HOSPITALS

HC Deb 21 July 1960 vol 627 cc807-57

7.12 p.m.

Dr. Edith Summerskill (Warrington)

I beg to move, to leave out "£345,672,485 ", and to insert "£345,671,485", instead thereof.

In the short time at my disposal, I propose to focus attention on certain conditions obtaining in our hospitals in order to try to elicit information which we failed to obtain at Question Time.

The whole House is familiar with the repeated complaints about the interminable delay in proceeding with some project which has already been approved, about the long waiting lists and the inadequacy of certain services. Over the years, I have listened to these repeated complaints, generally on Mondays, and, in consequence, I have been left with the impression that the approach of the Minister to the Service is completely haphazard and lacking in co-ordinated policy.

I hope that when the Minister speaks he will not plead that he had only £22 million or £25 million, or is going to have only £31 million, for capital expenditure and that therefore he is unable to respond to the requests from both sides of the House. I would emphasise that capital expenditure does not necessarily determine the quality of work in a hospital. The service should be measured by the degree of integration between the three parts of the National Health Service—namely, the hospitals, the general medical and dental services, and the services administered by the local health authorities. Only when this co- ordination has been secured and the emphasis place on preventive work and the domiciliary services, will the hospitals be used intelligently and economically. Therefore, in the first place, I would say that my proposals call not for more money but for first-class administration, which is sadly lacking.

Hon. Members on both sides of the House have mentioned the long waiting lists. These long waiting lists, which the right hon. and learned Gentleman the Minister of Health and his Parliamentary Secretary seek to explain time after time, are in part due to the failure to co-ordinate the local services. It is not surprising that there is a growing volume of complaint. In the last report, it was revealed that the hospital waiting lists rose to 476,000 at the end of 1959–33,000 more than the year before. Now we are told that, of patients seeking advice in the first place, 30 per cent. have a complaint which has a psychogenic origin. This in itself emphasises that there should be greater integration outside the hospitals to relieve pressure on the out-patients.

Again, on preventive work, the Minister comes to the House time after time and tells us how the poliomyelitis service is developing. We are told how many injections have been given and what he proposes to do in this work. But what of the other preventive work? The Minister never comes to the House to tell us that there is any co-ordination between his Department, the Ministry of Labour and the Home Office in order that the problem of occupational diseases can be approached. I do not have to remind hon. Members that, whereas tuberculosis has been reduced, the incidence of bronchitis, particularly in industrial areas, is very high. Bronchitis is not only related to pollution of the air, but to the conditions of work in industrial areas.

What has the Department done? What has the right hon. and learned Gentleman done? I should like him to give me his attention. He has not done so yet.

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

On the contrary. I do not know why the right hon. Lady should make that sudden, savage and unprovoked attack on me. I am listening with all my customary attention and a good deal of incredulity evoked by the right hon. Lady's observations.

Dr. Summerskill

The right hon. and learned Gentleman must not be so sensitive. His interjection has shown the House precisely what his attitude is to these important problems. His interjection is characteristic of his approach on Mondays.

Brigadier Sir Otho Prior-Palmer (Worthing)

Let us get on.

Dr. Summerskill

There we are again, intervening.

Mr. Walker-Smith

It was not I.

Dr. Summerskill

Well, his master's voice. What I was going to say was that I prefer the front of the Minister's head to the back. If he will listen to what I am saying, it might help him in the future. His behaviour now, as I say, is characteristic of his attitude to these appeals.

It seems that the doctors at the British Medical Association Conference at Torquay this year were highly critical of the Minister's totally inadequate planning. This is surprising, as the British Medical Association is a Conservative organisation. Has he read what the chairman of the consultants and specialists said? One would have thought that, as we have a Conservative Government in power, the doctors might have dealt tenderly with the Minister. Far from it. He has just tackled me; I forget how he described my approach, which so far has been very gentle. These are only the opening remarks. What some of the doctors at Torquay, who I am sure voted for the Conservative Government, said about the Minister's handling and his lack of planning is very surprising.

An even more alarming note was struck in the article by a special correspondent in The Times on 16th June. I would remind the right hon. and learned Gentleman that The Times is not a Labour newspaper. In an article on the future of the hospitals, with the title "Is there Crisis on the Way?" the writer says: This crisis, if it occurs, will be due to the failure of planning and building to keep abreast of the money available. I emphasise that point. I have already said that I hope the Minister will not tell the House the amount of money that he has spent. The criticism of him and his Department is their failure to plan and to keep abreast of the money available.

This special correspondent goes on: Apart from the encouragement given to mental hospital schemes and new towns, it is not easy to see any clear-cut policy concerning priorities, whether, indeed, a comprehensive search has been made for the areas with the most urgent need. I see that my hon. Friend the Member for Durham (Mr. Grey) is in his place. Time after time, he has pleaded for more attention to be paid to the North-East Coast. Time after time, he has pointed out that the waiting lists in that part of the country are longer than they are anywhere else and that there has been delay in planning. This is not just the voice of the Opposition. It is the voice of the special correspondent of The Times and the voice of the doctors' organisation at Torquay. They said precisely the same thing. The Minister has failed completely in recognising priorities and in planning.

Last Monday, there were two Questions about the maternity services. I understand that the Minister or his Parliamentary Secretary recently received a deputation from the new town of Harlow. Harlow has the highest birthrate in the country, yet still it has no special accommodation for its maternity cases. In Harlow, young mothers have no opportunity to go into hospital to have their first child.

I have given these details to indicate the Minister's lack of appreciation of priorities and lack of planning. Time after time, I have asked what determines the priorities, but I have never received a satisfactory answer. It seems that we have to wait for a serious state of affairs to develop before vigorous action is taken.

No doubt, greater attention will now be paid to the repeated complaints of hon. Members about the lack of adequate accommodation and the failure fully to implement the Cranbrook Report since the startling report on confidential inquiries into maternal deaths in England and Wales between 1955 and 1957. This report has been leaked to the Press. Apparently, it was not to be made public until the House rose. This is very significant. This was a report about which the House should have known. The Minister should have anticipated a debate on health. I find it difficult to understand why he should not. Wales had a day on Tuesday, and such was the dismay among my hon. Friends from Wales that they said that the subject of the debate should be health because the Minister's administration was so unsatisfactory. I assure the right hon. and learned Gentleman that there was no collaboration; I had no idea that health was the subject chosen for Tuesday's debate on Welsh affairs. In the knowledge that almost certainly there would be a debate on health before the House rose, the Minister should have seen to it that the report was published. He did nothing of the kind. It was leaked to the Press.

The Daily Telegraph had a long report about it. If the Minister likes to deny any of the things which were said, he may, but he did not do so last Monday. When I reminded him of the shocking revelations in the report, he contented himself by giving us figures of the number of women who had survived childbirth, the most inept and cynical answer I have ever heard in the House. Most people do not die of cancer. Most people are not killed on the roads. But is that a reason for complacency?

I see my hon. Friend the Member for Pontypool (Mr. Abse) in his place. I have read the speech he made last Tuesday, when he focussed attention on the fact that the infantile mortality rate, the stillbirth rate and the death rate for children in the first week were higher in Wales than in England. He, too, emphasised that the situation did not call for complacency. This report on maternal mortality should galvanise the Minister into action. What it reveals is reminiscent of conditions in the early part of the century, and it is an indication of the deterioration of the Health Service under the Conservative Government.

On 11th July, the Daily Telegraph said: More than 180 women died after Caesarian operations … In some cases, there was a failure to give a blood transfusion. Other deaths were due to the inexperience of the surgeon, and sometimes a consultant was called too late. This brings me to the matter which has been raised by my hon. Friend the Member for Manchester, Exchange (Mr. W. Griffiths) concerning the practice of allowing junior members of the staff to do work which should more properly be undertaken by their seniors. This is not a party matter. It is something about which hon. Members on both sides of the House should be anxious. We understand from the report on maternal deaths that these unfortunate women lost their lives owing to the incompetence or inexperience of certain individuals. What is being done to protect the public from the inexperienced doctor who is told to deputise for his superior? In my view, the public is entitled to a periodic inspection of the quality of medical care in our hospitals.

My hon. Friend the Member for Manchester, Exchange reminded the House that a consultant who was expected to be in charge was not there but a deputy. The consultant did not turn up. I put the practical point to the hon. Lady that if consultants do not turn up their remuneration should be reduced. Is any action of any kind taken by the Ministry? Is there an inquiry made in order to protect people? No answer was forthcoming and no answer has been forthcoming, except, I think, on one occasion a letter did follow telling me that these things had been followed up.

In medicine, experience is of tremendous importance. A case of Caesarian section is rushed into hospital. Perhaps there was not adequate accommodation in the first place. The woman was at home, and then it is decided that there should be a Caesarian operation. But then, we understand, in certain cases the operation has been done by inexperienced people, consultants were not called, and so on. In all these oases, there should be a follow-up to find out precisely why there was inadequate attention in the hospital concerned.

I come now to the Minister's complete failure to provide adequate facilities in our hospitals for the training of dentists. From both sides of the House, Questions have been asked on this subject time and time again, but the Minister has failed to respond to the demands which have been made. Hon. Members have asked why the children in their constituencies have not had adequate dental treatment, and this has been going on for years. If it was not of long standing, I should not complain, but it has been going on for years. I have asked whether candidates have been forthcoming, and I have been told that there would be plenty of dental candidates. Wales has been told that a dental hospital is to be established there. I think I am right in saying—the right hon. and learned Gentleman can correct me if I am wrong—that in this dental hospital the first student in Wales will not be trained until two or three years from now.

There has been great pressure for more accommodation to be provided for the training of dentists, and, as I say, this has gone on not for months but for years. The result is what we have expected. In his presidential address to the British Dental Association in Edinburgh on 13th July, just over a week ago, Mr. Duncan MacGregor said: The dental welfare and treatment of children amounts to a national scandal". It was estimated that the minimum proportion of dentists required was one to 3,000 children. At present, the average was one to 7,000 and, in many cases, one to 10,000.

It was stated at the dental conference that the incidence of dental decay was higher than ever and that the treatment of children in local authority schools throughout the country was less adequate than it was ten years ago. I would remind the House that that was about the time when the present Government came into office. Therefore, I think I am right in saying that there are serious signs of deterioration in the Health Service. This is a shocking indictment of the Tory Party's administration of that service. I was not surprised, when I read the report of the Welsh debate on Tuesday, to find strong criticism of the Minister by Welsh Members. I have told the House of the condition of dental caries in children in England, but, according to the figures, the position is far worse in Wales.

I hope that the Minister will not suggest that all these failures of administration are due to the fact that the Treasury has been parsimonious. Everything that I have mentioned so far can be traced to a lack of planning, a failure to recognise priorities, and the absence of a positive and vigorous lead. All the time—just as he has demonstrated today—the Minister has been on the defensive. We are only too anxious to help in our constituencies, but this absence of a positive lead marks the right hon. and learned Gentleman's approach to the Health Service.

I hope that he will not plead a shortage of money when he allows such a wastage of public money on drugs. Every year since the Minister has been in office, the drug bill has increased. The total cost in hospital and outside is now approximately £86 million. The Comptroller and Auditor General says that the profits of the drug firms, and especially the American-controlled firms, are well above the average for general industry.

In 1957, the drug manufacturers came to a three-year agreement with the Ministry. It has completely failed. The cost of prescriptions has risen every year. Last year, the total cost increased by £7 million. Although the prescribing of doctors in the general medical service is investigated to some extent, I should like to know precisely what control is imposed. The Minister must know that the general practitioner often makes the excuse that a hospital doctor prescribes an expensive proprietary drug and then expects him to continue the prescription.

Each time that I have ventilated this outrageous exploitation of the National Health Service, the Minister has assured me that he would make an announcement this month—when the three-year agreement came to an end. Hon. Members know that I have raised this matter on many occasions. I have been criticised because, on one occasion, I suggested that somebody was interested in the drug houses—but it was proved that I was quite correct. I have always said that a mistake was made in negotiating this agreement. What has the Minister to say? Is it really the fact that he has promised the vultures of the pharmaceutical industry yet another six months in which to make their unholy profits at the expense of the community? Surely the Minister has not done this. This is not a party matter; £86 million is coming out of the pockets of supporters of hon. Members on both sides of the House by way of taxes. I cannot understand why the Treasury has not taken a stronger line.

My last word concerns the non-medical staffs in hospitals. Many of them are so imbued with a sense of vocation that they are reluctant to press their claims for better conditions. Although new hospitals and new buildings are attractive, I always attach most importance to the quality of the people who serve in them. If the people serving in these non-medical jobs have a sense of grievance, they withdraw their services after a time, and then the Minister deplores the fact that there is a shortage of practising midwives or mental nurses, or radiographers. That is in spite of the fact that he has failed consistently over the years to anticipate these shortages, which arise because of the bad conditions and low pay, and the consequent deterioration in the service concerned. This is extremely difficult to understand, because pressure has been put on the Minister not for months or weeks but for years. He has been asked to take action, but he has not done so until it has seemed that a crisis is threatened.

There is no time to deal with further details in the short time available. I have endeavoured to show that there is clear evidence of a deterioration in the National Health Service, owing to a failure to integrate the Service, to recognise priorities, and to check results by the effects on the patients themselves.

7.36 p.m.

Lord Balniel (Hertford)

One of the most welcome sentences that I have seen in any of the Ministry of Health Annual Reports for many years is that used by my right hon. and learned Friend in the introduction to this year's Report, to the effect that the hospital building programme has now entered a period of steady expansion. I found the remarks of the right hon. Member for Warrington (Dr. Summerskill) bordering on the ungenerous. I should have thought that, irrespective of party, any hon. Member who is interested in the National Health Service would wish to congratulate my right hon. and learned Friend on securing from the Treasury a considerably increased sum of money for the hospital building programme. There was not a word about that from the right hon. Lady. Surely that is something in which we can all take a fair amount of pleasure.

The expenditure on new hospital buildings has increased from £10 million in 1955–56 to £31 million next year, which means that there has been a trebling in five years. I should have thought that that was a matter for congratulation, and not the occasion for a speech on a very sour note, such as we had from the right hon. Lady. Indeed, I would have thought that all those who are interested in health would have heaved a sigh of relief at the knowledge that priority, which for many years was rightly focused very narrowly on housing and education, has at last been widened to include the hospital service.

Although we should wish to congratulate my right hon. and learned Friend, none of us has any inclination towards complacency. The shift of emphasis to the Health Service has not come too soon. It is a remarkable fact that one-third of our children are now being educated in post-war schools; indeed, within the next two years two-thirds of all our children will be educated in schools built since the war. Yet only one hospital has been built and put into operation since the war.

We must not be complacent about this. In spite of the war damage—and we have only to have tea on the Terrace and look across the Thames in order to see how slow has been the process of repair of war damage—and in spite of the neglect of post-war years and the fact that two-thirds of our hospitals still in use were built before 1891, and that 20 per cent. of all the hospitals now in operation are over a hundred years old, we are spending less, in real terms, on new hospital building than we managed to spend in 1939. Far from being complacent, we all naturally wish to impress upon my right hon. and learned Friend the importance of spending yet further sums on the improvement of our hospitals.

In passing, I very much doubt whether any of us has much idea of what in the present affluence of the country, is the correct capital programme that we should devote to hospital building. As was pointed out in the article in The Times to which the right hon. Lady referred, there has not been a national survey of our hospital needs since the survey conducted during the war. I rather doubt whether any of us, including my right hon. and learned Friend, has much basis on which to assess the needs of our hospitals.

The only basis which we have is an emotional one, a sense of disgust which we all have that in the second half of the twentieth century so many of our doctors and nurses have to work in conditions which are very much out of date and that so many patients have to be treated in conditions which are not satisfactory. These conditions are put into contrast only by the wonderful care and devotion of our doctors and nurses in difficult conditions.

If we insist, as naturally we do, on yet more money being spent on our hospital building programme, we have a duty not merely to cry out for more money, but to examine the administrative structure by which the hospitals are built and to make certain that we get the very best value for our money. In particular, we should look at the two authorities which are charged with the responsibility of building hospitals, the Ministry and the regional boards. We must try to achieve a fair balance between these two authorities, a fair balance designed to achieve, on the one hand, efficiency and rapidity of building and, on the other, responsibility to Parliament and control of cost. I am not sure that we have yet achieved the perfect balance 'between these two authorities.

For a short time, I had the privilege of serving as a member of one of the regional hospital boards. My interest in serving on the board was in the building of the first post-war general hospital, the new Welwyn Garden City and Hatfield Hospital, a £2 million project. This hospital was given the highest priority in the country. Indeed, we were privileged recently to have my right hon. and learned Friend the Minister come to lay the foundation stone.

This new hospital has, quite rightly, been given the highest priority, because the needs of my constituents are, possibly, more grave and urgent than the needs of any other people in the country. In spite, however, of the prestige which attaches to the building of the first postwar hospital, in spite of the urgent needs of my constituents and in spite of the priority which is given to this project, never in my life have I seen in what, after all, amounts to a business opera- tion—the building of a hospital—such pettifogging, trivial, bureaucratic interference by the Ministry in the work of the board. Days, weeks, months and, indeed, years passed whilst pathetic little plans for pathetic little matters were shuffled about between the Ministry and the board. An entire year passed.

Another regional board member who is present for this debate will not contradict me when I say that an entire year passed because of a dispute and argument about whether the boiler house of this £2 million project should be a few feet larger or smaller. The whole progress of the project was in jeopardy throughout that time. Ultimately, there was a Ministerial decision, to which, of course, the regional hospital board had to bow. I mention the example of this hospital only because it is, I fear, typical of hospital building in many other parts of the country.

I sum up by quoting from the objective report of the board, but not in any way designed to prove the point which I am now making. The report begins by saying that The preliminary plans for this hospital provided for a 500 bedded hospital, with full ancillary services, and it was on this basis that discussions took place with the Ministry of Health in 1954. It ends: The Ministry's authority to go to tender on the main project was received early in July, 1958. As I say, the hospital is in process of erection and as a result of my right hon. and learned Friend's intervention work is certainly progressing faster.

By way of comparison, I might mention that a friend of mine who is staying with me this week is an architect from the United States. He is charged with the responsibility of building in Berlin a hospital over double the size of the hospital to which I have referred. A year ago, all that existed was the willingness of the German and American authorities to build the hospital, and the land. A year ago, my friend was asked to draw up from scratch the plans for this large hospital. It will be in complete commission within three years of my friend being asked to draw up the first preliminary plans. If that can be done in Germany, why cannot it be done in this country?

I do not wish to be destructive, because, obviously, there is real difficulty. Ultimately, my right hon. and learned Friend the Minister is responsible to this House for the expenditure of money. Equally obviously, Parliament intended that the hospital authorities should have a wide measure of freedom. If we establish regional hospital boards composed of distinguished men, we should be prepared to leave them a wide measure of freedom. I would prefer that, the Ministry having decided that a certain sum of money can be spent on a hospital, the regional hospital board should be left completely free, even for the building of hospitals of substantial size within the Ministry's allocation.

When in difficulties, it is good advice, at least for hon. Members on this side, to turn to John Stuart Mill. John Stuart Mill, who always gives practical advice, writes as follows: I believe that the practical principle in which safety resides; the ideal to be kept in view; the standard by which to test all arrangements intended for overcoming the difficulty; may be conveyed by these words—the greatest dissemination of power consistent with efficiency; but the greatest possible centralisation of information and diffusion of it from the centre. Therein lies the answer to many of the problems which we face within the hospital service—the dissemination of power consistent with efficiency and the centralisation of information from the centre.

First, let me say a word about dissemination of power. I should like to see far greater autonomy given all the way down the line. Starting with my right hon. and learned Friend the Minister, he in his Ministry should be given far greater autonomy or discretion by the Treasury. The tight Treasury control over his Department might achieve parsimony. It mast certainly does not achieve the best use of the resources which the Treasury places at its disposal.

Not only would I like to see my right hon. and learned Friend given greater power, but I should certainly like to see the regional boards given far greater autonomy in the management of their own affairs. To go one stage further, I should like to see the hospital management committees given far greater auto- nomy in the management of their own affairs.

Now a word about centralisation of information. If we are to leave greater control in the hands of the regional boards we shall, no doubt, get much greater individuality in the designs of our hospitals, and a very good thing, too; but, equally, if we are to achieve a large hospital building programme we must at the same time be prepared to accept some basic designs common to all the hospitals, on the lines, I think, of the extraordinarily successful standardisation in the school-building programme under the Ministry of Education. I am not just talking about the acceptance of a universal module for windows, doors, minor objects like that. I am talking about basic design on a far larger scale.

My right hon. and learned Friend has within his Department—I know that this is a matter to which he is giving his personal attention—a hospital design unit. He has recently appointed, very wisely, as we both come from Hertfordshire, a Hertford man to take control of this hospital design unit. But this hospital design unit was established in 1954, and so far it has produced only one publication. I hope that the appointment of a Hertford man will result in an acceleration of its work. I should like to see the day approaching—indeed, I rather regret it is not approaching very quickly—when any regional board building a hospital could turn to the Ministry and have ready made designs for outpatients departments and so on, completely prepared designs for a ward or for an operating theatre, so that all the intricate planning of those details would be readily available without a moment's hesitation. I think this hospital design unit could serve a most useful purpose in the dissemination of information all over the country.

There is one other suggestion that I should like to make to my right hon. and learned Friend, and this, again, is concerned with the dissemination of information. Has my right hon. and learned Friend given thought to the possibility, in order to improve the understanding between the Ministry and the hospital authorities, of exchanging staff between the hospital authorities and the Ministry, somewhat on the lines of the Colonial Office when it exchanges staff between the Colonial Office itself and the administrative officers in the field? This would seem to me to be advantageous to the regional boards themselves. It would, for instance, raise the ceiling of promotion. I have a feeling that the ceiling of promotion is at the moment, if we are to attract the very best people into our regional boards, a trifle too low and that salaries are not high enough.

Mr. Richard Marsh (Greenwich)

This is a very interesting suggestion. There is only one major problem about it as far as I can see. Hospital staff and administrative staff, and so on, have different employers from Ministry employees. One group is of civil servants and the other consists of regional board employees. I do not know whether the noble Lord has got an answer to that?

Lord Balniel

I am aware of this, and I realise that it would bring into the Civil Service a considerable body of people who are not there at the moment. I realise that, but I am by no means convinced that it is not a very good thing. What it would do, for instance, would be to bring into the Ministry persons with actual experience of hospital operative work which at the moment is totally lacking in the Ministry of Health, so far as I can make out.

This Ministry is rather different from most Ministries. It is not like the Ministry of Housing and Local Government and it is not like the Ministry of Education. This Ministry is directly running one of the largest organisations in the country, an organisation comparable in scale with British Railways or comparable in scale with new towns. I believe I am right in saying that in total the National Health Service is the third largest organisation in the country. It is now over twenty years since a young assistant principal was seconded for a two-year term to a county council office. I merely put forward the suggestion, in order to increase the understanding between the Ministry and the regional boards, that an interchange of staff should at least be thought about even if it does involve a substantial constitutional change.

7.55 p.m.

Mr. Laurence Pavitt (Willesden, West)

I have listened with considerable interest and enjoyment to the speech of the noble Lord the Member for Hertford (Lord Balniel). I felt that he developed a most thoughtful attack, after his preliminary opening remarks in defence. I had a good deal of sympathy with him in his defence, because what he was saying, in effect, was that it was so difficult to get buildings and organisation going after the war. We had had six years of war and it took some time to deal with other priorities before dealing with hospital building. I felt that he ought, perhaps, to have been on this side of the House at that stage, because we have so often tried, in other connections, to make the same case.

After his defence the hon. Member followed with a number of most useful points, and I hope that they will have some effect on the Ministry. I think that in this debate we find ourselves, as we sometimes do in this House, lining up together on the back benches in order to try to push the Front Benches into doing something better or more efficiently than before. One of the essential points of the noble Lord's speech was this everlasting division between central control and the need for responsibility to Parliament, on the one hand, and, on the other, the need, at the same time, to release initiative at other levels. I shall read the noble Lord's speech in HANSARD tomorrow and consider further some of the constructive suggestions he put forward in that respect.

In a whole series of national organisations we have this difficulty of how to get central administration clearly defined and central policy laid down and, at the same time, not clutter it up with such details as the size of a boiler in a local hospitial. I felt that when the noble Lord talked about the bureaucratic interference by the Ministry he was attacking more violently, perhaps, than my right hon. Friend the Member for Warrington (Dr. Summerskill). I do not propose to go as far as that. I recognise the noble Lord's difficulties in the situation in which he apparently found himself in relation to the delays in building Welwyn Garden City Hospital.

Before I leave the noble Lord's comments, however, I would say that a matter which would bear looking at far more thoroughly is that of the department within the Ministry, which would make available blue prints and information about building casualty departments, and other distinct parts of hospitals, and the noble Lord's point that there should be a mine of information readily available for hospital boards in deciding their programmes. Here the Ministry of Education has something good to offer in the way in which, in the post-war years, a tremendous building programme has gone on and in the way that it achieved economy by making this centralised information available for the building of schools. It cut down wasteful building, it cut down waste of space, and made a good job of it.

On the question of responsibility to Parliament, I am deeply concerned at the way in which the present Government have minimised discussion in this House of the National Health Service and, ipso facto, of the hospital service. We have two and a half hours allocation in the whole of this Session to discuss a part of the National Health Service. We are not even debating the whole of the Service. We are debating one-third of it, one section out of three.

I notice from Sir Harry Pilkington's Report, the one we shall not discuss till after the next one is out, that he has in it 124 paragraphs on the question of the hospitals. Yet the House is not to have an opportunity of discussing this matter because negotiations are already going on between the Minister and the profession as to what is to happen about hospital staff. My complaint is that we are removing from the House of Commons—not the Government—the right to participate in discussion of health matters.

A most formidable indictment was made was by Sir George Schuster, who is hardly likely to support this side of the House, in his essay which was published by the Acton Society Trust under the title, "Creative Leadership in a State Service." As a chairman of a regional hospital board himself he is entitled to claim some knowledge of the subject. He made three main charges. He said that there was a lack of creative leadership in the National Health Service for three reasons.

The first was that the Minister had been down-graded so that he did not sit in the Cabinet and this had affected the quality of the administrators who were willing to enter the Ministry. The second charge was that the senior civil servants in the Ministry have no practical experience of the hospital services. The third, which was the point to which the noble Lord the Member for Hertford was primarily addressing himself, was the entire lack of central intelligence or planning activity.

On the first point, I have tried to do my small part. I have put only one Question ever to the Prime Minister in this Parliament, and that was to ask that the Minister of Health should be given a seat in the Cabinet. I am sorry to say that the right hon. Gentleman did not accede to my request. I am attacking the Government more than the right hon. and learned Gentleman the Minister of Health. I realise that he is only one of a team and the fact that he is small fry is not his fault. It is the fault of the Government in not making him big fry.

Creative planning, without a great deal of extra expenditure, could secure tremendous advantages in the hospital service. Practical steps must be taken to secure greater integration of general practitioners and the local health authorities with hospitals. I wonder whether the Minister can find time to examine the outstanding results which have been achieved by making pathological, X-ray and sterile syringe services available to general practitioners in the vicinity of Chadwell Heath, Essex, Hospital. The services are used in about a dozen practices and since their inception the number of references to out-patient departments by these doctors have been cut down by 50 per cent. The reduction differs from specialty to specialty, but in connection with skin diseases attendance at out-patient departments has entirely disappeared because general practitioners are now able to secure sufficient information with the services at their disposal to give treatment.

What a relief it would be if we were able to cut by 50 per cent. the number of people who queue at out-patient departments. This could be achieved if we used the skill of the general practitioners by giving them the tools with which they could do the job. I should add, however, that at the Nelson Hospital, Merton, a similar scheme which was started with a great flourish had to be stopped because there was insufficient staff there. Radiographers were not available and the scheme had to be brought to an end. It is up to the Minister to clear up difficulties that emerge from a shortage of staff.

The appalling frustration and time-wasting in out-patient departments should be entirely unnecessary. By the employment of a little imagination and the use of the good offices of the Council for Industrial Design a good deal could be done to minimise the present discomforts and anxieties. I have recently been a patient at three out-patient departments. One was at the Ear, Nose and Throat Hospital. There were the usual forms for rows of waiting patients to sit on and, finally, no more than a cubby hole where four patients sat on a wooden bench and waited to go inside to see the consultant whilst two others waited without seats.

The other hospitals were the National Hospital. Queen's Square and the Maida Vale Hospital, where there were marvellous arrangements and fine organisation and administration. There were comfortable chairs, little tables and a small cafeteria in the corner of the room. Patients were made to feel that they were not a lot of sheep being pushed past hurdles, but human beings suffering from illness and being treated with sympathy and understanding. If this can be done in two hospitals, why cannot it be done elsewhere?

What prevents it? I cannot believe that it is shortage of cash. Fresh colours and a few pictures on the wall and a better way of handling people are not an expensive undertaking. Outpatient departments are now the only survival from pre-war days when employment exchanges treated the unemployed man as if he were a criminal. We still have not got out of that attitude of mind in the matter of treating people in the out-patient departments of some of our hospitals.

Many of our buildings are Victorian and antiquated. We on this side of the House welcomed the Minister's statement on 11th July that in the Treasury's desire to out public expenditure his plans would not be cut. A sum of £31½r million will be spent next year, an increase of 20 per cent., but the Minister will be under terrific pressure from other Departments to cut his programme. I implore him to resist that pressure.

This sum is not enough, but we want the right hon. and learned Gentleman to retain all he can. He has said that there are 180 schemes, that eight new hospitals have been partly completed, nine started and 17 planned, but for a population of 52 million this is still inadequate. We have not had any national survey made of the changes not only in the last ten years, but in the last five years in the whole pattern of the treatment of illness. The Ministry should be ahead of developments and should know its requirements to plan effectively the health services and the hospitals it needs.

The irrefutable argument which the right hon. and learned Gentleman can employ is the fact that these services have been allowed to run down disastrously and starved of development. It is only now that the Minister is getting into his stride. He is in the position of the householder who does not do repairs and is then caught with a heavy bill because things have got out of hand and, in the meantime, the cost of labour and materials has risen. I appeal to the Minister not to accept any pegging back of expenditure, but to secure, if possible, even more than £31½ million.

Not only are some of the buildings archaic, but the structure of hospital staffing is absolutely archaic and antiquated. The Government have failed entirely to modernise it. Two grades stick out like a sore thumb. The S.H.M.O.s were to be a temporary expedient and they have become so permanent that their numbers have increased by 30 per cent. since the inception of this grade. Now 3,000 of them feel very disgruntled because many of them do full consultant work without consultant pay. The S.H.M.O. receives £34,000 less than the consultant in his working life, and on top of that the consultant receives domiliciary fees, merit awards and also private fees. No wonder there is dissatisfaction and unrest.

Then there is the poor time-expired registrar. We have discussed his plight time and time again. The Minister has said that there were 120 of these who were fully qualified and were doing major consultant work, but who had no idea of their future and no certainty of obtaining a consultant post. Some of them held Hunterian professionships and many had higher degrees by thesis. When will the Minister do something for these forgotten men? No doubt he will say that we are waiting for the Platt Committee to report. We have already waited two years. If we have to wait very much longer the time-expired registrars will have expired themselves.

When he is looking at the whole structure I ask the Minister to regard this as a matter of urgency. When railwaymen were waiting for the Guillebaud Committee's Report the Government speeded up the Committee. The Minister might take a leaf out of that book and put a squib behind the Platt Committee. A committee, incidentally, which, with one exception, is drawn entirely from the teaching hospitals. This brings me to the point that it is time that the Minister tackled the problem of the huge chasm that exists between the highly developed teaching hospitals and the broad mass of hospitals under regional boards which are taking the bulk of medical work on their shoulders. Judged by the work that they do, taking on all corners, dealing with a larger number of patients in proportion to staff than the teaching hospitals, they have more than earned a status on a par with teaching 'hospitals. Yet the present system not only denies this, but gives the teaching hospitals the opportunity to set the pattern for the whole hospital service. The regional hospitals are in the majority, but the top consultants from teaching hospitals are the people who more or less impose their will over the whole of the Service.

I recognise that in the last two years things have been moving in the hospital service faster than they have moved in the previous ton. But there is so much to be done and so little time for those of us who are interested in this subject to contribute to the discussion that is given here to get things done. We have within the hospital service outstanding examples of what can be done. All we are asking is for the Government to raise the level of the poorer parts of the service to the heights reached by some other parts. Because the Government give little priority to these things and appear complacent and not seized of the importance of making vital reforms, we must exert our utmost pressure in this debate and whenever the chance is afforded to us.

8.11 p.m.

Brigadier Sir Otho Prior-Palmer (Worthing)

I hope that the hon. Member for Willesden, West (Mr. Pavitt) will forgive me if I do not follow him in his very interesting and reasoned speech. Although we may blame the 'present Government and the present Minister, it, was the original conception that was wrong. Whatever Government were in power today would have to face up to this problem. The whole Service wants complete reorganisation in the light of experience That is part of but not by any means the whole of the trouble.

A point made by my noble Friend the Member for Hertford (Lord Balniel) worries me a little. I am scared stiff, or, to use a more Parliamentary word, frightened, by all these hospitals going exactly the same way. That is one of the ways in which we have gone wrong. There is a growing need for other types of hospitals as well as the orthodox. Cottage-type hospitals are needed to deal with nursing cases, the aged and those in need of medical care and attention. There ought to be more of these hospitals.

I am sure that all of us think well of this great service of ours. I am also sure that it is top-heavy, that there are far too many cogs in the machine, and that too many people have to be consulted before anything is done. An east wind, as it were, should blow through this Service so that something can be done.

There is the question of the hours of waiting which outpatients have to undergo. I am rather an accident-prone person and when I have had to wait I have said to myself, "Heavens above, I can see about six ways of preventing this waiting." There are people who like it. They regard it as a nice little holiday at their employer's expense, but most people have work to do and are longing to get out and get on with their work. The moment one is in hospital one feels that there is no sense of time. The doctors and nurses seem to feel that because a man is ill he need not do any more work until he has been put right. Surely something can be done about that.

Then there is the question of waiting for a bed, not for months but literally for years. I can do no better than quote the actual case of my own constituency. In Worthing, as I have said before in connection with housing, we have twice the national average of old people, most of whom need medical care and attention. These are people mainly of very slender means, who have suffered from the post-war inflation and the new revolution, and who are living either on pensions or on a minute fixed income of £150 or £200 a year. I could quote hundreds of such cases. The Worthing Hospital Management Committee, although I say it, is one of the most enlightened in the country. We all know that Worthing Hospital was the very first hospital to introduce daily visits for children. It is a progressive and enlightened hospital, and it has been known for a very long time that the beds and accommodation of this hospital—and of others close by—are totally inadequate for the demands made upon them.

Discussions were started concerning this hospital in February, 1956, pointing out the urgent need for more beds and other improvements such as more operating theatres and even cooking facilities. Up to March, 1957, one year and one month later, nothing had been done. Then a meeting was called in March of this year—four years later—but no finalised plan for any part of the scheme has yet been approved, despite many visits and much correspondence.

It was in the middle of all this—it gets almost more incredible as I go on—that the Ministry decided that it could not look at the Worthing scheme in isolation from other schemes for hospitals in the neighbourhood. That is perfectly all right—why should they? But does it take two years to come to that decision before anything is done? Lt took two years to make a little decision like that. I can only say to those who are responsible that I am very glad for their sakes that they were never in my brigade when I commanded one.

That is not the end to this fantastic story. A year and a half later the management committee was informed that another meeting would be held to discuss the matter on the basis that it must be part and parcel of the whole scheme. The meeting was held, but the management committee was never informed and not invited and did not know until afterwards that the meeting had been held.

On another occasion, plans were submitted by the Southlands Hospital for improvements under the new scheme whereby all hospitals must be considered. The first thing that the management committee knew about a three-phased scheme which had been passed for this hospital was when it read it in a report in the Press.

I cannot conclude without a word about the Worthing Council of Social Service, which has been doing, and is doing, a magnificent job for these pathetic older people in my constituency, relieving their suffering in this respect and in respect of accommodation. The members of this council know the tragic end of the story through their visits and contacts.

In 1957, they sent a memorandum to the Minister setting out the whole situation as they saw it, and a deputation attended on the Minister. They recommended that a rock-bottom minimum of 375 beds was necessary in Worthing to bring it up to the national average. Bearing in mind that we have double the national average of old people, they were being very modest in their demands,. One must realise that our accommodation must serve not just the borough of Worthing but towns such as Littlehampton.

This council can testify to the piteous character of some of the cases which are postponed from month to month. Last September—this is the latest figure that I can obtain—the waiting list numbered 112, 43 of which were A.1 cases. The delay is anything from eight months to a year for serious and urgent cases.

There are hundreds of cases which I could quote, but I will quote only three. There is an old, immobile, very deaf lady with miocarditis being looked after by her husband of 80 years of age. She cannot get out of bed, and her husband can hardly move either. There is an old man of 91 who is senile and ill being looked after by an elderly daughter who is completely worn out and finished by her ministrations. There is a totally blind man of 79 being looked after by a crippled landlady. This is not to say that tremendous work is not done by the district nurses. They are absolutely splendid. But it is far more than they can possibly cope with.

At long last a scheme for 52 new beds for Swandean Hospital is being started. But that scheme was agreed—not just put forward—before 1956, before any of these proposals were put forward to the Ministry. So that is not anything very much to crow about. I learnt only today from the person with whom I have been in contact that other schemes have also been approved—for new bathroom accommodation, new sanitary annexes and new additions to the maternity hospital. Where is the list of priorities? It really is fantastic. It is beds that we need. I hope the Minister will look into this matter very seriously indeed.

I had a very courteous and charming letter from the Minister today. He knew that I would speak in the debate. He said, quite rightly, that building takes time. Of course it does. But it takes a great deal longer if it is four years before one lays the first brick. It is also said that the board is fully aware of the situation. It would be deaf or blind if it were not, because it has been continuously made aware of the situation.

In my Budget speech I said that there are certain Ministers—this goes for both sides of the House—who sit on Mount Olympus sipping the nectar and are isolated and insulated from those living in the valleys by a cloud of civil servants. I ask the Minister to descend from that height and look into this matter. He should institute a searching inquiry into this case. I do not believe we shall ever get rid of the disease which affects bureaucracy until a large number of heads have rolled.

8.24 p.m.

Mr. R. W. Sorensen (Leyton)

I am sure that the hon. and gallant Member for Worthing (Sir O. Prior-Palmer) will not mind if I do not follow the remarks that he has made. There is really nothing in what he said that we could debate because I so very greatly share his views and appreciate his remarks, particularly as he represents Worthing, in which I understand I was nearly born, it being my mother's home town, and also because his eulogy of the Worthing hospital service is well deserved. One of the most prominent representatives of the Worthing Hospital Board is a person whom the hon. and gallant Member will know as well as I do—Mr. Barber, who is, I know, typical of many others who have helped most remarkably to provide the hospital needs of Worthing in the past years.

I mention that because it links up with an observation of a general nature that I wish to make, that we are, obviously, all proud today of our National Health Service, even though there are defects which must be remedied. This view is now shared by both sides of the House. I do not seek to be contentious when I say that that view was not always held so enthusiastically as it apparently is now. Perhaps the elderly people in the Worthing constituency may spare a thought not only in appreciation of their Member of Parliament for speaking so impressively about their hospital service but also in appreciation of the initiation of the schemes from which they are glad to benefit at present.

In my visits to America I have once or twice been assailed by American critics about what they call our "socialised medicine". I well remember on one occasion being able to quote an hon. Member opposite who was lecturing in America while I was there. He assured his American audiences that all parties in this country now upheld our National Health Service. I am afraid that some of my American listeners, when they heard me quote that, muttered under their breath "What a liar that Limey is!" Be that as it may, there are a large number of Americans who visit this country, some of whom have stayed in my house, who now appreciate—perhaps they did so grudgingly at first—that here we have an example to the whole world of what may be done by organising social services to meet social needs. Whether we call that Socialism or by some other name I do not mind, because, whatever it is, it establishes a principle in which this side of the House always wholeheartedly concurs.

Perhaps I might also bear testimony here to the very fine work which is being done voluntarily by thousands of men and women of all parties and of varying types in our regional hospital boards and committees. I say that not merely because my wife is active in one of them but because I know that here again is an example of how, given the opportunity and the incentive, a spirit of public service, not for gain but simply for the sheer love of devoting oneself to public life, is evoked and can be implemented in a very splendid fashion. There are serious defects, however, and the criticisms from both sides of the House of the Minister are directed not only at him but at the whole institution which he represents in the House.

I could speak of many aspects of the hospital service, but I am conscious of the lack of time and I will confine myself to three brief remarks. If it is not entirely irrelevant, I should like to refer to the dental service, about which we have already heard something. I asked the Minister a Question the other day and was informed that, taking the country as a whole, the number of persons per dentist in the general dental service varies from 3,100 in London and the South-East to 5,900 in the Midlands and the north Midlands, and in my county of Essex the figure is 4,750 and in the Borough of Leyton it is 4,200.

I mention that because it is some measure of the growing requirement to secure more dentists, particularly for the children. I do not think that the later cumulative effect of bad teeth among children is sufficiently appreciated. The neglect of children's teeth affects later their mental as well as their physical health. Children should receive regular and frequent dental service. It is false economy not to do that now because we shall have to pay in other ways later on when the effect of the neglect is registered in the mental or physical illness of the child.

I ask the Minister again whether he can give some idea of the need for dentists for the next five years. In a Question to him on 18th July I asked specifically … what are the prospects for the next five years of a substantial increase in the training of dentists? To my dismay the right hon. and learned Gentleman replied: I regret that no estimate of shortages in particular areas is available."—[OFFICIAL REPORT, 18th July, 1960; Vol. 627, c. 1.] That is a woeful admission. Surely by now the Minister should have stimulated his staff to secure this information. I do not join in the criticisms of bureaucracy so lightly flung out by the hon. and gallant Member for Worthing. Surely the Minister should himself have stimulated his bureaucracy to making inquiries about what is the extent of the need. How are we to meet it if we do not know what is the need? In my view, this is a very grave defect on the part of the Minister and I hope that we may be given some more encouraging reply than that which I received on 18th July. The right hon. and learned Gentleman also said on that occasion: Plans for the expansion of dental training facilities are well under way. Cannot he elaborate a little? Cannot he give some information about haw he proposes to grapple with one of the most dominant needs of the present time? I ask him again to go out of his way a little in order to give us more information and encouragement.

The second point to which I wish briefly to refer in the short time which I am allowing myself to speak relates to the supply of nurses. I am glad that the nursing situation is not quite so serious as it was although it is still serious. There are hospital beds in various parts of the country which cannot be used because of a shortage of nursing staff. I do not know what we should have done without the services of girls from overseas, including those from various Colonies or ex-Colonies. I should like to register our gratitude to them for coming to our aid and I trust that they will also be of service to their own countries when they return.

Something should be done to secure a greater number of nurses and I would like to know what the Minister proposes to do to meet this need 100 per cent.? What is he doing to persuade the London teaching hospitals, which are relatively overstaffed, to distribute some of their nursing staff to other hospitals; not only to teaching hospitals but other hospitals which give as great a nursing and hospital service? What is the Minister doing to encourage regional boards and committees to co-ordinate its plans to remedy a situation in which one hospital may be fairly well staffed and another not far away grossly understaffed? What is he doing to encourage plans for distributing nurses and student nurses more fairly among the hospitals? I plead with the Minister to give serious consideration to this matter.

I join with other hon. Members in urging that much greater efforts should be made not only to renovate, repair, restore and decorate hospital buildings but, where possible, to scrap them and replace them with better buildings. In my own locality there are three hospitals. One is the Langthorne, where the nurses and staff are doing everything possible. The hospital committee to its credit has certainly succeeded in improving the building, but from the outside at any rate it still remains extraordinarily like a bastille of the past. I expect that this is only one of a number of similar hospitals throughout the country, and, in addition to the other request I have made of the Minister, I ask him to give particular attention to these hospitals which ought to have been scrapped long ago. Some of them, as in the case of the hospital I mentioned, were formerly workhouses and some semblance of that remains, although in saying that I do not wish to be misunderstood, particularly by my constituents. Those concerned, both committee and staff, have done their best in a difficult job.

I trust that the Minister will pay attention to the three points which I have raised, and, in particular, that he will give more information regarding dental training that he provided for me on 18th July.

8.35 p.m.

Mrs. Eveline Hill (Manchester, Wythenshawe)

It is obvious that on both sides of the House there is real anxiety that we should increase the efficiency of the National Health Service. I do not share the pessimism of the right hon. Lady the Member for Warrington (Dr. Summerskill), because, when all is said and done, many of us have cause to be very grateful to the Service. We do the Service itself a dis-service if we over-emphasise certain points. It cannot be a 100 per cent. Service, even after this length of time. There has been an enormous change from our original conception of the Health Service, and it takes time to get everything right. There are faults, but many people have benefited considerably from services given all over the country.

That is not to say that those of us who take active part in running hospitals are not anxious that there should be improvements in the administrative set-up of the Service. Far too much time is wasted between management committee and regional board, and regional board and central administration. That is one of the things to which I hope the Minister will pay attention, because it is largely in that way that some economy can be made, even if it is only an economy in the time of officials.

From my own knowledge of hospitals, I know how one can wait for nearly six years for building schemes finally to be approved. There is too much to-ing and fro-ing, wasting an enormous amount of time of management committee and regional board officials, as well as the time of officials of the Ministry, every time there is a difference of opinion. All those things cost money and I hope that the Minister will consider how these arrangements work.

It is obvious that the Service costs a good deal more money than was envisaged when it was inaugurated. There is a far greater population to serve and we are all anxious that the Minister should not be denied funds to make the hospital service in particular and the Health Service generally absolutely first-class. Over the last ten years, £600,000 has been spent on a hospital in which I am interested in modernisation and improvements, but that is not a great deal for a hospital with 1,000 patients and a staff of 1,000, especially when one thinks in terms of keeping the hospital in good repair and adding improvements, new departments and generally keeping up to modern standards.

I think that it is advisable for more power to be given to regional boards, the people on the spot, without their having to go to the Ministry so often about small details. Having to go to the Ministry merely when one wants a ward to be a little smaller, or a passage a little narrower, is often irritating. If the regional board were given so much money, it could plan its expenditure for its area. I cannot think that the Minister can be aware of the plans for all areas. The amount of paperwork involved makes that impossible.

What worries many hon. Members is the length of the waiting lists of consultants. There are long waiting lists in several respects, for instance, of women waiting for gynaecological operations, women living at only half pressure because they cannot do any better, and who are probably something of a nuisance to their families because they are somewhat irritable through feeling ill. There are also waiting lists for orthopaedic cases, many illnesses with which we can now deal but with which we could not deal a few years ago, varicose veins, for example. All those lists are tremendously long and the determining factor in their length is often the amount of operating space available.

The recruitment of staff has been mentioned. We have recruited many staff and I am not prepared to agree that the Service is worse under a Conservative Administration than it was before. Nevertheless, staffing is important. Hospital staffs now have much longer holidays, and, therefore, we need more and more staff, and even more money with which to pay these extra staff. Therefore, it is a tremendous problem with which the Minister has to contend and which he needs to give a great deal of attention. Let him set an example from the top, and say to the regional boards and to the management committees, "That is your job. Let us see you work more efficiently."

We are spending a lot of money and we are doing a lot of good, but the Health Service is linked up with other services, which point was touched upon by an hon. Member opposite, in relation to beds for those elderly people who are blocking our acute beds now. There is quite a lot of that up and down the country, and I wish that there were more homes to which we could transfer the acute patients so that we could make very much better use of the beds available for acute cases. If the Minister could do something on those lines, it would materially help the Service and it would also help to get rid of some of these very long waiting lists and to get into hospital those people whom we are anxious should get there—the elderly people who are ill in their one little room or little flat, and who really need our help very materially.

If the Minister, by all his efforts and by means of the money he is spending, can help in speeding up the production of new hospitals and new departments, and removing some of these obstructions, I am certain that he will earn the undying support of all those people who are now working in the Health Service, to which they give so very much of their time.

8.41 p.m.

Mr. John Mackie (Enfield, East)

I should like to support the plea which other hon. Members have made for less interference from Whitehall in regard to building, which is quite appalling. I have heard many cases in which local people on the regional hospital boards and management committees have been frustrated, as other hon. Members have said, by the delay which takes place. With all the earnestness at my command, I appeal to the Minister to do something to put an end to this frustration among local people who are doing a fine job of work on these regional boards and management committees.

I should like to see a service in children's hospitals which, I think, is very essential. It is the provision of beds for mothers to be able to stay the night when their children, especially younger children, are taken to hospital after accidents. I had the very unfortunate experience of taking my three-and-a-half year old son to hospital after a serious accident, and finding that he was literally plucked from my arms and taken away through a door, while I was left to state my religion and other particulars to a secretary.

I am certain that it would assist children in recovering from the mental and psychological shock if they knew that one of their parents was allowed to stay in the hospital, and that it would have a very powerful effect on the recovery of younger children. I have had three similar experiences, one of the others being concerned with my sister-in-law and her small child and the other being one of my workmen whom I took to hospital.

I understand that at the new hospital at Worthing, about which the hon. and gallant Member for Worthing (Sir O. Prior-Palmer) spoke, something has been done about this, and that visiting is permitted during the day every day. I am sure that this is a service which should be instituted where possible, and it should be possible. It would give tremendous relief to mothers who have to take children, particularly those between two and eight years of age, to hospital. Could the Minister do something by issuing a circular—though I understand that this has already been done—to see what can be done towards providing this service? It would be of very great benefit indeed.

I do not think that the hospital service has deteriorated, but since the Health Service was introduced it has not developed. We are supposed to be in an affluent society, in which we are spending much money on inessentials, while the essential thing to do is to develop our hospitals and health services—a development which has not taken place. I have friends in the medical profession and in the hospital service who tell me how frustrating it is, in our present affluent society, to see so much money being spent on inessentials while the hospital service is starved. I therefore appeal to the Minister to go ahead and develop these services so that our Health Service, which was once said to be the envy of some other countries, might become the envy of the whole world.

8.45 p.m.

Mr. Kenneth Robinson (St. Pancras, North)

When I sit down I have little doubt that the right hon. and learned Gentleman will rise to tell us about the expansion of the hospital capital programme and the steadily increasing expenditure on hospitals which have taken place during his year of office. He may even try to compare the expenditure today with the record of the Labour Government. I say "may" because I hope that he will not. I hope that he agrees with me that this dead horse was flogged by his right hon. Friends to the point of disintegration many years ago. In case he does, I want to put this matter into perspective and, in so doing, I think, put into persepotive also the opening remarks of the noble Lord the Member for Hertford (Lord Baliniel). These are the only remarks to which I shall take any exception from his admirable and hard-hitting speech.

The Guillebaud Committee found that the cost of the National Health Service, when expressed as a percentage of the total national wealth or the gross national product, had been falling year by year up to the time when it reported at the time of 1956. I am glad to say that that fall has been substantially arrested. The trend has flattened out and there has been a very slight reverse in the last year or two, but still, expressed as a percentage of the gross national product, the cost of the National Health Service today is substantially below that of 1950.

I agree that the right hon. and learned Gentleman has done a little better in capital expenditure. He can point to the fact that in the current year he hopes to exceed an expenditure of £30 million, a sum which the Guillebaud Committee recommended should be spent annually over seven years in order to modernise the hospitals. But, of course, that Report was four years ago, and £30 million then would be the equivalent of about £34 million today; and in real terms the figure has not yet reached the level which the Guillebaud Committee set five years ago. I should, however, like to congratulate the right hon. and learned Gentleman on having stood firm against the pressure from his right hon. Friend the Chancellor to cut the programme as already announced, and I hope that we shall find that he will be able to spend sufficient money in the course of the current financial year.

Our charge is not one which is mainly directed to matters of finance. My right hon. Friends and hon. Members on both side of the House have called attention to a number of shortcomings in the hospital service which could be put right without the expenditure of a single £1. I should like to refer to the Report of the Committee on Estimates which was published three years ago but which has never been debated in the House. It is a Report on the running costs of hospitals, and it contains some fairly sharp criticisms of the Department and the right hon. and learned Gentleman's predecessor, which, as far as I know, have never been met. I hope to show that these criticisms are still valid and have not been answered.

In its Report the Select Committee on Estimates enumerated certain duties of the Ministry as it saw them, and it went on to say: These obligations can only be met satisfactorily if the Ministry act with vigour and foresight. Your Committee are not satisfied that they have always done so. They were, in particular, disappointed to find that few conclusions had been reached by the Ministry on some of the cardinal problems affecting the Service. I hope that the Minister agrees that these are serious criticisms when one considers the normal meiosis which is employed by the Select Committee on Estimates. I was a member of the subcommittee which examined this Estimate, and what we complained about at the time was the lack of leadership. The short debate we have been able to have this evening has emphasised this time and again in speeches from both sides. I have seldom heard such sharp criticism of a Minister by hon. Members on the Government back benches.

We get from the Ministry plenty of detailed guidance. Some of it is good. Some of it is less good and might almost be termed unnecessary interference. Circulars fall like the leaves in Vallombrosa. There seem to be little or no forward thinking, no policy making, and marked indecisiveness where decision is needed.

The noble Lord the Member for Hertford went in some detail into the rather melancholy story of the planning of the now hospital at Welwyn. I assure the House from my own experience that what he said was absolutely sound. It illustrates as well as any illustration I could give—I could easily give others—the slow-moving machine we have in the hospital service when it comes to developments, and particularly new construction. The machine moves slowly, mainly because of delays at Ministry level in getting approvals and the fiddling interferences on points of detail that the noble Lord mentioned.

There are many other things in which I think there has been a lack of leadership from the Ministry. The Royal Commission on Mental Health and the Mental Health Act both envisage a fairly rapid development of psychiatric units in general hospitals. This is a development which we all find extremely desirable, and indeed urgent, or at any rate nearly all of us do. Among doctors in general hospitals there is undoubtedly a very marked prejudice against psychiatry. [An HON. MEMBER: "There was."] There still is. It is not quite as intense as it was a few years ago, but it is not improving fast enough. There will be a prejudice against the setting up of these units. We shall not get them unless a good deal of pressure is exercised on hospitals by regional boards, and, above all, by the Minister himself, in order to overcome these prejudices. There is little sign so far that any such initiative has been forthcoming.

The Minister tends to regard himself as a reconciler of interests in this service. In this rôle I and some of my hon. Friends have found that he shows himself excessively tender towards the medical interest. This does not prevent him from being criticised by the doctors at their annual conference, as my right hon. Friend pointed out.

I want to be fair about this. I agree that a Ministry which was having a perpetual running battle with the medical profession probably would not result in a particularly efficient hospital service, but where there is a conflict between the interests of the patients and the interests of the doctors it is the duty of the Minister to see that the interests of the patients prevail. This is not by any means always done.

I want to give a few examples. There is the example which my right hon. Friend mentioned, namely, the Cranbrook Committee's Report. The Minister knows full well that the Cranbrook Committee is right in insisting on an obstetric list with definite qualifications, and a list which is kept regularly up to date. He could have insisted on the implementation of this recommendation, instead of which, because the British Medical Association, representing the doctors, objects for some misconceived notion of professional prestige, nothing has been done about this matter for fifteen months, during which time dozens of women have died unnecessarily in childbirth following treatment by doctors who are not properly skilled in obstetrics.

Another complaint frequently heard in the House is about the minority of part-time consultatnts who are not doing the work for which they are being paid. They are leaving to their registrars far too many of the duties that they themselves should undertake. Everyone in the hospital service knows that this takes place. It is true that specific cases very seldom come to light, but the reason is quite simple. It is that the Ministry has come to be regarded as being automatically on the side of the consultant, right or wrong, and the people who know that these things go on and who are in a position to report them, are frankly afraid to do so because of possible consequences to themselves—and, indeed, of legal action.

This should not happen, but there are other common complaints—again, about the small minority of consultants. One is the way in which they persuade patients to undergo treatment privately in order to get some sort of priority for a bed in a hospital. Again, we do not often get specific details, but I have here a very interesting extract from the minutes of the consultants and specialists committee of the Manchester region. I will not mention the hospital concerned. The item is headed, "Consultant acting in an unethical manner," and reads: The chairman gave details of a case where a consultant had accepted a patient privately on the understanding that to wait for the required medical attention in the normal manner would result in a long delay, and that the general practitioner involved had been fined by the Executive Council for his part in the case. Several members expressed their views, but the chairman— that is, the chairman of that committee: said that little could be done because there was no comparable employing authority for consultants as there was for the general practitioner. Apparently, the general practitioner can be disciplined by the executive council but the consultant—who is under contract, I should have thought, to the regional board—is allowed to get away with it. This is the sort of situation that brings the hospital service into disrepute in some quarters, and a Minister who was properly jealous for the reputation of the service would take some vigorous steps to see that it did not go on.

Even the comparatively small matters about which we hear—like that raised at Question Time the other day by my hon. Friend the Member for Manchester, Exchange (Mr. W. Griffiths) about the right of out-patients to know the doctor who is actually treating them—meet with scant sympathy from the Minister. Who could really object to such an arrangement as that? Could it not be regarded just as part of the humanisation of our hospital service, which is perhaps the thing most sorely needed at the moment? One or two of my hon. Friends 'have spoken of this—in one case at least from personal experience. I ask the Minister to ponder the word "humanisation." It is important. There is room for a great deal more of it in the service. As my hon. Friend the Member for Willesden, West (Mr. Pavitt) said, the old attitudes still linger on in far too many places.

It is because the Minister has displayed a lack of vigour, a lack of enterprise and a lack of initiative on so many of these points that we have decided on this occasion to register our displeasure by dividing the House. I hope that the Minister will agree that there have been a large number of constructive suggestions made to him in a very short time, and also some very severe criticisms, which, I hope, he will take to heart and do something about.

8.59 p.m.

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

We have certainly had some very interesting contributions in what has necessarily been a short debate. First, perhaps I may say what pleasure it gave to me—and, I am sure, to other hon. Members—to (hear the speech of my hon. Friend the Member for Manchester, Wythenshawe (Mrs. Hill). I think that it was her first speech since she returned to the House after her illness, and it was made with all the quality, understanding, sympathy and constructive good sense that we have so long associated with her.

I was also very pleased to hear a speech from the hon. Member for Enfield, East (Mr. Mackie), being the first time that I have had that pleasure, and he now being a constituency neighbour of mine. The hon. Member for Willesden, West (Mr. Pavitt) regretted the shortness of the time given to this debate, and the shortness of time afforded in this Session for debating these problems generally. I entirely agree with him. Nobody wishes more than I that this could have been a whole day's debate. I do not know why it is not a whole day debate.

Nobody knows betters than the right hon. Lady the Member for Warrington (Dr. Summerskill) that the conduct and choice of business in these Supply day debates at this time of the year is substantially in the hands of the Opposition, except for legislation. Last year and the year before we had a whole Supply day. But this year we have only half a day, presumably because the Opposition thought that they had only half as strong a case to make.

Mrs. Eirene White (Flint, East)

We had half a day for the debate on the hospital service for Wales, a very important part of the United Kingdom.

Mr. Walker-Smith

I think that the hon. Lady was not present when her hon. Friend spoke. He gave full credit for that, but nevertheless regretted—and I think we all agree with him—that this could not have been a full Supply day debate.

We have, nevertheless, had a number of very interesting and constructive suggestions. The hon. Member for St. Pancras, North (Mr. K. Robinson) referred to a criticism—a harsh criticism, I believe he said. I did not find any very harsh criticism, except, of course, if one were so hypersensitive that one was not prepared to listen to anything except unqualified praise. He would be a very unwise and, I would think, unpromising Minister who took that view. Of course, suggestions and criticisms have been made. It would be remarkable if they had not. We at the Ministry of Health will certainly try to profit by any constructive suggestions.

My noble Friend the Member for Hertford (Lord Balniel), who made a very constructive speech himself and one to which, I think, we all listened with great interest, said some kind thing about me, as I think the hon. Member for St. Pancras, North will find if he refreshes his memory from the OFFICIAL REPORT of the debate tomorrow. My noble Friend observed—and on this he was unquestionably on non-controversial ground—that the National Health Service is a very large-scale industry indeed.

This is the background to the sort of problems that we discuss. We have no fewer than 2,641 hospitals, the subject of our discussion today; we have over 7,000 consultants in those hospitals, about 12,000 other doctors, 194,000 nurses and 12,000 midwives, to say nothing of about 233,000 other employees. We spend on the revenue account over £400 million a year on them, about four times the total of the whole annual budget that Mr. Gladstone was bringing in only 100 years ago.

Of course, this is a very large-scale enterprise and an enterprise which is inevitably labouring under certain inherited disadvantages, some of which have been referred to this evening. There are hospitals housed in old buildings, hospitals built when medical standards and knowledge were different, hospitals suffering under the technical limitations of an earlier age. Some are inconveniently sited. Of course, generally speaking, the whole pattern of our hospital building reflects a pattern of disease and of treatment which is not the pattern of today. But those are the physical factors implicit in the situation.

We are, of course, seeking to remedy these things by way of extension and modernisation of our existing hospitals and the building of new hospitals. On that I shall have a word or two to say in a few minutes. Meanwhile, I think it right that we should realise that a good deal of the work is necessarily done in difficult conditions, and we ought to have that in mind when we assess the quality of the work. I know that it adds to the admiration hon. and right hon. Members on both sides of the House feel for the quality and devotion of the service actually given in our hospitals, for which the country is and should be grateful.

At one point, my noble Friend compared the hospital service with British Railways. He did not elaborate that comparison, but I wish to make one point about it. There is a difference between the 2,641 hospitals and British Railways which is significant for our debate today. I have been for three years responsible at this Box for answering the questions of hon. Members on the day-to-day administration of each of those 2,641 hospitals. It follows, therefore, that the whole service is at all times under the close, keen and detailed scrutiny of the House of Commons. When the hon. Member for Willesden, West says that we have only this short debate—I agree with him in regretting it—he will not, I am sure, forget that there is that continued scrutiny on a day-to-day basis, of which he, to his credit, takes full advantage and in which he plays a keenly constructive and critical past.

To give the best service to the nation that we can, we must do two things. We have to extend and modernise our hospitals and build new ones, so far as our resources allow, and we have also to make the best use of the facilities we have. The need for this, of course, is emphasised by the pressures on our service illustrated, for instance, by the waiting lists about which the right hon. Lady the Member for Warrington and my hon. Friend the Member for Wythenshawe spoke.

The right hon. Lady's figures for the waiting lists are correct. The figure in my last Annual Report was 476,000. This was greater than the figure in 1958, about the same as it was in 1954, and about 55,000 less than it was in 1950. On the face of it, that is not a trend to give us great satisfaction, and certainly it is one which we do not view with any complaceny. One should not exaggerate the precise significance of these figures, because they are not a reliable index of the position throughout the year. They are figures taken for one day in the year only and they do not in any case completely measure the demand for hospital beds, because urgent and emergency admissions are not included.

The waiting list figures emphasise one important aspect of the problem we have in the hospital service, and they impose two clear duties upon us which we ought to seek to discharge as best as we may, the first being to operate a fair system of admission while we have waiting lists, the second being to improve our methods and expand our accommodation so as to reduce the waiting lists in that way. Those are, I think, the two principles that we should try to follow.

There has been some criticism of the methods of dealing with waiting lists and admissions, although I think I am right in saying that that criticism has not been reflected in today's debate. I would emphasise that patients are admitted immediately upon an emergency or accident basis, and in other cases they follow a medical assessment of the priority, normally—other things being equal—taking their place on the waiting list. But if we consider these waiting lists as illustrating the problems in the hospital service, we must also have regard to the other side of the picture, that is to say, the increased volume of work, within our present resources, which we are carrying out in the hospitals.

During last year, we achieved 4 million courses of in-patient treatment—an increase of 3 per cent. on the 1958 figure. This has involved a quicker treatment and turnover of patients. My hon. and gallant Friend the Member for Worthing referred to the necessity to concentrate on the provision of new beds. That is part of the expansion of facilities on which we are engaged, but it is part only, because there are many things in a hospital besides beds, and we find that many of the improvements that we make in modernising hospitals is not reflected in a proportionate net increase in the number of beds; indeed, as we upgrade wards, and give greater space, we do not achieve a greater number of beds, although we achieve better working conditions and, thereby, better treatment and an increased turnover.

We are also trying to ease the problem by the better use of our out-patient resources and the expansion of those facilities. Here we are making solid and sustained progress. In the last four years, we have increased the number of attendances at out-patient clinics by over 4 million—from 37 million to 41,250,000. These figures not only show an encouraging trend in the method of treatment but reflect the shift of emphasis which we are trying to bring about from institutional care to care within the community, whenever possible. This has important social and economic advantages, both for the individual and for the community. It helps the individual, because it means less separation from his family and less absence from work, and it helps the community, because it eases the heavy pressures on our in-patient accommodation, and it saves both time and money.

In this context I want to say a word on the subject of mental health in relation to out-patient clinics and generally—a subject referred to by the hon. Member for St. Pancras, North. In answer, I would say that the number of out-patient attendances has increased from 466,000 ten years ago to no less than 1,158,000, which is the latest figure I have, although even that is for a year or so ago. We are pressing forward with the development of the psychiatric out-patient clinics, to which the hon. Member referred.

Mr. K. Robinson

I was referring to psychiatric units, that is, in-patient units in general hospitals, about which very little has been done.

Mr. Walker-Smith

We have not got so far with that yet. The hon. Member knows that this is a new concept, flowing from the Mental Health Act. It did not take us long to get the Act on the Statute Book after the Royal Commission. At one stage the hon. Member seemed to be suggesting that I was not interested in the problems of mental health. This was the one charge I never expected to hear levelled against myself, having regard to the events of the last three years. We have developed nearly 400 of the psychiatric out-patient clinics at general hospitals, which are doing a good job of work, and there are about seventy day hospitals.

I should like to refer briefly to a question raised by the right hon. Lady about maternal deaths and, in particular, to the Report. I am sorry that it is not available in full for the House for this debate. The galley proofs were given in advance of publication to the British Medical Journal because, as the right hon. Lady will know, there are many distinguished gynæcological and obstetrical experts in London for the opening of the new building of the Royal College and it was desired that some comment should be available for them.

The British Medical Journal has said, and rightly so, that there were cases where elementary precautions were not taken and serious mistakes were made. That is most regrettable, but it is not true that all the avoidable factors were of this kind. Indeed, one of the commonest avoidable factors was failure by the patient or her family to take the advice given or even to seek professional care at all.

We also have to have in mind the scope of this Report. It deals with the cases of 861 maternal deaths directly due to childbirth in a period when there were 1,112 such deaths but more than 2 million births. Those are the sort of proportions with which we are concerned. The right hon. Lady said that it showed a deterioration under Conservative Government. In fact, the Report shows a marked decrease in the numbers of maternal deaths, a decrease of more than one-fifth in the short period since the first Report was published in 1957, and that despite a rising birth rate.

Mr. K. Robinson

Surely, it does not show any decrease at all in the proportion of avoidable deaths, which is the statistic that counts.

Mr. Walker-Smith

For that, the hon. Member will be able to draw his own conclusions, but the figures I am giving him are correct, just as is the decline in maternal deaths as a whole which, as I mentioned to the House the other day, have more than halved in the short period of ten years and are now down to.38 as against.87 in 1950. Again, the right hon. Lady said in this context and in regard to infant mortality that we were back in the days of the nineteenth century. At the turn of the century, infant mortality was 156. Today, it is only 23 or thereabouts. This is a decrease of a substantial degree over these decades.

Dr. Summerskill

The Minister must not misquote me. He knows precisely what I said. I quoted the report about the fact that these women had a Caesarian section performed by inexperienced people and that they were not properly treated. I said that this was the kind of report we used to have at the beginning of the century.

Mr. Walker-Smith

If that is the only point that the right hon. Lady was making, I am sorry. I do not want to misquote her, but it would be unfortunate if any wrong impression got out in regard to this matter, because the lessons of the report are clear and well understood.

Improvement depends on better antenatal care, better health education, better selection of cases for hospital care, and so on. The Report hammers all this home in an effective way which, of itself, is bound to lead to improvement. It also reveals clearly the lesson that the vast majority of pregnancies and births are safe and that only a very small number of maternity deaths occur, less than one-tenth of the rate of thirty years ago.

I am sure that this Report will reduce mistakes that are made. I certainly welcome its contribution in so doing and assure the House that we will press on with the elimination of mistakes wherever we are able.

I now want to turn to a rather different aspect of this debate, staffing and conditions of staff, referred to by several hon. Members. I was rather struck that there were no more references to this. Had we been having this debate three years ago, it would have centred very largely, at any rate to a very considerable extent, on the grievances and criticisms on staff questions at that time. I take the relative absence of observations in regard to these matters in this debate as striking evidence of the progress we have in fact made in applying in the hospital service a system of pay and conditions reflecting appropriate comparability with work in other walks of life outside and providing an appropriate career structure. That has been reflected very much in the figures of recruitment, in the figures of recruitment of midwives, for example, which is pertinent to this question of births, and of nurses, to whom the hon. Member and others referred.

Mr. Pavitt rose——

Mr. Walker-Smith

I will give way, but I think it must be for the last time.

Mr. Pavitt

Will the right hon. and learned Gentleman agree that one of the reasons why the question of staffing has not come out more is that the working party is still sitting and so we have no result to discuss?

Mr. Walker-Smith

The hon. Member is confining it to doctors. There are a great many people in the Health Service besides doctors.

We have got pay settlements in regard to nurses, midwives, administrative and clerical workers, manual workers, radiographers and all sorts of people, and soon we shall have the doctors and dentists under hatches as well. [Laughter.] I mean their pay and conditions under hatches. I was charged by the hon. Gentleman with being too tender to them. We shall also get the report from Sir Robert Platt on the staffing structure in our hospital service, and I am sure that the hon. Gentleman will find that it was well worth waiting for.

I turn for the last few minutes to questions of hospital building, to which a great deal of this debate has referred. I said at the beginning that we are in some difficulties in our hospital service by reason of the age of some of our hospitals and the fact that they were devised to suit quite different needs from those which exist today. It is also a fact that for various reasons which I need not now go into we were off to a very slow start in the post-war years, but it is a fact that of late the programme has gathered pace, and it is now going forward in a very satisfactory way both in regard to the erection of new hospitals and in regard to the extension and modernisation of existing ones.

The hon. Gentleman said that he hoped I would not make this point, but that is rather an old political trick, to ask one's opponents not to make the points which tell very strongly in their favour, and, therefore, I must disappoint him and insist on making some slight, passing and, I hope, appropriately modest reference to the great success we are having in this field.

We have, in fact, more than doubled the money available over the last five years for hospital building, and next year alone we expect to devote to hospital building as much money as was spent in total in the four years 1948–52. By the beginning of this year we had 180 major hospital schemes at varying stages of building or planning. We had eight new hospitals partly completed and partly brought into use. We had nine new hospitals started and we had 17 new hospitals at planning stage. These include all types of hospitals, teaching and non-teaching, general and specialist, psychiatric and others, dental and maternity and so on. But I would ask the House to believe that we are not content merely with spending money and, indeed, erecting more buildings. We are seeking to improve the design and quality of the buildings and to accelerate our procedures so as to quicken construction and to ensure that the end product is more in tune with contemporary needs and medical skill. I would certainly assure my noble Friend the Member for Hertford and others who spoke on these points that I have been very concerned about administrative procedures in respect of approval and so on, and we have set out to improve these. It will not be long before we are able to give the House more information about the improvement of the procedures.

All in all, we are making very satisfactory progress. I would be the last to claim that all our problems are solved. Thai would be a very unlikely thing in this progressive age, but in the case of all of them we have struck our lines of advance and we are pursuing them vigorously and with a considerable degree of success. We have in these matters a good record and a constructive programme. We are giving and will continue to give an improved and developed Service which will promote

the health and well-being of individual patients and the community as a whole.

Why the Opposition should want to vote against all this good work and good progress is best known to hon. and right hon. Members opposite but is not entirely clear to me. Were I in a controversial mood tonight, I should feel tempted to castigate their attitude in terms of appropriate severity, but I feel, due to the strength of my case and other matters, in a very kindly mood indeed and therefore I will content myself with saying that the decision of hon. and right hon. Members opposite is quixotic, inexplicable, indefensible, unwarrantable and wholly perverse and I would ask the House to vote against them.

Question put, That £345,672,485 stand part of the Resolution:—

The House divided: Ayes 218, Noes 149.

Division No. 144.]	AYES	[9.28 p.m.
Agnew, Sir Peter	Crowder, F. P.	Howard, Gerald (Cambridgeshire)
Aitken, W. T.	Cunningham, Knox	Howard, Hon. G. R. (St. Ives)
Allan, Robert (Paddington, S.)	Curran, Charles	Hughes Hallett, Vice-Admiral John
Allason, James	Currie, G. B. H.	Hughes-Young, Michael
Arbuthnot, John	Dalkeith, Earl of	Hulbert, Sir Norman
Ashton, Sir Hubert	Dance, James	Hurd, Sir Anthony
Atkins, Humphrey	d' Avigdor-Goldsmid, Sir Henry	Hutchison, Michael Clark
Balniel, Lord	de Ferranti, Basil	Iremonger, T. L.
Barter, John	Digby, Simon Wingfield	Irvine, Bryant Godman (Rye)
Batsford, Brian	Doughty, Charles	Jackson, John
Bell, Ronald (S. Bucks.)	Drayson, G. B.	James, David
Berkeley, Humphry	Duncan, Sir James	Jenkins, Robert (Dulwich)
Bevins, Rt. Hon. Reginald (Toxteth)	Duthie, Sir William	Jennings, J. C.
Bidgood, John C.	Emery, Peter	Johnson, Dr. Donald (Carlisle)
Bingham, R. M.	Emmet, Hon. Mrs. Evelyn	Johnson, Eric (Blackley)
Bishop, F. P.	Errington, Sir Eric	Joseph, Sir Keith
Black, Sir Cyril	Farr, John	Kerans, Cdr. J. S.
Bossom, Clive	Fell, Anthony	Kerr, Sir Hamilton
Bourne-Arton, A.	Fletcher-Cooke, Charles	Kershaw, Anthony
Box, Donald	Fraser, Hn. Hugh (Stafford & Stone)	Kirk, Peter
Boyle, Sir Edward	Fraser, Ian (Plymouth, Sutton)	Langford-Holt, J.
Braine, Bernard	Freeth, Denzil	Leavey, J. A.
Brewis, John	Gammans, Lady	Leburn, Gilmour
Bromley-Davenport, Lt.-Col. W. H.	Gibson-Watt, David	Legge-Bourke, Sir Harry
Brooman-White, R.	Glover, Sir Douglas	Lewis, Kenneth (Rutland)
Browne, Percy (Torrington)	Glyn, Dr. Alan (Clapham)	Lilley, F. J. P.
Bryan, Paul	Glyn, Sir Richard (Dorset, N.)	Linstead, Sir Hugh
Bullard, Denys	Goodhart, Philip	Litchfield, Capt. John
Bullus, Wing Commander Erie	Goodhew, Victor	Lloyd, Rt. Hn. Geoffrey (Sut' nC' field)
Campbell, Sir David (Belfast, S.)	Green, Alan	Longbottom, Charles
Campbell, Gordon (Moray & Nairn)	Grimston, Sir Robert	Longden, Gilbert
Carr, Compton (Barons Court)	Hamilton, Michael (Wellingborough)	Loveys, Walter H.
Cary, Sir Robert	Harris, Frederic (Croydon, N.W.)	Lucas-Tooth, Sir Hugh
Channon, H. P. G.	Harris, Reader (Heston)	MacArthur, Ian
Chataway, Christopher	Harrison, Brian (Maldon)	McLaren, Martin
Clark, Henry (Antrim, N.)	Harvey, Sir Arthur Vere (Macolesf'd)	McLaughlin, Mrs. Patricia
Clark, William (Nottingham, S.)	Harvey, John (Walthamstow, E.)	McMaster, Stanley R.
Cole, Norman	Harvie Anderson, Miss	Macmillan, Maurice (Halifax)
Cooke, Robert	Heald, Rt. Hon. Sir Lionel	Maddan, Martin
Cooper, A. E.	Hendry, Forbes	Maitland, Sir John
Cordeaux, Lt.-Col. J. K.	Hicks Beach, Maj. W.	Matthews, Gordon (Meriden)
Corfield, F. V.	Hiley, Joseph	Mawby, Ray
Costain, A. P.	Hill, Mrs. Eveline (Wythenshawe)	Maydon, Lt.-Cmdr. S. L. C.
Coulson, J. M.	Hill, J. E. B. (S. Norfolk)	Mills, Stratton
Craddock, Sir Beresford	Hirst, Geoffrey	Montgomery, Fergus
Critchley, Julian	Holland, Philip	Morgan, William
Crosthwaite-Eyre, Col. O. E.	Hopkins, Alan	Mott-Radclyffe, Sir Charles
Neave, Airey	Robertson, Sir David	Thompson, Richard (Croydon, S.)
Noble, Michael	Robinson, Sir Roland (Blackpool, S.)	Tiley, Arthur (Bradford, W.)
Osborn, John (Hallam)	Robson Brown, Sir William	Turner, Colin
Page, John (Harrow, West)	Roots, William	Turton, Rt. Hon. R. H.
Page, Graham	Ropner, Col. Sir Leonard	van Straubenzee, W. R.
Pannell, Norman (Kirkdale)	Russell, Ronald	Vaughan-Morgan, Sir John
Partridge, E,	Scott-Hopkins, James	Vosper, Rt. Hon. Dennis
Pearson, Frank (Clltheroe)	Sharples, Richard	Wakefield, Edward (Derbyshire, W.)
Peel, John	Shaw, M.	Wakefield, Sir Wavell (St. M'lebone)
Percival, Ian	Shepherd, William	Walker-Smith, Rt. Hon. Derek
Pickthorn, Sir Kenneth	Simon, Sir Jocelyn	Wall, Patrick
Pilkington, Capt. Richard	Skeet, T. H. H.	Watts, James
Pitman, I. J.	Smithers, Peter	Wells, John (Maidstone)
Pitt, Miss Edith	Smyth, Brig. Sir John (Norwood)	Whitelaw, William
Pott, Percivall	Spearman, Sir Alexander	Williams, Dudley (Exeter)
Powell, J. Enoch	Speir, Rupert	Williams, Paul (Sunderland, S.)
Price, David (Eastleigh)	Stanley, Hon. Richard	Wilson, Geoffrey (Truro)
Price, H. A. (Lewisham, W.)	Stevens, Geoffrey	Wise, A. R.
Prior-Palmer, Brig. Sir Otho	Steward, Harold (Stockport, S.)	Woodhouse, C. M.
Proudfoot, Wilfred	Stodart, J. A.	Woodnutt, Mark
Ramsden, James	Studholme, Sir Henry	Woollam, John
Redmayne, Rt. Hon. Martin	Summers, Sir Spencer (Aylesbury)	Worsley, Marcus
Rees, Hugh	Sumner, Donald (Orpington)	Yates, William (The Wrekin)
Rees-Davies, W. R.	Tapsell, Peter
Renton, David	Taylor, W. J. (Bradford, N.)	TELLERS FOR THE AYES:
Ridsdale, Julian	Teeling, William	Colonel J. H. Harrison and
Roberts, Sir Peter (Heeley)	Thomas, Peter (Conway)	Mr. Chichester-Clark.
NOES
Ainsley, William	Hayman, F. H.	Parker, John (Dagenham)
Albu, Austen	Henderson, Rt. Hn. Arthur (RwlyRegis)	Parkin, B. T. (Paddington, N.)
Awbery, Stan	Herbison, Miss Margaret	Pavitt, Laurence
Bacon, Miss Alice	Hill, J. (Midlothian)	Peart, Frederick
Beaney, Alan	Hilton, A. V.	Plummer, Sir Leslie
Benn, Hn. A.Wedgwood (Brist'l, S. E.)	Houghton, Douglas	Prentice, R. E.
Blackburn, F.	Hughes, Emrys (S. Ayrshire)	Proctor, W. T.
Blyton, William	Hunter, A. E.	Pursey, Cmdr. Harry
Bowden, Herbert W. (Leics, S.W.)	Hynd, John (Attercliffe)	Rankin, John
Boyden, James	Janner, Barnett	Redhead, E. C.
Braddock, Mrs. E. M.	Jay, Rt. Hon. Douglas	Reid, William
Brockway, A. Fenner	Jeger, George	Reynolds, G. W.
Broughton, Dr. A. D. D.	Johnson, Carol (Lewisham, S.)	Roberts, Albert (Normanton)
Brown, Alan (Tottenham)	Jones, Dan (Burnley)	Robinson, Kenneth (St. Pancras, N.)
Butler, Herbert (Hackney, C.)	Jones, J. Idwal (Wrexham)	Ross, William
Butler, Mrs. Joyce (Wood Green)	Kelley, Richard	Short, Edward
Callaghan, James	Kenyon, Clifford	Silverman, Sydney (Nelson)
Castle, Mrs. Barbara	Key, Rt. Hon. C. W.	Skeffington, Arthur
Cliffe, Michael	King, Dr. Horace	Slater, Mrs. Harriet (Stoke, N.)
Corbet, Mrs. Freda	Lawson, George	Slater, Joseph (Sedgefield)
Craddock, George (Bradford, S.)	Lee, Frederick, (Newton)	Small, William
Crosland, Anthony	Lever, Harold (Cheetham)	Smith, Ellis (Stoke, S.)
Cullen, Mrs. Alice	Lever, L. M. (Ardwick)	Snow, Julian
Darling, George	Lewis, Arthur (West Ham, N.)	Sorensen, R. W.
Davies, C. Elfed (Rhondda, E.)	Mabon, Dr. J. Dickson	Soskice, Rt. Hon. Sir Frank
Davies, Harold (Leek)	McCann, John	Spriggs, Leslie
Davies, Ifor (Cower)	MacColl, James	Steele, Thomas
Davies, S. O. (Merthyr)	McInnes, James	Stewart, Michael (Fulham)
Deer, George	McKay, John (Wallsend)	Stones, William
de Freitas, Geoffrey	Mackie, John	Stross, Dr. Barnett (Stoke-on-Trent, C.)
Dempsey, James
Diamond, John	McLeavy, Frank	Summerskill, Dr. Rt. Hon. Edith
Ede, Rt. Hon. Chuter	Mallalieu, E. L. (Brigg)	Swingler, Stephen
Edwards, Walter (Stepney)	Manuel, A. C.	Taylor, John (West Lothian)
Evans, Albert	Mapp, Charles	Thomas, George (Cardiff, W.)
Finch, Harold	Marquand, Rt. Hon. H. A.	Thornton, Ernest
Fletcher, Eric	Marsh, Richard	Wainwright, Edwin
Forman, J. C.	Mayhew, Christopher	Warbey, William
Fraser, Thomas (Hamilton)	Mendelson, J. J.	Weitzman, David
Gaitskell, Rt. Hon. Hugh	Millan, Bruce	Wells, Percy (Faversham)
Ginsburg, David	Mitchison, G. R.	Wells, William (Walsall, N.)
Gooch, E. C.	Monslow, Walter	White, Mrs. Eirene
Gordon Walker, Rt. Hon. P. C.	Moody, A. S.	Whitlock, William
Gourlay, Harry	Morris, John	Wilcock, Group Capt. C. A. B
Greenwood, Anthony	Mort, D. L.	Wilkins, W. A.
Grey, Charles	Mulley, Frederick	Willey, Frederick
Griffiths, Rt. Hon. James (Llanelly)	Oram, A. E.	Williams, Rev. LI. (Abertillery)
Griffiths, W. (Exchange)	Oswald, Thomas	Williams, W. R. (Openshaw)
Hale, Leslie (Oldham, W.)	Owen, Will	Woof, Robert
Hannan, William	Paget, R. T.
Hart, Mrs. Judith	Pargiter, G. A.	TELLERS FOR THE NOES:
		Mr. Howell and Mr. Mahon.

It being after half-past Nine o'clock Mr. SPEAKER proceeded, pursuant to Standing Order No. 16 (Business of Supply), to put forthwith the Question necessary to dispose of the Resolution under consideration.

Question,

That this House doth agree with the Committee in the said Resolution, put and agreed to.

Mr. SPEAKER then proceeded to put forthwith the Questions, That this House doth agree with the Committee in the outstanding Resolutions reported in respect of the Navy, Army and Air Services [Expenditure], Classes I to X of the Civil Estimates and of the Revenue Departments' Estimates, the Ministry of Defence Estimate, the Navy Estimates, the Army Estimates and the Air Estimates.

Question, That this House doth agree with the Committee in the Resolution relating to Navy Expenditure. 1958–59,

put and agreed to.

Question, That this House doth agree with the Committee in the Resolution relating to Army Expenditure, 1958–59,

put and agreed to.

Question, That this House doth agree with the Committee in the Resolution relating to Air Expenditure, 1958–59,

put and agreed to.