of hospitals. Perhaps he can tell us to what extent the various regional boards employ pharmacists in hospitals. From my experience as a past convener of Ayr County Public Health Committee, I would say that when we had a pharmaceutical service within a hospital, employing its own pharmacists, we effected large savings. When I was a member of the Western Regional Hospital Board I tried in a limited way to advance arguments why we should extend the service. I should like the right hon. and gallant Gentleman to tell us what is the position in Scotland.
This service has not had the help and extension which its importance deserves. It may be that the Health Service as such may not have settled down sufficiently to enable us to have come to definite conclusions about the pharmaceutical service in hospitals. It may be that we have not yet decided what would be the best plan. 466 I myself am thoroughly convinced that real economies should be made if such a service were general.
It may be that since I was a member of the Western Regional Hospital Board there has been an extension in the pharmaceutical service. I should like the Minister to tell us how many hospitals under the direction of regional hospital boards in Scotland have not the benefit of staff pharmacists. I am not unmindful of the fact that there are small hospitals in some groups and that there may be based on the larger hospitals a group of pharmacists who dispense medicines for supply to the orders of the small hospitals. Can the right hon. and gallant Gentleman ascertain whether there are any hospitals which have not the advantage of such a system?
I suggest that perhaps the Estimate is augmented because some hospitals have to depend on purchases from chemists' shops or have to deal with a store in Glasgow, Edinburgh or Inverness. Does that happen? If it does, would the right hon. and gallant Gentleman have some regard to the undoubted saving which results from the employment of pharmacists in hospitals?
This work can be divided into two parts. This is the dispensing work done by pharmacists within a hospital or group of hospitals and, apart from that, there is the question of the supply to the pharmaceutical hospital service of the ingredients used in dispensing. Although hon. Members opposite may not be aware of it, we are doing a fair amount of bulk purchase in this connection already. The regional hospital boards have a central supply system. Obviously this achieves a big saving, but is full advantage being taken of this method of bulk purchase? Some hospitals are not yet tied to a group for the supply of medicines and are still buying from shops.
In the old days, purchases were made from local chemists. That is a most extravagant and wasteful method of using public money. The local pharmacists may have their uses, but they lie in another part of the Health Service and they ought not to be used at all in connection with regional hospital board work.
The word "supply" covers a wider range than I have indicated. As the right hon. and gallant Gentleman will readily 467 acknowledge, hospital supply covers a very wide range, including fabrics and furnishings of all kinds. A vast amount of money is involved in the supply of hospital requirements. Has the Estimate on page 88 been augmented in any way because we are not acquiring many necessary articles by bulk purchase? These articles represent a terrific figure. The expenditure on hospital furnishings, curtain materials, chairs and so on, is very large.
If we are not covering the whole country in an adequate way, giving the rural hospital the advantage of just as good and expensive furnishings as those supplied in the more populated areas, we should examine the position. We could do the job much more cheaply if we dealt by way of bulk purchase. The regional hospital boards, or a central agency for the whole of the boards, should study the various hospitals and consider their needs over the whole range of supply.
I want to pinpoint the subject with which I started my remarks—the question of the hospital pharmaceutical service and just how far we are dealing with the position by employing pharmacists in hospitals. I know that there is a shortage of trained people. I hope that the boards and the Government will encourage the proper grading of people employed in the pharmaceutical service and provide proper salary scales to attract and to keep them. The employees should be provided with good working conditions. The hospital service could provide places of work which are preferable to some of the outside places. I am not saying that in a derogatory way, but if we are doing this we should provide the best possible conditions for these pharmacists.
On page 89 of the Supplementary Estimates, under "Advances to regional hospital boards," reference is made to additional provision required, owing to increases in remuneration and other costs. I can understand that there have been increases in remuneration, although I was not greatly attracted to the idea of the right hon. and gallant Gentleman that there were 53 pay-days in this year. That was predictable, and I cannot understand why he should mention it. But what comes under the heading of "other 468 Costs"? Can the right hon. and gallant Gentleman give us the supplementary figure for the actual food cost for the hospital service in Scotland? Can we be told why the costs have gone over the figure provided? Are the Government allowing food prices to run away?
We have over £800,000 indicated in this Vote, and a considerable proportion of that may be attributable to added food costs. It will be even worse in the latter part of the year. For example, how much extra will tea cost? I hope that the right hon. and gallant Gentleman will give us a figure, and I hope that he will be able to discover something in connection with my earlier remarks about the numbers of hospitals in Scotland which have not the benefit of a pharmaceutical service either individually or in their group.

§ Mr. George Lawson (Mother well)
All hon. Members, certainly all hon. Members on this side of the Committee, are concerned to ensure that the hospital service and the Health Service as a whole is run as efficiently as possible. We are all concerned to see that better and better results are achieved for less and less social effort. I do not propose to suggest many ways of improving the Service, but I wish to refer to the sum of nearly £1 million which is required for the general running of the hospitals.
A regional hospital board arrives at its estimate by inviting the various management committees in its region to submit estimates. My own experience is that estimates so submitted are the result of very careful consideration, but it would seem almost as if regional boards operate on the principle of thinking of a number and then halving it. No matter how modest, or how carefully calculated, any figure submitted is certain to be drastically reduced. I can understand that regional hospital boards receive similar treatment from the Department of Health. Naturally, the management committees and the regional board start the year on an estimated basis which they know to be quite inadequate to provide the necessary services.
7.45 p.m.
I believe that to be an accurate statement, although I anticipate that as more experience is gained in the hospital service, and comparisons are made with the working of previous years, the estimating may not be so blind. But there 469 may still persist a great deal of this blind method of slashing whatever figure is put forward. I suggest that hospital boards are operating——

Commander Galbraith
I do not think that the hon. Member is correct. Sums are allotted to the regional hospital boards by the Department.

§ Mr. Lawson
Yes, the Department allocates a sum presumably on the basis of the estimates from the regional hospital boards and those estimates are, in turn, derived from the figures of the management committees within the region. So we get down to the management committees which are seeking to discover what it costs to run a group of hospitals over a given period. My experience is that no matter how carefully the figure is estimated it is always drastically reduced, and it would seem as if the method is that the figure should be slashed, no matter what it proved to be. I expect an improvement as the hospital service progresses and comparisons are made with the figures of previous years.
I wish to refer to a feature of the accounting system which seems to be wasteful, and it is the question of waste that we are discussing. Estimates having gone out, eventually a hospital group is given an agreed figure within which it is expected to work. That figure will cover many items, and it may be that quite a number of them are difficult to obtain. As the end of the financial year approaches there may be a substantial sum in hand. That is not due to overestimating, but because of difficulty in spending money on essential items.
Those concerned find themselves in the position of having money which, if not spent by the end of the financial year, will, in effect, be taken from them; and they fall over themselves to get rid of it before the end of the financial year. That seems a most wasteful method of expenditure. Often these people feel themselves obliged to spend money unnecessarily, because if they do not spend it they will be so much short in the next financial year.
We must recognise that spending is a continuous process and does not end at a time convenient to someone's accounts. The allocation of this money should not be subjected to such a break. It causes 470 dislocation, waste and sometimes almost a feeling of guilt in the minds of honest men who feel that they are obliged to do something which they would not otherwise do because of this recurring break and the necessity to render an account in order not to lose an essential part of the next allocation. That is a point which should be considered. Surely we can find ways and means of allowing for this continuity of spending and not compel hospitals to operate upon the present basis.
My next point concerns the employment by hospital management committees of technicians, such as architects and engineers, to do certain jobs, often at very high fees. It is normal for a regional hospital board to have its own engineer or architect, but it is often found that the board cannot make him available for jobs which a management committee expect to have to do, and the management committee has to bring in an outside technician. This has caused a duplication of expenditure in respect of work which could well have been carried out by a staff of technicians employed by the regional hospital board, servicing all the hospital management committees in its area. If those two points were considered substantial improvements might be made.
My last point is that to show a saving in the running of a hospital strange demands are sometimes made of management committees. At the beginning of this financial year the board of management with which I was concerned was instructed to dispose of valuable stock which it had built up over a period—because, by disposing of it, it was possible to show a certain income which, upon the basis of the present system, would indicate a saving in the running of the hospital. Valuable stock, including clothing material, was disposed of almost for a song to show a certain seeming saving that was, in fact, a scandalous waste. This was something that the people running the hospitals were very much against, but they had to do it.

§ Mr. C. N. Thornton-Kemsley (North Angus and Mearns)
Who gave these instructions? It must have been the regional hospital board.

§ Mr. Lawson
These instructions came via the regional hospital board, pre- 471 sumably from the Department of Health. It was said that stocks held had to be go rid of, that no matter what loss was made upon the disposal of stocks the business was to be done, in an effort to show savings which were really substantial losses. If we scrutinise these items carefully we can do very much to improve the Health Service without drastically increasing the cost of running it.

§ Mr. Thornton-Kemsley
We must all deprecate a thing like that. Is it quite certain that these instructions came from the Department—that valuable stock could be sold at a loss to show a paper saving? It seems incredible.

§ Mr. Lawson
What I am saying is that the board found itself obliged to dispose of stocks which it held. It was not said that the stocks must be disposed of at a loss, but that they must be disposed of.

Commander Galbraith
This is something of which I have never heard. What I understand from the hon. Member's remarks is that the board actually disposed, by sale, of stock.

§ Mr. William Hannan (Glasgow, Maryhill)
I am sure that the right hon. and gallant Gentleman will have some regard to the experience of my hon. Friend the Member for Motherwell (Mr. Lawson), who has served upon some of the boards in Scotland. I want to be brief and shall therefore make only two short points, more by way of seeking information than anything else. In regard to Subhead B—Hospital, Specialist and Ancillary Services—I wonder if the right hon. and gallant Gentleman can say whether the sum asked for includes a sum in respect of any increase in the number of chest surgeons or specialists? He will know that in Scotland some perturbation has arisen over this matter. The right hon. and gallant Gentleman knows that surgery, especially in the case of tuberculosis, is playing an increasing part in effecting cures and rehabilitating people. The increase in the incidence of lung cancer is also causing some trouble, and surgeons are rather perturbed about the future.
My second point relates to the increased amounts asked for under the general dental, pharmaceutical and ophthalmic 472 services. The sums under those three Subheads amount to about £500,000. What are the sums which have come in byway of income in charges for dental services, for spectacles and for shilling prescriptions? If we could be told that, we should be able to have a better idea of these matters and view them in their proper perspective. For example, the income from dental charges in 1953 was about £600,000, and ophthalmic charges amounted to £431,000—a total of £1 million for those two items alone. Yet the increased sum asked for here is about £250,000.
I suggest that, balancing these charges against the increase for which he is asking, the right hon. Gentleman should reconsider his whole attitude to these charges and in future take a little more advantage of the discussion of Estimates in the Scottish Grand Committee. If he asks for an extra £2 million to cover these charges, I am sure that the Committee will not refuse it.

§ Mr. Thornton-Kemsley
I shall not delay the Committee more than two or three minutes, but the hon. Member for Motherwell (Mr. Lawson) made what seemed to me to bean unsubstantiated statement which, if true, should be probed by the Committee. If I understood him correctly, a certain regional hospital board had instructions—which he inferred came from the Department of Health—to dispose of valuable stocks at a loss in order to show a certain paper income which would help its finances to look better than they were. Perhaps I was wrong.

§ Mr. Lawson
It was said that the stocks they were carrying were too large and required to be reduced.

§ Mr. Thornton-Kemsley
That seems to be quite a different matter. Naturally, if the stocks were too large, it might be prudent of the Department to suggest that a reduction should be made. I thought the hon. Gentleman was saying that they were forced, rather against their wish, to dispose of valuable stocks imprudently and not prudently; and there is a difference between the two versions.
I rose to suggest that if the hon. Member has a specific instance in mind, I hope he will let my right hon. and gallant Friend know so that the Committee may be told what is the truth of the matter, 473 because, as he presented the case to the Committee originally, it seemed to be something into which the Committee ought to probe.

§ Mr. E. G. Willis (Edinburgh, East)
I want to reinforce the point made by my hon. Friend the Member for Motherwell (Mr. Lawson) about this ruthless cutting of the hospital boards' estimates. It all derives from the right hon. and gallant Gentleman's own Department. His is the Department which does the cutting, and the regional hospital boards have to accept the cuts. Can the right hon. and gallant Gentleman tell us to what extent the additional £987,000 which is required under Subhead B bears a relation to the cuts which were made by the Department when it examined the regional hospital boards' estimates? I am convinced that there is much in what my hon. Friend says—that the management committee of a hospital has a pretty shrewd idea of what it will spend.
From the facts given by the right hon. and gallant Gentleman when he introduced the Supplementary Estimate, it seems that the reduction in the stocks held by hospitals are very substantial. What was the reason for that reduction? Is it intended now to increase these stocks? If so, is it intended to revert to the level of stocks held two years ago or is it intended to revert to another level? We would like some information about that.
The third point I wish to make concerns the pharmaceutical services and the average cost of prescriptions. I support the plea of my hon. Friend the Member for Central Ayrshire (Mr. Manuel) for the extension of these services in the hospitals, and also, I should have thought, along the lines of the service which has been established at the Sighthill Centre. A dispensary has been established with a trained staff of pharmacists. I understand that the work done there is increasing enormously, and it seems to me that if the work at the Sighthill Centre pharmacy is increasing to such a large extent, similar provisions ought to be made wherever possible in the Health Service. It seems to me that by the provision of facilities similar to those at Sighthill it ought to be possible to effect a considerable reduction in the cost of these pharmaceutical services.
474 This Estimate, which originally was for £1,482,000, has been reduced by certain savings and by appropriations-in-aid, amongst which is included the receipt by the regional boards of £75,000. I ask this question simply in an exploratory manner: to what extent do the payments for fee-paying beds in hospitals enter into this calculation? Has there been an increase in the amounts being received in respect of fee-paying in hospitals? Hon. Members on this side of the Committee would like some information about that.

§ Mr. William Ross (Kilmarnock)
I apologise to the right hon. and gallant Gentleman for the fact that I missed his speech.
It is amazing; never has £1¼ million been asked for and expected with so few words. It shows the temper of the Committee today. The Government are asking for nearly £39 million extra today. I have a very good memory and I remember the speeches which used to be made on the subject of Supplementary Estimates by hon. Members opposite. As a member of the Estimates Committee it is part of my duty to look at this question of Estimates. I recall the Prime Minister, when he was Leader of the Opposition, talking about a spendthrift Labour Government spending our substance. I have been making some calculations and I find that if we vote this extra money, then the Government will have spent, every single day of last year, over £1½ million more than was ever spent by the Labour Government.

§ Mr. Thornton-Kemsley
On a point of order. Are we able to discuss the Estimates as a whole? Are we not discussing only Class V, Vote 11, National Health Service, Scotland, where the Supplementary Estimate asked for is under £1¼ million?

§ The Chairman
That is the figure—£1¼million—which the hon. Member for Kilmarnock (Mr. Ross) gave.

§ Mr. Ross
Yes. This £1,253,000 is part of the sum which is the subject of our discussions in Committee. I can well understand the hon. Member for North Angus and Mearns (Mr. Thornton-Kemsley), who was famed for his wonderful "spendthrift" speeches at Conservative garden fetes, being a little 475 rankled by being reminded of the failure to live up to promises.

§ Mr. Willis
His election promises.

§ Mr. Ross
Here we have something which can be explained by only one of two things—or by a combination of the two: a request from the Secretary of State for this extra £1¼million, which is due either to an increase in cost or to bad estimating. I am surprised that there should be this bad estimating.

§ Mr. Manuel
Why?

§ Mr. Ross
I am surprised in the light of what hon. Members opposite said. I will prove my case by quotations. One cannot accuse them of anything other than small increases in remuneration and other costs with reference to the £987,000, which is the biggest item. There is no suggestion that there has been an extension of the services.

§ Mr. Willis
There has been no extension.

§ Mr. Ross
That is what I am saying.

Commander Galbraith
I think I ought to correct the hon. Member for Kilmarnock (Mr. Ross). He was not in the Committee when I spoke, but I believe that the hon. Member for Edinburgh, East (Mr. Willis) was present. I pointed out that the improvement in certain services was running at the rate of £700,000 in the full year.

§ Mr. Ross
It is a pity that anyone who reads these Estimates should not be told that.

§ Mr. Willis
We were told that £100,000, in round figures, was for additional wages, because the Government forgot that there was an extra pay day. We were told that there was another £100,000 because of wage increases. Then we were told that there was another £200,000 because of the increased cost of provisions. That is £400,000 at least. I am not including all the other items which the right hon. and gallant Gentleman mentioned. Arising from that, would the right hon. and gallant Gentleman explain where he gets the figure of £700,000 for additional services?

§ Mr. Ross
I am sure my hon. Friend has made that speech in a far more concise form than that in which it was made 476 originally by the right hon. and gallant Gentleman, and I am very grateful to him.
If the right hon. and gallant Gentleman has any explanation of his Estimates to make, we have prescribed a form for estimating in this way. The bulk Estimate is given first and then it is broken up into headings and "Details of the foregoing "is the title. All that is here is: Additional provision required, owing to increases in remuneration and other costs. There is no reference to any suggestion of increased services or expansion of services. Can the right hon. and gallant Gentleman tell us of any single new service that has been introduced which accounts for any of this £987,000? If he could it was his duty to have it properly put into the Estimates, to guide those whose business it is to go through the Estimates.
I ask why the right hon. and gallant Gentleman made such a mistake in this estimating when we consider what has been the trend on the hospital side in the past two or three years since his Government took over? If the right hon. and gallant Gentleman turns to page 59 of the Reports of the Department of Health for Scotland and the Scottish Health Services Council, he will see that the average cost of maintaining a patient in hospital in Scotland during the year ended 31st March, 1953, was 22s. 8d. per day.
That was an increase of 5.5 per cent. over the year before when the average cost was 21s. 5d. per day. The right hon. and gallant Gentleman knows what the trend has been. It has been very much controlled by the financial policy of the Government which has increased the cost of food since then. I want to know why these increases of costs which were known to the Government, and were the direct result of Government policy, were not adequately covered by their budgeting.
Will the right hon. and gallant Gentleman tell us what is the average cost of keeping a patient in hospital today, so that we can compare this with the efforts of the Government to keep down the cost in 1952–53–54? Is it yet another increase of 5₷5per cent., or very much more? The same applies to the treatment of outpatients. That went up from 16s. 4d. per patient to 17s. 2d. in the years 1952–53–54. 477 That was due to increased cost of materials and other matters.
I turn to the pharmaceutical services. There no new service was provided, but the services were used much more than had been anticipated. I want to know exactly how that has happened and whether the Government have been controlling it properly—[Interruption.] I am not concerned with the mutterings of the hon. Member for North Angus and Mearns. If he wants to make an interruption, let him get on his feet. I hope he will be a little more effective than he was last time.

§ Mr. Thornton-Kemsley
I was saying that if the hon. Member wanted to know these things he should have done my right hon. and gallant Friend the courtesy of being here to listen to his speech and not put these questions, all of which have been given a satisfactory answer.

§ Mr. Ross
It is very nice to see the hon. Member here at all today——

§ Mr. James McInnes (Glasgow, Central)
There are only four of the 35 Tory Scottish Members present.

§ Mr. Ross
It is nice to know that the hon. Member for North Angus and Mearns is the only back bench Conservative Scottish Member, apart from those on official duties, here today. I was very busy in the Library and as soon as I saw the name of the right hon. and gallant Gentleman go up on the annunciator, I rushed to my place. When I got there the right hon. and gallant Gentleman was just sitting down. That was why, at the beginning of my speech, I made reference to the fact that this large sum of money was being proposed with so few words.
What is happening in the pharmaceutical service? The right hon. and gallant Gentleman will remember that this has been causing a certain amount of concern to the Government. They took the opportunity to draw up a full prescription list form which they sent to doctors. In 1953, they thought that was having the effect of reducing the number of prescriptions and the average cost of prescriptions. Now we see that they have gone up, not only in numbers, but in average cost.
I want to know whether the same vigilance is exercised with regard to prescrib- 478 ing by doctors as was suggested as necessary in the Report for 1953, on pages 37 and 38. If that is happening the estimating should have been very much better. The Report said: The production of these figures will assist doctors to watch their prescribing in the light of their own and their colleagues' costs and will also indicate to local medical committees the doctors whose prescribing might merit investigation under the regulations. In the past, it has been necessary to investigate the prescribing of doctors and in 1953 13 doctors had sums varying from 5s. to £50 withheld from their remuneration and 16 other doctors were warned. Can the right hon. and gallant Gentleman tell us whether account was taken of this? The answers to Questions we have asked show quite clearly that in the poorer part of Glasgow the average cost of prescriptions was very much lower than the cost in the more residential part of the city. Has that been properly investigated in order to bring down the cost of prescribing by some doctors?.
These are questions which must be answered. I hope that the right hon. and gallant Gentleman has all the relevant data and that in his winding-up speech he will be a little less sparing of time devoted to this extra £1¼ million.

§ Mr. Emrys Hughes (South Ayrshire)
I listened to the speech of the Minister more in sorrow than in anger, because he lives in my constituency. Unlike my hon. Friend the Member for Kilmarnock (Mr. Ross), I always come into the House to listen to my constituent, because I may have many questions to answer about his conduct when the General Election comes.
The right hon. and gallant Gentleman and I both have to pay rates to the county council of Ayrshire. I wonder what the right hon. and gallant Gentleman would say if that county council estimated in this slipshod, reckless and extravagant manner. I am quite sure he would say that this was Socialist squandermania. I had to listen to his extremely inadequate, concentrated, on-explanatory statement, and I really do not know what I am to say when I have to defend the Minister in my part of Ayrshire.
What would we say to the county council if it had forgotten a week's wages? It is his duty as Minister to 479 supervise the estimates of local authorities. He should set an example to them. Like Caesar's wife, he should be above reproach. I hope next time he speaks he will improve on this inadequate explanation and these extremely careless Estimates. I am sure that next time he writes to Ayrshire County Council telling it to be more careful about finance it will have a reply to which he will have no adequate rejoinder.

Commander Galbraith
I have certainly been given plenty to answer and I will endeavour to do so to the best of my ability, although the Committee will realise that there are some things which obviously could not possibly be answered "off the cuff."
I was rather pleased with a remark made by the right hon. Member for Greenock (Mr. McNeil) at the start of his speech. He chided me with being, perhaps, too frank and not too politic. I feel that when one comes before this Committee to ask for money one should say as honestly as possible why the money is needed. I stand on that, and I do not feel that I have really been chided by the right hon. Gentleman.

Mr. McNeil
I was not chiding the right hon. and gallant Gentleman; I was feeling a little sympathetic. I should like him to come up and admit that he had missed one of the Saturdays.

Commander Galbraith
It was not a Saturday that was missed. I will tell the right hon. Gentleman later what it was.
The right hon. Gentleman evidently did not hear what I said, because he suggested that I had indicated that the weather in Scotland had something to do with the additional number of prescriptions or cost. I said nothing whatever about the weather. What I said was this: "The increased number of prescriptions reflected a rather high level of sickness in the early part of 1954, and also the recent influenza epidemic." Those are my actual words.

Mr. McNeil
I am sorry.

Commander Galbraith
The right hon. Gentleman then put to me a number of questions, the first of which was in connection with the increased number of prescriptions and how many there were. I can give the figures for the 11 months from January to November, 1953, and for 480 the same months in 1954. The number of prescriptions in that period in 1953 was 18,700,000, and in 1954 19,060,000, or an increase of approximately 360,000.
The right hon. Gentleman proceeded to refer to what he considered to be the difference proportionately in this Supplementary Estimate and that for England and Wales.

Mr. McNeil
The Minister was kind enough to give those figures. Can he state the average cost per prescription, which was given by his hon. Friend the Parliamentary Secretary in respect of England and Wales?

Commander Galbraith
The average estimated cost of prescriptions has risen from 5s. 4d. to 5s. 5₷7d.

§ Mr. Ross
I did not catch the number of prescriptions. Will the right hon. and gallant Gentleman repeat it?

Commander Galbraith
In the first 11 months of 1953, 18,700,000, and in the first 11 months of 1954, 19,060,000.

§ Mr. Ross
The estimated number of prescriptions dispensed in 1953 was 2,049,000.

Commander Galbraith
I am giving the period of 11 months. The hon. Member must have got something wrong somewhere.

Mr. McNeil
Was the number really 18 million? That would be 50 per head of population. It must surely be a different figure from that.

§ Mr. Ross
Eighteen million is astounding.

Commander Galbraith
That is the figure I have been given——

§ Mr. Manuel
That is the figure for the United Kingdom.

Commander Galbraith
—and I believe it to be correct. This is the number of prescriptions for Scotland in the 11 months.

§ Mr. Ross
That is an increase of 16 million. Perhaps the right hon. and gallant Gentleman will listen carefully while I read from the account of the pharmaceutical service: The estimated number of prescriptions dispensed in 1953 was 2,049,500. That represents a difference of about 16 million.

Commander Galbraith
I have had the figure given to me, and at the moment it must stand.
I was speaking of the difference in cost and the size of the Estimates for Scotland and for England and Wales. The main difference is in the hospitals. The average cost per bed in Scotland is lower than in England, and it seems that savings are possible only on a smaller scale.
I was then asked why we had not estimated for the Whitley awards. As a matter of fact, we endeavoured to estimate to the best of our ability. The estimated amount that we allowed for the increase was £804,000 and the sum actually needed was £893,000; so we did not make a bad shot at it. In connection with the extra week's payment, of which such fun has been made, the mistake came about in a very simple way; it was the kind of mistake that could easily be made. There happened to be 53 Thursdays in the year and it was not realised that the money was drawn on a Thursday, although it was paid on a Friday. That is how the error crept in.
The question that has disturbed the Committee most of all has been that of hospital stocks. We set out deliberately to reduce the stocks during last year. The reason was that we thought the stock being carried was too high, and the items which we proposed to run down were drugs and dressings, bedding and linen, and hardware. We proposed that we should continue the run-down during the present year, because the stocks held were obviously too heavy and, as the Committee will realise, it is no good keeping money bound up in stocks which are not required and are not being turned over. What happened was that the hospital stocks ran down much more than we had anticipated and we have now to reduce the further call on stocks to enable the expansion of which I spoke to take place.
The hon. Members for Central Ayrshire (Mr. Manuel) and Edinburgh, East (Mr. Willis) pressed the point regarding the pharmaceutical services. They both thought that it would be advisable if pharmacists were employed to a greater degree and that supplies should be bought in bulk. Surely, both hon. Members know that practically all the Scottish hospitals draw their main supplies under contracts placed centrally for the whole 482 of Scotland. It is, therefore, unlikely that better buying prices could be secured, but the possibility of economies resulting from more skilled local handling will certainly be borne in mind. I will endeavour to discover the statistics about the hospital pharmacists and will send them to both hon. Gentlemen.

§ Mr. Willis
I wanted to ask the right hon. and gallant Gentleman about the pharmaceutical service at the Sighthill Health Centre, and whether he has any information about its cost, in comparison with pharmaceutical costs generally. Perhaps he will let me have that information later on?

Mr. McNeil
I think if the right hon. and gallant Gentleman looks at Appendix X he will be able to correct the error about the prescriptions.

Commander Galbraith
The hon. Gentleman the Member for Kilmarnock(Mr. Ross) referred to a figure of 2 million. I am told that it should be 20 million. There was a misprint, and it was explained, I understand, at the time that the Estimates were discussed in Committee. That misprint evidently accounts for the difficulty in which we have found ourselves.
The hon. Gentleman the Member for Maryhill (Mr. Hannan) asked me about the dental charge. He does not seem to be in his place, but I will give him the figure all the same. The dental charge has amounted to between £700,000 and £750,000. He also asked me about the optical charge. It has been running at about £460,000.
The hon. Gentleman the Member for Kilmarnock asked me about the cost of drugs. While the estimated cost of the pharmaceutical service this year has risen the latest figures of costs are encouraging. They suggest that the information about drug costs which we are now supplying to each doctor three times a year has helped doctors to observe economy in their prescribing without any detriment to their patients. This information, which is being sent out in response to requests from the medical profession, shows each doctor his own costs both per patient and per prescription, and gives him the corresponding average figures for the doctors in the area and for doctors in the whole of Scotland.
483 The right hon. Gentleman asked me if I would be good enough to break down some of the figures. I will give him figures in respect to increases in the general figure for the hospital service. The increase in the cost of provisions was £160,000. The increase in the cost of dressings was £40,000. The increase in the cost of boiler fuel was £72,000. The increase in the cost of laundry was £36,000, and of electricity and gas £17,000.
I think I have covered most of the questions that were put to me.

§ Mr. Willis
Would the right hon. and gallant Gentleman answer my question?

Mr. McNeil
What was the figure for fee-paid beds?

Commander Galbraith
I am sorry, but I have not that figure, and cannot make it available to the Committee at the moment.

Mr. McNeil
I am not blaming anybody, and I remember this misprint, and I remember drawing attention to it last year, but the right hon. and gallant Gentleman has left the Committee in the most baffled condition. If the figures he has given us are right, and there is an increase in prescriptions of 360,000, and if the cost of a prescription is about 5s., then we get a figure of £95,000, but the figure asked for the pharmaceutical service is £1,250,000.
Plainly, in this difference the right hon. and gallant Gentleman has given us there must be something wrong. He told me there were 360,000 more prescriptions, and he told me the cost was 5s. 4d., an increase of l.7d.—inconsiderable this time. However, if the increase is 360,000 prescriptions, and if each costs 5s., the total the right hon. and gallant Gentleman should be asking for is £95,000 or thereabouts, whereas he is asking the Committee for£1,250,000. Therefore, although I do not like to hold up our proceedings, I feel we must have a little more information on that point.

Commander Galbraith
The right hon. Gentleman's accounting is a little out. Let us get it square first of all that the 484 number of prescriptions is approximately the number which I gave. The right hon. Gentleman has only applied the cost to the increase and not the increased cost per prescription to the other 19 million odd prescriptions. If he does that mathematical exercise he will find that that figure is correct. I hope that that is a good enough picture.

Mr. McNeil
I am indebted to the right hon. and gallant Gentleman, but if he is out by 19,700,000 in his statement to us he might be a little more generous to a poor Member like myself.

Commander Galbraith
I was not out at all. The hon. Member for Kilmarnock, quoting from last year's Reports, said that the number was 2 million. It was nothing of the kind.

§ Mr. Ross
I quoted the actual words from the Reports. It is not the right hon. and gallant Gentleman who is out, but the Secretary of State, who is responsible for the Reports.

Commander Galbraith
The hon. Member has a very long memory, sufficiently long to remember that that mistake was corrected seven or eight months ago, if not more, and brought to the notice of the Scottish Grand Committee at that time.

§ Mr. Ross
No.

Commander Galbraith
I have dealt with the questions raised to the best of my ability in the time available to me. I now ask the Committee to grant the Supplementary Estimate for which I have asked.