Motion made, and Question proposed,
That a supplementary sum, not exceeding £2,295,000, be granted to Her Majesty, to defray the charge which will come in course of payment during the year ending on the 31st day of March, 1956, for the salaries and expenses of the Ministry of Health and the Board of Control; expenditure on the Polish health services; measures for civil defence; port health administration; residential accommodation for the aged, infirm, etc.; purchases on repayment for other Government Departments; expenses in connection with welfare food services and food hygiene; and sundry other services, including a subscription to the World Health Organisation.
§ 8.23 p.m.
§ The Minister of Health (Mr. Iain Macleod)
We turn from considering the affairs of the Ministry of Agriculture to those of the Ministry of Health, but we are still concerned with food because this sum of rather more than £2¼ million on my Vote arises out of the Transfer of Functions Order made by the Privy Council on 30th June and laid before this House a week ago. That Order transfers to me food hygiene functions from the day after the Order was laid-6th July—and welfare foods responsibility from 1st October.
It is with those two matters, almost entirely with the second, that this Supplementary Estimate is concerned. The financial implications of the transfer of food hygiene functions are very minor and form only part of subhead A.1, which relates to salaries and transfer of staff to my Department. Any other expenditure I may have to meet—for example, expenses of the Food Hygiene Advisory Council—can be met from administrative expenditure already voted. I take it, therefore, that if the Opposition wants to criticise or oppose the Order in Council that has been laid before the House it will take another opportunity of doing so. I propose to concentrate my remarks tonight on the welfare food side of this Vote.
There is one general remark to make, that the comparatively small sum of £2¼ million is very misleading. It is misleading, in part, because I am only taking these functions from 1st October and, secondly, because very large sums have already been voted by Parliament to the Ministry of Food and can be 1842 appropriated against the amounts for which I am asking. In fact in a full year the amount comes to something more than £30 million. It is, therefore, a most formidable addition to the responsibility of the Ministry of Health. It is borne on the Ministry of Health Vote and not on the National Health Service Vote.
I only intend to say a sentence or two on the food hygiene functions. Our intentions have been indicated to the House by the Lord Privy Seal and the Minister of Agriculture on 28th March. With my right hon. Friend I am jointly responsible for regulations. Therefore, all we are transferring is the primary administrative responsibility. I think it is generally known that regulations under the Food and Drugs Act dealing with hygiene on food premises and with the handling and distribution of food, with the exception of milk, meat and slaughterhouses, will come under my Department. Unless hon. Members wish to develop that side of the question, I shall concentrate my remarks on welfare foods.
The welfare food scheme for some time has provided milk and various supplements to expectant and nursing mothers and children under five. The scheme was administered by the Ministry of Food and the Government were faced with a problem when, in July last year, with the closing of the local food offices we had to make new arrangements for distribution. There was no problem of distribution of liquid milk—that went on through the dairies. We had the choice of using Government Departments as agencies—no doubt we would have to use the Ministry of Pensions and National Insurance or the Ministry of Labour and National Service —or of asking local authorities to undertake this task.
There were two considerations which particularly influenced the Government in inviting local authorities to take on this work. First, it was giving a most important function back to local authorities and on the whole that is a good thing because we have taken many functions from them in recent years. Secondly, it was because local health authorities are responsible to me for so many aspects of the health of mothers and young children that it seemed appropriate that they should also have the distribution and encouragement of the use of these services.
1843 Therefore, I should be concerned with the definition of the beneficiaries, with the fixing of the quantities of welfare foods, with the determination of prices and with enforcement, if that is necessary in the event of offences. It follows that if I am to determine policy I should also be responsible for cost. Under the appropriate subhead of this Supplementary Estimate, I.3, I am using the Ministry of Agriculture, Fisheries and Food, the Ministry of Pensions and National Insurance, and the Ministry of Labour and National Service as agency Departments. I am using the last two for the issue of documents, which obviously fits in, and the Ministry of Agriculture, Fisheries and Food for, in certain cases, the procurement of bulk supplies of welfare foods.
There are two main points to emphasise. First, this transfer of functions make no change whatever from the point of view of beneficiaries. Mothers and children are entitled, and will continue to be entitled, to the same quantities of food, on the same terms and from the same places. The other thing to emphasise is that I regard, and the Government regard welfare foods as a most important part of the country's social services.
The only other point on which I think the Committee would like to hear from me is what has happened in the year that the functions have been under the charge of local health authorities. Naturally, we do not yet have figures for the full year—it is just only coming to an end—but we can make a reasonably good estimate. I gave some figures to the right hon. Member for Middlesbrough, East (Mr. Marquand) and to the House, and they will be found in HANSARD for 2nd May.
Comparing July to December, 1954, with the same period in 1953, the consumption of national milk fell by 8 per cent., cod liver oil by 14 per cent., orange juice by 13 per cent. and vitamin tablets by 20 per cent. We have the figures for the first quarter of this year and to some extent this trend has continued with dried milk and with orange juice, but there has been a rising tendency with cod liver oil and vitamin tablets. I took a few spot checks in different parts of the country and there does not seem to be much significant difference between them. Therefore, we can say that these 1844 trends seem to be level throughout the country.
The important question is what we should read into this, and I suggest that those figures should give cause for considerable thought but not necessarily for concern. I think it was my right hon. Friend the Member for Woodford (Sir W. Churchill) who said that the best investment for the country was putting milk into babies—and that, no doubt, is true; but only a certain amount of milk can be put into any one baby, and we cannot assume from any drop in the figures of national dried milk, for example, that there is any nutritional significance. It may merely mask a turn towards some of the proprietary brands that are very popular indeed. Again, the demand for welfare orange juice is affected by the availability of fresh fruit and there are many other sources of Vitamin D except cod liver oil. All the same, the drop is very substantial and one that we must watch in the, next few months and on which I would wish to report again to the House as soon as we have full figures.
I think that the local authorities can help. Part of the drop may be because of the difference in the siting of the places where these foods are now available. It may be that distribution through local health authority centres, clinics and so on, has meant a wider choice for the consumer, but it is sometimes unquestionably true that the hours at which those centres are open are not so convenient as before and it is possible that this has some effect. But it gives point to the consideration that was indicated as one of the main reasons for this change to local health authorities.
What we are really concerned with is to be certain that the diets of those children and mothers which may be deficient are supplemented. That is our main worry. It is precisely because the local health authorities, who know who those mothers, families and children are, play their part, as I am sure they will, that we will get the full benefit of this important part of our social services, going to the people who need it most. Local health authorities, through their staff at clinics and their health visitors and in many other ways are well placed to see that the strongest possible advice to take up the welfare foods is given to those whose diet might otherwise be deficient.
1845 Those are the reasons that led to this change and those are the explanations that I thought the Committee might like to hear from me when considering this Supplementary Estimate. It is one of much more importance than the figures show. It amounts to no less than £30 million or more of our money every year but I am sure the Committee will agree that it is money well spent. I ask hon. Members in due course, after we have had a discussion, for their approval of this Estimate.
§ 8.35 p.m.
§ Mr. A Blenkinsop (Newcastle-upon-Tyne, East)
We have listened with interest to the Minister explaining the Supplementary Estimate, because of course it is true, as I think we can say on both sides of the Committee, that expenditure in this field is regarded as of the very greatest importance. It is therefore natural that we should be anxious if there should be any sign of any drop at all in the use of the service. It is true that over a period of some years there has been a fairly steady decline in the use of these welfare services, a decline which has been even more marked during the past year, since the transfer to the local authorities.
I should like to mention first, with regard to the transfer of food hygiene functions—and I quite agree with the right hon. Gentleman—that it would be preferable to discuss separately these very important changes which have been made in an Order recently before the House, and I hope that we shall have an opportunity before very long of discussing them in some detail. Therefore, like the right hon. Gentleman, I propose to deal purely with the welfare foods sections.
Some of the points which I wish to raise with the Minister have already been mentioned. It is satisfactory to us that this change has taken place and that the transfer has been made to the local authorities. We think that broadly it is desirable that the local authorities should have the responsibility for this work. We agree with the right hon. Gentleman that this is a most important part of our social services. If that is so, it is a matter of some anxiety that there should be as great a decline in the use of the services as we have seen from the recently quoted figures.
1846 In addition to the figures to which the right hon. Gentleman referred in an Answer to a Question put by my right hon. Friend the Member for Middlesbrough, East (Mr. Marquand) and the additional figures which the Minister has given today, I have also seen some figures from the London County Council area, which confirm this trend. Although they do not show any improvement in the cod liver oil and vitamin figures, they suggest that a sufficiently adequate period is necessary for a proper test. Taking the average weekly issue in March, 1954, and in March of this year, there has been a very considerable drop, which is shown all through the figures relating to these welfare foods.
Some figures have also been made available from Liverpool where, by the way, there is a complaint of not having been able to obtain from the Ministry of Food the comparable figures for the period before the change-over to local authority responsibility. Such figures as are available in Liverpool suggest a considerable decline, but they also suggest that there has undoubtedly been some change from National dried milk to proprietary brands of milk, purchased in some cases from the clinics. That is mentioned in the case of Liverpool, and certainly in the case of London, and we must bear it in mind.
We must also bear in mind the number of children who are able to take advantage of this provision, but I think it would be fair to say that the matter is sufficiently important to warrant a very close check being made by the Ministry on the reasons for the decline. I think it would be well worth while if some special investigation could be made, perhaps of the character of the most valuable survey that has been and is still being made in Newcastle, into the state of health of children and of families. That survey has now been going on for five years, and is turning out some very valuable social information.
I think it would be most helpful if the Minister could consider setting on foot some special spot investigation in a particular part of the country which he may select in order to find out something more about what is happening, and in particular about the use of milk in families with young children of pre-school age. I think that we are all agreed that 1847 some of the greatest advances made in child health during the last few years have been due entirely to the emphasis that has been given to proper nutrition. That has probably been of more value than all the great improvements in medical treatment, valuable as those in turn have been. It is, therefore, a matter of very real concern to all of us when we find that the consumption of fresh milk and of special welfare foods has been declining as noticeably as it has been recently.
I suggest, therefore, that the Minister should set on foot a careful spot investigation to secure more information about the causes. There is possibly something also in the point which the Minister made that local authority clinics are not open all day. It is suggested that in some places that fact has had some effect. There is certainly need for a considerable publicity drive to make the public conscious of the fact that, unless the fullest advantage is taken of the facilities, we may find in future that some of the high standards in the care of children which we are so proud to have reached may be lost. We could then, of course, experience a very rapid slide downwards.
There are very few, but unfortunately there are some, cases of rickets in the country. We do not want any at all. The Minister has said that he does not regard the situation as being a matter for anxiety, but I also hope that he will not regard it as a matter of no importance and that he will investigate it very carefully so that we may maintain our high standards in the care and development of our children.
§ 8.42 p.m.
§ Dr. Barnett Stross (Stoke-on-Trent, Central)
I have listened to the Minister with great interest, and I should like to say first that I am sure that the Ministry of Health is the right place for the functioning of the National Health Service with reference to welfare foods. I am glad that that function has been made over to the Ministry and that the local authorities are to be attached to the scheme in the way which has been outlined, for obviously this function is part of preventive medicine and is something which we have not been very good at as yet in the Health Service.
1848 We all accept that the Health Service is essentially a curative service and that we have not been able to tackle the prevention of sickness in the way in which we should all like to do. But here, in connection with welfare foods, is a classical method by which we can prevent disease and possibly encourage good health. Therefore, obviously it is a good thing that the Minister should have this function within his Department.
I speak from memory, but there is an instance of how the condition of young children has been improved in the past years. An investigation was conducted in London into the teeth of five-year-old children. A very large sample was examined by Lady Mellanby. Five-year-old children from the same schools and nursery schools were examined in 1926, in 1935 and just after the war.
The first examination showed that only 5 per cent. of the children had completely perfect teeth. The second examination, ten years later, of the next generation showed that about 17 per cent. had perfect teeth at the age of five. The third examination showed a percentage of over 30. This is a very real measure of what preventive medicine can do and it is very heartening. We must look with anxious eyes upon any fall in the use of welfare foods and, as the Minister has rightly said, make certain that we do everything we can to see that the consumption of these foods is increased.
I remember the figures that were given by the Parliamentary Secretary on 2nd May last in answer to a Written Question. I wondered whether she was right in her opinion as to the cause. She said herself in the answer that this trend might be expected to continue and might be due to the fact that there was a rising standard of life and people were going elsewhere to buy these things because they had surplus money and, therefore, could not be bothered to accept them at the reduced rate.
At that time I thought her answer was suspect, and I hope she will be careful. There may be other causes in addition to the one she gave. She may possibly be correct in part, but there may be other causes, and I wonder, for example, whether there were quite as many nursing and expectant mothers in 1954 as there were in 1953. I wonder if the number of children is falling a little. 1849 Then we have the right hon. Gentleman's view of the changes which have rather confused people, and his suggestion that the hours at which they can get these foods might not perhaps be convenient to them.
I remember during the war that the Ministry of Food spent a great deal of money advertising the need for this service. They booked space in the National Press to tell mothers why they should take advantage of it if they were nursing and expectant, and if the babies needed it. Gradually that amount of money was cut and the Ministry of Food up to two years ago, with very little money left, tried to find other methods to use the Press of the country to give advertisements for this Service.
Members of Parliament were enrolled to be photographed pointing at chubby children in their constituencies, and these photographs and articles were sent to the local Press, who were pretty good in publishing the photographs and short articles stressing the need for making full use of the service. There are many ways in which we can help in this matter.
I should like to ask one or two questions. First, has the Minister in mind how he can bring to the notice of the public how important is this service. I personally do not care, nor does any hon. Member in this Committee, whether mothers go to the centres and get the food cheaply, or whether they buy it at a higher price over the counter in the chemist's shop. That is my least concern. I only want to be certain it is available and that they have it. I want to know what the Minister is going to do to insure that the public are told from time to time how important these foods are.
Secondly, I wonder if he has any information as to whether the decline to which he has been referring—some of it rather staggering; for example, a drop of two million in bottles of orange juice from one year to another—is uniform throughout the country, and whether the local authorities have any responsibility for any of this. Some local authorities may well be, and I am sure are, more than eager to press this service. That will depend upon their size, background and history.
My own local authority in Stoke-on-Trent, of which both I and my hon. Friend the Member for Stoke-on-Trent, 1850 North (Mrs. Slater) are members, is very conscious of the difficulties that faced us in the past when we had long periods of unemployment, when wages were low and when children were not having a very good time.
When I became a medical man in the area in the first place the death rate of mothers when bearing their children was very high. It was seven, eight and nine per thousand births—a shocking situation. Since then there has been a complete transformation in all these figures and also in the appearance of the children.
I was puzzled when I first read Chaucer as to how one could make a girl like Griselda of twelve years of age a heroine and a married woman. Later I wondered how anyone could become a passionate heroine at the age of fourteen as Juliet did. In Stoke-on-Trent we have discovered the reason because, since we have had an improvement in our standard of living—it all dates roughly from 1939 to 1940—we see that our children are not only taller and heavier but that they become nubile at the age of 13 or 14. At those ages they are young ladies and they look like women at 15. They look very different from the way they looked when I first went to the area 30 years ago. I also know now why it was possible for Juliet, perhaps living in the country, eating maslin and cheese and drinking lots of milk, to be able to have a passionate love affair when she was fourteen years of age.
Joking apart, this is indeed an important service and I hope we shall be given an absolute assurance that it will be looked upon as being at least as important as the curative aspects of the medical health service.
§ 8.51 p.m.
§ Mr. Victor Collins (Shoreditch and Finsbury)
I do not know whether welfare food services were more efficient in Juliet's day than they are now, but I do know that what the Minister said on this subject met not only with my warm approval, which is not so important, but with the warm approval of every hon. Member here. Therefore, it is not necessary for me to dilate on what the right hon. Gentleman said.
I want to make one or two suggestions arising out of a small investigation which 1851 I made in my own constituency into the sales of welfare foods. It arose from a point in my mind about the mention of local authorities handling these foods. The London County Council is not very local where some of the London boroughs are concerned. That is not in any way meant to be criticism of the London County Council, but the County of London is a large place, and when the Minister is investigating this matter he may find that to be one of the reasons.
For example, my constituency consists of two small boroughs. In one there were seven distribution centres and two Ministry of Food centres. It has a large daytime population of people who come into the borough, and no doubt the husbands found it convenient to go to the food offices, obtain the welfare foods and take them home. So I expect the Minister will find patchy figures in such places.
The general trend in my constituency, however, is that the percentage drop appears to be much greater than the national figure, and I regard that as serious. It may well be that something has happened which we would rather not see happen, namely, that those homes where one would expect the children and mothers to be most in need of these welfare foods are in the area where the drop is greatest.
That is no reflection on the Minister or on the local authorities, but it has to be combated. I have figures for the sales of National Dried Milk in the two boroughs of Shoreditch and Finsbury for every quarter since March 1954,. The percentage drop in the sales of National Dried Milk was 15 per cent. in Shoreditch whereas in Finsbury it was 16 per cent. The sales of orange juice in both boroughs fell by only 10 per cent. There was a remarkable drop in the sales of cod liver oil, the figure being 15 per cent. in Shoreditch and 55 per cent. in Finsbury—an extraordinary drop from 259 to 113 bottles a week. I cannot explain it but I know that the figures are accurate. In one borough the drop in respect of vitamins was 25 per cent. and in the other 20 per cent.
If those figures were the national figures, I am sure they would be the cause of very considerable anxiety. The thought that in my area, a working-class area in which people are still living in 1852 very congested conditions and where, unfortunately, there is still a high proportion of slums, there is a bigger drop than the national drop, causes me concern.
I feel that when the Minister investigates the matter it may be found that it is the old customers who are continuing, and the would-be customers are the young mothers who are not so familiar with the advantages of the foods. It may be that previously mothers went to the food office about other matters and were thus able to have the welfare foods brought to their notice.
Whatever may be the reason, I feel that a survey, conducted in whatever way the Minister thinks best, is an urgent necessity, so that he may later be able to give the House not only the national picture but a picture of the kind of areas where the drop is greatest and where it is least. Perhaps we can then discuss the matter and make suggestions for improving the situation. This is a vital service in which we are all interested, and it is to be hoped that under the aegis of the Minister it will render an even greater service to mothers and children than it has done.
§ 8.57 p.m.
§ Mr. Iain Macleod
Perhaps I might briefly reply to the very important points which have been raised. I am most grateful for the way in which the Supplementary Estimate has been received. The hon. Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop) made two most important suggestions.
The figures which I have for the London County Council area—that was one of the areas in respect of which I took a check—would seem to bear out what I said, that a comparison between the estimate for the six months now ending and the six months ending at the end of last year shows an increase in the consumption of cod liver oil and vitamin tablets.
I will take first the two suggestions made by the hon. Member for Newcastle-upon-Tyne, East, for they are the two most important suggestions in the whole debate. He suggested that we should have a special inquiry so that we might be fully satisfied about the reasons for the decline. I accept that straight away. I am sure the hon. Member is right. I had intended to do that in any event. Therefore, I will undertake to put in hand such an inquiry.
1853 I want, in particular, to find out, if there has been a drop in the consumption of National dried milk, what the effect has been in respect of liquid milk and proprietary brands of feeding mixtures. I will undertake to make that inquiry, and also to pay particular attention to such places as Shoreditch and Finsbury.
It would be helpful if hon. Members who are particularly interested in the subject would themselves carry out a little investigation and let me know the results. If they had a few minutes' conversation with their medical officers of health and health visitors, I might be given some leads to the true position, for which I should be most grateful.
I shall not follow the hon. Member for Stoke-on-Trent, Central (Dr. Stross) into his literary researches. I do not know whether the local health authority in Verona issued vitamin tablets or cod liver oil. However, in the large cities throughout the country and the one rural county in respect of which I have had time to make a check the decline appears to be uniform.
The hon. Member asked me about publicity, and with this goes the second point of the hon. Member for Newcastle-upon-Tyne, East. I will also undertake to bring to the notice of local authorities, in whatever way is most suitable, that they should consider their siting arrangements 10 make certain that they are the most convenient that they can devise for the beneficiaries of these services.
I think that ordinary publicity is probably now best done locally rather than nationally, considering that local authorities now have the responsibility. But, of course, centrally one can help a considerable amount, I myself, for example, when I meet representatives of local authorities and such bodies as executive councils, can be sure to emphasise these particular points.
Those were the topics which were raised and I think that we agree that it is right that this work should be transferred to the Ministry of Health and also right that it should go to local health authorities. I will undertake, however, to make such inquiries as are necessary to satisfy myself that this decline in consumption is due to what we might call natural causes.
§ Question put and agreed to.1854
That a Supplementary sum, not exceeding £2,295,000, be granted to Her Majesty, to defray the charge which will come in course of payment during the year ending on the 31st day of March, 1956, for the salaries and expenses of the Ministry of Health and the Board of Control; expenditure on the Polish health services; measures for civil defence; port health administration; residential accommodation for the aged, infirm, &c.; purchases on repayment for other Government Departments; expenses in connection with welfare food services and food hygiene; and sundry other services, including a subscription to the World Health Organisation.