HC Deb 01 February 1960 vol 616 cc721-33

Order for Second Reading read.

7.53 p.m.

The Parliamentary Secretary to the Ministry of Health (Miss Edith Pitt)

I beg to move, That the Bill be now read a Second time.

The purpose of the Bill is to make permanent provision for the collection of certain statistics relating to births, stillbirths and deaths. Until now, that information has been obtained under the Population (Statistics) Act, 1938, which was originally passed for a period of ten years and which, since 1948, has had to be renewed each year under the Expiring Laws Continuance Acts.

In recent years, there has been criticism in the House during the passing of the latter Acts that this legislation had not been made permanent, and I therefore trust that Members on both sides of the House will welcome the fact that we are now taking the first steps toward making the legislation permanent.

In substance, the Bill provides for the same information as the 1938 Act, with some minor changes, but with one addition of some importance. Clause 2 provides for the collection of information on the causes of still-births in England and Wales, and I will return to that change in a moment and explain why it is included.

The purpose of the 1938 Act was to provide statistical information which would help in the study of population problems and the information obtained has made it possible closely to study the changes affecting the country's birthrate. In 1938, the need for that information was emphasised by concern about the possibility of a decline in the population combined with an increasing aged population. But that is not the position today, or, rather, there is no decline in the birthrate. The higher birthrate since the war has completely altered the situation, though the importance of a reasonable assessment of probable future trends of population remains.

Changes in the size of families and in the size and age structure of the population affect particularly the amount to be paid in family allowances, the need for educational facilities, the demands on the Health Service, and the amounts paid in retirement pensions and other National Insurance benefits. The need for information on population trends therefore continues.

The Bill provides that the 1938 Act shall be made permanent with some modifications gained from experience of that Act. There are few changes in the Schedule. Generally, the question asked under the 1938 Act were found adequate for the purpose of studying population changes. Because hon. Members will wish to know, I should also state that in general there has been no complaint about that 1938 Act. It has worked smoothly and reluctance to give the information asked for has been very rare.

At the request of the Medical Research Council, the age of the father at registration of birth has been added to the Schedule, and that is important in connection with fertility studies. The only new item, except for the question of whether the mother was previously married, at present asked on a voluntary basis, is that question about the age of the father.

There is another question, because of the need for separate statistics, due to the fact that the number of women, widowed or divorced has risen. We now wish to know the distinction between widowed and divorced women at death. On the other hand, the items dealing with the number of children of the mother have been simplified and two items normally required at death have been left out.

Again, I stress that the information obtained under the Schedule of the Bill will not be recorded in the permanent registers, and the present Act imposes a specific bar on disclosure, except as may be necessary for the compilation of statistics.

I referred to the information on the causes of still-birth. The position here is rather different and needs Amendments of the Acts relating to the registration of still-births. That information has been obtained in Scotland for the past twenty years, but not in England and Wales. Although infant mortality has been declining steadily in recent years, which is a matter of considerable satisfaction to all of us, the decline is largely accounted for by the reduction in the mortality of children between one week and one year.

The mortality of children in the first week of life has not declined so rapidly, nor has the still-birth rate shown much variation until the last two years. There is a close connection between the causes of early infant death and the causes of still-birth, and a study of the problem would be greatly helped by a collection of information on the causes of still-birth.

A person registering a still-birth is already required to produce a certificate showing that the child was not born alive, and, in Scotland, stating the cause of death. All that is unchanged, except that in all cases the cause of death will be asked for and, in addition. the Bill provides that certificates shall include the estimated duration of the pregnancy. Clause 3 provides for the last paint also to apply to Scotland where it is already sometimes included as part of the statement of the cause of death.

The House will wish to know that medical and midwifery organisations are in general agreement with the proposal to obtain information about the causes of still-birth, and among those who have been consulted are the British Medical Association, the Royal College of Obstetricians and Gynaecologists, the Society of Medical Officers of Health and the Central Midwives' Board.

The statistics derived from the information obtained under the Population (Statistics) Act, 1938, and comments on them are published in the annual reports of the Registrars-General. The statistics obtained from the new information will be published in the same way. Under the Expiring Laws Continuance Acts the present powers will be continued until 31st December this year and it is proposed that when the Bill has gone through all its stages, it will be brought into operation as of 1st January next year, so that continuity of the statistics will be maintained.

Thus, the yearly renewal under the Expiring Laws Continuance Act will no longer be required, and I think that that will please the House.

8.0 p.m.

Dr. Edith Summerskill (Warrington)

This is a short but very important Bill of four Clauses. It is a Bill of tragic significance. I am astonished that the hon. Lady sought completely to evade the significance of the Bill. When I read the inept speech of the Minister for Science in another place, I realised that he was endeavouring to do the same thing until, at the end, a noble Lord asked him a question and, in his winding-up speech, he was compelled to explain to the House the purpose of this little Bill.

I agree that unless accurate statistics are forthcoming one can get only a blurred picture of the conditions obtaining in any area, and that statistics enable assessments to be made of progress, or lack of progress, in the reduction of the incidence of disease. Figures produced in hon. Members' constituencies by their medical officers of health every year provide an index to the incidence of disease in their own limited areas, and from those figures can be deduced environmental factors which are related to the aetiology of certain complaints. What I have just said is rather related to the purpose of the Bill.

The Bill makes a further contribution to the information regarding still-birth and foetal abnormalities. I do not blame the hon. Lady, but I am appalled by the brief which she has just read to the House. Scotland is a small country—the Scots will forgive me for saying that—but there is a large population here. Why does the hon. Lady think that doctors are to give a diagnosis of the cause of death? Why does she think that it is now said that if a doctor is not there the midwife will do it? Why has she not explained all this to us? There is a reason for it. The doctor has more knowledge. Why does she think that for the first time in Scotland and England the duration of pregnancy has to be given?

Why has the hon. Lady not told the House? This is very curious. Why is it necessary to know the duration of pregnancy? Why has the age of the father of a still-born foetus to be given? The hon. Lady said, "We have got to examine fertility". We really must not be mealy-mouthed about this. Why are we suddenly making inquiries into the fertility of men at various ages? Are there things about the fertility of men which are not known to scientists?

Why, in the Schedule to the Bill, are we suddenly told that the age of the father has to be given? The hon. Lady is here to give the House this information. Why has it not been given? The hon. Lady says that we are having the father's age for the first time because we want to study fertility? Let me tell the hon. Lady why. I am surprised that her right hon. Friend has not introduced the Bill. On second thoughts, perhaps I understand why he has not done so. The hon. Lady should have been told this by her Department. Why has it been found necessary to introduce the Bill in the middle of the twentieth century, a century in which we thought the Welfare State had cut down the incidence of disease?

These are the reasons. First, when the doctor diagnoses the cause of death as far as he can—and it will have to be a visual diagnosis—he will describe the condition of the foetus. Not only has the still-birth rate not dropped, but the number of microcephalics—and we were warned about this in the reports concerning nuclear radiation—has increased. When he reports the cause of death the doctor will state the condition of the foetus. He will also report the number of foetal abnormalities which are being Dorn. The duration of the pregnancy is also to be reported. The hon. Lady dismissed all these grave questions by talking about fertility. I shall explain later that in terms of reproduction the age of the foetus is of tremendous importance.

Has the Minister gone far enough in the registration of congenital abnormalities in this country? We have heard that all those organisations associated with these questions have welcomed the Bill. They welcomed it because they know what is happening. They know that the still-birth rate is stable but that the number of monstrosities, as we called them when we were students, has increased.

I ask the right hon. Gentleman to read an article in this week's B.M.A. Journal on anencephaly and other congenital abnormalities. The article was written by Dr. M. P. Plydell, the Medical Officer of Health for Oxfordshire, and deals with an epidemiological study in Northamptonshire. He says that congenital abnormalities merit the same detailed epidemiological study today which, in the past, has been directed to infectious disease. He then proceeds to explain how he had to collect his material from various sources. This investigation and the conclusions he draws are so valuable that it would appear that the time had arrived for a comprehensive form of registration, or notification, or certification, whatever the Minister thinks proper, of congenital abnormalities.

This limited Bill will enable us to obtain more information relating to still-births. The fact is that for centuries venereal disease has been responsible in a great part for still-births. That is why the population at the beginning of the last century was remarkably low. The number of still-births in this country was out of all proportion to the population and to the number of live births. The antidote to venereal disease has been discovered. One would therefore expect a spectacular reduction in the still-birth rate. That has not happened.

Although the infant child mortality rate has fallen considerably, the neonatal rate—that is, death in the first week—has continued high. The reasons for the death rate of babies within the first week, and the death rate of babies before birth, in the utera, in the womb, are related.

It is clear from the information which has been asked for in the Schedule that this little Bill is related to the serious menace which threatens those living, and posterity, namely, the genetic effect of nuclear radiation. It was only when the Minister for Science, in another place, tried to evade the issue—as the hon. Lady has tried to evade what is the real significance of the Bill—and was pressed, that in his winding-up speech he said something which made it quite clear that he was unfit for his job. He talked about human mutations and the effect of radiation on mutations. He was compelled to do that because one of the medical noble Lords pressed him to answer a question.

In 1956, the Medical Research Council, which, I understand, welcomes the Bill, published a Report called "The Hazard to Man of Nuclear and Allied Radiation". We had a debate on the Report and I had the privilege of speaking from this Box on behalf of my party. This Bill is consequential upon that Report. I ask the hon. Lady to read it. On page 22, under the heading, The effects of exposure to radiation during pregnancy", it states After heavy doses of radiation, a pregnant woman may miscarry or give birth to a stillborn child. There is no comfort in arguing that she will not often be subjected to a heavy dose of radiation; the genetic effects of radiation are cumulative, which means that every dose of radiation, whatever the source, is of the greatest importance.

The Report of the United Nations Scientific Committee on the Effects of Atomic Radiation emphasises that there is at present no known threshold of radiation exposure below which genetic damage does not occur. The Prime Minister should have remembered this before he told the Africans not to worry about the Sahara bomb because it would release only a small amount of radioactivity. However small the amount of radioactivity, genetically it is of great importance.

I now come to the question of the father's age. To make any worth-while deductions it is necessary to have the father's age, for the genetic effects can be assessed only if the length of the reproductive period of life, during which both mother and father have been exposed, can be estimated. The stillborn foetus was not the product of its mother; it was the product of its mother and father. Therefore, in order that the statisticians should have a proper picture they must know precisely how long each parent has been exposed to radioactivity. The only time that really matters is the reproductive period.

This is the reason for the introduction of the Bill. I have spoken rather strongly because, on every occasion when a Question has been put down, let us say, upon the increase of leukaemia—and there is no argument about it; leukaemia is increasing in this country—there has been an evasion of the issue. We have never been able to get a Minister to admit that radioactivity is partially responsible for the increase.

But here we have a Bill the import of which every scientist who reads it will know precisely. We have had a speech which underestimates the intelligence of hon. Members—a speech which not for one moment touched upon the real reason for the introduction of the Bill. Unhappily, man-made radiation has now so polluted the atmosphere that the Bill must be made a permanent Measure. That, also, is significant. No longer can such a Measure be introduced every year; it is necessary to have these statistics perhaps for as long as any hon. Member will live. Let us not pass it lightly when considering the reasons which make it necessary in the middle of the twentieth century.

The irony of the situation is that many hon. Members who are listening to me tonight have devoted much of their lives, in the field of social services, to trying to reduce the incidence of disease, and yet now, in the twentieth century, we have deliberately injected into the atmosphere something which the Report on the Hazards to Man of Nuclear and Allied Radiation says may harm some who are now living, and may harm posterity.

8.15 p.m.

Mr. William Ross (Kilmarnock)

I hope that the Minister of Health will intervene in the debate, because this is a matter of considerable importance. If we cannot have the Minister of Health, let us have the Secretary of State for Scotland.

Knowing how attentive the Parliamentary Secretary is to her duties, I am sure that it will come as no surprise to her that I am speaking tonight. If she looks through the reports of our debates on the Expiring Laws Continuance Bill for the last eight or nine years she will find that I have spoken on nearly every occasion upon the subject of the Population (Statistics) Act. It is strange that we have been continuing this Act ever since 1948 on a year-to-year basis. During that time we have had the Report of the Royal Commission on Population, which had much to say on the question of what statistics were available and could be made available, and the importance of them.

Time after time I asked the Government why they continued something so important as this upon a year-to year basis. It was about four years ago that we were compelled, as Scottish Members are occasionally compelled, to drag a Scottish Minister to his feet and admit that the reason for the delay was the concern about the hazards of nuclear radiation. For the first time we had an admission from the Joint Under-Secretary of State for Scotland—now Lard Craigton—that what was holding up the Government's decision to have permanent legislation was the fact that they did not have particulars of all the additional questions that would require to be asked as a result of studies being carried on into the effect of radiation upon the population.

Having heard the hon. Lady speak, my sole purpose in intervening is to ask what has happened to the studies that the Government were carrying out, and why we have not been told that in making this legislation permanent the Government have at last decided that they have now asked all the necessary questions to guide them in dealing with the effects of radiation upon the population.

I thought that my right hon. Friend the Member for Warrington (Dr. Summerskill) was a little hard upon the Parliamentary Secretary. The fault was not entirely the Minister's. But my right hon. Friend was right in stressing the importance of the subject. The additions being made to the legislation are really very few. They relate to the incidence of still-births, the age of the parents, and the duration of pregnancy in relation to still-births. These questions are related to the studies which, as Lord Craigton told us four years ago, were giving the Government concern, and in respect of which the Government thought that until they were completed they would not be able to make up their mind what to put into the permanent legislation.

Are these seemingly simple changes brought about because of the Government's realisation of what is happening, and the necessity for having year-to-year information about the growing effect of radiation? I am surprised that the Government did not mention this. It may well be that they know quite well the history of this Measure. In 1938, when the first Act was introduced, there was quite a storm in the country. A great newspaper campaign was carried on about the invasion of the privacy of the individual and about asking such questions.

I think that what the Government are doing is right, but I think it wrong that the Government are not telling the country why they are doing it. I hope that the Minister of Health, or someone of his stature who has not already intervened in the debate, will take the opportunity now and tell the country why these questions are being asked.

8.20 p.m.

Mr. Ede (South Shields)

My right hon. Friend the Member for Warrington (Dr. Summerskill) has made a speech which, I venture to say, will arouse some anxieties outside the House. It is a pity that there have not been more hon. Members present to hear her indictment of the Government on this matter.

Her speech was followed by a speech by my hon. Friend the Member for Kilmarnock (Mr. Ross), in which he pointed out the successive stages through which this matter has gone in this House without attracting any very great attention here or in the world outside. We have the privilege of the presence of the Minister of Health, to whom my right hon. Friend made a direct appeal, which was followed by my hon. Friend the Member for Kilmarnock, that he should intervene and say how far the strictures made by my right hon. Friend and my hon. Friend are justified, with the knowledge that he has now been head of his Department for some years.

As a rule, he is very communicative to the House in regard to matters which come within his purview. On occasion when his Department has been attacked he has tried to press down hon. Members on this side of the House with a ferocity which would make him appear to be a lineal descendant of the late Sergeant Buzfuz. I was rather anticipating that tonight the right hon. and learned Gentleman would rise in the spirit which he showed when dealing with my hon. Friend the Member for Coventry, North (Mr. Edelman), who made certain allegations against his Department in regard to the importation to this country of a vaccine which the Minister thought he was being unjustly attacked about.

This is a very important matter. Now that it has been raised so definitely by my right hon. Friend the Member for Warrington, I would have thought the Minister of Health would have seized the opportunity, either of saying that my right hon. Friend's case was quite unfounded, or of admitting that the questions she suggested from her professional experience were involved in this Bill were, in fact, the motivating power of the Government in introducing it. I hope the right hon. and learned Gentleman will not miss the opportunity of informing the country about how far he accepts what has been said by my right hon. Friend in the course of the remarks she addressed to us.

8.24 p.m.

The Minister of Health (Mr. Derek Walker-Smith)

I certainly would not take the occasion of this Bill to make an extensive commentary on what fell from the right hon. Lady the Member for Warrington (Dr. Summerskill). As the House knows, I have not got her medical qualifications and experience on these matters. I assure the right hon. Member for South Shields (Mr. Ede) that I would not take this particular topic to make the sort of speech to which he referred, a speech which, I think, he compared to the orations of Sergeant Buzfuz in another context.

The Bill changes the method of collection of these statistics. In respect of still-births there are the important additions in respect of the age of the father and the length of pregnancy. The right hon. Lady has said that there are more congenital abnormalities. Part of the object of this Bill is to find how many births there are of congenital abnormalities, in other words, to answer that question. Therefore, the machinery of the Bill is a good one.

We are here operating on the advice of the Medical Research Council. As the right hon. Lady and the right hon. Gentleman know, I am not the Minister responsible for the Medical Research Council, in spite of its name. It is the responsibility of my noble Friend the Minister for Science, who introduced the Bill in another place.

The studies which the Medical Research Council is making on this matter will be assisted by the wider information which is to be obtained, and that is a valuable thing. It is happily true that the proportion of mutational births is very small, but in the context of radiation, which as the House knows comes from all sorts of sources—we have had this at Question Time many times—there is natural radiation and diagnostic radiation as well as radiation arising from tests. In a modern society—I was going to say a sophisticated society, but I do not know that that is a particularly happy word—in a society such as we have today, the question of radiation becomes more important. Even if the number of mutational births is very small indeed, nevertheless there is something here which we have to study. The Medical Research Council is anxious to study it, and we are anxious to give the Council the facilities and scope under this Bill which will enable it to do so.

Than is part of the reason why we think this is a good Bill, because it makes this addition to what was possible before. The other reason why we think it a good Bill is that it is giving permanent form to something which heretofore, as the hon. Member for Kilmarnock (Mr. Ross) said, was subject to annual re-enactment under the Expiring Laws Continuance Bill. I am sorry I am not able to follow the right hon. Lady in the medical technicalities of this matter, nor do I think she would expect me to do so, as I do not enjoy the advantages she has in this respect, but I hope that explanation will reassure the House that the object of this Bill is a good one and one which deserves an unopposed Second Reading tonight.

Dr. Summerskill

Will the right hon. and learned Gentleman say why this whole aspect has been evaded? He has accepted it now. He has spoken about mutational births, as he called them. Of course, there are spontaneous mutations and mutations related to radioactivity. Why did his representative come to this House to tell us that here was this simple little Bill dealing with population when he now admits that its real purpose is related to radioactivity?

Mr. Walker-Smith

Obviously that is not the whole purpose of the Bill. This system of collecting the statistics and having them available for scientific study dates back, as my hon. Friend explained, to 1938. It has a history of mare than two decades and is of great value, as the right hon. Lady knows or should know, in all sorts of ways quite apart from the more specialised use she has been discussing. This Bill and the study of statistics which will flow therefrom are of great importance in many contexts, in the social services amongst others.

Mr. Ede

Will the right hon. Gentleman assist us to this extent? I understand that the Minister for Science is represented in this House and his Department is answered for by one of the Parliamentary Secretaries or Under-Secretaries. Will he assure us that we shall have the presence of that hon. Member to assist us in the further stages of the Bill?

Mr. Walker-Smith

There are various Ministers entrusted with the diverse and important functions of the Minister for Science when they come to this House. I have no doubt that on the Committee stage of the Bill the Committee will have the assistance of my hon. Friend and myself and a suitable Minister for Scotland. We shall endeavour to deal with any points which may be put. If the right hon. Gentleman has any particular point in mind which he thinks is of a specially technical nature, it would be characteristic of the courtesy and constructive approach which he always shows if he would communicate it to me first, which would enable me to get the most expert advice that I can.

Question put and agreed to.

Bill accordingly read a Second time.

Bill committed to a Standing Committee pursuant to Standing Order No.38 (Committal of Bills).