HC Deb 12 July 1956 vol 556 cc721-32

Motion made, and Question proposed, That this House do now adjourn.—[Mr. E Wakefield.]

9.54 p.m.

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

I am grateful to the right hon. Gentleman the Minister of Health for coming here tonight. I hope he will feel that his presence is justified, because the question that I wish to bring to the attention of the House concerns not only my own constituency but, as far as I can see, also raises wider questions of Government policy.

If I may briefly refer to the constituency point first of all, the older parts of Middlesbrough, which lie within my constituency, are a monument to the excesses of capitalism. When the iron and steel works, the railways and the docks were built there in the middle of the last century, what were put up for the labourers to live in were no better than stables, and many of these houses unfortunately still remain. In such conditions, mothers and children had no chance whatever, and over a prolonged period, the rate of maternal and child mortality in Middlesbrough was so high that it was frequently referred to in books on the subject as proof of the fact that the figures of maternal and child mortality were much higher in the poorer parts of every town than in the better-off parts. Though a great improvement has been made as a result of the work of a progressive town council since 1945, the figures still remain much higher than those for the rest of the country.

The right hon. Gentleman will no doubt correct me if my figures are not strictly accurate, but I believe it is fair to say that, for the last three years, the average infant mortality in Middlesbrough was 34 per thousand, in round figures, whereas for England and Wales as a whole it was only 26. In spite of the rapid building of new houses and the transfer of population from the old slum areas to the new estates, and in spite of the work of this progressive authority in building new maternity and child welfare clinics and improving all other facilities connected with the welfare of mothers and children, we still are at a great disadvantage compared with the rest of the country.

The authority wants to continue this progressive work. It recently opened in a part of the town called Thorntree a new maternity and child welfare centre. The right hon. Gentleman was represented at the opening of that centre by one of his officials who expressed high approval of the project. The latest proposal that the town council has is to build a somewhat similar centre in a district called Park End, the population of which at the moment is 6,000, though it is planned to reach 10,000.

When this project was first put forward, a letter was received from the right hon. Gentleman, dated 1st September, 1955, stating that the need for a clinic of this kind to serve that area was agreed, but not on the scale proposed. Nobody can object to that. Nobody can object to a question whether the scale of the clinic was adequate or not. The authority, far from objecting, set to work to look over its proposal again. It submitted a revised plan on 23rd April, 1956.

For a long time no reply was received, and eventually the local authority sent an urgent reminder. On 7th June, it got a letter sent by one of the right hon. Gentleman's officials speaking in his name. I will not read the whole of the letter, but I will pick out the salient points. It said: I am directed by the Minister of Health … to say that: .. the Minister is unable for the time being to recommend loan sanction for the building of clinics. .. This is shifting the issue altogether. This is not whether or not a particular clinic is too expensive or not quite suitable for the area concerned. This is the statement of a new principle, that the Minister is unable to give loan sanction for the building of clinics—presumably all clinics anywhere. This is justified by a reference that: … the best use should be made of the limited financial resources available. In this letter, for the first time the local authority is made aware not merely of a possible criticism of the adequacy or otherwise of its proposed clinic, but of a new statement of policy that the building of clinics cannot at present be considered for loan sanction.

This surprised the local authority, and I must say that it is still very mysterious to me. As far as I know, until the last few weeks, we have had no indication of this new policy. We knew two things in this connection about the right hon. Gentleman's policy. We knew that he had accepted in principle the Guillebaud Report—

It being Ten o'clock, the Motion for the Adjournment of the House lapsed, without Question put.

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Barber.]

Mr. Marquand

We knew that the right hon. Gentleman had accepted the Guillebaud Report and that in that Report one of the most outstanding features was the endorsement by the Committee of the work of local authorities. They said in effect that the local authority part of the National Health Service was the best and ought to be encouraged and developed and, indeed, built up.

We knew that the right hon. Gentleman praised the work of the local authorities as well as did the Guillebaud Committee. That part of the right hon. Gentleman's policy was specifically related to health. We knew also that it was the general policy of Her Majesty's Government that the sharing out of resources amongst all the different claimants upon our national resources was in future to be done in the market through the instrument of the rate of interest. That is an argument which we do not like on this side of the House, as we have often said, but we can understand it. First it is said that resources are limited, as they always are. Then it is said that the best way to deal with it is to fix a high rate of interest for raising money so that those most in need will be willing to pay it. Well, here is a situation where the local authority is willing to do that. It may not like the Government's policy, but it accepts it and decides that, despite the high rate of interest which it is necessary to pay to obtain capital, it will pay that and it will decide its own priorities.

Can there conceivably be any higher priority in the National Health Service than the lives of mothers and babies? I try never to talk extravagantly, but I do not think it is extravagant to say that maternity and child welfare clinics save the lives of mothers and babies. These may be saved in the hospital and home by the work of the obstetrician, but we know that education in nutrition and in the proper treatment of children preserves and saves their lives, and that the pre-natal care which the clinics give to the mothers saves their lives also. So there could be no higher priority than this in the National Health Service.

In reply to a recent supplementary question put by my hon. Friend the Member for Clapham (Mr. Gibson), the hon. Lady the Parliamentary Secretary said: … all Departments have had to make some contribution to the Government's policy. These schemes have not got the highest priority …"— In my time I have had to make many replies to supplementary questions. I know how difficult it is, and that one does not always get the opportunity to make a fully considered statement. Well, the opportunity is given to the right hon. Gentleman to say tonight whether that was a considered statement of Government policy. Is it now Government policy that the building of maternity and child welfare clinics has not got the highest priority? We would like to know.

I would like to know also why the Minister is taking away from local authorities the right to decide priority. They have been running these services all the time, and they have a certain definitely limited share of the National Health Service to carry through. Why are they not allowed, within their own sector of the National Health Service, to determine their own priorities? They know the circumstances of their towns. They know what matters most—in Middlesbrough, Coventry, London or wherever it may be.

One could imagine that in more wealthy towns it might be thought that some other part of the National Health Service was more important. In Bournemouth, for example, where there are lots of old people and not so many young mothers, and where there are very good housing conditions, it might be thought more important to provide a chiropody service for old people. In Middlesbrough the highest priority is still the welfare of mothers and babies. That is what Middlesbrough says, and I claim that Middlesbrough should have the right to say it.

In answer to a Question put by me on the same date, the Parliamentary Secretary used the word "extravagant" about the proposals of the Middlesbrough authority. She said: … we had to ask the authority to look at the plans again, because if extravagant plans are approved in one area, another area loses an advantage which it might otherwise have."—[OFFICIAL REPORT, 2nd July, 1956; Vol. 555, c. 975–979.] Again, is that a considered opinion? Is the proposed clinic at Park End, Middlesbrough, an extravagant plan in its revised form? If it is, was the Thorntree Clinic an extravagant plan? It was the Thorntree Clinic where a representative of the right hon. Gentleman praised the work. I have seen that clinic, and it does not seem to me to be in any way extravagant. I should like to know whether it is now thought to be extravagant.

Is it now the settled policy of the right hon. Gentleman that the building of maternity and child welfare clinics has a low priority, or is this merely the result of some absurd ruling from the Treasury that, as the hon. Lady said, all Departments have to make a contribution? Has the word gone out that Government expenditure must be reduced by a certain amount and every Department must make a contribution? What a fatuous doctrine that is if one is deciding that it is necessary to restrict expenditure which was at one time thought essential and was voted by Parliament. If one decides that it must be restricted, surely the way to do it is to determine the priorities within the expenditure and deliberately pick out those which are less important than the others and not say that all Departments have to make some contribution. Has this been a sort of blind search for some contribution from the budget of the Minister of Health? If it has, why has he picked upon maternity and child welfare centres to make the contribution?

I have talked about policy in general terms rather than dwelling too long upon the problem arising in my constituency. I have done that because it arose in that way during question and answer in the House and because, naturally, I feel that those who have the privilege of speaking from the Front Bench should use the right to raise matters on the Adjournment as rarely as possible and only when large and general questions are involved.

I want to return at the end of my remarks to the case of the clinic in Middlesbrough. I want to know the right hon. Gentleman's policy. That is why I have asked these questions tonight. Apart from that altogether, is the case of the Park End Clinic now finally closed, or is the right hon. Gentleman, in view of what I have said, or in view of reconsideration of the matter since I gave notice of the subject, still willing to look at it again? Must it be put off until an indefinite date in the future when the Ministry is no longer required to make a contribution or when the lack of priority for maternity and child welfare centres as a whole has been abandoned, or is the right hon. Gentleman still prepared to look at representations which the local authority would like to make to him? In short, if a deputation came from Middlesbrough, would it be wasting its time entirely, or would the right hon. Gentleman be prepared to see it and discuss with it the possibility, after all, of continuing with the plan?

10.10 p.m.

The Minister of Health (Mr. R. H. Turton)

I am very grateful to the right hon. Member for Middlesbrough, East (Mr. Marquand) for providing this opportunity for a statement on and discussion of the whole issue of loan sanctions and Government policy on it. That is why I have taken this opportunity to reply to one of my predecessors on what is a matter of vital importance.

Let us get the history of this matter in perspective. On 26th October last year my right hon. Friend the Lord Privy Seal, then the Chancellor of the Exchequer, and the Minister of Housing and Local Government, in a circular or message, asked all local authorities to make a review of capital expenditure in view of the overload on the economy of excessive local authority capital expenditure. That was followed, as I am sure the right hon. Gentleman has not really forgotten, by the statement in the House by my right hon. Friend the Chancellor of the Exchequer on 17th February, when he announced the Government's policy on loan sanctions.

On that Friday, he began by saying: The Government have come to the conclusion that further measures are required to deal with the overload which has put such a strain on our balance of payments. Later, he went on to deal with the topic of loan sanctions and said: The grant of loan sanctions for other capital schemes of local authorities will have to be severely restrained, except where there are exceptional circumstances. The sanctioning Ministers will be sending out circulars to explain the new arrangements for the services with which they are concerned."—[OFFICIAL REPORT, 17th February, 1956; Vol. 548, c. 2665–70.] That imposed a virtual embargo on all new capital projects and extensions of existing schemes and a shut down on all loan sanctions for a period of at least six months.

My task has been to carry out this policy, having due regard to the priorities of the Service. The right hon. Gentleman will remember that in the debate in the House on 7th May, I stated my priorities absolutely clearly and, I thought, very definitely. The first priority was to improve unsatisfactory or inadequate hospitals, and to provide new hospitals. The second was to improve the mental and mental deficiency service. The third was to make due provision for the old.

Translating that list of priorities into action first meant that our present hospital building programme was to continue untouched. That means that this country will be spending on hospital capital expenditure this year £4¼ million more than in 1950–51. We shall be spending £13 million this year, as opposed to £8,830,000 in 1950–51.

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

The right hon. Gentleman must first take account of the change in value of money over the period and, secondly, take account not just of the period of one year, but of the period of greater capital expenditure, the year before 1950–51.

Mr. Turton

I think that the hon. Member is at fault in that. In the year before 1950–51, capital expenditure was slightly less. I am not making any point of that. I want to give the House a comparison between the two. The year 1950–51 was a fair year to take, because it was one when economic conditions were getting rather difficult, as they are at the present time. At all events, our hospital programme is going forward untouched, both for mental and general hospitals.

Secondly, because of my second priority, for mental deficiency, all applications for loan sanction for occupation centres are being accepted where need is established. That means that 20 occupation centres will be constructed in this year, at a cost of £274,000. Thirdly, loan sanction is being granted in respect of Part III hostels for the old, where the need is most urgent. More than 60 schemes will be in progress this year, and the total expenditure will amount to £2½ million.

Mr. Blenkinsop

Does the Minister suggest that the case which he knows so well, and which I have discussed with him so often—the Newcastle case—is not urgent from the point of view of the old people's welfare?

Mr. Turton

I have said that we have granted loan sanction where the need is most urgent. At the present time, work is in progress on 60 hostels, at a cost of £2½ million. We have made these exceptions from the broad rule with regard to loan sanction which was contained in the 17th February announcement. We must face the fact that the grant of loan sanction both for ante-natal clinics and for ambulance stations is not exempted from the general policy announced by the Chancellor on 17th February.

The only thing about the right hon. Gentleman's speech which surprised me was the fact that he was unaware of this. It was quite clearly stated by the Chancellor, and I sent out a circular on 17th February to all local authorities, announcing this policy and pointing out the exemptions, and saying that owing to the overload of local authority expenditure at present no new loan sanctions for these clinics could be issued for a period of six months. That does not mean that no local authority maternity and child welfare clinics are being constructed this year. Far from it. There will be 19 clinics under construction, of a total value of £269,000.

That, again, is a greater expenditure upon maternity and child welfare clinics than occurred in 1950–51. Although it is quite true that the expenditure is smaller than last year—and it must be remembered that last year's expenditure amounted to £505,000—it is greater than the 1954 figure.

Mr. Marquand

rose—

Mr. Turton

I think that I am going to answer the right hon. Gentleman's question, but if I do not I will give way to him. The question is—what will happen after this period of six months? The position will then be reviewed, although I cannot make a statement tonight as to what the result may be. As we have stated in the circular, a standstill order in regard to loan sanctions has been applied because of the overloading on the economy, and the position will be reviewed after six months.

Meanwhile, the whole question of the future rôle of maternity and child welfare clinics is under review by the Cranbrook Committee, as a result of the recommendations made in the Guillebaud Report. I want to refer to that Report, because it referred to a certain confusion existing in the organisation of the maternity and child welfare services. As stated in the Report, there is no doubt about the value and importance of clinics as part of our maternity services. That is made clear in paragraph 638 (3). But, as the Committee pointed out, it is a matter for concern and inquiry that the number of women attending local authority clinics has fallen.

I hope that in this period we shall gain not only from the Cranbrook Committee's inquiry but also from the consultations which I have initiated into the incidence of toxaemia in pregnancy. Meanwhile, we can look with satisfaction at the great improvement in infant mortality, where we have a new low record of 24.9 per thousand births over the year. I do not quarrel with the figures given by the right hon. Gentleman. I know Middlesbrough has an unhappy record, but I think that all over the country, including Middlesbrough, the position is being improved. There is a new neo-natal mortality low record of 17.3 per thousand births. I hope that the Report of the Cranbrook Committee and my consultations about toxaemia in pregnancy will help and inform us about how we may make even greater progress.

Mr. Marquand

May I now make the intervention which I wished to make earlier? The right hon. Gentleman was making a comparison with earlier years. The point is that during those earlier years, and since, large numbers of houses were being built on the new housing estates. Often it is only at this point, after a substantial number of houses have been built and great populations which will need the services of the clinics created, that the appropriateness of building the clinics arises. That is why in past years the number of clinics built may not have been so great. Surely, the argument of the Minister, that the number of women using clinics may be declining, is due to the fact that they have moved out to the new housing estates where there are no clinics available; and they cannot push their prams for long distances back into the town to use the clinics there.

Mr. Turton

That is a good reason why it would be helpful to learn what the Cranbrook Committee has to say. It may be that expectant mothers are making greater use of the doctors' surgeries, or are going to the hospitals. That is one of the things which I wish to find out. We are still going ahead with a substantial programme of construction of these clinics, although at the moment there is a standstill order for six months on the approval of loan sanctions.

Now I come to the problem at Middlesbrough. Having dealt with the general policy I wish to examine the problem at Park End. There are 10 clinics in Middlesbrough serving a population of 140,000. The Middlesbrough Council deserves great credit for that. The position there is well up to the average throughout the country, and a clinics was opened as recently as last year. A clinic at Park End was proposed at a cost of £21,000 to serve an eventual population of 10,000. But that estate is not completed. At present there is a population of only 6,000, and the facilities of the clinic will not be needed fully until the estate is completed.

The estimated cost is still above the average throughout the whole country. In fact, it is higher than the estimates for any similar maternity and child welfare clinic at present under construction anywhere in England and Wales. Therefore, I took the view, and my Ministry so informed the Middlesbrough Council, that the estimate should be reduced. We believe that the figure should be about the average of that for the clinics in the rest of the country, which would make it about £15,000. I hope that in the interval provided by this temporary ban on loan sanctions, the council will reconsider its estimate. I feel sure that the right hon. Gentleman would not claim that Middlesbrough should be able to build a more expensive clinic than any of the others.

I can assure the right hon. Gentleman that if the council can put forward a scheme for a clinic at the average cost, its scheme will receive due consideration when this standstill order ends. I know that the Middlesbrough Council has a very high standard. I am certain that it can reduce the cost of the clinic satisfactorily when the standstill order ends.

Mr. Marquand

Bearing in mind, of course, that this is a new housing estate and that the clinic must conform with the amenities, etc. It cannot be as it would be if it were built in an old part of the town. We have to have regard to the amenities on a new housing estate, and that may raise the cost a little.

Mr. Turton

I have the list here; some of the clinics are related to new housing estates and some are not. The present estimate was submitted during the period of the standstill order and was a great deal higher than any of the other estimates which have been approved and are going forward. Therefore, I hope it will be duly reconsidered and later resubmitted when the standstill order is over.

Question put and agreed to.

Adjourned accordingly at twenty-six minutes past Ten o'clock.