§
The general abstracts which under section nineteen of the Registration Service Act, 1953, and section seven of the Registration of Births, Deaths, and Marriages (Scotland) Act, 1854, are required to be sent annually to the Minister of Health and the Secretary of State respectively and to be laid before Parliament shall include the statistical information compiled—
§ Brought up, and read the First time.
§ 5.49 p.m.
§ The Minister of Health (Mr. Derek Walker-Smith)I beg to move, That the Clause be read a Second time.
The object of this new Clause is to secure that the fullest information be laid before Parliament, including new information to be obtained under Clause 2, and also to see that this is put on to a proper statutory basis. The new Clause achieves this object. It is the same, I think, as the object the right hon. Member for Warrington (Dr. Summerskill) and her hon. Friends had in suggesting the new Clause Co which reference has been made.
I pointed out in Committee that there was some complexity of drafting in regard to the Bill. The Government have the advantage of the expert assistance of Parliamentary counsel, and I therefore commend this Clause to the House.
1133 The position at present is that these matters are governed by Section 19 of the Registration Service Act, 1953, which requires a general abstract to be laid before each House of Parliament. Though the authority is in the 1953 Act, the reporting dates back over a hundred years before that, and originates with the Births and Deaths Registration Act, 1836, and always, right from the start, I think it has been taken to mean that there should be a full presentation of such statistical information, derived from the registers, as is likely to prove useful, keeping the interests of research very prominently in mind. There is no statutory requirement in respect of the Population (Statistics) Act, 1938, but that information has habitually been given in the reviews under the principle which I have just enunciated.
Coming to the terms of the new Clause, the effect of paragraph (a) is to put on a proper statutory footing the reporting to Parliament of the statistics derived under the procedure of the Population (Statistics) Act, 1938. The effect of paragraph (b) is to deal with the information regarding still-births, and to achieve the reporting of that to Parliament, as expanded by the amendment of Section 11 of the 1953 Act by Clause 2 of the present Bill. This expansion of the basis of statistical information and the reporting thereof will in particular help research and subsequent genetic evaluation.
In order to investigate a genetically determined condition, it is necessary to know all the cases occurring in a population of adequate size, including those born dead. In Scotland, the cause of death of still-births is already recorded. There are only about 2,300 still-births a year in Scotland, and of those only 538 are certified as due to congenital deformity. After birth, nearly 500 per annum are certified as dying from this cause, but these numbers are quite insufficient for research purposes of the kind to which I have referred.
By recording the cause of death of still-births in England and Wales, which we do in Clause 2 of this Bill, it is expected that about 3,800 still-births and 3,400 deaths after birth will be available each year for the study of congenital malformations. With the Scottish figures, 1134 this will give a total of about 8,200 cases a year, which will be enough to allow the necessary research to be undertaken. With these figures, we may hope that in due time we shall be able to determine the proportions and types of congenital abnormalities due to genetic defects.
It will then be possible to go further and investigate what factors are responsible for producing these genetic defects, and to find the proportion of cases due to the workings of genetic defects long present in the race, compared with those due to newly arisen genetic change. Of course, this evaluation is not yet possible. Time is required to enable that to be done. In the present state of knowledge, it is not possible to make a worth-while comment on the significance of the figures obtained for congenital abnormalities, even if the data had been complete for both still and live births. But the research is directed to this end, and the expanded information will assist the research.
If I may now say a word on the mechanics of the reports, the tables relating to the causes of still-birth—this is a Clause 2 matter—will be published in Part I of the annual review; that is to say, the medical tables. Part 2 is entitled "Population Tables", and includes a special series of tables, 20 in all, derived from information obtained under the 1938 Act. Tables concerned with fathers' ages, which are in the Schedule, will appear under the authority of this Bill.
Part 3 of the review is entitled "Commentary", and it includes the comparisons, reviews of trends and explanations of changes. It deals with the statistical significance of trends and comparisons, but is prepared by doctors and statisticians who are themselves expert in the interpretation of medical statistics, and of population and fertility statistics. It is in the commentary part that there will be a comment and explanation, review of trends and so on, of the new information which is authorised in the Bill; that is to say, the statistical part will be set out in the tables and the commentary will come in Part 3, which is the appropriate place for it.
In summary, there are four matters with which we are concerned. There is the 1135 broadening of the base of statistical information, there is the promulgation of this new information, thus spreading further light on the genetic structure of the human population, there is the research by the Medical Research Council on the basis of the above, and further evaluation by the Council in the light of the results of its research. We are broadening the base in Clause 2 and the Schedule, and the Registrar General will be able to do the promulgation and the commentary in the annual reports under the new Clause, and the Medical Research Council will be assisted in its research both by the broadened statistical information and the commentary, and will be able to make its further evaluations in the light of them. All in all, this will be a valuable addition both to our statistical information and to our research and evaluation.
§ Dr. Edith Summerskill (Warrington). I think that it would be a little ungenerous for me not to stand up and thank the Minister wholeheartedly for conceding my point, but I am wondering whether he has given us only a slice or two of bread and not the whole loaf.
What I am particularly worried about is that in his concluding sentence the right hon. and learned Gentleman said that we had broadened the statistical information. I do not want to repeat the speeches that I made in Committee. I realised that he was sympathetic to my point of view, because I can remember one sentence which he used time after time. He said, "Yes, I quite understand that you want the statistics supplied by statisticians, but you want scientists to come along to make the scientific inferences from them," which is precisely what I want. The Minister has said that in the commentary that will be so but then he said that as a result of this, the Medical Research Council will have statistics which will enable it to evaluate the true position in this country regarding the effect of nuclear radiation. That is why I feel that we have not gone far enough.
I am a little surprised that my new Clause has not been called, because it dealt with a different point. I would have been quite happy if the Minister in his annual report had also got together 1136 as many experts as he could to report on this, because, as I said to him, the annual reports in the past, which have been very good annual reports from his Department, have dealt with most of the diseases with which people are very much concerned in this country, particularly those where the etiology is a little suspect, and so on. What I wanted was a yearly report from the Medical Research Council. I felt that that would not be asking too much. However, in our new Clause we asked for a full report in the Minister's annual review. We accepted the Minister's new Clause. When we see the annual report, we shall then be able to see how far it has gone towards satisfying us.
One thing which hangs over the whole world today is the fear of the effects of nuclear radiation on the health, the morbidity and the mortality of the population.
6.0 p.m.
I wanted the Minister to come here and tell us that the Medical Research Council, which was responsible for the first large Report on the Hazards to Man of Nuclear and Allied Radiations, had recognised that this matter was of such prime importance to the whole world that it would give an annual report. I know full well that the Minister cannot direct the Medical Research Council to do anything. The Council makes its own decisions.
I wish to register the fact that we have arrived at a stage when the Medical Research Council has made a report, and not an adverse one. The Council might make an encouraging report every year and say, "We are very glad to say that the strontium rate, which was found to be high in the bones of small children last year, or which was found to be high in milk last year, has now been reduced and, therefore, the apprehensions aroused last year can be dismissed". There is no reason why any report should necessarily be of a depressing character. It could be of an encouraging character.
I use again the analogy which I used upstairs. The Minister held up all his statistics and said to me, "Look at these statistics. Is this not enough for you?" I replied," It is rather like holding up a bunch of X-rays and saying, 'These are X-rays.' However, they are no good with-out a scientist to interpret them." This 1137 afternoon I feel as though the Minister, doing his best under difficult circumstances, has said, "I showed you that bunch of X-rays upstairs. I have my arms full again this afternoon. Does not this satisfy you?" I want the people who interpret these things to say, "This is happening in this area because of such and such a thing."
I cannot press the Minister further on this. We shall have to accept this and wait for the first annual report. I do not ask the right hon. and learned Gentleman to write this down, but on the Clean Air Bill when the Minister said that we could have an annual report we asked him if he would use his good offices when the time came for a debate. I will not press him. I merely ask him to bear it in mind. It would make a useful subject for a debate. It would give us an opportunity to air our views
Whenever this subject arises, when it appears that radioactivity has increased in the atmosphere, the only way we can extract more information is by Question and Answer. That is most unsatisfactory. Hon. Members see reports in the papers and table Questions. Mr. Speaker, quite rightly, is always pressing us to hurry on with our supplementaries. When two or three supplementaries are put on any scientific problem, it inevitably evokes groans. When we want to extract the information, we recognise that we must be very quick about it.
I press this point because the Minister will realise how strongly we feel at this time that the fullest information should be available for us all. I am sure that my hon. Friends will accept the offer of the Minister to add this Clause to the Bill. However, I hope that at the end of the year the Minister, as the guardian of public health, will speak very strongly in certain quarters and say, "It is my responsibility to see that the country has this information." As time goes on, perhaps we shall be given even more information than we have been offered in the new Clause.
§ Mr. William Ross (Kilmarnock)Before we start thanking the Minister, let us ask him just exactly what we are thanking him for. The additional Clause sounds all very high falutin':
Additional matters to be included in annual reports of Registrar General and Registrar General for Scotland".1138 Will the Joint Under-Secretary of State for Scotland tell me what we shall get under the new Clause which we are not getting already? Shall we get anything?I do not ask the right hon. and learned Gentleman that question. I address my question to the Joint Under-Secretary of State for Scotland, because he will appreciate that what we are doing in the rest of the Bill is to bring the English law more or less into line with that in Scotland. In Scotland we already have information available on this matter. Indeed, we already obtain from the Registrar General for Scotland the information which the Minister now tells us we shall get under the new Clause.
The Minister himself gave the game away. He said that what we shall get under this is full information. Would we not get it without the new Clause? He knows quite well that we get it now and that we have been getting it. The only difference is that we now get it on what he called a "proper statutory basis".
§ Mr. Walker-Smithindicated dissent.
§ Mr. Walker-SmithThere are two points which I sought to make clear. We are putting on to a proper statutory basis the statistical information already derived under the Population (Statistics) Act. That information is given at present, but we are under no statutory obligation to give it. The information which has previously been given in Scotland will now be given for the first time in England under Clause 2, namely, the causes of still-births. I will answer the hon. Gentleman's question about what Scotland will get out of this. As I have already pointed out, the number of cases from Scotland are not sufficient to enable research and scientific deductions to be made. Therefore, Scotland will get the benefit that there will now be a totality of cases sufficient for research to proceed and evaluation to be made. There is no difference in these things, whether they arise north or south of the River Tweed.
§ Mr. RossI do not doubt that at all. Would we not have got that without the new Clause? What exactly will Scotland get from the new Clause? We would have got it without the Clause We are 1139 getting it in Scotland at the moment without the Clause. The totality of which the right hon. and learned Gentleman speaks comes not from the new Clause but from the rest of the Bill. I have not the slightest doubt that we should have got it already.
I am sorry to press the Minister like this, but he seemed to give us the impression that he had more or less conceded our case and that what was in our new Clause, which is not selected, is contained in his new Clause. He knows quite well that it is not.
The new Clause promises us statistical information, nothing more nor less. The Minister will also provide the commentaries in Part 3 of the Minister of Health's annual report.
§ Mr. Walker-SmithThe hon. Gentleman is wrong again.
§ Mr. Walker-SmithIf the hon. Gentleman would prefer to persist in an error, I will not rise to interrupt him. If he wishes to be right in what he is saying to the House, I should tell him that these are not my reports in the sense of being Ministry of Health reports. They are the statutory reports compiled by the Registrar-General, for whom I have Ministerial responsibility, but who is not part of the Ministry of Health.
§ Mr. RossThe new Clause says that these reports
are required to be sent annually to the Minister of Health and the Secretary of State respectively and to be laid before Parliament".We are now saying that theyshall include the statistical information compiledOne source gives the tables of causes. The other source gives the population tables. They are in Part 3 of the commentaries.
- (a) from particulars furnished to registrars …
- (b) from certificates delivered to registrars …".
The importance of this, as the right hon. and learned Gentleman said, is that what follows therefrom is that a new and greater amount of data will be available to those interested in research on population trends. The Minister men- 1140 tioned the Medical Research Council's evaluations from the data. What we wanted was that the House and the country should be kept up to date by an annual report giving us the latest stage of evaluation. That is what we wanted and that, with all due respect to the Minister, is what we shall not have.
We are glad that the right hon. and learned Gentleman has taken our point, but he has not met it. He has deliberately left it to the Medical Research Council, for the reports of which we must keep pressing him, asking when they are coming. It would be far better, now that we have this greater totality of information and data, to have an annual estimate or evaluation of the important trends arising from the information. The Government themselves in past years, including the Joint Under-Secretary of State that was, insisted upon the importance of the matter; they could not bring in the legislation until they had all the information from those who were advising them about the effects and hazards to man of radioactivity, and so forth.
We are surely entitled to have this information in an annual report of some kind. The Minister is giving us data. He is giving us a limited commentary, but we are not to have that specialised evaluation which, in my view, the country needs and which the House hitherto had expected would come under this Bill. I certainly shall not oppose putting on a proper statutory basis information which we are already receiving and which we should have without the new Clause. I regret that the Minister has not gone further.
§ Mr. B. T. Parkin (Paddington, North)Like my right hon. Friend the Member for Warrington (Dr. Summerskill), I appreciate the courtesy, the ingenuity and the drafting skill which has gone into the endeavours to frame this new Clause, but, like my hon. Friend the Member for Kilmarnock (Mr. Ross), I am very sad at the Minister's success because I fear that what he has succeeded in doing is to take most of the life out of the proposals which were embodied in the wording of our new Clause. I am sad at the loss of words which gave us the impression that the Minister of Health might be laying before Parliament an annual report with information about trends.
1141 My right hon. Friend and my hon. Friend have asked for more evaluation of the statistics, but, of course, there are other trends besides those which were in the minds of those who framed the new Clause. I had hoped that, if the Minister accepted our new Clause and agreed to make a report himself to the House, there might be the possibility of discussing it. I have never yet, however, heard any clamour on Thursday afternoons for a discussion of the annual returns of the Registrar General. There are too many statistics and too few people trying to interpret them and detect trends in them. I had hoped that the new Clause would set a precedent for the Minister reporting annually on some of the trends in society which are important not only to his Ministry but to others.
As a parallel to what has been discussed both upstairs and this afternoon, I will take one example from the very first item in the Schedule to the Bill. Unless we know what is going to be done with the information when we have it, I do not know why we should give the Minister the new Clause or the Bill. It is said in the Schedule, under "Particulars which may be required",
On registration of a birth or still-birth(a) in all cases the age of the mother.We are told that there is a trend in the population towards the earlier maturity of children. From time to time, someone seems to notice it. We want information based upon a broad enough sample, with medical advice as to whether it really is definite enough to indicate a pattern and whether it is likely to persist. After that, we want a political assessment of what effect this trend might have on the work not only of the right hon. and learned Gentleman's Department but of other Departments as well.If it is true that children are, on the whole, maturing earlier, then the Minister, if he studies the reports and information, may one day find it desirable to tap the shoulder of his right hon. Friend the Minister of Education and say, "It is not my business, but the whole of your planning for the education system of this country has gone wrong." We might have got things wrong. We might have decided, years ago, an inappropriate age for children to change 1142 their schools in order to avoid their doing it at a period of emotional disturbance in their lives. We might find that we had, in fact, planned for the change from one school to another to occur just at the moment when emotional disturbance was most likely.
Who will have the courage to face that? How is it to be brought to the notice of Parliament unless we have Ministers who are not only studying trends and accumulating evidence in the form of statistics but evaluating them? My right hon. Friend asked for a scientific evaluation. We need a political evaluation also. I had hoped that the Minister would be a pioneer in the trend, which I think I discern, towards the coordination of the social services and an examination of cases where they are breaking down through lack of cooperation between one Ministry and another. I had hoped that the annual report envisaged in the new Clause would, one day, find its place in an annual social survey.
6.15 p.m.
The House has a Defence White Paper which it discusses before it moves on to the individual Estimates. It has an Economic Survey presented to it once a year before it moves on to Budgets and individual Estimates. Why should it not have a social survey, an analysis of trends interpreted with a political balance by the Government as a whole and by the Minister in charge within the Government of co-ordinating the work of all the welfare Departments? Why should there not be a full-scale debate on such an annual social survey, followed by a succession of debates devoted to the Estimates of the particular Departments in turn? We should then find out, sometimes, how we could save by altering the programmes of some Ministries because the work they were angaged upon had either become no longer necessary or had been taken over by others.
That is a long-term vision which I permitted myself for a brief time to dream might be brought a little nearer to reality by this Clause. I am, therefore, very sorry that the Minister has preferred to retreat and to use the old, accepted method of feeding us all the statistics and none of the judgment through the medium of the Registrar General's annual return instead of 1143 through the dynamic political leadership which we expect from those responsible for our welfare services.
§ Mr. Ron Ledger (Romford)I think that the Minister has made a little progress since the Committee stage. He may not have expected us to agree wholeheartedly with his new Clause or to say that it meets us fully, but perhaps he thought, when introducing it, that it might make us a little happier. The tone of his introduction of it tended to suggest that.
As my hon. Friends have said, the new Clause may very well offer us nothing at all that we have not already. There is, however, the strong possibility that the Minister could give us a good deal under the new Clause. One of the main concerns of my right hon. and hon. Friends has been the effect of nuclear radiation upon births and still-births, and related matters. We wanted to have available a medical interpretation of statistics in this way. We wanted to know to what degree nuclear radiation was affecting the statistics. While we shall not vote against this proposed new Clause, I warn the Minister that we shall be watching these annual reports very carefully to see whether he has accurately interpreted our needs. We shall judge whether the Minister as given us anything when we read the first report and see whether we laymen can intelligently learn something from the statistics.
§ Mr. Walker-SmithBy the leave of the House, and out of courtesy to the right hon. Lady the Member for Warrington (Dr. Summerskill) and to other hon. Members who have spoken, I should like to make three short points arising out of the observations that they have made.
First, there will be not only statistcs in the Registrar General's annual report or annual review to which the proposed new Clause refers, but, as I have said, also the commentary in the third part of the annual review which will be made by people of medical as well as statistical skill. If I did insufficient justice to the technical expertise of the commentators in Committee I must apologise, because these people are expert not only in the statistical sense but also in the medical 1144 sense. There will be those reports based on the statistical part which will appear in the statistical tables. They will be valuable apart from anything which will come out of the Medical Research Council as such.
As its name suggests, the function of the Medical Research Council is research. It will use these statistics for its research and, on them, will base a further scientific assessment and evaluation of the sort which I think the hon. Member for Paddington, North (Mr. Parkin) and other hon. Members wish to have. The Medical Research Council, albeit it will not be reporting under this machinery on an annual basis, will continue to present the results of its researches as and when it is useful, possible and valuable so to do. As I have said on another occasion, we shall be having later in the summer an up-to-date assessment by the Council on the whole broad subject dealt with previously in the 1956 Report.
To return to what was said by the right hon. Lady and other hon. Members, as I said in what was meant to be, and I hope was, a helpful intervention in the speech of the hon. Member for Kil-marnock (Mr. Ross), we are concerned with the statutory report by the Registrar General, which he makes to the Minister of Health and which, in turn, the Minister of Health lays before Parliament. But I have a dual rôle here, because I am the Minister responsible for the Registrar General in the Parliamentary sense and also, as Minister of Health, I have the other Ministry of Health reports referred to by the right hon. Lady, including the excellent and valuable reports made annually by my Chief Medical Officer. In addition to what we are doing under this proposed new Clause, I am also considering whether I can, through my Chief Medical Officer, provide any more information on this general range of topics in the Ministry of Health report. There is no necessity for legislation for that because it is an administrative matter and, therefore, I did not mention it in moving the new Clause. As I say, however, it is a subject to which I am giving attention.
§ Question put and agreed to.
§ Clause read a Second time, and added to the Bill.