§ 3.43 p.m.
§ Mr. H. A. Marquand (Middlesbrough, East)
I beg to move, in page 2, line 1, at the beginning to insert:Subject to the provisions of subsection (4) of this section."?
§ The Chairman:
It would be convenient if the Committee considered the first two Amendments together. The second is in page 2, line 15, at the end to insert:(4) Regulations may provide that in discharge of any liability of a person under subsection (2) of this section there shall be credited to that person, in such manner and subject to such conditions as may be prescribed, the amount of any payments made by that person during the fifty-two contribution weeks immediately preceding the occurrence of the liability, being payments made in respect of charges under section one of the National Health Service Act, 1951. or under sections one or two of the National Health Service Act, 1952.
§ Mr. Marquand
I agree, Sir Charles. The first Amendment is only a paving Amendment for the second.
The Clause embodies the main principle of the Bill, namely, the establishment of a separate contribution for the National Health Service over and above the contribution which everybody makes, whoever he may be, however young or however old, in the form of taxation. Everybody in the country pays taxation of one form or another. Over and above that, we are asked to approve a special contribution from those who are insured under the National Insurance Act.
One is in difficulty in moving these Amendments, because they appear to accept the principle of the Bill to which we are opposed. I must explain, for although hon. Members will be aware of it those outside may not, that it is simply because of our procedure that I have to move the Amendments in this way at this stage. When we come to the Question, "That the Clause stand part of the Bill," we shall be able to 866 make clear what are our objections to the Clause.
For the moment, we have to assume that the Committee has accepted the Clause, although we hope it will not. On the assumption that the Clause be accepted, which, we hope, will not eventuate, we move, in effect, that the contributions which any insured person is expected to make to the National Health Service shall be offset by any charges which he may have been required to make for services rendered by the Health Service to him.
If the Clause were accepted, it would provide that in future there should be three forms of payment for the Health Service: payment from taxes, which all citizens pay; payment by contributions from the insured; and payment for particular services under the general service in the form of charges on the Health Service. Our Amendment suggests that if there is to be a contribution and if we are to have this new form of tax to pay part of the cost of the Health Service, at least it should replace the third form of payment to which I have alluded, the charges which are levied on the particular parts of the Service.
We dislike the contribution, but we dislike the charges even more. If we were forced to have the contribution we should at least find our opposition modified a little if, in the process, we could get rid of the charges. We suggest that persons who have had to pay charges ought not to pay contributions.
In commending the Bill to the House on Second Reading, the Minister of Health, as reported at col. 992, of HANSARD, said:After all, the facilities of the Health Service are available to everyone on a basis of equality. It is, therefore, reasonable, in my view. that there should be a contribution from everybody during the period in which they are fit and well towards the cost of a Service which helps them when they are sick, and in youth and in old age, when they do not contribute to it."—[OFFICIAL REPORT, 8th May, 1957; Vol. 569 c. 992.]I agree with the principle which he enunciated that it is reasonable that people should pay when they are fit and well and: should not pay when they are sick, and the Amendment gives the right hon. Gentleman an opportunity to incorporate in the Bill that principle which he himself enunciated. I believe that it is a 867 good principle. Indeed, I believe that it is the principle upon which the Health Service was mainly founded when the Acts establishing it were introduced in 1946.
The idea is that we should pay while we are fit and well and earning wages or other incomes, and then, when we need the Service, should receive it at that time, when we are unable to earn our incomes, without being asked at that point to pay. Apparently the right hon. Gentleman agrees with that principle. If he does, this is an apportunity to incorporate it in the Bill.
The charges under the National Health Service Act, 1952, are charges for dentures, spectacles, surgical appliances of various kinds, dental treatment and prescriptions. Let me remind the Committee that all these charges are in force today by virtue of the Act of 1952, an Act introduced by a Conservative Government and passed through the House with the help of their majority in the last Parliament.
It is true, of course, that the original charges for dentures and spectacles were introduced by an Act of 1951 to which we have, for technical reasons, had to make reference in our Amendment. Though we have had to make that reference, it is, of course, indubitable that the charges levied by the 1951 Act are in operation today solely by virtue of the 1952 Act. By the 1951 legislation, the charges for dentures and spectacles would have come to an end in April, 1954. They have continued since, and are at present in permanent form, by the Act of 1952. Therefore, we no longer have any responsibility for those charges being enforced. Though they remain enshrined in the Statute Book for 1951, they would not any longer be enforced had not the 1952 Measure been passed.
This, therefore, is the only Amendment which we could devise to provide that people who are now required to pay these charges while they are sick and ill should be relieved, to the extent of the charge that they have paid, of the liability to pay the new Health Service contribution. It is not, I agree, a perfect Amendment, because the Health Service contribution is levied upon those who pay insurance contributions, whereas the charges themselves, as we all know, bear 868 most heavily not upon people who pay those contributions, but upon the children, the mothers and the old people who are not required to pay contributions under National Insurance.
I recognise that the charges do bear most heavily upon those people, and the right hon. Gentleman might say in criticism of the Amendments that we are now considering that they would not relieve the most deserving cases. I admit that that is true, but, as I have already said, I am under the difficulty of having to propose Amendments to a Clause to which, in principle, I object in any case. What I hope we shall have, as a result of the Amendment, is serious consideration by the Minister himself of the principle which he enunciated on Second Reading, and which I have already quoted; the principle that he introduced this Bill partly to ensure that, as he put it,… there should be a contribution from everybody during the period in which they are fit and well …and not when they are sick and ill.
That is the purpose of the Amendment. Its clumsiness or lack of complete satisfaction is due simply to procedural difficulties. Though the Minister may well say that he cannot accept the Amendment as it is, I hope he will say that he now recognises that he is proposing to have a general contribution in addition to tax contributions from insured persons and that he ought to get rid of the charges; that it is quite illogical and absurd to introduce a Bill for a contribution on the ground that we should pay when fit and well, and then continue to exact charges from persons who are not fit and well—persons who require medicines, or spectacles, or appliances, or whatever it may be.
If he would go so far to meet us, he would do a good deal to remove our objections to the Bill. If he were to say, "I cannot do it under this Bill, but I will introduce another Measure and will get rid of the charges," then, indeed, much of the objection that we have, not in principle but as practical citizens, would be removed.
If, on the other hand, he can say nothing of the kind, but says, "I shall continue with this totally illogical situation—which I have myself described as illogical; I shall continue to have special 869 contributions and taxes paid while people are fit and well, but shall, in spite of that, continue to impose on the old people, the children, and the mothers of large families this heavy burden of having to pay for medicines, drugs, and sometimes for appliances which they need when sick," we must then press our Amendment and indicate our dissatisfaction with the Government's attitude to the whole business.
I hope that the right hon. Gentleman will feel, when he deals with this Amendment, that he can come some way to meet us. Let him, at least, say that he will get rid of some of the charges. If he were to say, "In this particular year I cannot go so far as that, but I will get rid of the most objectionable of them," he would be going some distance towards it. The most objectionable charge of all, of course, is the charge last imposed by the former Minister of Health—the charge of 1s. per item on the prescription instead of 1s. for the single prescription.
As we have said many times, that is an abominable charge. It is the worst and most loathsome of all these charges, and could not be justified by the right hon. Gentleman's predecessor except by saying that it was the only way he could raise £5 million or whatever the amount was. It was a comparatively small sum of money—I do not recollect exactly what it was, but the Minister must know. It was a miserable amount of money, saved in the most objectionable possible way.
I hope that the Minister will at least leave us that, and say, "I cannot get rid of all the charges at the moment, although I agree that there should be no charges and have said during the Second Reading debate that people should pay when fit and well, but not when sick". If he would say, "I should like to get rid of all the charges", that would make people think that the Government believed in some of the pledges which they put out at the last General Election.
If he could say that, and then add. "Though I am not able to go so far as that, since I am imposing this new levy I will at least offset it by abolishing this prescription charge altogether," that would give hope and comfort to the thousands, nay, millions who voted for the Conservative Party at the last General Election because of its promise to provide a better Service for the same money. 870 That was the promise contained in the Conservative Election manifesto.
Therefore, however clumsy this Amendment may be—and I realise that it has imperfections—it does provide the right hon. Gentleman with a golden opportunity, as Minister of Health, succeeding the right hon. Gentleman the Member for Thirsk and Malton (Mr. Turton), really to make a mark today, if he wishes, in the way in which he deals with it. I hope that he will seize that opportunity with both hands and make the best of it.
§ Mr. Raymond Gower (Barry)
I think that both sides of the Committee will recognise that the main objective that the right hon. Gentleman the Member for Middlesbrough, East (Mr. Marquand) and his colleagues have in mind might be deemed a very good one, but it is not by any means clear whether this Amendment would achieve that objective. Indeed, as he himself admitted, it is doubtful whether it would bring relief to those who are most in need of help. It may be that to help people who are in particular need other remedies might be more appropriate.
The right hon. Gentleman specified certain categories of persons, such as the older people, and widows and mothers, and it might reasonably be argued that the more appropriate way of helping such people would be to confer upon them the necessary increases in other National Insurance benefits which they receive from time to time.
I am open to correction from my right hon. Friend, but I imagine that there may be another objection to this form of words. The Amendment seems to identify the contribution and the charge together, and, although I may be wrong, I imagine that the contribution is something which is devoted to the whole Health Service, while the charge is specifically attached to a particular aspect of the Service.
We all recognise that the contribution is used in toto to sustain, among other things, such matters as the hospital services, while the charge is appropriated to a particular aspect of the Health Service. It may be objectionable—although, as I have said, I am open to correction—that an attempt is made to identify a part of the Service with something which is more appropriately related to the whole of the Service.
871 If I may say so respectfully, I thought that the right hon. Member for Middlesbrough, East made some remarkable party political points. He said that he dislikes the contributions, and he then said that he dislikes the charges even more. It seems peculiar that he should say that, in view of the fact that he was a member of the Government which introduced the principle of the contribution. Indeed, he was the Minister to introduce the Measure which first established the principle of the charges.
The right hon. Gentleman also said that he agreed with the principle that we should pay the doctor while we were well but not when we were ill. He and his hon. Friends have constantly advocated that more and more of this burden should be attached to taxation, which, of course, includes indirect taxation. It might be argued that when a person is ill his indirect taxation continues, whereas the actual contributions may he held in abeyance. In other words, the remedies which hon. Members opposite seek are more difficult to relate to illness than are the remedies which are in the Bill as it stands.
The right hon. Gentleman attributed the charges to the Act of 1952 passed by a Conservative Government, but I submit that that is a specious form of argument in view of the fact that the principle was definitely laid down by a portion of the party opposite in which the right hon. Gentleman was a leading light. Indeed, he introduced the Measure, rightly or wrongly, which established that principle. I agree that the motive for helping those in need is very good, but I doubt whether the instrument chosen in this Amendment is appropriate.
§ Mr. A. Blenkinsop (Newcastle-upon-Tyne. East)
I am very glad indeed to support my right hon. Friend the Member for Middlesbrough, East (Mr. Marquand) in his contentions. While in detail there may he some alterations that hon. Members may wish to make, the principle of the matter is clear enough.
I was not quite clear from the hon. Member for Barry (Mr. Gower) whether he objected to the general principle of the Amendment or whether he thought that the wording needed tidying up. If he feels that the wording needs to be altered, we will welcome his help, his 872 further suggestions and possibly support later in our discussions. If, on the matter of general principle, the hon. Member feels that charges should he imposed both while people are ill and when they are not. that we should have in a sense a duplication of the charges for which the National Health Service Bill provides, then we oppose his point of view.
I wish to emphasise. in particular, the very strong objections which are being expressed in my constituency, as in many others, about the effect of some of the charges. Like my right hon. Friend, I agree that we might very well have adopted a more friendly attitude to this Bill had it linked with its Proposals the abolition of the charges. at any rate, in some part. The feelings that are being expressed in my constituencv—and I do not pretend that they are peculiar to my constituency—relate to the effect of the prescription charges and particularly the addition which has recently been made to them.
I am glad to see the hon. Member for Putney (Sir H. Linstead) in his place. I have had a great number of representations from pharmacists in my division concerning many cases which they feel indicate extreme hardship due to the operation of these 1s. charges. Only the other day a further case was brought to my attention by a local pharmacist. He said that a lady in my division had brought to him a prescription that was clearly a few days old, although the prescription was very urgent. The lady said that she had not been able to bring it earlier because she could not afford the charge.
It is all very well for hon. Members opposite to scoff at the fact that these difficulties still arise, although admittedly people with average wages are able to meet certain payments. But the fact is—and it is demonstrated every week of the year—that these things are happening, and that there are many people who cannot immediately meet these charges. It is not just a question of 1s. sometimes the charges amount to quite a few shillings, and many people feel that they have to delay going to the chemists for some days. The effect from a medical point of view can be serious.
The pharmacist in the case to which I have just referred told the lady that she 873 should have gone to him in any case and that he would have dealt with the prescription whether she had the necessary money or not. I am sure that there are many pharmacists who hold that point of view. Nevertheless, these difficulties arise. There are other cases. Pharmacists have been reporting to me cases of people who omit items from their prescriptions in order to reduce the charge that they have to pay.
These are ridiculous matters for any responsible service. It is a disgrace that the Service should be reduced to this position. I should have thought that the right hon. Gentleman would have seized the opportunity of trying to put an end to this miserable charge as some kind of alleviation of the Health Service contributions that are now proposed. But not a bit of it. He is apparently welcoming both the charge and the contribution with open arms.
I should have thought that the Minister would have considered some of the points referred to by the Guillebaud Committee. We have the Committee's very clear views, in this case unanimous views, about dental treatment, for example. The Committee recommended a new approach to the question of charges for dental treatment. I am not saying that I regard that as sufficient or satisfactory, but at least it would be something. The Committee suggested that once people had a clean bill of dental health, from that date onwards they should not be expected to meet any further dental charges. It was the Committee's view that the charges for dental treatment constitute a very real hardship to the community and interfere with the value of the Service.
In fact, the Guillebaud Committee used these words:It seems to us that the charge for dental treatment is impeding a number of people from making use of the general dental service…So far as the existing charges are concerned, the Report goes on to say:…we would regard the reduction of the incidence of this charge as having the highest priority when additional resources become available.I agree that the Committee inserted that saving phrase.
Presumably right hon. Gentlemen opposite will always say that the additional resources are not available. They 874 always say that, but I thought that the Bill was making resources available and that that was part of its purpose. If the Bill is making any financial resources available, why should they not be used for this first priority which the Guillebaud Committee suggests? Surely that is a quite reasonable proposition. I do not see, therefore, why it should be impossible for the right hon. Gentleman to consider the basis of the case which we are putting forward.
The same point arises not only on dental treatment, but on charges for spectacles. The Guillebaud Committee, not merely a minority in this case, but the whole of the Committee, said:It seems to us that the level of the charge for spectacles is such as to constitute a barrier to a proportion of the people who need to make use of the service; and we recommend that, when the resources become available, a fairly high priority (second only to an adjustment of the dental treatment charge) be given to a substantial reduction in the amount of the charge for spectacles.The right hon. Gentleman has said nothing to show that he regards that as being as important as the Guillebaud Committee regarded it.
I should have thought that he would have been glad to sweep away some of the other disgraceful charges, for example, on appliances, which are effective today. This would have been an opportunity for him to have done just that. Let him not imagine that there is not very strong feeling in the country on this subject. Many people seem to give the impression that because the average level of earnings is, we are glad to know, relatively high, charges do not constitute a barrier to very many people in a community. But very many among the lower-paid workers and many others who, for one reason or another, may not be able or not want to claim National Assistance, find them a barrier.
The other factor which we have had so prominently brought to our attention, even if we did not know it before, has been demonstrated by an investigation into the care of old people in Salford, in which it was found that many people, even though they could have claimed National Assistance, do not do so. There are very many people who do not want to make claims and who are caused additional hardship by the health charges. Again, one would have thought that the 875 right hon. Gentleman would have regarded that as a useful lever in his arguments and discussions with the Treasury.
One knows that the right hon. Gentleman is not an entirely free agent in matters of this sort and that the Treasury has very strong views on them. That being so, one would have thought that the right hon. Gentleman would have attempted to use some diplomacy and would have agreed to a proposal of this kind, for an additional flat rate contribution, only if he could get, on the other side, some remission of charges which are already becoming intolerable. One would have thought that as Minister of Health he would have taken an opportunity of this kind.
It is very disappointing to hon. Members to find that he has either attempted to do so and failed, or has not attempted it. Many hon. Members feel that it would have been better if the whole wretched Bill had been handled by the Treasury rather than the Minister of Health. It is very disappointing to find the Minister of Health having to discuss questions of this kind rather than important health matters which we are all eager to discuss. I can only reinforce the case made by my right hon. Friend again urging that even if the wording of the Amendment does not prove satisfactory, the right hon. Gentleman will give serious thought to the general principles.
I very much hope that the hon. Member for Putney will feel able to comment on, or to reinforce, some of the things I have said. Certainly, our experience of pharmacy and the other evidence which comes to us is in the same direction, that the position for many people in our constituencies is becoming very serious. After all, it is the pharmacists who are, as it were, almost in the front line and who receive evidence perhaps even before it comes to hon. Members. On those grounds, I very much hope that the right hon. Gentleman will be able to show his willingness to consider our proposal.
§ 4.15 p.m.
§ Mr. Philip Bell (Bolton, East)
It is interesting that the right hon. Gentleman the Member for Middlesbrough, East 876 (Mr. Marquand) and the hon. Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop) made it quite clear that this is not merely a Committee point, but involves a big difference of principle between the two sides of the Committee. I found it very disappointing that neither hon. Member should have said how much the proposal will cost. However much we may think that something is desirable, we must find out from where the money is to come. The Amendment involves more money being spent.
Let us take an extreme example. Supposing that the proposal in the Amendment costs £100 million—I know that it does not—would the same arguments be used? Would hon. Gentlemen opposite say that they do not mind whether the proposal costs £100 million, that they must have it because of a grave injustice, and that the country is suffering under these charges? It would not have been said if the cost had been £100 million, so there is very little justification for the elaborate statements that everybody is groaning under these charges.
Let us find where we can agree. We can agree that there are some people who are so poor or so ill that they must he assisted and not charged anything. However, there is already provision for that in National Assistance benefits and for repayment of the money paid under the recently imposed charges. At any rate, that will help the people who are poorest.
Now comes the division. The Opposition say that irrespective of whether someone can afford it, irrespective of whether he is getting £20 a week, £200 a week, or £2 a week, he must have his aspirins paid for by all the taxpayers.
§ Mr. W. A. Wilkins (Bristol, South)
I thought that hon. Members opposite wanted the classless society which they are always advocating.
§ Mr. Bell
I do not know what the hon. Member means by "classless society". Perhaps we can discuss that on another occasion.
I was saying that that is a point of view, that everything should be paid for irrespective of means. I can understand it, but I am bound to say that we have to consider where the money will come from. We must still look at the cash. There is no top limit to what can be spent on 877 medicine. We could have people X-rayed every week, if we had the money; we could have their doctors visit them every fortnight, if we had the money; we could have their teeth inspected every month. if we had the money. I have no doubt that everybody would be better off if that were done, but, in fact, we have to have a practical limit.
We take a view different from that of the Opposition, not because of a slogan about a classless society, but because some of us think that first things should come first and that, on the whole, we are more likely to help the urgent needs of the Service. more likely to have more money for hospital beds and new hospitals for large numbers of people, if we do not spend too much on people who can, without any inconvenience, afford to spend it for themselves. That is why we have heard this half-hearted nonsense that some people object to the Amendment.
It is a matter of whether it is better for the whole of the people to charge a few of the people for some things, so that money is not simply thrown away, or whether to make the payment irrespective of means. This is an honest and genuine disagreement. One person thinks one way and another person thinks differently, but it is a genuine matter of difference. I regret very much that it should be suggested that our attitude is dictated by anything except a difference in weighing up what is better for the Health Service.
It was once pointed out by a distinguished right hon. Gentleman opposite, in a phrase which most of us remember, that torrents of medicine were being poured down people's throats. [HON. MEMBERS:" Cascades."] There is another argument—
§ Mr. Blenkinsop
Is the hon. and learned Member aware that rather more cascades are now going down, in spite of the charges?
§ Mr. Bell
That is the interesting thing. It shows that the charges do not seem to be putting people in the grave distress of not being able to obtain the attention that they need. Although the amount of medicine now going down people's throats is greater, I doubt whether people's health is improved as a consequence.
878 The Clause, which raises the question whether charges should be made, involves the payment of money. We need to know what amount is involved by the Amendment and to weigh it against the hardship that is being caused. The hon. Member for Newcastle-upon-Tyne, East did not state the amount involved and I hope that my right hon. Friend the Minister can tell us. The hon. Member told us something of the inconvenience which people suffer, but I did not find his argument really strong. I have not noticed any desperate condition which must be relieved.
If, however, a proposal on the lines suggested by the right hon. Member for Middlesbrough, East is accepted, I hope people will face up to the fact that there must be either increased payments or higher taxation to deal with it, and not merely to deal with it but to enable a lot of people who can now well afford a few shillings not to pay these few shillings. I should have thought that in the present state of our economy we are not behaving like realists if we accept what are well intended but, when looked at closely, only sentimental points.
§ Mr. W. Griffiths (Manchester, Exchange)
The Committee should be grateful to the hon. and learned Member for Bolton. East (Mr. Philip Bell), who has reminded us once again of what one might call the classical philosophy of the Conservative Party in its approach to social security. There were many Tories —and they were in the House of Commons—who disapproved of the whole principle of the National Health Service, for they voted against the Second Reading of the Bill and at the end of the day, after many hours of anxious inquiry in Committee, when the Bill came back to the House they voted against the principle on Third Reading. From their point of view, why should they support such a policy of redistribution as envisaged in Measures like the National Health Service Act?
Many Conservatives who speak just as the hon. and learned Member for Bolton, East has spoken this afternoon have never been worried about having to pay for medicine or professional advice in their lives. They might have had to pay for lawyers, but payment for doctors, dentists, chemists, ophthalmologists and 879 opticians has never been a matter of concern to them. We are grateful, therefore, for a restatement in 1957 of the Conservative case.
I support wholeheartedly the intentions underlying the Amendment. As my right hon. Friend the Member for Middlesbrough, East (Mr. Marquand) said, it has been extremely difficult within the procedure imposed upon him to frame an Amendment which would adequately meet the case he has put forward. However, I do not know whether he is any more optimistic than I am. I doubt very much whether we can hope for anything more from the present Minister of Health, the latest in a melancholy line since 1951. All of them have imposed a further cut upon the National Health Service during their occupancy of that office.
§ Mr. Griffiths
Crookshank did not last long enough.
Of course, the great occupant of that office was the right hon. Gentleman who is now Minister of Labour. He was promoted to stardom on the basis of revealing from the back benches a knowledge about the minute details of the National Health Service which nobody in either the party opposite or this party suspected. The party opposite was so astonished that the right hon. Gentleman at once had his meteoric rise to fame and was promoted to the Front Bench.
Even that right hon. Gentleman, however, in an unguarded moment, added his testimony to the philosophical approach of the Conservative Party to the National Health Service. He did not say that the charges were necessary merely for an interim period, as my right hon. Friend was obliged to say in 1951 and as he rightly reminded us today. Those charges would have expired and been finished with but for the action taken by the present Government.
The present Minister of Labour did not seek to justify the charges on the grounds of the economic difficulties facing the nation, to which the hon. and learned Member for Bolton, East has referred. The right hon. Gentleman said that he was in favour of charges not only on financial grounds, but on social and 880 ethical grounds. If the Minister of Health really wants to know what are the social and ethical consequences of these charges which he seeks to perpetuate, let him go, for example, to the chain stores.
My hon. Friend the Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop) referred to the recommendation by the Guillebaud Committee that as a second prority there should be a removal of the charges on spectacles. Very well. Let the Minister of Health go to the chain stores, to Woolworth's, and observe the people who are trying to choose far themselves a pair of spectacles. He will see that the vast majority of them are elderly people. He will find, if he troubles to make inquiries, that the sales of such spectacles have boomed considerably in the past six or seven years. He will find, also, in his Department an abundance of qualified advice that this may well be a contributory cause to the incidence of blindness.
§ The Minister of Health (Mr. Dennis Vosper) indicated dissent.
§ Mr. Griffiths
There is such opinion. I do not want to argue it in detail, but it is the opinion of many experts that that is a contributory cause, and I will say why.
A person who has reduced visual standards seeks to remedy those reduced standards of his own volition and without skilled professional advice. It is quite possible that that person may be in the early stages of a serious pathological condition which would be detected if skilled advice were sought. The reason these people do not get the skilled advice is that they cannot meet the charges entailed in obtaining it. Let the right hon. Gentleman deny that if he can.
There are very large numbers of people who are really burdened by the charges. It is no use for the hon. and learned Member for Bolton, East saying that the worst-hit people can have recourse to the provisions of the National Assistance Act. This is quite extraordinary. The hon. and learned Member really does not know what is happening in Lancashire, part of which he and I represent in the House of Commons. The fact is that there are a large number of sick and aged people, and people who are temporarily off work, who do not have 881 recourse to National Assistance and who, if they applied to the National Assistance Board for such help, would be refused it. That is quite apart from the fact that the lower-paid wage earner is nothing like on the scale to which National Assistance applies. It is not true that this is a very small thing. Anyhow, on this side of the Committee, we reject this business of applying different standards in a National Health Service to different sections of the community.
We support the principle of a free National Health Service because we believe that the £200 a week man, the wealthy man, should have appliances free like anybody else, but we reckon that in our system of taxation we shall see to it that he makes an appropriate contribution towards the whole. This is the social gulf between the two sides of the Committee. We, on this side, believe that the highest priority should be granted to the weakest in the community and that the strong should make the maximum contribution.
As to the "cascades of medicine "and the level of expenditure that the Health Service has reached, we should remind ourselves that much of the control of the public money is vested in the hands of professional men and women who are employed in the Service. It should never be forgotten that the cost of drugs is related to the prescribing done by the general practitioner. If the general practitioner had had the courage and integrity —as I am sure many of them have, though some certainly have not—to bear that in mind in treating the sick we should not have had much of the expenditure that we have had in the past.
We, on this side of the Committee, will continue to put forward, when opportunity and time permit, the kind of proposals that we have put forward today to restore the Health Service to the free service that its designers produced and had in mind to expand, and, as soon as possible, take it out of the hands of this melancholy series of Ministers of Health whose function, in the past few years, has been to mutilate what was a grand idea.
§ Sir Hugh Linstead (Putney)
The hon. Member for Manchester, Exchange (Mr. W. Griffiths) used the phrase "a cut in the National Health Service" in relation not 882 only to my right hon. Friend, but to his Conservative predecessors as Minister of Health. I am fairly certain that the costs of the Service have steadily increased over recent years and that there has been no sign of a cut in the ordinary financial sense in the financing of the Service.
§ Mr. Blenkinsop
I am sure that the hon. Member will agree that there has been a cut in real terms and a very serious cut in the earlier years of this Administration's life in capital expenditure on hospitals, for example.
§ Sir H. Linstead
If the hon. Member defines "cut" in such a way as to give it a specialised meaning, I have no doubt that he can make a case, but from the ordinary point of view of the use of the word "cut" one would assume that the statement made by the hon. Member for Manchester, Exchange meant that expenditure on the Service had been cut. I am certain that in the past four or five years expenditure has steadily increased. If hon. Members define "cut" in a highly specialised way they can make it prove what they like, but "cut" in the ordinary sense surely means spending less money than previously.
§ Mr. W. Griffiths
I will define very simply what I mean. There are, in 1957, a number of services which were available to all without charge and which now bear a charge as a result of action by Conservatives.
§ Sir H. Linstead
In that case, the hon. Member will disagree with my further comment on his speech. As I see it, these charges do not constitute a cut in the Health Service. They constitute providing that Service with funds in a manner that will enable us to expand its services. The practical effect of the Amendment would be to reduce the amount of money which would be available for the expansion of the Health Service. By any ordinary interpretation of "cut", the cut will come if the Amendment is accepted. It will not come if the provisions of the Bill are left as they are.
The hon. Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop) asked me about reports of individual cases of hardship. I have no doubt that here and there in the country there are still cases of hardship and of pharmacists who, out 883 of a general sense of charity, are providing medicine without collecting the shillings, but I personally have not had brought to my notice any cases of hardship in recent months. I asked my hon. Friend the Member for Barry (Mr. Gower) and my hon. Friend the Member for Ilford, South (Mr. Cooper), both of whom are here, and they told me that in the last two or three months they have had no such cases of hardship brought to their notice. I do not say that they do not exist, but I am objectively reporting my personal experience in the light of what the hon. Member for Newcastle-upon-Tyne, East has said.
§ Mr. Blenkinsop
I am sure that the hon. Member will agree that pharmacists in many parts of the country have passed very strong resolutions urging the Government to reconsider this very point.
§ Sir H. Linstead
I have no doubt that such resolutions were passed when the charges were originally introduced, but in the last three or four months cases of hardship have not been brought to my notice.
§ Sir H. Linstead
No, I am sorry. I do not think that I should give way again. I think that we have disposed of that point.
We are discussing, on the Amendment, our priorities in the Health Service. The case for the Amendment is based on the fact that the first priority in the Service is to remove the charges. I cannot see that this really is the first priority. Suppose the Amendment had the effect of handing back £5 million, £8 million or £10 million by way of refund of charges. I cannot feel that that would be the best way of spending £5 million or £8 million if the Minister had that money available.
It seems to me still that in the Health Service, ahead of a refund of charges, I should put the mental health service as the first priority for' any money the Minister has available. I should put second the tuberculosis service, because of its impact upon the young and upon public health generally. I should put third the condition of some of our hospitals, particularly those for the chronic sick.
884 Until I had those three priorities out of the way, I do not think that I should come to refunding money to those who are in work, because it would be those in work who would get their money back. It would be only somewhat low down in the scale of priorities that I should put a refund of several millions of pounds to those people.
This question of priorities dominates the discussion on the Amendment. I am quite clear that the priorities of mental health, of the treatment of tuberculosis, and of the provision of hospitals for the chronic sick should come before refunding charges to those who are in work.
§ Mr. Douglas Houghton (Sowerby)
I think of most matters in terms of taxation. This scheme of National Health contributions is a form of taxation. In fact it is a Budget tax which was announced before the Budget. The only additional tax in the Budget was the television duty. This scheme is just as much part of the budgetary framework as anything else that the Chancellor announced at that time.
The Amendment seeks to provide a form of tax relief. The idea is that those who pay charges in one year shall receive either a refund or a set-off against National Health contributions in the following year. The Minister, among other criticism of the Amendment which he may make, will probably tell us that this would be an administrative nightmare. Of course, it would. We do not like this Amendment any more than the Minister does. We would have preferred to achieve its object in a different way; but since we cannot bring forward an Amendment under this Bill to abolish charges, we thought that to have a "back-hander" at the charges, if we could do so within the rules of order, was a perfectly logical standpoint.
We take the view that the charges were introduced into the Health Service at a time when it was thought that the total expenditure on the Health Service was getting too big to be borne out of general taxation. It was the prevailing thought for some time that the two methods of financing the National Health Service were Exchequer grant out of general taxation and the health charges.
885 Now we have a third leg of support to the National Health Service—the National Health contribution. We think that if we are to have National Health Service contributions then the charges ought to go, but as we cannot propose their abolition as an Amendment to the Bill, we think that it is only right that those who pay contributions and also pay charges should be relieved of the payment of charges by a refund or setoff against the contributions for the following year.
The charges which may be made under the Health Service may. I know, be used as a kind of contribution to the other parts of the Health Service in need of expansion. The hon. Member for Putney (Sir H. Linstead) said that if he were looking at the priorities of the Health Service, the abolition of the charges would not be the first one. if I were to say that we would make it the first priority, that is not to deny the need for expansion of the Health Service in other directions. especially in regard to the treatment of mental health.
Charges run counter to the very principle on which the Health Service was introduced. That is our objection. It really does not matter whether they are large or small, over a wide area or a narrow one. We think that it is in conflict with the principles of the Health Service that a charge should be made for the services when they are required. We believe that payment for the Health Service should be made at all other times except that at which the services are required.
There may be a difference of opinion as to whether the Health Service should be wholly financed out of taxation or partly financed out of taxation and partly out of a National Health contribution of this or some other type. We should certainly enter into debate on the relative merits of the methods of financing the National Health Service. Those of us who believe in the principle of the original National Health Service are certainly united in the view that we should not make charges for services when required, whether in sickness or in health. There is really no difference between the two. That is why we shall, in due season, be opposing the Motion "That the Clause stand Part of the Bill." 886 We ask the Minister to consider the conflict in principle between levying charges alongside contributions.
I wish it to be clearly understood that in opposing charges and wanting a rebate of them through contributions we are fully conscious of the need for an expansion of the Health Service in a number of directions, but we do not think that that should be obtained, by means of prescription charges or charges for appliances, etc., provided for under the existing scale of charges under the Health Service.
This is, therefore, perhaps a clumsy way of ventilating our point of view on the relationship between charges and contributions, but it is the only way in which the rules of order enable us to do it, and we hope that when the Minister replies he will have something to say about this important conflict, as we see it, in principle between the levying of charges, the imposition of contributions and the general levy of taxation overall. We ought to get the financing of the Health Service straighter than it is and not drift into a collection of levies and impositions and a kind of empirical hand-to-mouth approach to the National Health Service, which was founded on a noble conception and, as we thought at the time, on very firm financial principles.
§ Dr. J. Dickson Mabon (Greenock)
I am very glad that my hon. Friend the Member for Sowerby (Mr. Houghton) underlined the objection that we have to the point raised by the hon. Member for Putney (Sir H. Linstead). The hon. Member for Putney used a rather peculiar phrase—and I listened very carefully to him, because I thought that he would be one of the first Conservatives to announce his complete conversion to the idea of a Health Service devoid of charges. I can say that he has managed, in his pronunciation of sentences in that passage, to avoid saying that.
The hon. Member has only argued the point that as a first priority there are other things that come before the abolition of charges. He gave me the impression that as the conscience of the Conservative Party he secretly believes that the charges ought to go some day. I hope that that is the case. I would hope to see a gradual conversion in the ranks opposite that we would wish to see 887 the day when charges would go no matter what priorities are in the minds of hon. Members opposite at present. I do not think that would be a fair assumption to make at the moment, when one considers the speech made earlier by the hon. and learned Member for Bolton, East (Mr. Philip Bell).
The hon. Member seemed to be advancing in the true light of the former Minister of Health, but one who claimed that the charges were sound not only for financial reasons but also for social reasons. There is, therefore, now a split in the Conservative Party.
§ Dr. Dickson Mabon
One among many others.
I have no wish by any means to discourage the part of the split with which I agree, that is, the part which seeks to try to get the charges abolished. The hon. Member for Putney argued the case about the sequence of priorities. It may well be true that charges from all points of view may not occupy the first priority. I personally do not agree, but it may well be true. I put this to him. If one is to look at priorities within the Health Service and come to that rather awkward conclusion, would it not be fairer to lift one's eyes a little higher and see priorities in their national sense, throughout the whole compass of the Exchequer?
How is it possible to argue that charges, while not being a first priority, are so well behind in the list and are beaten by the Surtax payers? If the hon. Member comes before us as the disciple of priorities—and I submit, that, as a right hon. Friend of mine has said, Socialism is the language of priorities—and maintains that the charges are not first priority, he has to look at all the priorities throughout the system. Does he honestly think that Surtax payers come before health charges? There are numerous other items that could be mentioned in the recent concessions which have been made and in the concessions which have been made over the last five years. They cannot be said to come before health charges.
I cannot believe that the hon. Gentleman, occupying the position which he does, can really have health charges so well down the list of priorities with 888 mental health, tuberculosis and the care of old people just slightly above the health charges, but still below the Surtax payers. The more one analyses the argument about priorities the worse it gets. All these fine and commendable things to which I have referred should stand before the concessions which have been made in favour of the better-off sections of the community.
I do not believe that the hon. Gentleman can honestly hold to such an opinion. I believe that, since he is a believer in priorities, he will look at the matter again. It may be that he will find himself supporting our Amendment. After all, being in the position in which he is, he will, I am sure, shortly receive from the many pharmacists throughout the country excellent testimony about what is going on as a consequence of the charges imposed last December.
Reference was made earlier to the fact that many hon. Members find that people are asking their chemists to give them only one medicine of the four or five medicines prescribed. In the back of a chemist's shop I have seen E.C.10 forms bearing four items, but three of them have been scored out because the person concerned is unable to pay the extra 3s. Since this has happened in my constituency and I know many of the cases, even knowing them professionally, I can say that many of these people are doing without medicines which they ought to have. It vitiates medical practice badly when a patient decides which medicine out of the three or four medicines prescribed for him will be most valuable for him.
The hon. Member for Putney must know that the ordinary person cannot judge reasonably and accurately which of the medicines prescribed are vital to his well-being. Indeed, one assumes that all the medicines prescribed are well meant and that all should be taken. Where even one or two are discounted, how is the person concerned to know which he must have and which he may leave? Also, should a chemist assist a patient in discounting medicines prescribed by a doctor? I wonder what the ethical position of pharmacists is in consequence of such a thing happening.
This matter vitally concerns the hon. Member for Putney and his profession. The Amendment is redemptive in character. The hon. Gentleman can save his 889 pharmaceutical soul if he supports an Amendment of this kind. He can join the Minister in this matter, because he, as my hon. Friend the Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop) said, has the opportunity to tell us that he will accept the Amendment, or some form of words embodying the substance of our claim.
Surely the right hon. Gentleman will, in this redemptive mood, say that he realises the imposition placed on many people by the charges, and that, because the National Insurance contribution is to rise in this regard, he will be able to reduce charges in some other sphere. The spheres from which he can choose include surgical appliances, drugs, spectacles and dentures.
The right hon. Gentleman has before him the Guillebaud Report, now the bible of the National Health Service. He now has a wonderful chance to be the first really sound Conservative Minister of Health. The rest have all been good in the financial sense. for they have suited the Conservatives and carried out their philosophy well, but they have been damaging to the National Health Service, which has been the prisoner of the Treasury since 1951.
The Minister will probably tell us that he has argued this with the Treasury and has failed miserably. or he will put it in such a keenly diplomatic way that even though he does not say that to us direct we shall all know about it. The political commentators will say, "Here is a confidential agent for the Health Ministry working against the Treasury."
§ Mr. William Ross (Kilmarnock)
My hon. Friend is taking too much for granted in respect of the Minister of Health. The right hon. Gentleman is not the only Minister responsible. There is also the Secretary of State for Scotland. I am sure that the Minister of Health will say that he was in favour of accepting the Amendment, but the Secretary of State for Scotland just would not have it all.
§ Dr. Dickson Mahon
Knowing the Scottish Ministers responsible for health matters, I am delighted to be able to deal with Scottish affairs through the Minister of Health. I much prefer to deal with the right hon. Gentleman. I find it more 890 awkward to deal with my own people. Whatever I say to the right hon. Gentleman about health services applies for the purposes of this argument not only to England and Wales, but to Scotland as well.
If he has had negotiations and has failed, I should like the right hon. Gentleman to say something which will allow the political commentators to say, "We have a Minister of Health with a backbone. Here is a man who is able to stand up to the Treasury. On this occasion he has been unsuccessful in securing a concession from the Treasury, but we have high hopes that if the Treasury puts any more pressure on the Ministry of Health the Minister will stand firm or resign.
On the other hand, it may be that the right hon. Gentleman is not in a position to do so because, as my hon. Friend the Member for Newcastle-upon-Tyne, East suggested, he has not argued the case with the Treasury. If that is true, the right hon. Gentleman should be ashamed of himself and has no right to be Minister of Health. He would be completely blind to the reports of his officers if he did not know that there is a great deal of anguish over the prescription charges.
There is the British Medical Association, with whom the right hon. Gentleman is on such friendly relations at present. What is its opinion about charges? Is it against the charges solely on administrative grounds because the doctors do not want to operate such charges? Not at all. The resolution passed by the B.M.A. stated that, in relation to the practice of medicine, the charges are unsound and unworthy of the country. The Medical Practitioners' Union is also on record against the charges. In fact, the two bodies representative of doctors are against the charges on strictly professional grounds. I cannot believe that there is not already in the Ministry sufficient evidence to show that the charges are wrong, and I am convinced that the Minister ought to make a concession.
The hon. and learned Member for Bolton, East (Mr. Philip Bell) said that the amount involved might run to about £100 million.
§ Mr. Philip Bell
I did not say that. I asked whether, supposing it went to £100 million, the hon. Gentleman would use the same argument. All he said was 891 that it would not be £100 million. and he did not answer the point. Would he say that it would cost £100 million?
§ Dr. Dickson Mabon
The hon. and learned Gentleman has rescued himself now by making the point hypothetical. but at the beginning I did not get the impression that it was hypothetical. He referred to £100 million, and his subsequent words suggested to me that he was as remote from the problem itself.
The fact is that these charges cost about £5 million, which is the estimated charge for prescriptions plus a very small amount for surgical instruments and other services of different kinds. We are dealing with what are, in fact, infinitesimal amounts compared with the Votes for the Army and the Navy or, indeed, compared with the large tax reliefs given in the recent Budget.
These are such fiddling amounts that the hon. and learned Gentleman ought to wonder whether they are worth while arguing about in relation to the social misery consequent upon them. If he feels that, socially and ethically, the charges ought to remain then, surely, he would admit that there are certain charges, such as prescription charges, which hit the community harder than others. Therefore, I hope that whatever pressure he can put on his Minister he will put in order to get a remission of a charge of this kind.
I hope that the Minister will look at the Amendment reasonably and will be able to say that he can see his way towards meeting it, at least in some respects. If he cannot, he will simply be adding his name to the other two Ministers of Health who preceded him and who have done such a lot of damage to the whole concept of the National Health Service.
§ Mr. Vosper
I am certainly not going to take the right hon. Member for Middlesbrough, East (Mr. Marquand) to task for referring to what he called the inadequacy of the Amendment because I realise the difficulties involved in framing an Amendment of this nature. I am glad that the right hon. Gentleman pointed out that, of course, its weakness lies in the fact that it would not help those who are 892 the most deserving because such people either do not pay contributions or get a refund of the charges from the National Assistance Board.
Persuasive as the right hon. Gentleman and his right hon. and hon. Friends were, he will not be surprised when I tell him that I do not intend to accept the Amendment because it is contrary to the intention of the Bill, which is that contributions should be paid by all insured persons, irrespective of charges. I am not quite certain whether right hon. and hon. Members opposite realise that the Amendment apparently does not include prescription charges as being subject to refund. if they have prescription charges in mind, it would, I am advised, be necessary to refer to the 1949 Act as well as to those Measures referred to in the second Amendment.
I gather that the purpose of the Amendment is to include prescription charges as well as charges for spectacles and dentures and dental treatment. Therefore, as my hon. and learned Friend the Member for Bolton, East (Mr. Philip Bell) pointed out, it has to be considered in reference to the cost. The estimated yield for the current year, 1957–58, is, for spectacles, £6.3 million, for dentures and dental treatment, £9.5 million, hospital charges other than bed charges, £.5 million, prescription charges, £13.8 million, making a total for the current year of £30.1 million. If the hon. Member for Greenock (Dr. Dickson Mabon) considers that to be a fiddling amount, then he is a wealthier man than I thought he was. To me, as the Minister of Health responsible for the Service, it is a large amount.
§ Mr. Vosper
The figures refer to Great Britain as, indeed, do all my arguments.
It therefore follows that if I accepted the intention of the Amendment it would reduce the money available for the Health Service by the equivalent amount, or, alternatively, would increase the burden on the general taxpayer by the same amount.
In my Second Reading speech, I pointed out to the House that the Financial Memorandum to the 1946 National 893 Health Service Bill anticipated that the contribution from Exchequer funds towards the Service would amount to 72.4 per cent. of the total. In 1949–50 that percentage rose to 76.3 per cent., and last year to 80.2 per cent. of the total.
The point that I wish to make to the Committee is that the total income from contributions under the Bill in a full year, together with the total income received from charges, would make the Exchequer contribution 74.1 per cent., still well above the figure envisaged in the Financial Memorandum to the original National Health Service Bill and not much below that for the first full year of the working of the Bill.
As a result of this Bill, contributions in a full year will bring in 11½ per cent., and charges, which are the subject of the Amendment, will bring in 51½ per cent. The point that I particularly want to make is that those two items together come to just over 17 per cent., which will still be less than the 20 per cent. anticipated in the Financial Memorandum to the original Bill. As I have already said the Exchequer contribution will be more than the anticipated figure.
The right hon. Member for Middlesbrough, East quite correctly quoted my reference on Second Reading. I said that, generally speaking, I was in favour of the principle that those who were fit and well should pay for those who were sick. I agree. If the imposition of the charge meant that those who are sick would have to meet a large proportion of the cost of the Service, I would, of course, have to accept the Amendment. But the proportion falling on the Exchequer is still nearly three-quarters of the whole, those who are fit and well pay a further 11½ per cent and the proportion borne under the charging scheme by those who are sick is still only 5½ per cent. of the total cost. Therefore. I do not think that my Second Reading speech is invalidated because I cannot see my way to accept the Amendment.
If the right hon. Gentleman had gone a little further and suggested that instead of doubling the contribution, the Bill should treble it to cover the loss of £30 million from removing charges, I should. of course, have had to consider that request. But the Amendment does not do that, It merely asks me to remove the charges. The hon. Member for Sowerby 894 (Mr. Houghton) used the words "administrative nightmare." I had not thought of that, and I wondered why I had not, but the right hon. Member for Middlesbrough, East, who has been Minister of Health, will realise that, even had I been in favour of the Amendment, it would be administratively almost impossible to do what it requires. The patients would have to keep a record of their charges and the contributors would have to incur either different rates of contributions or else the same rate of contributions for a differing period. In any case, to administer a scheme of this nature, or anything approximating to it, would be a matter of extreme complexity. Therefore, for this further reason, I feel unable to accept the Amendment.
There is a further point, which is that the provision of finance was, I think, not the only reason for the introduction of charges under the scheme. Both my predecessors and right hon. and hon. Members opposite have made this point on previous occasions. The charges under the scheme, as well as being a means of raising revenue, are a means of canalising the available resources, which we accept are limited, to those sections of the Service which need expanding— the point so well made by my hon. Friend the Member for Putney (Sir H. Linstead)— and, furthermore, of preventing abuse such as over-prescribing or, perhaps, over-concentration on dentures at the expense of dental treatment.
I do not believe that the policy in that respect has been unsuccessful, because for the year just ended the number of dental courses, as opposed to the provision of dentures, was 10 per cent. higher than the figure for the year prior to the introduction of dental charges. I think the Committee knows that children, the all-important class, are now getting 30 per cent. of the total dental courses as compared with only 7 per cent, before the introduction of the charges. As a result of charging, there has been a tremendous switch of resources to the priority and needy classes.
§ Mr. W. Griffiths
Can the Minister tell us how charging the patient could prevent over-prescribing?
§ Mr. Vosper
So far as dental treatment is concerned, the charging policy has 895 meant a switch of resources away from dentures to the more important work of conservative dental treatment.
§ Mr. Vosper
The answer to the question asked by the hon. Member for Manchester, Exchange (Mr. W. Griffiths) is that the charging policy was designed in part to switch the resources to where they were most needed.
It was the hon. Member for Manchester, Exchange who raised the question of sight testing. I would agree that we should not at this stage anticipate what may or may not be in the forthcoming opticians' Bill. He made the point, and I accept it, that there may be cases when old people are deterred from going for sight tests because they can get cheap pairs of spectacles, but in the last year, 1956–57, the number of sight tests in this country—I am speaking of the United Kingdom— was an all-time record. There was a concentration on the most deserving categories.
Prescriptions have been the subject of several speeches. I must disagree with the suggestion of the hon. Member for Greenock that the prescription charge is causing grave hardship, because the advice that I have received— and I have taken great trouble to get this advice— is to the contrary. There have been cases of hardship, but, as I have told the Committee, I will always take up individual cases. That, as one hon. Member knows, is not always unsuccessful. Though there have been cases of hardship, I believe that they are exceptions, not the rule, and I have no evidence, unpopular though the prescription charge is, that it is at present causing hardship.
The number of prescriptions on a per capita basis in December, 1956, the first month of the new charging policy, was exactly the same as the average number of prescriptions, on a per capita basis, in 1949. In 1949 hon. and right hon. Gentlemen opposite were tending to suggest that there was over-prescribing. What was right in 1949 is surely right now. I do not accept that prescriptions were unduly limited in the first month of the new charging policy.
For all these reasons—because money is needed to develop the Service, because 896 the proposal would be an administrative nightmare, because there is sense in having a charging policy to divert resources to where there is the greatest need—I am unable to accept the Amendment, and I ask the Committee to reject it.
§ Mr. Marquand
The reply of the right hon. Gentleman was, I am afraid, very much as we expected. Of course, we are bound to agree with him that technically what we propose would be administratively, if not impracticable, at least very difficult. We are bound to admit, as I did in my previous speech, that it would not help the most deserving. Nevertheless we are very disappointed at the rejection of the main idea that we have put forward, that if we now introduce a special contribution to be paid by persons fit, well and working, we ought to take the opportunity at least to reduce some of the charges which have been found in practice to be unfair and most objectionable.
We hoped that the right hon. Gentleman could have advanced a little way towards us. We have had an excellent debate, and my hon. Friends behind me have put some extraordinarily interesting arguments and examples of the way in which these charges are opposing the purposes of the National Health Service. In reply, the Minister treated us to what was very largely a Treasury argument. It was not a health argument. It was a Treasury argument, the argument of what percentage should come from taxes and what percentage should come from charges or contributions. It was purely and entirely a Treasury argument.
Even on that ground we challenge it, but we feel that the arguments that we have put in favour of immediately beginning to reduce charges which are in existence are overwhelming. They have not met with an adequate response, and we must divide the Committee. We no longer accept the argument, though, I admit, it can be quoted from speeches that we have made in the past, that charges would divert the resources—or, as the Minister put it, would canalise the resources—of the National Health Service into the right channels. We do not believe that any more. We believe it possible to find other methods, like Lord Cohen's various committees, through, for 897 instance, the issue of advice to general practitioners about prescribing. There are far better ways of avoiding any abuses which may have occurred in prescribing than by levying charges on the old, sick and infirm. I could go on, but I shall not, because I think we have had a good debate on this subject, and that we have succeeded in establishing very clearly
§ what the difference is between the two sides of the Committee. We feel that we must divide the Committee on the Amendment.
§ Question put, That those words be there inserted:—
§ The Committee divided: Ayes 162, Noes 207.899
|Division No. 106.||AYES||[5.16 p.m.|
|Ainsley, J. W.||Griffiths, William (Exchange)||Paton, John|
|Albu, A. H.||Hale, Leslie||Pearson, A.|
|Allaun, Frank (Salford, E.)||Hall, Rt. Hn. Glenvil (Colne Valley)||Pentland, N.|
|Allen, Arthur (Bosworth)||Hamilton, W. W.||Plummer, Sir Leslie|
|Allen, Scholefield (Crewe)||Hannan, W.||Popplewell, E.|
|Balfour, A.||Harrison, J. (Nottingham, N.)||Price, J. T. (Westhoughton)|
|Bellenger, Rt. Hon. F. J.||Hastings, S.||Probert, A. R.|
|Benn, Hn. Wedgwood (Bristol, S.E.)||Hayman, F, H.||Proctor, W. T.|
|Benson, G.||Henderson, Rt. Hn. A. (Rwly Regis)||Rankin, John|
|Beswick, Frank||Herbison, Miss M,||Redhead, E. C.|
|Bevan, Rt. Hon. A. (Ebbw Vale)||Hobson, C. R. (Keighley)||Reeves, J.|
|Blackburn, F.||Holmes, Horace||Reid, William|
|Blenkinsop, A.||Houghton, Douglas||Robens, Rt. Hon. A.|
|Blyton, W. R.||Howell, Charles (Perry Barr)||Roberts, Albert (Normanton)|
|Bowden, H. W. (Leicester, S.W.)||Howell, Denis (All Saints)||Robinson, Kenneth (St. Pancras, N.)|
|Bowles, F. G.||Hughes, Cledwyn (Anglesey)||Ross, William|
|Broekway, A. F.||Hunter, A. E.||Royle, C.|
|Broughton, Dr. A. D. D.||Hynd, J. B. (Attercllffe)||Short, E. W.|
|Burke, W. A.||Irving, Sydney (Dartford)||Silverman, Julius (Aston)|
|Burton, Miss F. E.||Janner, B.||Simmons, C. J. (Brierley Hill)|
|Butler, Herbert (Hackney, C.)||Jeger, George (Goole)||Skeffington, A. M.|
|Butler, Mrs. Joyce (Wood Green)||Jenkins, Roy (Stechford)||Slater, Mrs. H. (Stoke, N.)|
|Callaghan, L. J.||Jones, David (The Hartlepools)||Slater, J. (Sedgefield)|
|Carmichael, J.||Jones, Elwyn (W. Ham, S.)||Sorensen, R. W.|
|Castle, Mrs. B. A.||Key, Rt. Hon. C. W.||Soskice, Rt. Hon. Sir Frank|
|Chapman, W. D.||Lawson, G. M.||Sparks, J. A.|
|Chetwynd, G. R.||Lee, Frederick (Newton)||Stewart, Michael (Fulham)|
|Collick, P. H. (Birkenhead)||Lee, Miss Jennie (Cannock)||Summerskill, Rt. Hon. E.|
|Collins, V. J. (Shoreditch & Finsbury)||Lewis, Arthur||Sylvester, G. O.|
|Corbet, Mrs. Freda||Lindsay, Martin (Solihull)||Taylor, Bernard (Mansfield)|
|Cove, W. G.||Moban, Dr. J. Dickson||Tomney, F.|
|Craddock, George (Bradford, S,)||MacColl, J. E.||Ungoed-Thomas, Sir Lynn|
|Crossman, R. H. S.||McGee, H. G.||Viant, S. P.|
|Cullen, Mrs. A.||Macpherson, Malcolm (Stirling)||Weitzman, D.|
|Darling, George (Hillsborough)||Mainwarning, W. H.||Welts, Percy (Faversham)|
|Davies, Ernest (Enfield, E.)||Mallaliou, J. P. W. (Huddersfd, E.)||Welts, William (Walsall, N.)|
|Deer, G.||Marquand, Rt. Hon. H. A.||West, D. G.|
|Delargy, H. J.||Mason, Roy||Wheeldon, W. E.|
|Donnelly, D. L.||Mellish, R. J.||White, Mrs. Eirene (E. Flint)|
|Dugdale, Rt. Hn. John (W. Brmwch)||Messer, Sir F.||White, Henry (Derbyshire, N.E.)|
|Dye, S.||Mitchison, G. R.||Wigg, George|
|Ede, Rt. Hon. J, C.||Moody, A. S.||Wilcock, Group Capt. C. A. B.|
|Edwards, Robert (Bilston)||Morrison, Rt. Hn.Herbert(Lewis'm,S.)||Wilkins, W. A.|
|Evans, Albert (Islington, S.W.)||Moss, R.||Willey, Frederick|
|Fienburgh, W.||Moyle, A.||Williams, David (Neath)|
|Fraser, Thomas (Hamilton)||Mulley, F. W.||Williams, Rev. Llywelyn (Ab'tillery)|
|Gaitskell, Rt. Hon. H. T. N.||Noel-Baker, Francis (Swindon)||Williams, Rt. Hon. T. (Don Valley)|
|George, Lady Megan Lloyd (Car'then)||Noel-Baker, Rt. Hon. P. (Derby, S.)||Willis, Eustace (Edinburgh, E.)|
|Gibson, c. W.||Oliver, G. H.||Winterbottom, Richard|
|Gordon Walker, Rt. Hon. P. C.||Oram, A. E.||Woof, R. E.|
|Greenwood, Anthony||Orbach, M.||Yates, V. (Ladywood)|
|Grenfell, Rt. Hon. D. R.||Owen, W. J.||Younger, Rt. Hon. K.|
|Grey, C. F.||Paget, R. T.||Zilliacus, K.|
|Griffiths, David (Rother Valley)||Paling, Rt- Hon. W. (Dearne Valley)|
|Griffiths, Rt. Hon. James (Llanelly)||Pargiter, G. A.||TELLERS FOR THE AYES:|
|Mr. John Taylor and Mr. Rogers.|
|Agnew, Sir Peter||Barter, John||Bossom, Sir Alfred|
|Aitken, W. T.||Baxter, Sir Beverley||Bowen, E. R. (Cardigan)|
|Amory, Rt. Hn. Heathcoat (Tiverton)||Beamish, Maj. Tufton||Boyd-Carpenter, R. Hon. j. A.|
|Arbuthnot, John||Bell, Philip (Bolton, E.)||Boyle, Sir Edward|
|Ashton, H.||Bell, Ronald (Bucks, 8.)||Braine, B. R.|
|Atkins, H. E.||Biggs-Davison, J. A.||Braithwaite, Sir Albert (Harrow, W.)|
|Balniel, Lord||Birch, Rt. Hon. Nigel||Bromley-Davenport, Lt.-Col. W. H.|
|Barber, Anthony||Body, R. F.||Brooke, Rt. Hon. Henry|
|Brooman.White, R. C.||Hinchingbrooke, Viscount||Page, R. G.|
|Browne, J. Nixon (Craigton)||Holland-Martin, C. J.||Pannell, N. A. (Kirkdale)|
|Bullus, Wing Commander E. E.||Hornby, R. P.||Pickthorn, K. W. M.|
|Burden, F. F. A.||Horobin, Sir Ian||Pilkington, Capt. R. A.|
|Butcher, Sir Herbert||Horsbrugh, Rt. Hon. Dame Florenoe||Pitman, I. J.|
|Butler, Rt. Hn.R. A.(Saffron Walden)||Hughes-Young, M. H. C.||Pitt, Miss E. M.|
|Campbell, Sir David||Hulbert, Sir Norman||Pott, H. P.|
|Carr, Robert||Hyde, Montgomery||Powell, J. Enoch|
|Cary, Sir Robert||Hylton-Foster, Rt. Hon. Sir Harry||Profumo, J. D.|
|Channon, Sir Henry||Iremonger, T. L.||Raikes, Sir Victor|
|Chiohester-Clark, R.||Irvine, Bryant Godman (Rye)||Rawlinson, Peter|
|Cole, Norman||Jenkins, Robert (Dulwich)||Redmayne, M.|
|Conant, Maj. Sir Roger||Jennings, J. C. (Burton)||Rees-Davies, W. R.|
|Cooke, Robert C,||Johnson, Eric (Blackley)||Remnant, Hon. P.|
|Cooper, A, E.||Keegan, D.||Ridsdale, J. E.|
|Cordeaux, Lt.-Col. J. K.||Kerby, Capt. H. B.||Rippon, A. G. F.|
|Corfield, Capt. F. V.||Kerr, H. W.||Robertson, Sir David|
|Craddock, Beresford (Spelthorne)||Kershaw, J. A.||Robinson, Sir Roland (Blackpool, S.)|
|Crosthwaite-Eyre, col. O. E.||Kimball, M.||Robson-Brown, W.|
|Crowder, Sir John (Finchley)||Kirk, P. M.||Rodgers, John (Sevenoaks)|
|Cunningham, Knox||Lagden, G. W.||Ropner, Col. Sir Leonard|
|Currie, G. B. H.||Lambton, Viscount||Russell, R. S.|
|Davies, Rt.Hon.Clement(Montgomery)||Lancaster, Col. C. G.||Scott-Miller, Cmdr. R.|
|Digby, Simon Wingfield||Langford-Holt, J. A.||Simon, J. E. S. (Middlesbrough, W.)|
|Dodds-Parker, A. D.||Leavey, J. A.||Smithers, Peter (Winchester)|
|Doughty, C. J. A.||Legge-Bourke, Maj. E. A. H.||Smyth, Brig. Sir John (Norwood)|
|du Cann, E. D. L.||Legh, Hon. Peter (Petersfield)||Spearman, sir Alexander|
|Dugdale, Rt. Hn. Sir T. (Richmond)||Lennox-Boyd, Rt. Hon. A. T.||Speir, R. M.|
|Eden, J. B. (Bournemouth, West)||Lindsay, Hon. James (Devon, N.)||Spens, Rt. Hn. Sir P. (Kens'gt'n, S.)|
|Elliott,R.W.(N'castle upon Tyne.N.)||Linstead, Sir H. N.||Stanley, Capt. Hon. Richard|
|Errington, Sir Eric||Lloyd, Maj. Sir Guy (Renfrew, E.)||Stevens, Geoffrey|
|Farey-Jones, F. W.||Longden, Gilbert||Steward, Harold (Stockport, S.)|
|Fell, A.||Low, Rt. Hon. A. R. W.||Steward, Sir William (Woolwich, W.)|
|Finley, Graeme||Lucas, Sir Jocelyn (Portsmouth, S.)||Stoddart-Scott, col. M.|
|Fisher, Nigel||Lucas, P. B. (Brentford & Chiswick)||Storey, S.|
|Fletcher-Cooke, C.||Lucas-Tooth, Sir Hugh||Stuart, Rt. Hon James (Moray)|
|Fort, R.||McAdden, S. J.||Studholme, Sir Henry|
|Fraser, Hon. Hugh (Stone)||McCallum, Major Sir Duncan||Summers, Sir Spencer|
|Freeth, Denzil||Macdonald, Sir Peter||Sumner, W. D. M. (Orpington)|
|Godber, J. B.||McKibbin, A. J.||Taylor, Sir Charles (Eastbourne)|
|Goodhart, Philip||Mackie, J. H. (Galloway)||Taylor, William (Bradford, N.)|
|Cower, H. R.||McLaughlin, Mrs. P.||Teeling, W.|
|Graham, Sir Fergus||Maclean, Fitzroy (Lancaster)||Temple, John M.|
|Grant-Ferris, Wg Cdr. R. (Nantwich)||Macleod, Rt. Hn. lain (Enfield, W.)||Thompson, Kenneth (Walton)|
|Green, A.||Macmillan, Rt.Hn.Harold(Bromley)||Thompson, Lt.-Cdr.R.(Croydon, S.)|
|Gresham Cooke, R.||Macmillan, Maurice (Halifax)||Thornton-Kemsley, C. N.|
|Grimston, sir Robert (Westbury)||Macpherson, Niall (Dumfries)||Tiley, A. (Bradford, W.)|
|Grosvenor, Lt.-Col. R. G.||Maddan, Martin||Turton, Rt. Hon. R. H.|
|Gurden, Harold||Maitland, Hon. Patrick (Lanark)||Vane, W. M. F.|
|Hall, John (Wycombe)||Marshall, Douglas||Vaughan-Morgan, J. K.|
|Harris, Reader (Heston)||Mathew, R.||Vosper, Rt. Hon. D. F.|
|Harrison, A. B. C. (Maldon)||Mawby, R. L.||Wakefield, Edward (Derbyshire, W.)|
|Harrison, Col. t. H.(Eye)||Medlicott, Sir Frank||Wakefield, Sir Wavell (St. M' lebone)|
|Harvey, Air Cdre. A. V. (Macclesfd)||Milligan, Rt. Hon. W. R.||Wall, Major Patrick|
|Harvey, John (Walthamstow, E.)||Molson, Rt. Hon. Hugh||Ward, Rt. Hon. G. R. (Worcester)|
|Hay, John||Nabarro, G. D. N.||Ward, Dame Irene (Tynemouth)|
|Heath, Rt. Hon. E. R. G.||Nairn, D. L. S.||Waterhouse, Capt. Rt. Hon. C.|
|Henderson-Stewart, Sir James||Nieholson, Godfrey (Farnham)||Whitelaw, W. S. I.|
|Hicks-Beach, Maj. W. W.||Nicolson, N. (B'n'm'th, E. & Chr'ch)||Williams, Paul (Sunderland, S.)|
|Hill, Rt. Hon. Charles (Luton)||Nugent, G. R. H.|
|Hill, Mrs. E. (Wythenshawe)||Oakshott, H. D.||TELLERS FOR THE NOES:|
|Hill, John S. (Norfolk)||Orr, Capt. L. P. S.||Mr. Wills and Mr. Bryan.|
§ Motion made, and Question proposed, That the Clause stand part of the Bill.
§ Miss Margaret Herbison (Lanarkshire, North)
We have attempted to amend Clause 1, but we have failed. None the less, we want to have a discussion on it, because it is the Clause which carries out the principle of the Bill. During the Second Reading debate, I made it clear that we on this side felt that it was a Bill which should not be handled by the Minister of Health, but that the proposal which it contains ought to have been in the provisions of the Budge 900 and be put in a Finance Bill. However, since the Minister of Health has accepted responsibility for the Bill, I wish to complain at the absence of the Secretary of State for Scotland during the discussion of it.
This Bill affects Scotland, just as it affects England and Wales. We have a Secretary of State for Scotland, who is responsible for the health of Scotland. He has three Joint Under-Secretaries of State, one of whom, one assumes is in charge of health in Scotland. We cannot get one of that galaxy of Scottish 901 Ministers to sit on the Government Front Bench and listen to the arguments which have been put forward.
§ Miss Herbison
That may be, but if they do not like the Bill that is all the more reason why they should be sitting on the Front Bench, listening to the debate, in order to learn whether they can find arguments from this side which would help them in any fight which may be put up to annul the provisions of the Bill. I hope that the Minister of Health will carry that message to the Secretary of State for Scotland and to the Joint Under-Secretaries of State.
We oppose Clause 1 because, for the first time in the history of the National Health Service, it provides for a completely separate contribution for the Health Service, the intention being to have a contribution for the Health Service and a contribution for other services. We oppose it also because not only is there to be this additional contribution from our people, but our people are at the same time, according to the Minister in his reply to the Amendment, contributing over £30 million in charges this year towards the financing of the National Health Service.
In trying to make out his case for the extra contribution and for the continuance at the same time of the Health Service charges, the Minister quoted the White Paper on Social Insurance, published in 1944. Fortunately, I have that White Paper with me. I find that very little indeed is said about these contributions. I find, in page 37. beginning at paragraph 168, a section headed "The finance of the scheme." We have to reach paragraph 170 to find what is said about the finance of the scheme for the National Health Service, and there we are told:Towards the cost of the National Health Service, insured men and women will contribute 10d. and 8d. a week respectivelyand it goes on to say that:Of this, the employer (where there is one) pays 1½d.That, except for a sentence giving the reason for the 1½d. payment by the employer, is all that I can find said about the financing of the Service. We are 902 given a table of what was expected to be the cost of the National Health Service, and I find that for 1945 it was considered that the figure would be £148 million. In the next column, the figure for 1955 is given as £170 million.
§ Miss Herbison
Exactly. For 1965, the figure is put at£170 million, and, going further ahead, for the year 1975 it is again put at £170 million. Yet, at the present time, the cost is running at over £600 million.
That was the weakest part of the Minister's argument, when he tried to offer, as a basis for his argument in favour of an increase, the few words which were said in, as my hon. Friend the Member for Tottenham (Sir F. Messer) has pointed out, a Conservative White Paper in 1944. It has been proved absolutely conclusively that what is put in that White Paper has really not come about at all.
§ 5.30 p.m.
§ Mr. Vosper
The hon. Lady must have misunderstood me. In my last speech I referred not to the White Paper of 1944 but to the Financial Memorandum of the 1946 Bill.
§ Miss Herbison
I am sorry. Even if the right hon. Gentleman were referring to the Financial Memorandum, at that time, as I pointed out in my Second Reading speech, not even the officials—not even the Ministers—had any realisation of the great needs for a National Health Service, just as the people had no realisation.
It is quite wrong at this stage to attempt to bring up to date what was thought in those very early days might be the proportion which came from National Insurance contributions. In the Second Reading debate, the Minister had something to say about that, as had the hon.. Member for Putney (Sir H. Linstead). The latter tried to make out that there had been a definite statement in the Beveridge Report as to this 19 per cent which would be covered. I have taken very great care to examine the whole of that part of the Report which deals with the National Health Service. The hon 903 Member for Putney quoted paragraph 287. At the very beginning of that paragraph there are these words:There is nothing sacred about the division suggested in this Report; it is no more than a basis for discussion and argument.It goes on:On behalf of insured persons it can be argued that even if the contribution proposed is within the capacity of most adult men, it is not within that of persons with low wages, and that these should be relieved at the cost of the taxpayer or the employer.That was a very important statement. One of the reasons why we are opposing the provisions of Clause 1 and the First Schedule is the effect they will have on the low-wage earner.
§ Sir H. Linstead
I think that the hon. Lady must agree that Lord Beveridge's general position was this: he found that the cost of the Health Service was to be about £170 million, applying the best information that he could at the time, and he finally concluded—whether rightly or wrongly, and in the light of all sorts of conflicting ideas—that £40 million of that should come out of contributions.
§ Miss Herbison
No. That is the very point that I am trying to make. He did not finally conclude that 19 per cent. ought to come out of contributions.
I want to go further. Again, in the same paragraph, it is stated:…the rates of contribution proposed are even more provisional "ߞThat was not definitely telling us that what he suggested was what he thought ought to be paid—…for they depend on views of financial policy and social equity as to which reasonable men may differ…He continued:All that is claimed is that the proposals made here are a fair basis for discussion. and that if the Security Budget is looked at as a whole, the division proposed between the three parties is not on the face of it unreasonable.Therefore, I think that Beveridge showed very clearly in that paragraph that there were so many considerations to be taken into account that he could not say clearly and definitely that 19 per cent. of the cost of the National Health Service ought to be covered by contributions. I could make a great many other quotations from that Report, but I will not weary the Committee with them.
904 I advise hon. Members opposite to read the part of the Report which deals specifically with the National Health Service. Then they will realise, just as clearly as I have realised from reading it, that the Government cannot possibly base their reasons for this increase on what was said in that Report. Even if they were able to bring the Report to their support, I would say to the Government that Lord Beveridge and his Committee were not infallible; and we ought, each time we consider these matters, to consider them on their merit.
When my hon. Friends and my right hon. Friend were dealing with the question of the increased contribution and the effect that it would have, coupled with the charges, we had a number of speeches from Members on the back benches opposite. The hon. Member for Putney —and I am most surprised at his attitude on the subject of the prescription charge—pointed out that there may have been some complaints but that in the last few months he and those of his hon. Friends whom he had questioned had had no complaints made to them. The only answer I can give is that the constituents of those hon. Members have come to the conclusion that it is not much use complaining to them, since they are wholeheartedly in support of paying for prescriptions, and paying for each item.
My hon. Friends on this side of the Committee—the hon. Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop) and the hon. Member for Greenock (Dr. Dickson Mabon), who is himself a doctor and most interested in these matters —were able to produce evidence that this charge was a very grave hardship on some people and that indeed it was militating against any good work that the doctors might be doing for their patients. There is much evidence to show that there is hardship and that medical difficulties are being caused.
When we add to these present hardships the hardship which will be caused by this increased contribution, it seems to me that the Government are doing something completely wrong in the light of the Budget which the Chancellor of the Exchequer produced a short time ago. The priorities about which we heard so much in the debate today are completely wrong. This is putting burdens on the low-wage earner at a time when the 905 Government are giving a great deal of money, through the Budget, to those who are already wealthy.
I turn to the question of the National Assistance Board. The hon. and learned Member for Bolton, East (Mr. Philip Bell) told us that where there was hardship, those suffering it could have recourse to the National Assistance Board. That showed clearly that he knew very little about the position of many of his own constituents. Only those whose incomes are so low that they must be on the National Assistance Board scales can have relief at present. There are people in my constituency some of whom will never be able to work again. They include men who have been so severely disabled in the collieries that they cannot work. They need many prescriptions, and they found it a great hardship when this Government put a shilling charge on each prescription. They are finding it an almost. intolerable burden now that the Government have put a shilling charge on each item of the prescription.
One old man has no other source of income but his industrial injuries benefit, or what is now known as his disability pension, for himself, his wife and two children, and he has to pay 1s. for every item on his prescription. I wish that hon. Members opposite would try to get to know what are the grave hardships of other people before they take part in supporting a Measure such as this.
I would say to the Minister that, as Minister of Health, he ought to have opposed this Bill very strongly, and should have made his opposition known to the Chancellor of the Exchequer and to the Cabinet, but he tells us that he did not oppose it. He tells us that he is in support of the Measure, because of the priorities, and because whatever money comes in as a result of the Bill will help in the development of the Service elsewhere. I say to him that as a result of the combined charges and this increased contribution, it may be that we shall need even more hospital places than we have at the present time, and that the whole purpose of the provisions in this Bill will be sabotaged because of the increase in illness in the country.
I have my priorities, and we on this side of the Committee have our priorities, 906 not only in regard to the National Health Service, but in respect of our social services and in what should be done for our people. Rather than put this extra burden on our people, I would say, as I said on Second Reading, that if the Government had their priorities right, if they were interested in the well-being of our people, these provisions would not have come before us. They would have said that the National Health Service had far greater priority than have Surtax payers in this country at present.
That is the difference between the priorities on this side of the Committee and the priorities of right hon. and hon. Gentlemen opposite. We oppose Clause 1 completely. I hope that my hon. Friends will give many more reasons for our opposition, and we shall certainly carry that opposition to a Division.
§ Mr, W. Griffiths
I listened with great interest to the speech of my hon. Friend the Member for Lanarkshire, North (Miss Herbison), in which she so ably gave examples of the lack of knowledge on the benches opposite of the effect of these charges on lower-paid workers.
I do not want to repeat the arguments, but I should like to remind the Committee—and it has been said more than once today—that when we were arguing that, along with this increased contribution, there should be a reduction in charges, it was suggested that the people who found those charges a burden could always nave recourse to the National Assistance Board. That is one of the points that was dealt with by my hon. Friend, and we have been seeking to demonstrate by example that anybody in any part of the Committee who advances that kind of argument just does not know the facts.
Further examples of this kind could be given. Let us take the position of people who are in receipt of National Assistance, and consider the effect of charges in the Health Service upon a worker who is temporarily away from work for a week. Let us assume that during the week when he is away from work he breaks his spectacles. It may be that he is totally dependent upon them, and that he is in possession of only one pair. He cannot get from the National Health Service any assistance at all towards the cost of the repair of that appliance. He cannot go to the National Assistance Board—and 907 here is another anomaly—because, even if he were eligible for National Assistance, under the present Regulations the Board is compelled to tell him that it can give him nothing at all for repairs. Therefore, the unfortunate man must he without that appliance until such time as he returns to work and does sufficient work to earn enough money to pay for its repair.
That may sound a small thing, but it is a real tragedy for the people concerned. I honestly think that there are a number of people who do not know that that is exactly what happens under the present Regulations. Quite apart from the example that I have just given—the man who is off work for a short period—even those who are eligible for National Assistance cannot, under the present Regulations, get anything towards the cost of the repair of such an appliance. Nor are spectacles the only example because there are other appliances which bear charges at present. I do not think we should part with this Clause without some of us reiterating our opposition to the whole policy of the Government, and what is in effect a poll tax on that section of the community. It is something which is anathema to all of us on this side of the Committee.
It is not good enough for the Minister to advance what my right hon. Friend the Member for Middlesbrough, East (Mr. Marquand) said was a Treasury argument. What is the validity of an argument advanced in 1957 which, in effect, says, "The percentage of the cost being borne by the Treasury as a grant from the Treasury in 1957 is pretty much the same as that envisaged in the Financial Memorandum attached to the original Bill". Who, in 1946, could envisage what this revolutionary development of the National Health Service would demand in the future? We had to give people an opportunity to behave themselves in using the Service. We had to see what was the extent of neglect from past years.
Some of my right hon. Friends who had the job of administering the Service in its early years were subjected to criticism because often their estimates were wrong. The perfect answer to that is that nobody knew the extent of the 908 accumulation of years of neglect of our people in health matters. It was found that in many respects the problem was much worse, and that a bigger problem had to be faced than even the most pessimistic amongst us had anticipated. In that there is nothing surprising. It would not astonish me in the least if the estimates made in 1946 were completely inadequate in the light of the knowledge which we now possess in 1957, and we make no apology at all for that.
What we oppose all the time is not any expansion of the Service, but its curtailment, and this business of imposing extra contributions all round is absolutely contrary to the principles of those of us on this side of the Committee. Let me repeat that these principles are that, in the financing of the National Health Service, and indeed of all our social security programme, the greatest contribution towards these national schemes must come from the strong, and the minimum financial burden must be placed on the weak. I heartily endorse the observations made by my hon. Friend the Member for Lanarkshire, North, and I am glad to hear that we are going to carry our opposition into the Division Lobby.
§ Sir F. Messer
I want to make only two points. The first is that I oppose this proposal because it is basically unjust. We are saying in effect that a service which has hitherto been financed almost entirely from national taxation is now to have its basis of finance changed. Once we have started saying that a certain amount of the National Insurance contribution is devoted to a certain service, we may wonder how long it will be before that amount is increased. As the expenditure on the Service increases the contribution may increase.
If I am asked why I consider this proposal unjust, I would remind the Committee that it was believed that the Service would be financed out of national taxation. We are saying that insured people earning £6 a week shall pay a further 8d. per week while those who get £40 per week shall also pay 8d.—exactly the same as people on the lower scale of income. The proposal is unjust, therefore, because those with means are lightly assessed as compared with people who have little means. My first objection, therefore, is that this proposal increases the financial 909 difficulties rather than solves them by transferring them to he people who should benefit from the Service.
The next point concerns the charges, one aspect of which has not been taken sufficiently into account. In our constituencies we all know people who are on the border line; they do not get National Assistance because they are just above the qualifying figure. If the amount to be paid for prescriptions brings them below that line, they still cannot go on National Assistance. The payment for prescriptions therefore has a deterrent effect in regard to these people going to the doctor.
That is true particularly with people who suffer from certain complaints. Let me take the case that has already been cited. When National Insurance was started by Mr. Lloyd George as far back at 1911, tuberculosis treatment was a free service. When the National Insurance Commission at that time took charge of tuberculosis, sanatorium patients were not assessed according to their means as ordinary patients were in poor law hospitals. The service was entirely free. When the county borough councils took over the work of the boards of guardians, the service was still free.
Then there developed what were first called "tuberculosis dispensaries" and afterwards "chest clinics". People were attracted to the clinics for preventive reasons. The service was completely free. Indeed, during the war we did even more than that. We gave a special grant under Regulation 266T to people who were undergoing treatment for tuberculosis. That was a sum of about 18s. a week. We did everything to help people to get treatment.
The present charges do not exclude tuberculosis patients. If these patients are now deterred from getting treatment it is a bad thing, not only for the patients but for their contacts. Fortunately, T.B. is on the decrease, so perhaps we need not worry too much about the deterrent effect. Provided that other things are equal, we may be able to overcome that effect.
There are other examples. Let us take the case of someone who is getting on in years, and it suffering from post-encephalitis or from Parkinson's disease. These conditions usually require the taking of a large number of tablets over a period. It is very often necessary to 910 give medicines like vitamin tablets or soporific tablets. The patient will want three or four items on the prescription. How can the patient tell the pharmacist which one of them to omit? It may very well be that the patient's choice will be wrong because of inability to know what the tablets are really meant for. The patient's case may be made more difficult or even made more serious.
For all these reasons we ought to consider, if we are to have a special contribution, whether it should not offset the more serious effects of the charge for prescriptions. My chief objection and reason for opposing the proposal before us is the danger of the Service coming to depend for its finance not on taxation, but on whether a patient has the requisite number of stamps on the card to entitle him or her to treatment.
§ Mr. E. G. Willis (Edinburgh, East)
I support my hon. Friend the Member for Tottenham (Sir F. Messer) wholeheartedly in his condemnation of the Clause and of the new principle which it introduces. The principle can be extended very much to the detriment of the people, simply on the whim of a Chancellor of the Exchequer who happens to find himself hard up for reasons which have nothing to do with the health of the people. but because of Government policy. He can say, "This is costing a lot of money. We will add a bit more to the charges".
I listened to the arguments, and I found no principle about them. All we had was a lot of statistics and percentages of contributions paid in different circumstances. Whatever percentage of contribution is now suggested is entirely arbitrary; there is no principle behind it. I listened to the Minister introducing the Money Resolution, and not a single principle was enunciated in his speech which would persuade people to support his arguments.
When the Minister was at the Treasury at least he tried to look at matters in a humane way, but he has now to depend upon statistics which are related to nothing but expediency. Before we leave the Clause the right hon. Gentleman ought to tell us what is behind it. What are the governing principles? Government ought to be by principle and not by statistics produced at the Treasury by a bright boy behind the scenes. and the 911 principle ought to be based upon moral considerations.
The Bill, examined from that point of view, is rotten. There are no moral considerations in it at all; in fact, it is grossly immoral. We have been told that £31 million towards the cost of the scheme has been raised by these charges. It seems very unfair to raise money by putting a charge on the unlucky people. It is the first time I have heard that because a person is unlucky he has to be charged. I thought the principle was to help people who were unfortunate, not to charge them because they happen to be unfortunate.
We are to raise an additional £42.1 million under this Bill by a flat poll tax. I had several things to say about that when the Money Resolution was before the Committee. There is no equity in that at all. It is simple for someone who is very wealthy to say to someone who is comparatively well off, "Let us all put a ' bob ' into the kitty," but that is most unreasonable, certainly unfair, and I think it is immoral. As a result of this Bill we are to pay £71 million in ways which to me seem dubious and certainly not in accord with what my hon. Friend the Member for Sowerby (Mr. Houghton) thought the very noble principles on which this Service was based in the first place.
The National Health Service, as it was conceived and brought into being, captured the minds of all classes of people in this country and people all over the world, because, almost for the first time in history, we were trying to do something which was out of accord with capitalist methods of accountancy. We were saying, "We all live together. Let us contribute what we can and distribute it according to need." It was a very fine principle of government, but more and more we are departing from it.
All the usual arguments have been trotted out by the Conservative Party. It is easy for hon. Members opposite to argue that we should pay for these things if we can afford to do so. They are not on the border line, having to pay for these things but to do without a considerable number of other things. They are not in the position of many families to which an extra 8d. or 10d. a week makes all 912 the difference. Often it makes all the difference between having an extra pint of milk for that family or not having it.
This Bill is a bad Bill, this Clause is a bad Clause, and I am certainly glad that we are to divide against it.
§ Mr. Marquand
The Clause under discussion implements the main new proposal in the Bill, the establishment of a separate contribution in the National Health Service. Although, unfortunately, I did not have the opportunity of listening to the Second Reading debate, I have read very carefully all that was said by all who took part in it. and particularly what the Minister said.
As I understand from what I read in the speech, the right hon. Gentleman had two main arguments in support of the new proposal. The first we have dealt with already at some length on the Amendment the Committee disposed of a short time ago. The first argument was the fit and well argument, in which the Minister said that people should pay when they are fit and well and receive from the Service when they are unable to work and earn. We have already disposed of the contradictions in that argument coming from that source.
The second argument adduced by the Minister in favour of this new proposal was a very astonishing one. The right hon. Gentleman wanted:to take the opportunity to do everything possible to remove the frequent misunderstandings that either all, or none, of the National Health Service is financed by weekly contributions."—[OFFICIAL REPORT, 8th May, 1957; Vol. 569, c. 993.]I should be all in favour of removing a misunderstanding about how the National Health Service is financed. The only misunderstanding I ever came across when I was Minister of Health was, not that anyone thought that none of the Service was financed by contributions, but the misunderstanding by which very many people thought the whole of the Service was financed by contributions. I tried again and again, on almost every opportunity I had when making a speech in those short nine months when I was Minister, to destroy that illusion, but, of course, it had very little effect.
It was a very deep-rooted belief, and I think it still is. It has been fostered by the newspapers, although they have been 913 told dozens of times what the truth is. Again and again they have referred to the National Health Service stamps and suggested to the public that they paid the full cost of the Health Service through their Health Service stamps. That was a mistaken idea, and it had bad results. It created in some minds the idea, "I have paid for it. haven't I? Therefore, I am entitled to this, that and the other ".
In so far as there were exigent demands placed on doctors and others in the Service for services not required, they arose, I think, from that root source—the idea that people paid their Health Service contribution and therefore the sky was the limit, that they ought to have all the medicines, treatment and everything available under the Service. That was a bad thing, and I tried to remove the misunderstanding.
This Bill does not remove that misunderstanding, but just doubles it. It makes it perfectly clear to everyone by a separate stamp that this is a contribution for the National Health Service which makes it twice as much as it used to be. It seems to me that they will be more convinced than ever that the contributions pay for the whole Service. The argument breaks down completely and we are left only with the first argument, which we debated at length and about which I do not propose to advance any more views.
During Second Reading my hon. Friends said they believed that this further tax on insured workers was bound to fall most heavily on lower paid workers, on the fathers of families and those who find it most difficult to make do on their wages. My hon. Friends said then, and have repeated this afternoon, that the Government were reducing the Surtax, which was a progressive tax, and increasing the National Health Service contribution, which was a regressive tax. They increased a regressive tax in order to reduce a progressive tax. On those grounds, chiefly, we objected to the proposal.
I want to draw the attention of the Minister particularly—that is the only reason for which I rose—to the feeling evident on this side of the House during Second Reading, which certainly has not been disposed of by anything which has been said so far this afternoon, that this new charge was the introduction of a new 914 and dangerous principle. My hon. Friend the Member for Tottenham (Sir F. Messer) said on Second Reading,I do not think that this Bill is introduced merely for the sake of getting £40 million.A little earlier he had said:I hope my fears will never be realised, but I see in this Bill the grave danger of a qualification for benefit that will depend upon a contribution to insuranoe."—[OFFICIAL REPORT. 8th May, 1957; Vol. 569, c. 1042.]That may have been pooh-poohed when he said it, but the hon. Member for Cheadle (Mr. Shepherd)—I am sorry he is not here this afternoon; he is one of the ablest hon. Members opposite and, if he had his deserts, he might one day become a Member of the Government—said later in the debate:I believe that the present contribution is inadequate, and we ought to work, albeit by easy stages, towards an arrangement whereby at least one-third of the total cost of the National Health Service is covered by contributions. If we could do that, or something towards it, we should he able to do away with…the chargesߪ"—[OFFICIAL. REPORT, 8th May, 1957; Vol. 569, c. 1065.]We hope that in his reply the Minister will be able to deal with this argument. Will he deny categorically the validity of the fear expressed by my hon. Friend the Member for Tottenham and my hon. Friend the Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop) on Second Reading—the fear that this is the introduction of new insurance principle into the National Health Service and that as time goes on opportunity will be taken more and more to increase the size of the contribution and to make the receipt of benefit under the Service more and more depend on the payment of a direct flat-rate contribution?
Is that the Government's intention? If not, will the Minister repudiate the view expressed by the hon. Member for Cheadle? We want an answer today, and we hope that we shall get a clear and categorical answer to the suspicions which have been raised in the minds of my hon. Friends and to the confirmation of those suspicions expressed on the last occasion by the hon. Member for Cheadle.
§ Mr. Blenkinsop
I want in no way to prolong the debate, but there are two points which I want to raise. The first arises out of our earlier debate in Committee. I had hoped that the Minister 915 would not regard the comments made by the hon. Member for Putney (Sir H. Linstead) about the pharmacists as being the view of pharmacists generally about the imposition of the charges.
§ Sir H. Linstead
I was very careful to say that no correspondence had reached me in my capacity as a Member of this House.
§ Mr. Blenkinsop
It is important that that should be made clear, because I, for one, have had very strong representations from pharmacists in my division.
The second point which I wanted to raise was this: I assume that the Ministry have been able to give proper consideration to the whole question of priorities in the Service and that some effective research has been carried out in the Department. It has always been agreed amongst many of us that one of the difficulties one faced in the early days of the Service was the lack of adequate information about trends and developments within it. It was very difficult to plan development of the Services as one would like without thta range of information which one wanted.
Here I may be taking objection to the opposition which one of my hon. Friends seemed to make to statistics. I am sure he was not opposing the collection of statistics generally but was taking objection to the idea that statistics should be applied without regard to principle. I and, I am sure, many of my hon. and right hon. Friends take the view that there is need in the Ministry of adequate research and statistics. One of the recommendations of the Guillebaud Committee was that this should be instituted, and after that recommendation had been made we understood that the Ministry had made an appointment, although I do not think it could be regarded as a special department of the Ministry, as is called for in the Guillebaud Report. I am trying to stress that within all our health work there is a great need for some careful evaluation of the work which is being done.
To give one example, it is astonishing that even now we know very little about the value to the community of the hospital work which we are doing in this country. I think the Chief Medical 916 Officer of Health has made the point in one of his recent reports that our knowledge of what happens to patients after they leave the hospital is remarkably slight even after all these years. I am asking whether we are satisfied that we have made a sufficient estimation. Have we material to make our estimates and to estimate the value of the Service which we already have at our disposal? Is the Department able to make its decisions, including this decision with which we have been confronted, upon adequate information? I suggest that the Ministry of Health is still in the difficulty that it cannot provide an adequate background of information upon which decisions of this kind are put before us. The Guillebaud Committee made that very clear. In its recommendations it said that it wasOf the opinion that the knowledge at present available about the working of the National Health Service is inadequate and should be considerably extended and improved, since it is only on the basis of such knowledge that the right decisions can be made for the future development of the Service.All of us who have had some experience of this Department have found the danger of taking decisions about development without that background knowledge which, I think, everyone regards as essential. I very much fear that the Department has not been able to continue to build up that adequate background of knowledge which we wish to see, but instead is still taking this kind of decision in order to collect together more finance for the scheme without any adequate review of the whole background of the working of the Service.
I know that this is a little outside the immediate context, but I ask the Minister in his reply to bear in mind that it is relevant and to tell us the importance which he attaches to the research and statistical part of his Department.
§ Mr. A. E. Hunter (Feltham)
I will not detain the Committee for very long, but I should like to add my voice in protest to that of my hon. Friends. There is strong feeling amongst the lower-paid workers about this increase in the contribution. It involves another 10d. a week for a man, 8d. a week for a woman and 6d. a week for a boy or girl. Some of these people are among the lower income groups of workers. There are still people in this country not earning more than 917 £6 a week. Some women are earning less than £5 a week. The extra contribution means an extra charge on their small incomes.
The Bill will give the Chancellor of the Exchequer over £40 million a year, and the money should be used to improve the Service. There are still to be charges for spectacles, for teeth, for invalid boots and for other appliances, and it is therefore clear that the extra £40 million which is to be gathered from the workers of the country will not be used for improving the National Health Service.
We are very proud of our National Health Service. I remember the hospital services when I served on a board of guardians in the years between 1925 and 1930 and the great change that has taken place. Hospitals were often stinted for money, many lacked X-ray apparatus. and many lacked the modern equipment which we see in the splendid hospitals of today. The National Health Service has brought about this great change. But Conservative Party Election manifesto said that the Conservative aim was to extend, expand and improve the Health Service; but we now find that the Government have limited the Service by charges on surgical appliances and have put on a prescription charge of 1s. for each item. I know that the person on National Assistance can get a refund, but, as my hon. Friend the Member for Tottenham (Sir F. Messer) has said, there is a margin just short of National Assistance where the extra prescription charge imposes a very heavy burden.
I therefore add my protest against these extra contributions which are not to be used for improving the Service or removing charges for appliance and prescriptions, which merely give the Chancellor £40 million to pay for the tax relief to the highest income group.
As has been made clear, this Clause contains the substance of the Bill. I am sure that the Committee would not want me to repeat the speech which I made on the Ways and Means Resolution, or that which I made on Second Reading, but there are just one or two points to which I should reply.
The hon. Lady the Member for Lanarkshire, North (Miss Herbison) referred to the absence of the Secretary of State for Scotland. I will, of course, bring to the notice of my right hon. 918 Friend any points that refer specifically to Scotland in what is otherwise a United Kingdom Bill. She will, however, have noticed that the Joint Under-Secretary of State listened to her speech.
The hon. Lady referred, as have other hon. Members, to the Beveridge Report. I have, of course, studied that Report on many occasions. The only conclusion I have ever drawn from it, in introducing this Bill, is that the Beveridge Report was not against the contributory principle. In fact, that contributory principle was accepted by the party opposite when, in 1946, there was introduced, first, the Financial Memorandum to the Bill, and, finally, the National Health Service Bill which became the National Health Service Act of 1948.
That principle was established as far back as 1946. and has been maintained, in effect, ever since. I accept that there is nothing sacrosanct in the proportion given in that Financial Memorandum, but it did so happen that in 1946, as I have already told the Committee, the percentage to he financed by contributions was 20 per cent. That figure was never realised, and it recently shrank to 6 per cent.
But Her Majesty's Government believe that the principle contained in the Beveridge Report—which the party opposite accepted and maintained throughout its years of office—is correct; that there should be a contributory element towards the finances of the National Health Service. They believe, further, that if 20 per cent. was thought fit and proper in 1946, a contribution that would now bring in just over 11½ per cent. is not unreasonable today. That is the percentage represented by a contribution of 1s. 8d. to be provided for each employed man.
That is the first reason for this Bill: that there shall be a contributory element towards the financing of the Health Service paid by those who are fit and well towards those who are sick. In fact, the hon. Member for Manchester, Exchange (Mr. W. Griffiths) suggested that the contribution should be even larger, because he quite rightly said that the figures produced ten or twelve years ago vastly underestimated the cost of the Service. In those days, the figures anticipated a total national cost of £174 million, to which 919 there should be a 20 per cent. contributory element.
As hon. Members know, that total figure has now risen to £690 million, so there would be an argument,on that basis, for increasing the contributory charge above even that envisaged in the Bill. The Government have not thought fit to do that, but have decided to double the figure to keep it in line with what was thought reasonable in those early days.
The hon. Member for Tottenham (Sir F. Messer) made an interesting speech. If I may say so on this particular occasion, and as I think the Committee knows, the National Health Service owes him a tremendous debt of gratitude for what he has done as Chairman, until recently, of the Central Health Services Council. I know that he is anxious, as I hope he will believe that I am, to see the Service develop. I was disappointed, therefore, to note that he was not in support of the contributions, although he must know that as there must be a limit on the amount of national finance provided a small increase must surely be welcomed by anybody believing in the Service.
A point made by the right hon. Gentleman the Member for Middlesbrough, East (Mr. Marquand) is that for the first time this Bill establishes a separate charge. The reason is that we are anxious to see established in the minds of the public the principle that there is a separate contribution towards the National Health Service. I fully accept, as he made quite clear, that the public are confused on two grounds: either they think that there is no contribution towards the cost of the Service, or else that it is
§ entirely financed by contributions. I hope to be a little more successful than he—although I may be optimistic—and, during the latter part of the year when this Bill has, I hope, been put on the Statute Book, to be able to establish in the public mind that a small proportion only of the total cost is financed by direct contribution.
§ I appreciate the point made by the hon. Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop) about priorities. I accept, in principle, what he said, but he will forgive me if, on this occasion— which, I think, is hardly the appropriate one—I do not go further into priorities of expenditure.
§ I was asked by the right hon. Member for Middlesbrough, East to give an assurance that this was not the thin end of the wedge; that this Measure did not begin a cycle of increasing contributory elements. All I would say is that to increase the charge by any amount above that stated in the Bill would require further legislation. To introduce legislation into this House is not an easy matter, and I cannot believe that Her Majesty's Opposition would lightly let it go through. I therefore think that that assurance, that a further increase would require a further Bill, should be the answer to his question. On those grounds, I should like to think that the Committee might come to a decision and approve this Clause.
§ Question put, That the Clause stand part of the Bill: —
§ The Committee divided: Ayes 199, Noes 159.923
|Division No. 107.]||AYES||[6.28 p.m.|
|Agnew, Sir Peter||Browne, J. Nixon (Craigton)||Davies, Rt. Hon. Clement(Montgomery)|
|Aitken, W. T.||Bryan, P.||Deedes, W.F.|
|Amery, Julian (Preston, N.)||Bullus, Wing Commander E. E.||Digby, Simon Wingfield|
|Amory, Rt. Hn. Heathcoat (Tiverton)||Burden, F. F. A.||Dodds-Parker, A. D.|
|Arbuthnot, John||Butcher, Sir Herbert||Doughty, C. J. A.|
|Atkins, H. E.||Butler, Rt. Hn.R. A. (Saffron Walden)||du Cann, E. D. L,|
|Baldwin, A. E.||Campbell, Sir David||Dugdale, Rt. Hn. Sir T. (Richmond)|
|Barter, John||Carr, Robert||Eden, J. B. (Bournemouth, West)|
|Baxter, Sir Beverley||Cary, Sir Robert||Elliott,R.W.(N'castle upon Tyne.N.)|
|Beamish, Mai. Tufton||Channon, Sir Henry||Errington, Sir Eric|
|Bell, Philip (Bolton, E.)||Chichester-Clark, R.||Farey-Jones, F. W.|
|Bell, Ronald (Bucks, S.)||Cole, Norman||Fell, A.|
|Biggs-Davison, J. A.||Conant, Maj. Sir Roger||Finlay, Graeme|
|Bishop, F. P.||Cooke, Robert||Fisher, Nigel|
|Body, R. F.||Cooper, A. E.||Fletcher-Cooke, C.|
|Bossom, Sir Alfred||Cordeaux, Lt.-Col. J. K.||Fort, R.|
|Boyd-Carpenter, R. Hon. J, A.||Corfield Capt. F. V.||Fraser, Hon. Hugh (Stone)|
|Boyle, Sir Edward||Craddock, Beresford (Spelthorne)||Garner-Evans, E. H.|
|Braithwaite, Sir Albert (Harrow, W.)||Crosthwaite-Eyre, Col. O. E.||Godber, J. B.|
|Bromley-Davenport, Lt.-Col. W. H.||Crowder, Sir John (Finehley)||Goodhart, Philip|
|Brooke, Rt. Hon. Henry||Cunningham, Knox||Gower, H. R.|
|Brooman-White, R. C.||Currie, G. B. H.||Graham, Sir Fergus|
|Grant-Ferris, Wg Cdr. R. (Nantwich)||Lloyd, Maj. Sir Guy (Renfrew, E.)||Rees-Davies, W. R.|
|Green, A.||Longdon, Gilbert||Remnant, Hon. P.|
|Gresham Cooke, R.||Lucas, Sir Jocelyn (Portsmouth, S.)||Ridsdale, J. E.|
|Grimston, Sir Robert (Westbury)||Lucas, P. B. (Brentford & Chiswick)||Robertson, Sir David|
|Grosvenor, Lt.-Col. R. G.||Lucas-Tooth, Sir Hugh||Robinson, Sir Roland (Blackpool, S.)|
|Gurden, Harold||McAdden, S. J.||Rodgers, John (Scvenoaks)|
|Hall, John (Wycombe)||McCallum, Major Sir Duncan||Ropner, Col. Sir Leonard|
|Harris, Reader (Heston)||Macdonald, Sir Peter||Russell, R. S.|
|Harrison, A. B. C. (Maldon)||McKlbbin, A. J.||Simon, J. E. S. (Middlesbrough, W.)|
|Harrison, Col. J. H. (Eye)||Mackie, J. H. (Galloway)||Smithers, Peter (Winchester)|
|Harvey, Air Cdre. A. V. (Macclesfd)||McLaughlin, Mrs. P.||Smyth, Brig. Sir John (Norwood)|
|Hay, John||Maclean, Fitzroy (Lancaster)||Speir, R. M.|
|Heald, Rt. Hon. Sir Lionel||Macleod, Rt. Hn. lain (Enfield, W.)||Spens, Rt. Hn. Sir P. (Kens'gt'n, S.)|
|Heath, Rt. Hon. E. R. G.||Macmillan, Rt.Hn.Harold(Bromley)||Stanley, capt. Hon. Richard|
|Henderson-Stewart, Sir James||Macmillan, Maurice (Halifax)||Stevens, Geoffrey|
|Hicks-Beach, Maj. W. W.||Maddan, Martin||Steward, Harold (Stockport, S.)|
|Hill, Rt. Hon. Charles (Luton)||Maitland, Hon. Patrick (Lanark)||Steward, Sir William (Woolwich, W.)|
|Hill, Mrs. E. (Wythenshawe)||Manningham-Buller, Rt. Hn. Sir R||Stoddart-Scott, Col. M.|
|Hill, John S. (Norfolk)||Marshall, Douglas||Storey, S.|
|Hinchingbrooke, Viscount||Mathew, R.||Stuart, Rt. Hon James (Moray)|
|Holland-Martin, C. J.||Maudling, Rt. Hon. R.||Studholme, Sir Henry|
|Hornby, R. P.||Mawby, R. L.||Summers, Sir Spencer|
|Horobin, Sir Ian||Medlicott, Sir Frank||Sumner, W. D. M. (Orpington)|
|Horsbrugh, Rt. Hon. Dame Florence||Milligan, Rt. Hon. W. R.||Taylor, Sir Charles (Eastbourne)|
|Hulbert, Sir Norman||Molson, Rt. Hon. Hugh||Teeling, W.|
|Hyde, Montgomery||Nabarro, G. D. N.||Temple, John M.|
|Hylton-Foster, Rt. Hon. Sir Harry||Nairn, D. L. S.||Thompson, Kenneth (Walton)|
|Iremonger, T. L.||Neave, Airey||Thompson, Lt.-Cdr.R.(Croydon, S.)|
|Irvine, Bryant Godman (Rye)||Nicholson, Godfrey (Farnham)||Thornton-Kemsley, C. N.|
|Jenkins, Robert (Dulwich)||Nicolson, N. (B'n'm'th, E. & Chr'ch)||Ti|ey A, (Bradford, W.)|
|Jennings, J. C. (Burton)||Nugent, G. R. H.||Turner, H. F. L.|
|Johnson, Eric (Blackley)||Oakshott, H. D.||Turton, Rt. Hon. R. H.|
|Keegan, D.||Orr, Capt. L. P. S.||Vaughan-Morgan, J. K.|
|Kerby, Capt. H. B.||Page, R. G.||Vosper, Rt. Hon. D. F.|
|Kerr, H. W.||Pannell, N. A. (Kirkdale)||Wakefield, Edward (Derbyshire, W.)|
|Kershaw, J. A.||Partridge, E.||Wakefield, Sir Wavell (St. M'lebone)|
|Kimball, M.||Pickthorn, K. W. M.||Wall Major Patrick|
|Lambton, Viscount||Pilkington, Capt. R. A.||Ward, Rt. Hon. G. R. (Worcester)|
|Lancaster, Col. C. G.||Pitman, I. J.||Ward, Dame Irene (Tynemouth)|
|Langford-Holt, J. A.||Pitt, Miss E. M.||Waterhouse, Capt. Rt. Hon. C.|
|Leavey, J. A.||Pott, H. P.||Whitelaw, W. S. I.|
|Legge-Bourke, Maj. E. A. H.||Powell, J. Enoch||Williams, Paul (Sunderland, S.)|
|Legh, Hon. Peter (Petersfield)||Raikes, Sir Victor||Wills, G. (Bridgwater)|
|Lindsay, Hon. James (Devon, N.)||Rawlinson, Peter|
|Linstead, Sir H. N.||Redmayne, M.||TELLERS FOR THE AYES:|
|Mr. Barber and Mr. Hughes-Young.|
|Ainsley, J. W.||Dye, S.||Jenkins, Roy (Stechford)|
|Albu, A. H.||Ede, Rt. Hon. J. C.||Jones, David (The Hartlepools)|
|Allaun, Frank (Salford, E.)||Edwards, Robert (Bilston)||Jones, Elwyn (W. Ham, S.)|
|Allen, Arthur (Bosworth)||Evans, Albert (Islington, S.W.)||Jones, J. Idwal (Wrexham)|
|Allen, Scholefield (Crewe)||Flenburgh, W.||Jones, T. W. (Merioneth)|
|Awbery, S. S.||Fraser, Thomas (Hamilton)||Key, Rt. Hon. C. W.|
|Benn, Hn. Wedgwood (Bristol, S.E.)||Gaitskell, Rt. Hon. H. T. N.||Lawson, G. M.|
|Benson, G.||George, Lady Megan Lloyd (Car'then)||Lee, Frederick (Newton)|
|Beswiok, Frank||Gibson, C. W.||Lee, Miss Jennie (Cannock)|
|Bevan, Rt. Hon. A. (Ebbw Vale)||Gordon Walker, Rt. Hon. P. C.||Lewis, Arthur|
|Blackburn, F.||Greenwood, Anthony||Low, Rt. Hon. A. R. W.|
|Blenkinsop, A.||Grenfell, Rt. Hon. D. R,||Mabon, Dr. j. Dickson|
|Blyton, W. R.||Grey, C. F.||MacColl, J. E.|
|Bowden, H. W. (Leicester, S.W.)||Griffiths, David (Rother valley)||McGhee, H. G.|
|Bowles, F. G.||Griffiths, Rt. Hon. James (Llanelly)||MacPherson, Malcolm (Stirling)|
|Brockway, A. F.||Griffiths, William (Exchange)||Mahon, Simon|
|Broughton, Dr. A. D. D.||Hale, Leslie||Mainwaring, W. H.|
|Burke, W. A.||Hall, Rt. Hn. Glenvil (Colne Valley)||Mallalieu, J. P. W. (Huddersfd, E.)|
|Butler, Herbert (Hackney, C.)||Hamilton, W. W.||Marquand, Rt. Hon. H. A.|
|Butler, Mrs. Joyce (Wood Green)||Hannan, W.||Mason, Roy|
|Callaghan, L. J.||Harrison, J. (Nottingham, N.)||Mellish, R. J.|
|Carmichael, J.||Hastings, S.||Messer, Sir F.|
|Castle, Mrs. B. A.||Hayman, F. H.||Mitchison, G. R.|
|Chapman, W. D.||Henderson, Rt. Hn. A. (Rwly Regis)||Monslow, W.|
|Chetwynd, G. R.||Herbison, Miss M.||Moody, A. S.|
|Collick, P. H. (Birkenhead)||Holmes, Horace||Morrison,Rt.Hr.Herbert(Lewis'm,S.)|
|Collins, V. J.(Shoreditch & Finsbury)||Houghton, Douglas||Moss, R.|
|Craddock, George (Bradford, S.)||Howell, Charles (Perry Barr)||Moyle, A|
|Cullen, Mrs. A.||Howell, Denis (All Saints)||Mulley, F. W.|
|Darling, George (Hillsborough)||Hughes, Cledwyn (Anglesey)||Noel-Baker, Francis (Swindon)|
|Davies, Ernest (Enfield, E.)||Hunter, A. E.||Oliver, G. H.|
|Davies, Stephen (Merthyr)||Hynd, J. B. (Attercllffe)||Oram, A. E,|
|Delargy, H. J.||Irvine, A. J. (Edge Hill)||Orbaeh, M.|
|Donnelly, D. L.||Janner, B.||Owen, W. J.|
|Dugdale, Rt. Hn. John(W. Brmwch)||Jeger, George (Goole)||Paling, Rt. Hon. W. (Dearne Valley)|
|Pargiter, G. A.||West, D. G.||Wells, William (Walsall, N.)|
|Paton, John||Silverman, Julius (Aston)||Wheeldon, W. E.|
|Pearson, A.||Simmons, C. J. (Brierley Hill)||White, Mrs. Eirene (E. Flint)|
|Pentland, N.||Skeffington, A. M.||White, Henry (Derbyshire, N.E.)|
|Plummer, Sir Leslie||Slater, Mrs. H. (Stoke, N.)||Wigg, George|
|Popplewell, E.||Slater, J. (Sedgefield)||Wilcock, Group Capt. C. A. B.|
|Price, J. T. (Westhoughton)||Snow, J. W.||Wilkins, W. A.|
|Price, Philips (Gloucestershire, W.)||Soskice, Rt. Hon. Sir Frank||Willey, Frederick|
|Probert, A. R.||Sparks, J. A.||Williams, David (Neath)|
|Proctor, W. T.||Stewart, Michael (Fulham)||Williams, Rev. Llywelyn (Ab'tillery)|
|Rankin, John||Summerskill, Rt. Hon. E.||Williams, Rt. Hon. T. (Don Valley)|
|Reeves, J.||Sylvester, G. O.||Willis, Eustace (Edinburgh, E.)|
|Reid, William||Taylor, Bernard (Mansfield)||Winterbottom, Richard|
|Robens, Rt. Hon. A.||Taylor, John (West Lothian)||Woof, R. E.|
|Roberts, Albert (Normanton)||Tomney, F.||Yates, V. (Ladywood)|
|Robinson, Kenneth (St. Pancras, N.)||Ungoed-Thomas, Sir Lynn||Younger, Rt. Hon. K.|
|Rogers, George (Kensington, N.)||Viant, S. P.||Zilliacus, K.|
|Ross, William||Weitzman, D.|
|Royle, C.||Wells, Percy (Faversham)||TELLERS FOR THE NOES:|
|Mr. Short and Mr. Deer.|