NATIONAL HEALTH SERVICE BILL

HC Deb 09 February 1961 vol 634 cc653-765

Order for Second Reading read.

4.34 p.m.

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

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

The purpose of the Bill is to bring up to date the charges for dentures and spectacle lenses. At the same time the opportunity has been taken to provide for further exemption from charges in respect of priority classes. Since 1951, when charges were introduced, the costs of these appliances have increased, and thus the contributions which users pay have represented a diminishing proportion of the cost. The present proposals restore the position. The increases bring the contributions up, to the nearest round figure, to the corresponding proportionate amount of the total cost charged in 1951, although there have been some concessions, as I have already indicated.

Ever since 1951 the aim has been to give the first priority in the dental services to the conservation of teeth, especially those of children and adolescents. Dental fitness for the nation is best secured through the proper dental health of the younger generation. In the case of adults an additional aim has been to give priority to conservation treatment over extraction and the provision of dentures. The result has been very much as desired, and we may properly conclude that the arrangements for charges played a significant part in producing this result, of emphasis on conserving one's own teeth.

The introduction of charges for dental treatment in 1952 did not cause any drop in the number of courses of treatment provided. I have brought with me figures showing the total number of courses of treatment over the years, but as we have already lost so much time the House will probably not want me to weary it by referring to those figures in detail. By contrast with dentures, where the number dropped sharply after 1951 and has since risen again to only slightly above the 1952 figure, the amount of conservation work has increased steadily, and is now almost double what it was in 1951. More important, this increase contains a much bigger increase in the number of courses of treatment provided for children and adolescents. The annual number of such courses has risen over threefold since 1951, and the House may be interested to know that the figures for England and Wales have increased from about 1½ million to about 5 million.

The increased charges now proposed for dentures, combined with the decision not to increase the charges for treatment, should assist in maintaining this change of emphasis in the general dental service. As to the priority classes for dentures, in our consideration of the exemptions we felt that we should take the opportunity of removing an anomaly. At present, the priority classes have to pay statutory charges if they obtain their dentures as out-patients at a hospital or through the general dental service, but not if they obtain them through the local authority dental service.

We took into account three reasons for suggesting a change. As hon. Members will be aware, local authorities have a duty to provide free dental services for expectant and nursing mothers, children under school age and children attending schools maintained by them. For one reason or another—either because a person chooses to go to a general dental practitioner, or because of the shortage of local authority dentists—some members of the priority classes have to pay a charge while others obtain the service free through the local authority.

The present proposals remove another anomaly in that they will provide for free orthodontic appliances with teeth through the general dental service. They have been available through the local authority service, but not if people use the dental practitioner service. All these proposals may well result in less denture work for the local authority.

Parents will not have to reflect that if they go to the local authority clinic, service will be free whereas if they go to the dental practitioner they will have to pay, and with that consideration removed we hope that it will provide additional capacity at the local clinics for conservation work. Although the increased cost of this proposal is relatively modest—in fact, it is £100,000—I think that it is satisfactory that at a comparatively small cost we are able to remove the anomaly which I have just described to the House.

On spectacles, the increases are again proportionate, as I have explained in connection with the dental appliances. On bifocals, as hon. Members will have noticed, the increase is larger than for ordinary spectacle lenses. This also is to remove an anomaly. The lenses for bifocals and multifocals, of course, cost more than ordinary lenses, and so the person who has a pair of bifocals virtually gains two pairs of glasses, but he only has to pay the charges for one. In the normal way, if people wanted glasses for both reading and long distance, short of having bifocals they would have to pay the charges for two pairs of lenses and two pairs of frames. It seems unfair to the individual who buys two pairs of glasses that the person who obtains one. pair of bifocals should not pay his proper contribution.

The Standing Ophthalmic Advisory Committee of the Central Health Services Council recently reviewed the frames available under the service. It was impressed by the evidence that metal frames were no longer acceptable by older children, with the result that they incur charges for lenses as well as frames because they do not take the spectacles available to them under the service. The Committee advised changes, but recommended no change for younger children because it was still satisfied that up to the age of 9 metal frames are satisfactory in appearance and in wear and have advantages in fitting.

The Bill essentially implements the advice of the Committee though in a broader way. The Committee's recommendation was for the addition of two more frames at varying ages, but the charge for the frame will still be payable, which is reasonable because this question of choice is really an aesthetic matter rather than one necessitated on clinical grounds.

Mr. Charles Loughlin (Gloucestershire, West)

Does the hon. Lady really think that this question of choice is an æ sthetic matter? Does she not know that, particularly with children's spectacles, it is very desirable to allow the child to wear a frame which she wants to wear, because if she does not want to wear it she will not wear the glasses. It is not a question of aesthetic taste at all.

Miss Pitt

That is the point I am trying to make, that it is the choice of the child on personal or aesthetic grounds rather than a matter of accepting the frames which are available and which adequately serve the purpose. The hon. Gentleman has really put into words the point which I was trying to make.

Mrs. Harriet Slater (Stoke on Trent, North)

My hon. Friend's point is that if a child needs glasses it is vitally essential that the child should be given every encouragement to wear them so that its sight might be corrected. Therefore, it is better that the child should not be put off by an ugly-looking frame.

Miss Pitt

That is exactly what we propose to do.

The charge for the most popular frames is 10s. 8d., or 11s. 8d. I think that hon. Members know that frames can be reused for changes of prescription, when no charge is made.

Mrs. Alice Cullen (Glasgow, Gorbals)

Will not the hon. Lady abolish steel frames, for no child wants them?

Miss Pitt

We are advised by the expert committee that steel frames are suitable for children up to the age of nine. We are prepared to accept that, above that age, there may be objections, and I will say a further word about those in a moment.

If children have private frames they will continue to pay the same charges as adults for lenses. The category of children to whom this concession will apply will be those aged from 10 to 15 or over the age of 15 while attending school full-time. The cost of exemptions in this category will be £170,000.

I now turn to the main proposals of the Bill. Clause 1 (1) increases the charges for dental appliances supplied through the general dental service or to out-patients through the hospital and specialist services by 5s. in each case for a single denture, by 15s. for more than one denture, from £4 5s. to £5, and the maximum charge for general dental services, which include the provision of dentures, is similarly increased by 15s.—from £4 5s. to £5.

Subsection (2) increases the charge for spectacle lenses from 10s. to 12s. 6d. per lens or to £1 per lens for bifocal or multifocal lenses. The provisions of the 1951 Act concerning charges for spectacle frames and exemption of children's glasses from charges for lenses or frames remain unchanged. Glasses supplied to hospital in-patients also remain exempt from any charge.

Subsection (3) amends the 1951 Act by exempting from charges for dentures children under 16 or who are attending full-time at school—within the meaning of the Education Acts—or nursing and expectant mothers. Subsection (4) implements the proposal to exempt from charges spectacle lenses supplied to children aged 10 to 15 or aged 16 or more while attending full-time at school, again defined by reference to the Education Acts, where lenses are fitted to any National Health Service type of frame.

This Clause also gives regulation-making power to my right hon. Friends the Minister of Health in England and Wales and the Secretary of State in Scotland to prescribe the method of certification of the conditions satisfied in order to qualify for the exemptions which I have been outlining. The regulations so made will be subject to the negative Resolution procedure of the House.

Clause 2 enables Ministers to vary by regulations the amount of, or to abolish, any charge authorised by the 1951 Act for any dental or optical appliance, or to vary the descriptions of dental or optical appliances for the purpose of charges, or to vary the amount of, or abolish, any of the charges authorised for dental treatment by the 1952 Act. Regulations made under this Clause are to be Statutory Instruments and subject to annulment by a Resolution of either House. The other charges are on the basis that they may be varied up or down. Even prescriptions are on that basis. Therefore, the proposal in the present Bill would bring everything into line.

I should like to explain—though I think that most hon. Members will know it—that arrangements already exist for the refund of charges where these would cause hardship. The National Assistance Board refunds in full, without further inquiry, the amount of charges for dental treatment, dentures and glasses where these have to be paid by persons already in receipt of a weekly assistance allowance. Anyone not already receiving a weekly assistance allowance, to whom the payment of these charges would cause hardship by the standards of the National Assistance Board's regulations, will be repaid the amount of the charge, either in whole or in part.

In deciding whether any payment can be made, the National Assistance Board makes a liberal allowance for expenses in connection with employment. The Board's procedure is very well tried, as hon. Members know, and I think it is fairly well understood in the country. I feel that the House would like to hear some of the latest figures of the amount of assistance in respect of dentures and spectacles. Last year, for Great Britain, optical charges cost £651,000, which represented 373,000 cases, and for dentures and dental treatment the cost was £387,000, which represented 114,000 cases.

During recent years there has been a steady improvement in the number of dentists taking part in the National Health Service. At the same time, there has been a substantial increase in the courses of treatment as I have indicated, especially conservation treatment. Regarding spectacles, again there has been an increase in the number of sight tests and spectacles supplied. There is, of course, a discrepancy between the two figures, but the number of spectacles supplied represents about 43 per cent. over the past nine years.

The proposal which I have outlined to the House, I hope clearly, is to increase charges for dental appliances and spectacle lenses and there will be a further exemption for the priority classes. In short, these proposals do no more than bring into line the charges for the Service which have already been in operation so that they bear the appropriate proportion of the cost which they did when first imposed, and I hope that the House will be prepared to give the Bill a Second Reading.

5.54 p.m.

Mr. Kenneth Robinson (St. Pancras, North)

The Parliamentary Secretary has moved the Second Reading of the Bill in tones calculated to minimise its impact on our people which, of course, is entirely on a pattern with what the Minister of Health has been doing about these increases ever since they were introduced.

Whatever may be the outcome in other respects of the incidents in the early hour of this morning, I should like to express the hope that at least they have conveyed to the right hon. Gentleman the depth of our indignation and feeling about the measures that he is taking—an indignation and resentment which, we believe, is shared by the vast majority of the people.

The Bill imposes additional charges of just over £ 2½ million in a full year. ft is, of course, a part of a much larger operation which we were discussing in broader terms yesterday. But we have not yet received from the Minister—certainly, the hon. Lady did not turn her attention at all to them today—any answer to the repeated questions we have asked about why, for instance, in these so-called affluent days, we cannot afford an expanding National Health Service. We have had no answer to why we have had to cut back, in one way or another, when we are today spending no more—on certain calculations we are spending still less—than we were spending on this Service in 1951.

It is quite clear what are the answers. There are two reasons for the decision to impose these charges and increase contributions. The first is an arbitrary decision by the right hon. Gentleman—no doubt in collusion with the Chancellor—to limit the Exchequer contribution to this Service. The second stems from the doctrinaire hatred on the part of hon. Gentlemen opposite to the whole idea of the Welfare State. We have only to contrast the way in which that phrase is uttered by hon. Members on this side of the House and by hon. Members opposite. We speak of the Welfare State with pride. Hon. Members opposite utter the words with a faint but perfectly susceptible sneer.

Yesterday, when talking about these charges, the Minister said it was a question of adjusting the financing of the Service, and in answer to our charges he said that the result would be not that the Service would be undermined, but that it would be underpinned. I think that that phrase reveals the right hon. Gentleman's total lack of comprehension about, at any rate what we understand, and what the overwhelming majority of people understand, by the term "National Health Service". If one really says that imposing charges in this way is underpinning the Service, where do we stop? If it be a good thing for the Service—because that is what underpinning is—to impose charges on the patient, clearly it is desirable to continue and expand the process; and that is what I believe we shall see happen in the years to come.

I should have thought that the Conservative attitude to the Welfare State ought by now to be crystal clear. It is an attitude of lip-service during election time and of steady erosion between elections. Conservatives tell us that the people must be made to pay for what they get, or else they will not appreciate it. They must be made to stand on their own feet. These are the kind of catch phrases which we so often hear falling from the lips of hon. Members opposite.

Now we have the Bow Group and the noble Lord the Member for Dorset, South (Viscount Hinchingbrooke) advocating fees in State schools—again, all part of the same pattern. Of course, as they say, they would exempt the very indigent people—provided that these people adopted a suitably humble attitude to the charity of the Government. I have heard it called a safety net to catch these very indigent people, but it is a safety net in which the right hon. Gentleman is not averse to snipping one or two holes even in respect of these unfortunate people.

We have never accepted that the Minister was faced with the alternative of cutting back the Service or imposing charges. I wish to make absolutely clear that, of course, we are in no way opposed—indeed, we welcome—the expansion of the hospital programme. We should like to see it further accelerated, because it has been delayed all too long. But for a moment, since this is one of the Minister's arguments for these charges, let us look at the position a little more closely.

It was the Minister's predecessor, the right hon. and learned Member for Hertfordshire, East (Sir D. Walker-Smith), who increased the hospital capital programme by, I think, about £5 million to about £31 million in the current year, and, at the same time, he announced that it was going up another £5 million to £36 million in 1961–62. All that the present Minister was able to announce a week or two ago at his Press conference—and this I am sure was the thin sugar coating for the intensely bitter pill which was to come a week or two later—was merely the continuing increase of the hospital buiding programme at the same rate, rising to £50 million in 1965.

It is a strange coincidence that this figure of £50 million happens to be exactly the figure that was included in the Labour Party's election programme as a desirable objective as soon as it could possibly be attained. If hon. Members opposite would take a little time off and read the document called "Members One of Another", the Labour Party's election programme on health, they would understand a little more our attitude to this Service. They would find that we put forward this precise proposal as an immediate objective, an annual capital development programme of £50 million for the hospitals.

I thought that there was just a possibility when the right hon. Gentleman took on the office of Minister of Health, and became responsible for what I, at any rate, think is probably the greatest single social service in the world, that he might have shed some of his previous attitudes and been—I think that I can use the word—inspired to defend this Service against the Chancellor and against the Cabinet, because, after all, in a sense, perhaps in a limited sense, that is rather what happened to the right hon. Gentleman who is now Secretary of State for the Colonies. He had been as bitter a critic of the Welfare State as the right hon. Gentleman. They seemed to me in those days to share very similar views and they certainly shared the authorship of many pamphlets.

The same sort of fears were expressed when the right hon. Gentleman the present Colonial Secretary took over, but it so happens that he did not impose any new charges on the patient during nearly four years he was in office. He took over just before the Royal Assent was given to the Bill which his predecessor, now Viscount Crookshank, had introduced. Nevertheless, he himself did not introduce charges and I think that he defended the Service against the Treasury to some extent. Clearly, the right hon. Gentleman the present Minister has decided not to take that course. He is, perhaps, of a more granite disposition and he is not changing his views.

The right hon. Gentleman has decided to impose these fresh charges for what I think are the flimsiest of reasons, even by his own standards. I shall read to the House what The Times said in its leading article on Thursday of last week, the day after he made his announcement: None of the additional charges promises any conspicuous improvement in either the financial efficiency of the service or of the standards of medical and dental care. The operation is largely a matter of book-keeping intended not so much to restrain the cost of the National Health Service as to restrain the annual increase in the amount borne by the Exchequer. The political incentive for the action is obvious. As I have said in my opening remarks, the Minister has been trying to minimise the effect of these charges on the patient and to pretend that they are something rather derisory. In his speech yesterday I think that he called the dental charges "tiny and negligible".

The Minister of Health (Mr. Enoch Powell)

Will the hon. Member give the context?

Mr. Robinson

It is conceivable that he was not talking about the increase in dental charges, but he certainly used the phrase "tiny and negligible". I shall give him the context in a moment. Apparently he regards dentures for the toothless and spectacles for those whose sight is going as something inessential. On the B.B.C. Home Service last week the Minister ended an interview with the following rather extraordinary statement: Everything in this Service which is of essential importance is and remains absolutely free. That is a misleading statement even for a Minister of this Government—and their standards of misleading the public are rather extreme.

Mr. Powell

I can supply the context for the words. I said, as reported in col. 439 of HANSARD for yesterday: …. are tiny and negligible in comparison with the increase in all kinds of benefits and earnings since those charges were fixed."—[OFFICIAL REPORT. 8th Feb.. 1961; Vol. 634, c. 439.]

Mr. Robinson

I am glad the right hon. Gentleman has given the context. I leave it to the House to judge whether I misrepresented his attitude to these charges in any way.

Perhaps I might now come in more detail to the actual proposals of the Bill. I take first, the denture charges. I should remind the House of what the Guillebaud Committee said about charges for dentures. We must not forget that that was the Committee set up by the present Colonial Secretary when he held the position of the right hon. Gentleman and it reported to a Tory Government. That Committee said: It seems to us that the charge for dental treatment is, in fact, impeding a number of people from making use of the general dental service; and, so far as the charges on the existing charges in the Service are concerned, we would regard the reduction on the incidence of this charge as having the highest priority when additional resources become available. That was five years ago and we have now had five years of Tory affluence. The right hon. Gentleman said yesterday that dental treatments had gone up 20 per cent. in that time. I hope that he was not suggesting that there was any cause for complacency here. Everyone knows that the standard of teeth in this country is nothing we can be proud of and that it certainly does not compare with the standard in the United States. It would not be an overstatement to say that the teeth of people in Britain compared with those of people in the United States are a disgrace. We in Britain spend infinitely less on teeth than the Americans do. The way the dental charges system works must be a substantial contributory factor to that.

I wish to quote the Economist on this subject. It had a leader which, like those of most of the newspapers, criticised the right hon. Gentleman, but it had this difference—that it criticised him for not having gone far enough in these charges, for not having been brutal enough and thorough in them. Nevertheless, the Economist made one point which I think worth calling to the attention of the Committee and which, I think, is a valid point. Talking about dental charges, it said: a radical reformer would have changed the whole system of charges for dental treatment, which at present relieve people of the last part of any big dental bills (thus subsidising those who keep away from the dentist until all their teeth rot) but make them pay in full for the first £1 of all dental bills (thus penalising people who go to the dentist regularly). In case there is misunderstanding, I repeat that we are against all dental charges, but, if we are to have dental charges, there might be a case for so arranging them that they encourage a little more than the present system does the conservation treatment of teeth.

Before I leave the question of dentures and dental charges, I wish to read a letter to the Committee. It is a letter which came "out of the blue" from a dental surgeon working in London, and it said: I would like to bring to your attention the difficulties of old people, particularly pensioners, in meeting the cost of N.H.S. dentures. Many old people in this district need new dentures, but are prohibited by the cost of £4 5s."— now to be £5. On the whole, they are most reluctant to apply for National Assistance.In many cases old age pensioners have been refused National Assistance. It appears rather strange that the group who are the most likely to need dentures and can least afford it, are the old and there is no suggestion of helping them. They can always try to get a refund from National Assistance, but the process is not quite as smooth and easy as the hon. Lady tried to make out. The person who is not in receipt of a regular Assistance payment has to undergo a means test. However this is conducted, it obviously deters large numbers from even applying. Then there is all the physical inconvenience, especially for old people, of getting to the Assistance Board, waiting for a bus to get there, waiting at the Board, and waiting for a bus to get back. I can understand it, reprehensible though it may be, if an old person says, "Is it really worth the trouble?" I say again that these charges are a disincentive to treatment, both in the dental and the medical field.

I turn now to the spectacle charges. Here there is a double deterrent in operation. First, the charges certainly deter those people who are near the National Assistance margin from going to get eye tests and the spectacles that they probably need, with the inevitable consequential risk to their eyesight. I put it no higher than that.

There is another deterrent. The charges are now sufficiently high to deter people from using the Health Service for their spectacles. They are high enough to encourage them to deal privately with their opticians for their lenses, frames, etc. I am told by opticians that this is a discernible trend at the moment, has been for some time, and will undoubtedly increase as a result of the Bill if it goes through in its present form.

This is not quite so dangerous as self-medication, which is encouraged by the prescription charge, but it is a deplorable thing if we are driving people out of the National Health Service into the hands of private prescription for glasses. This is just what the Minister wants. Think of the effect on his Estimates. The cost of the ophthalmic services will fall until it reaches the point at which the National Health Service really and truly caters only for the indigent.

When dealing with the charges for spectacles I find it convenient to double all the figures, because the figures are per lens, and one normally gets two lenses and a pair of spectacles. The hon. Lady explained to us the Government's reason for taking this action in relation to bifocals. It is true that if a patient obtains bifocal lenses in one pair of glasses he does the same as he could do with a pair of reading glasses and a pair of distance glasses. It is not because it is unfair to other patients that the charge has been raised to £1 or £2 for the pair. It is raised because it is unfair to the right hon. Gentleman. It is because he thinks he is being "done" by the customer who gets the equivalent of two pairs of glasses for the charge in respect of one.

No patient who has a pair of Health Service reading glasses and another pair of distance glasses resents the fact that another patient has obtained a pair of bifocals for the same price. This is ludicrous. It can perhaps be described as putting right an anomaly, but I do not think that it was a sufficiently serious anomaly to bother about.

I should like to ask one question. The Bill also mentions multifocal lenses. I know that there are such things, but I am told that they do not appear on the official schedule which the Ministry supplies to opticians in connection with prescriptions under the National Health Service.

Before coming to the main increase for the ordinary type of lenses, I repeat the welcome I gave yesterday to the concession for free lenses for children over 10. Since this is costing only £170,000 in a full year, why does not the Minister throw in the frames as well? It would not cost him very much. The hon. Lady's figure was that the popular line cost about 10s. 8d. My guess is that that would perhaps have cost the right hon. Gentleman another £90,000, bringing this concession up from £170,000 to £260,000, compared with the £65 million that he is taking back from patients and the public in a year. Perhaps between now and the remaining stages of the Bill the Government will look at the possibility of adding free Health Service frames to the free lenses they are already granting.

I come now to the increase in the standard charge for lenses, which at 2s. 6d. in the Bill—that is, 5s. a pair—does not look a very large increase, although it is an increase of 25 per cent. On spectacle charges the Guillebaud Committee expressed itself in these very strong terms in paragraph 586: … it seems to us here too the level of charge is likely to constitute a barrier to a proportion of the people who need to make use of the service. We recommend therefore that, when the resources become available, a fairly high priority (second only to an adjustment of the dental treatment charge) be given to a substantial reduction in the amount of the charge for spectacles. But there is a 25 per cent. increase five years later.

The increase has produced a very interesting result. To make my point I may have to inflict on the House some rather wearisome details, but I want to take the case of a person who needs two pairs of glasses, one distance and one reading. The arrangement is, as I understand it—I am open to correction by the Minister—that the optician is paid by his Department the net prescription cost of the lenses—that is, less the patient's contribution—and the dispensing fee. With two pairs at once, the dispensing fee is 24s. on the first pair and 10s. on the second pair. The cost of lenses varies considerably, but I am told that 10s. 6d.

a lens is quite a reasonable average price for an average type of lens.

I want now to deal with the curious situation which arises when two pairs are ordered at once. This will affect very much the older age groups. It is the older people who need two pairs of glasses much more than younger people. On the second pair of glasses the net prescription cost will be 10s. 6d. on the type of glasses which I have chosen. The dispensing fee will be 10s., making a total cost of £1 0s. 6d. to the right hon. Gentleman's Department. But the patient will be contributing £1 5s. Therefore, on the second pair of glasses the patient is not contributing to the cost of the spectacles. After paying in full for the spectacles, he is making a forced payment of 4s. 6d. into Exchequer funds. The House cannot permit this. It must be looked into immediately by the right hon. Gentleman.

The situation is not very much better when the two pairs are considered together. I do not want to be unfair to the Minister. The net prescription cost for two pairs is 21s. The double dispensing fee—the large first one and the smaller second one—is 34s. The total is 55s. That is the cost to the Minister. Fifty shillings are paid by the patient. Therefore, the right hon. Gentleman's contribution is 5s.

I am told that before the National Health Insurance system came in, the poorest grant given by one of the industrial insurance firms that made grants for spectacles was 17s. 6d. per pair, and that some trade unions gave their members up to 45s. 0d. a pair. That was in the years before we had a National Health Service.

Hon. Members will have noticed that here, as opposed to their method of dealing with prescription charges and amenity beds, the Government have proceeded by means of a Bill, and Clause 2 gives the Minister power to vary the charges by regulations. I imagine that, in this context, "vary" is a euphemism for "increase". If this Clause is accepted, this will be the last time that Members will have an opportunity of properly debating increases in charges, and suggesting Amendments. We shall, in future, simply have Regulations, subject to annulment if a Prayer is tabled against them. We object very strongly to the Minister being given this dangerous power, and we shall resist this Clause to the uttermost.

Incidentally, I notice that, so far, the Minister has given no date for the coming into operation of these increased dental and optical charges. Perhaps he was wise not to do so—

Mr. Powell

Seven days after the Royal Assent.

Mr. Robinson

Yes, but there is no specific date. In other words, the Minister has not yet expressed a hope as to when he expects these charges to come into effect. That may be very wise on his part.

We hear a lot of talk nowadays about images, and those hon. Members who travel abroad a good deal must have discovered that, despite Britain's reduced power in the world, her image in the eyes of other countries has been—until recently, at any rate—that of a humane, progressive society that had its priorities right. To that image, the Welfare State, and particularly the National Health Service, made an immeasurable contribution. All this constant whittling away and hacking away at the Service by the right hon. Gentleman and his hon. and right hon. Friends is not only lowering our health standards but, intentionally or otherwise, is actually damaging the country in the eyes of the world.

We regard this as an inequitable and unnecessary Bill, and we shall vote against it.

5.23 p.m.

Sir Hugh Linstead (Putney)

I was not able to take part in yesterday's debate, as I was not able to catch the eye of the Chair. I am, therefore, grateful to the hon. Member for St. Pancras, North (Mr. K. Robinson) for having opened up the scope of today's debate beyond the narrow limitation of optical and dental treatment and, to that extent, has enabled me to say some of the things that I would have said had I been called yesterday—

Mr. Deputy-Speaker (Sir Gordon Touche)

Perhaps I should warn the hon. Member that what the hon. Member for St. Pancras, North (Mr. K. Robinson) said has not increased the scope of the debate, or of the Bill.

Sir H. Linstead

I was about to use the simile of Scylla and Charybdis, but perhaps that is dangerous. I am conscious of the difficulty of keeping within the bounds of order today.

I hope next week to be able to express my disagreement with one part of my right hon. Friend's proposals—the prescription charges—but I warmly support his other proposals. If he will allow me to do it, it is appropriate that someone in the House should make a reference to the personal situation in which the Minister has been placed so far during the debates that we have had.

I prefer to look at his proposals from the point of view that he has found £60 million annually of new money for the National Health Service. Although one may criticise the ways and means by which it is proposed to collect that money, he has started his administrative period by making certain that the money he feels that the Service needs is available.

We have had too many Ministers of Health—too many changes—but I welcome my right, hon. Friend's appointment because I believe that he will create a really viable National Health Service. I believe, too, that in a year or two this House will find itself grateful to my right hon. Friend for the drive and development he will put into this Service and that, historically, the proceedings of last night, today and next week will look extremely curious when we finally assess the real value of his work—

Mr. Laurence Pavitt (Willesden, West)

I did not quite catch the word used by the hon. Gentleman. Did he say that the Minister was creating a "viable" service or a "violated" service?

Sir H. Linstead

That is just the sort of cheap sneer that is far less than deserved by what my right hon. Friend is trying to do. We had the same thing a moment ago from the hon. Member from St. Pancras North. When, referring to the word "vary" in Clause 2, he said sneeringly "That of course, means 'increase'"—

Mr. K. Robinson

I merely said that I took that word to be a euphemism for "increase". I was going on past experience of the Government. So far, they have done nothing but increase charges.

Sir H. Linstead

That completely overlooks the fact that Clause 2 (2) specially provides that The power to vary a charge conferred by this section shall include power to direct that it shall not be payable. I protest against the type of criticism to which my right hon. Friend has been subject—criticism that I feel quite certain some people will regret when the results of his work become more clearly visible.

Ever since it started, I have been deeply involved in the development of the National Health Service—in the pharmaceutical and hospital worlds, and on the Central Health Services Council. It is a service of which I am extremely proud, but when I listened to the description of it given by the right hon. Member for Belper (Mr. G. Brown) yesterday I could not recognise it as the Service that I know and respect and cherish. If I thought that the kind of proposals my right hon. Friend has put forward would undermine that Service, the last thing that I would wish to do would be to support him in any way.

Mr. Scholefield Allen (Crewe)

Has not the hon. Gentleman seen reports in the medical Press, from his medical friends and from practitioners of all kinds, from almost the whole profession, saying that the Government's proposals are an attack on the foundations of the Health Service? Even the cartoons are to the same effect. We know what has happened in the past. We know what has happened about the hospitals we have been promised. We have had a deputation from Lancashire County here, the Members of which said that they had schools to build, but, as soon as they got going, their facilities and plans were withdrawn. The Tories claim the credit—

Mr. Deputy-Speaker

I think that the hon. and learned Member is reverting to yesterday's debate and going rather far from the present Bill.

Mr. Scholefield Allen

May I just have a moment or two to finish? The hon. Member is suggesting we are cynical. We are cynical from experience. If we sneer, it is because we have heard these things so many times.

Sir H. Linstead

Reverting more closely to the Bill, what the hon. and learned Member says emphasises a point which I want to make. In considering the Health Service, we are in grave danger of looking at it in a vacuum. We must not look at any section of the social services in a vacuum. All are interrelated. When comments are made about delays in the building of hospitals, one has to remember that that was the price paid for the building of new schools.

Mr. Scholefield Allen

Office buildings and luxury hotels.

Sir H. Linstead

What it means is that the country has had to choose between the various sections of the social services which are to be developed, and to determine, as is so frequently said, the priorities.

Mr. Scholefield Allen

How many hospitals have the Tories built in ten years? The hon. Member is frightened so much—

Mr. Deputy-Speaker

Order. If the hon. Member addressing the House does not give way, the hon. and learned Member must resume his seat.

Mr. Scholefield Allen

I am sorry, Mr. Deputy-Speaker, but we on this side are very angry about the way in which this debate has been conducted and about the things which are said on the other side, the misrepresentations which are made. You must allow us a little liberty. I am sorry. I do not usually let myself explode, but I cannot stand the cynicism we are getting from the benches opposite.

Mrs. Slater

Will the hon. Gentleman—

Sir H. Linstead

I am sorry, but I cannot give way to the hon. Lady.

Mr. Scholefield Allen

Will the hon. Gentleman answer my question? How many hospitals have the Tories built in ten years?

Mr. Deputy-Speaker

I must ask the hon. and learned Member to resume his seat.

Sir H. Linstead

I am not at all anxious to raise the temperature of the debate, but I want hon. Members opposite to realise that we on this side are just as jealous about the development of the social services as they are. Our feelings about the development of these services are as deep as theirs, and they must allow us to express our feelings as warmly as they take the liberty of expressing theirs.

Mr. Scholefield Allen

It was hon. Members opposite who voted against the services.

Sir H. Linstead

I believe that what is happening as a result of the new financial Measures which my right hon. Friend is proposing is to give the Health Service a new "break" which it has been waiting for for many years. What is now proposed in relation to the Service as a whole means that—in respect of direct payments—those who have the benefit of it will fall into three fairly clear classes. First, there will be those who, for want of a better word. I shall call the indigent, who will pay nothing. Next, there will be the working population, who will pay towards it a contribution which they will regard as an insurance contribution. There will then be the remainder of the population, a very large remainder, who will pay charges only.

Looking at the receipt of benefits from the Service in the light of those three classes, I should have thought that the system adds up to something of which we can be quite proud, with one proviso—this unites me, to some extent, with hon. and right hon. Members opposite—the proviso that there shall be a built-in assurance against hardship. As I have already said, it is on this question that I have certain doubts.

My assessment of the situation is this. About 80 per cent. of the population will be able to take these new charges and contributions in their stride. About 10 per cent. of the population will have them paid through the National Assistance Board machinery. The group which, frankly, gives me concern is the fringe group not entitled to refunds through the National Assistance Board which will yet have to look at both sides of half-a-crown rather carefully before parting with it. This is the group on which, I trust, my right hon. Friend will keep his mind wide open.

My right hon. Friend gave us an undertaking that, if examples of hardship could be given within this group of patients, he would give his careful attention to them. I am grateful to him for that because my feeling is that the machinery of the National Assistance Board, as the hon. Member for St. Pancras, North has said, does not work as smoothly and easily as it may be described as working. In country districts, too, it is by no means easy for people to collect refunds from the Board. I hope that after the new scheme has been running for a few months my right hon. Friend will actively make inquiries among those who deal direct with the patients to find out whether or not the belief which he has expressed, that hardship can be met, is soundly based.

Mr. Stan Awbery (Bristol, Central)

There are circumstances which will arise where the Minister cannot help. On Saturday, I met a man who told me that he had expected a 7s. 6d. increase in his pension, but had just received a letter saying that it would be 1s. because of what he was receiving from the National Assistance Board. This man has to go to the doctor twice a week and he has to pay for two prescriptions. The Minister cannot do anything for a man like that.

Sir H. I.instead

The point to be remembered is that none of the payments made by the National Assistance Board in refunds operate in any way as a reduction of pension. They are separate and apart from any pension payments of any kind at all.

Mr. R. E. Winterbottom (Sheffield, Brightside)

May I just put one exploratory question to the hon. Member? I am obliged to him for giving way. He says that the National Assistance Board payments are outwith the pensions received. Will he examine the position of the permanently injured ex-Service man and see whether that is true in his case?

Sir H. Linstead

I think I am right in saying that the permanently injured ex-Service man, in respect of any medical needs arising out of his disability, has no payment of any kind to make at all.

Mr. Winterbottom

But what about prescriptions?

Sir H. Linstead

That is out of order. I must not be tempted into giving way again.

I have one other suggestion to put to my right hon. Friend. Will he consider sending a circular to the almoners of hospitals drawing their attention to the fact that out of funds at their disposal they can sometimes help with payments in these borderline cases of hardship? I know that such help is given in some hospitals and that it varies considerably between one hospital and another.

I have substantial doubts, which I hope to express next week, about the effects of the prescription charges. I have no regrets about any other part of my right hon. Friend's proposals. Generally, I congratulate my right hon. Friend on what he is doing to find new money for the Health Service. By having had this type of debate at the very beginning of his period at the Ministry he will get over his major hurdle, and I hope that when the dust has settled he will have before him a fruitful period of development of the great Service of which he is head.

5.41 p.m.

Dr. A. D. D. Broughton (Batley and Morley)

The hon. Member for Putney (Sir H. Linstead) has let us know quite clearly that he regards the imposition of these charges as a thoroughly good idea. Judging by the compliments which he paid his right hon. Friend the Minister of Health, one might think that the right hon. Gentleman is a pin-up boy. The hon. Gentleman must forgive me if I do not follow him along those lines.

I wish to add my voice to those raised in protest against these charges. I condemn the Government for the imposition of these monstrous charges. I am aware that the Bill relates to increased charges for dentures and spectacles, but it is only part of the very gloomy picture which the Minister of Health painted when he told us of bis policy for taking more money from patients who need the services of doctors, opticians and dentists. It is difficult to confine one's remarks strictly to the Bill. I should like to be allowed to speak on the Bill in conjunction with the other charges which are to be made and the increased contributions for the Health Service which are being demanded.

It seems clear to me from the debate earlier in the week that the country's economy is not in a particularly healthy state. Therefore, the Minister of Health, with the approval of the Government, has decided to save a matter of £65 million. We know that there has been a rising bill of costs in the Health Service, but I believe that these proposed economies are quite unnecessary because the proportion of the national income spent on the Service has not risen. It is still about 4 per cent.

Mr. Deputy-Speaker

I think that the hon. Gentleman is reverting to yesterday's debate.

Dr. Broughton

I will not pursue that point any further. One is in some difficulty, because, as I said, these proposals are but a part of the policy which the Minister is putting forward.

Mr. K. Robinson

On a point of order. As these proposals are part of a much wider set of proposals, surely it is in order to argue, as I sought to do, against the reasons advanced by the Minister for introducing any of these charges. Surely that must be in order on Second Reading.

Mr. Deputy-Speaker

An hon. Member can refer to that as the background to the Bill, but, in my view, he cannot go into a long debate on a far larger issue which is not raised by the Bill.

Mr. Michael Stewart (Fulham)

Further to that point of order. My hon. Friend the Member for Batley and Morley (Dr. Broughton) had only just begun to refer to this matter. I do not think that he was proposing to go into a long debate. Surely it is in order, and one of the characteristic features of a Second Reading debate, for an hon. Member to deal not only with what is in the Bill, but with the relation it bears to the general trend of Government policy. I think that that is what my hon. Friend was doing.

Mr. W. Griffiths (Manchester, Exchange)

Further to that point of order. The Minister of Health said several times—this was his justification for these charges—that the hospital building programme would be jeopardised if he did not impose these charges. Surely my hon. Friend, or any hon. Member, is entitled to try to rebut that argument as it is an essential part of the Minister's argument for the Bill.

Mr. Deputy-Speaker

It is all a matter of degree. We had better see how we get along.

Dr. Broughton

I did not wish to pursue that point at great length, but, as my hon. Friend the Member for Fulbam (Mr. M. Stewart) was good enough to explain, I wished to mention it in passing.

Having said that, I wish to say emphatically that, in my opinion, there is no valid reason for the imposition of these charges. What is to happen is that money is to be taken from the old, the sick and the disabled for charges for dentures and spectacles as well as for other things—prescriptions, welfare foods, and so on.

In support of my protest, I should like to read a letter which I received only today. It came from the Wakefield and District Area Council of the National Federation of Old Age Pensions Associations. While my constituency does not cover any part of Wakefield, this area council covers part of my constituency. The letter reads: We of the above area meeting, representing eight branches of the National Federation of Old Age Pensions Associations, strongly protest against the proposed increases as outlined by Mr. E. Powell, the Minister of Health…. Along with other organisations, we deplore such increases as they are outrageous and no doubt a serious inroad into the Welfare State, and they are falling most heavily on those least able to bear them. I agree with that letter. I think that it is very depressing for us to receive letters of that kind. Money is to be taken from the old, the sick and the disabled, and, so the Minister tells us, it is to be used for building hospitals.

To try to take our minds off the hardship which these charges will inflict on patients, the Minister told us about a wonderful long-term hospital programme. I have the privilege of working in a famous hospital, and the Minister must know that there will always be pressure from the medical, nursing and administrative staffs in hospitals, as well as from hospital management committees and regional hospital boards, for more and better facilities. I realise that there is a need for hospitals and I am glad to hear of the improvements which are to be made in that direction, but I believe that the Minister is putting too much emphasis on hospitals. He has told us nothing about prevention.

Mr. Deputy-Speaker

I do not think that that arises from the Bill.

Dr. Broughton

I was going no further with that aspect.

The Bill increases charges for dental and optical treatment. As I understood it, the Minister said that this money was needed to be taken away from these people and that it would be used for building hospitals. I am pleased that the hospitals are to be built, but I think that the Minister has laid too much emphasis on the matter of providing hospitals.

What is required at the Ministry of Health is an imaginative architect who would come before this House to launch an inspiring policy. I can tell the Minister what some of that policy should be. Instead of there being a wretched Bill of this description, imposing these charges for dental and optical treatment, there should be absolutely free medical, dental and optical 'treatment, as well as free welfare foods, for all expectant and nursing mothers. They are the most important people in the nation and they should be cared for in that way. The provision of free medical, dental and optical treatment as well as welfare foods should be given to all children up to the age of 16. That would be a great investment: a healthy population for the future.

I believe that the operation of this outrageous policy which we are having to consider will fill the hospitals that the Minister is talking of building. These charges, as well as the others that we considered yesterday and will be talking about next week, will deter patients from seeking treatment when they need it and will, therefore, lead to chronic illness. What the Minister should be doing is launching a programme which would be a long-term policy for closing hospitals.

These charges together with the others are cruel and callous. Looked at as a policy for improving the health of the nation, they are absolutely wrong and disastrous. They will hurt a lot of people who can least bear the pain. I regard these measures as a retrograde step and we shall strongly oppose them.

5.53 p.m.

Mr. David Webster (Weston-super-Mare)

I have great pleasure in following the hon. Member for Batley and Morley (Dr. Broughton). I heard him with great interest when I first arrived in this House discussing a non-partisan but controversial Bill.

This is an equally controversial Bill, but it is not unpartisan. First, we should remember that it is only a small amount that is being saved—between £ 2½ million and £3 million. I cannot think that that amount of money, divided among the entire population, will cause the distress and hardship which has been depicted with great sincerity from the other side of the House.

We on this side are anxious about the hardship aspects of the Bill. They have been mentioned from this side and I hope later to mention them myself, because they are something about which we have been concerned. In many cases, however, we are satisfied that the hardship has been overstated.

The basic purpose of the Bill and of the entire exercise that my right hon. Friend is now pursuing, this week and next week, is to maintain the balance in what is being paid to support our magnificent Health Service and to maintain the balance in what is paid by the user or by the same person as a taxpayer. In many respects, I do not think that hon. and right hon. Members opposite can quarrel with this balance.

With the new scheme and the new savings, at the end of the year the total outlay for the country will be £867 million. I cannot think that when £663 million, or 70 per cent., is paid out of Exchequer finances, it is only the indigent who is using it. It is a large proportion—70 per cent.—of the service which is being paid by the Exchequer. The argument about indigence, therefore, does not hold good. It is consistent with the policy of hon. Members opposite when in office and when, at the inception of the scheme, the Financial Memorandum stated that we would have a Health Service costing £175 million, of which £110 million was to be contributed by the taxpayer. That also bears the same percentage—72 per cent.—of the total amount paid out of Exchequer funds.

The figures have risen considerably and they have been extremely erratic from time to time. Despite their erratic nature, however, the one thing that has remained constant is that both parties in this House, when in office, maintained the proportion of 70 per cent. which was paid out of Exchequer funds. I am surprised to see hon. Members opposite kicking up such a clamour today when we are simply maintaining the same percentage as they maintained in 1946 and 1949–50, when, of a total expenditure of £452 million, 76 per cent., or £345 million, was paid out of the pockets of taxpayers.

It was at that moment that the Leader of the Opposition, whose name I found, with great surprise, accompanying the Motion of censure yesterday and opposing the Bill today, imposed the £400 million limit.

Mr. Emrys Hughes (South Ayrshire)

I recollect that I was here and voted against that proposition, but I did not find any Tories in the Division Lobby with me.

Mr. Webster

I am sorry that I was not here to see the hon. Member, but I am always interested in his activities. I was interested also to see from a certain paper that he might have become one of the Opposition Whips in the House. I do not know how that would have fitted in with his Division record at that time.

We realise that there have been financial changes, but the principles evaluated in those days by the Leader of the Opposition still remain constant. When talking about the £400 million level, the Leader of the Opposition said that the only way to limit the expenditure to £400 million, which he found to be a suitable figure at that time—we have exceeded it by 52 per cent. in ten years— without reducing the standards of the hospital, family doctor and consultant services below what is really essential is to find some other source of revenue."—[OFFICIAL REPORT, 10th April, 1951; Vol. 486, c. 851–2.] That is what we are doing today. We are, in fact, doing as the Leader of the Opposition, when Chancellor of the Exchequer, said in his Budget speech in April, 1951.

I find it very odd that the party opposite in general supported that policy without the support, it is true, of the hon. Member for South Ayrshire (Mr. Emrys Hughes)—and yet today, as one man, Members opposite are in complete clamour against the policy that they themselves carried out.

Mr. Thomas Fraser (Hamilton)

Is the hon. Member aware that my right hon. Friend's speech which he has quoted was made during the Korean War, when world prices were rocketing and when the Chancellor of the Exchequer was substantially increasing taxation, and that what was done at that time was done temporarily to cover the country's difficulties? Is the hon. Member aware of all these things?

Mr. Webster

I am. I am only sorry that the hon. Member either was not here or was not listening to me when I pointed out that I was aware of the financial difficulties, but that the principle and the ratio of 70 per cent. had been consistent throughout the whole of National Health Service policy. Money is money, from whomsoever it comes. It still has to be found. That percentage ratio is one thing which has been maintained by both political parties when in office. Now the Opposition are acting very differently from what they did when they were responsible for the country's administration.

Mr. W. Griffiths

I wish that the hon. Member would not keep saying that it is always 70 per cent. That is quite untrue, In his own speech he has referred to it as at one time 76 per cent. He must not keep on saying 70 per cent. It is quite inaccurate.

Mr. Webster

We are not measuring it to the nearest millimetre, but that is a ratio which has been kept throughout the history of the Health Service. I think that it is a very fair ratio and both parties when in office have definitely supported that amount.

I have already said that many of us on this side of the House experienced considerable anxiety when my right hon. Friend put forward his proposals because we were anxious that there should not be distress for the needy. Hon. Members opposite must allow us on this side to have the same sincerity as well. There has been a great deal of bandying about of words like "cynicism" during the debate. It is not fair to say that we are not sincere. We were sincerely anxious about need and we are glad that provisions for the dental and medical services release the nursing and expectant mother from difficulties in that respect.

Children under 16 or up to school age, whichever is the greater, if school age can be considered a great age, are also to be excluded from the dental provisions of the Bill. It is an excellent thing that we as Conservatives should support a policy of conserving children's teeth and it is good that these charges are not increased by ray right hon. Friend's Measure.

I support the hon. Member for Batley and Morley in his plea that we should stick to preventive medicine. Certainly, that policy has been carried out in the provisions that we have made for the preservation of the teeth. The provision of lenses for children up to the age of 16 is a good thing. It is also excellent that children over 10 years of age should be allowed a choice and not be compelled to have the metal-frame type of glasses which are less attractive, particularly for the teenagers who begin to take an interest in their appearance.

Children under 10 years of age are a problem in this respect. I have my own contribution coming on to the teenage problem, two of over 10 years of age and one very much under 10 years, who has had to wear glasses. I am sure that if they had been of the non-metal kind they would have been broken many times.

Mr. W. Griffiths

Does the hon. Member's son wear metal-framed glasses?

Mr. Webster

He did, but he does not now. I am glad to say that the curative effects of the Health Service have been so beneficial that he does not now require them. But he managed to break even a metal pair and what he would have done to the other kind might have caused the Service a great deal of expense.

I share the view already expressed that it is not only those who are in receipt of supplementary benefit who need to receive a refund by payment through the Post Office and, if necessary, in advance. I would ask my hon. Friend to take note of those who live in rural areas such as my constituency. Their homes are often quite a distance away from the Post Office. I am aware that few dental or ophthalmic specialists set up shop under the village chestnut tree, but this same principle applies to all aspects of prescription and refunds paid by the National Assistance Board through the Post Office, and hardship can result to people who live some distance away.

The total savings from all these measures are about £65 million in a full year of which £48 million are to be met by contributions and £17 million by charges. After deduction of £12½ million for prescription charges the remaining charges are a very small proportion of the whole. It is very unfair to say that grievous hardship will be caused. The contribution paid by the recipient of benefit is not great when it is remembered that in the last decade average earnings have gone up to £14 10s. from £7 10s., or nearly by 100 per cent. I believe that a great many people are quite willing to stand on their own feet.

My basic problem with the Ministry of Health ever since I came into the House has been to secure a new hospital for my constituents in Weston-super-Mare. I am quite determined that this should not be jeopardised, but I am sure that if we were to continue to pay out all the charges for which my right hon. Friend now seeks approval, and those for which he will seek approval next week, we would jeopardise the country's hospital building programme. There are people of modest means who need spectacles and dentures and prescriptions of various kinds, but, as we all know, the greatest need, in the end, is for hospital accommodation.

I still think that when the hour of need conies it is hospital accommodation of an up-to-date kind that is most required. A theme which we might note in dealing with the Bill is that throughout history a country or a Government has been successful in its policy if its aims and its means have been commensurate and if its means have not been disbursed on every small thing that comes along and have been kept for the main purpose. Where there has been failure, it has been where there has been large disbursements on small things and the essentials have been forgotten.

In this Bill we come back to the sound principle of saying that people can contribute towards what they receive in order that there may be more available to enable the Health Service to expand and to enable us to have new hospitals. All these measures put our policy in a brave new light.

6.8 p.m.

Mr. Laurence Pavitt (Willesden, West)

I assure the hon. Member for Weston-super-Mare (Mr. Webster) that we on this side of the House respect the sincerity of a number of hon. Members opposite.

On a Bill of this kind and matter affecting the National Health Service there is always a hard core of hon. Members on both sides of the House, though all too few, who will always try to catch Mr. Speaker's or Mr. Deputy-Speaker's eye. We on this side, however, are far more concerned about the large number of hon. Members opposite who do not seem to speak the same language as ourselves.

The hon. Member was typical of this approach when he spoke about preserving a balance between the user of the National Health Service and the taxpayer, as if in some way or other use of the Service was a privilege giving advantage and gain. We are talking about people who have disabilities or are in some distress. The basis on which we approach this Bill and similar Measures is that we try to preserve the principle that people who suffer disabilities of any kind should be looked after by those who are more fortunate.

The hon. Member harked back to a subject which has been frequently mentioned in debates of this kind, namely to what happened at the time of the Korean War. My hon. Friends have already answered that point, but I have not heard any hon. Member opposite so far make clear that the measures taken at that time were to be of limited duration and that those who reluctantly agreed to them did so on the understanding that they could be ended in the ensuing three years.

Although hon. Members opposite talk about these new provisions not doing a grievous amount of damage, we regard these proposals as rather like a case of dental caries. They might be small in relation to the whole income and prosperity of the country, but this Measure is like a small hole in a tooth, indicating decay which we fear might grow and destroy the rest. Some of the things that we have heard in the course of the debate suggest that our fears are justified.

I am sorry if any of my words have given offence to the hon. Member for Putney (Sir H. Linstead), who has now left the Chamber, because he has played his part in this kind of issue previously. Yet he must understand that we feel so deeply about Measures of this kind that at times we can no longer contain our irritation. If this causes you any embarrassment, Mr. Deputy-Speaker, then I also apologise to you, but when we feel so profoundly we cannot avoid giving vent to our feelings.

This Bill is part of a greater measure of economy carried out in order, the Minister claims, to underpin the National Health Service. I understand that it is the duty of Her Majesty's Opposition to oppose. One point of order which you were unable to hear last night, and which I was trying to put, Mr. Deputy-Speaker, was an appeal to you to tell me how after sitting in the Chamber from 2.30 to midnight I was to have the opportunity to oppose. I am very glad to have that opportunity now. Those of us who have had some association with the National Health Service, and feel keenly about it, will relentlessly oppose every dot and comma of the Bill, or any other Measure which tries to destroy the principle in which we believe.

The Bill seeks to find a further £3 million in a full year, and £1¾ million this year. As I have said, this is part of a greater campaign. We should like to know how hard the Minister fought his colleagues on this issue. If our affluent society is in such dire straits, was there any attempt to find these economies elsewhere? On the contrary, however, it seems to be a principle, announced with crusading fervour from the benches opposite, that the sick should pay for the healthy.

Did the Minister seek to save this £3 million from the Minister of Agriculture instead of from the National Health Service? Yesterday hon. Members opposite talked on the question of how far the Government could continue to subsidise. At one stage we almost got a debate on council housing. But, in looking for £3 million, could not the right hon. Gentleman have used his powers of persuasion to examine the £187 million subsidy on deficiency payments, at the grant of £26 million for structural improvements and at the other agricultural subsidies totalling about £40 million—making altogether a total of more than £250 million?

Mr. Richard Marsh (Greenwich)

Surely my hon. Friend misunderstands the position. Does he think that the Minister of Health had any qualifications for his present office other than that he detests the National Health Service, root, tooth and branch?

Mr. Pavitt

I accept my hon. Friend's opinion. I was trying to see, without going to the root and branches of agriculture or to other fields or pastures new—but we had enough clichés from the Chancellor of the Exchequer earlier this week and I shall not pursue that further. There are other ways in which the Minister of Health could have used his forceful personality to find the £3 million he wants to save the Exchequer funds.

My hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) has drawn the attention of the House to some weird coincidences. I was tackled in my constituency by doctors who, strangely enough, received their retrospective payment arising from the Pilkington award on 1st February—the day the Minister made his announcement here. Again, strangely enough, the supplementary Estimate which we passed as the result of the Report of the Royal Commission on Doctors' and Dentists' Remuneration exactly equates with the amount to be raised from prescriptions. Another strange coincidence I noticed in The Times was when on one page it announced that the Government were to save £65 million on health and on another page told of the amount actually paid out so far on the Blue Streak fiasco cost £67 million.

I wonder why the Health Service is always the first scapegoat for the Government. It is always the first in the queue for this sort of treatment. The biggest fallacy which we had when the Service was first introduced was that because false teeth were free people were dashing to the dentist and having teeth pulled out right, left and centre. It was said that they were being pampered. It was said that people would go to the doctor simply because his services were free. What nonsense this was.

Any barrier between a man who is suffering illness or disability and the necessary therapy to cure him is a bad thing, yet the Minister is producing more and more such barriers. Most of us try to avoid awkward situations. We try to avoid going to the dentist's chair. Now there is the incentive of a cash barrier between us and the dentist's chair which makes a ready excuse for putting off treatment that ought to be undergone.

The hon. Lady the Parliamentary Secretary has said that the whole basis of good dentistry is the conservation of teeth. I wish she would apply the principle of conservation to the Health Service. In that case, would it not have been better to have looked further into improvement of the dental service, to see if anything could be done about fluoridation? Ministry of Health officials have been very forthright about it, have given some good advice and are in favour of it. Yet we find no action by the Minister that could measure up to the possibility of saving the teeth of millions of children from dental caries through the fluoridation of water.

Fluoridation has already been carried out in New Zealand, the World Health Organisation has recommended it, and Ministry of Health officials support it. But the Minister of Health has had only three schemes—I believe at Watford, Anglesey and Kilmarnock—two or three years ago and, as far as we know, no results have been communicated to us. If the Minister is trying to conserve the teeth of our children could he not have done something energetic about that?

Dentists are paid by item of service. The more the Minister can conserve teeth in our youngsters, the less he will have to pay later. I think that it was the British Dental Association which, when recommending the raising, by a small percentage, of fluorides in water, estimated that this would save half the dental treatment in this country and so save a much greater sum than this, miserable £3 million which is to be extracted from people needing treatment for their teeth and eyesight.

We can, at least, be grateful that he stopped short at children under 16. They—or their parents—can be saved this increased cost. Instead of looking at ways and means of saving money we should be doing something about the school dental service. We have enormous numbers of children served by a woefully inadequate number of dentists who somehow have to examine and conserve their teeth.

This Bill, of course, is not for that purpose, but it seems very relevant that these kind of measures should be taken and should have priority over the sort of Bill for which the Minister is now asking us to give a Second Reading. The right hon. Gentleman has no idea of the family economics of people who live on weekly incomes, of the way in which the ordinary person meets the extra bills, whether an old-age pensioner, meeting the impact of coal bills in winter or the charges for spectacles or dentures. This is a sudden charge, once in a while, that does not come in the normal weekly payments. It is no good hon. Members opposite talking about thrift because the whole background and pattern of our society is to persuade more and more people to keep up with the Joneses even by hire-purchase. People are got at, through T.V., at 15-minute intervals. If one saves for one's dentures or is very patriotic and puts some money into War Loans one finds, as compared with equities, that the price for £100 of War Loan is now £57, so thriftiness does not help.

Looking at the problem of spectacles and the charges to be imposed, may I say to the Parliamentary Secretary and to hon. Members opposite who defended the case for children under 9 having steel-rimmed spectacles, that there is a terrific psychological background to be considered with youngsters. How many of us have heard "Four eyes, four eyes" being called out to children with steel-rimmed spectacles? The hon. Lady said that she had had the advice of experts upon this. I wonder how many paediatricians or psychologists had some say in how this affected the youngster who was thus different from the others as the one person in a class wearing spectacles whereas the others did not. I cannot accept that even with children under 9 there is not a case for giving a freedom of choice of frames to the parents so that the children can be made to feel that they can wear their glasses with the same amount of pride as the teen-agers who wear the fly-away wing efforts which even do sometimes enhance their beauty.

The Minister's Bill has shown what, again, is typical of the approach of the Government in most things, that the consumer is the residual legatee after the rest of society have had their pick. One can have pressure groups from industry, producers and retailers, but the person wearing the glasses is the person eventually selected to meet the Exchequer's deficiency. I wonder what other avenues the right hon. Gentleman has explored. I am thinking very much in terms of my hon. and gallant Friend the Member for Kingston upon Hull, East (Commander Pursey) and of the campaign he has waged about lenses and frames.

I have just had my first pair of spectacles and I took the trouble of finding out what the National Health Insurance frames look like. I was shown 43 different types but they were 43 variations on a theme of three basic types. The only difference was in the position of the covering.

If we are trying to build a progressive health service, for people who have deficient eyesight can we not be prepared to provide a design which is comparable with anything private enterprise can give, and so we can bring down the cost to what is absolutely necessary. If hon. Gentlemen opposite are to force these charges on us, is it not possible to look at ways and means to reduce the cost of frames for people who want a choice?

Looking at the material of which the frames are made I think this could be done. I can see no reason why Her Majesty's Government, with all the power of the Exchequer behind it cannot make a wide variety of designs that have a forward looking modern appeal in National Health spectacle frames. There is a huge market in which they would be used and it should be possible to produce them cheaper than the private industry can. Is the right hon. Gentleman as frightened to compete with the manufacturers of spectacle frames as he seems to be frightened of the pharmaceutical industry? Before this Bill was introduced how much research work had the Minister done on the whole costing of spectacles and their frames and all that goes to make them up?

As I said before, my main charge on this question of spectacles is that some people are reluctant to visit the optician and get that help which will make their lives a little easier, and it is easy for them then to put it off rather than meet the extra charge, especially if they also need to go through all of the problems of going to the National Assistance Board. It is easier to go along to the nearest Woolworths and get a pair of spectacles that more or less suits their eyesight.

What we are trying to do with the National Health Service is to give ordinary people the best qualified attention in sickness, distress or disability. The Bill does precisely the opposite. It persuades people away from the specialist and encourages them to do nothing and to put up with it, or to take the burden on their own shoulders and to treat themselves.

In presenting all these changes in the Health Service the Minister has been accused by my hon. Friend of thinking in words of statistics. He has been accused of being the hatchet man. I am disappointed because when the Minister was a back bencher I listened to his speeches with great interest. They were always logical and when he had a case, although I did not always agree with it, it was at least a case which could be logically made. I cannot say that the National Health Service is all Greek to him, although I might have said that of his predecessors, but he has not a clue about the way human relationships tick. When he brings his Measure before us he says he is hoping to look specially at the human relationship between doctor and patient, and so on. He shows a profound lack of understanding of the relationship between, for example, optician and patient, and dentist and patient.

The thing that the National Health Service has sought to do most is to relieve anxiety at times of distress. There should be no anxiety as to payments, and no anxiety as to ways and means of getting help. The right hon. Gentleman has made it quite clear that he is quite prepared that at the very lowest level, when a person is absolutely at the bottom rung of the ladder, he should be helped, but he is not prepared to have a constructive approach to the mass of the community so that they shall be able to employ a Service which will bring them up to the level of healthy citizens and give them the relief from the things from which they suffer. As my hon. Friend the Member for Batley and Morley (Dr. Broughton) said, it is a question of this, as with other issues, being introduced by the Minister of Health. It is the old people who really take most of the burden. Although I accept the fact that hon. Gentlemen opposite quite sincerely believe that their provisions for National Assistance have safeguarded the very worst cases in the community, those of us who have anything to do with old people know their near terror of coming into contact with any officials, and the idea of putting a case and talking about their personal conditions is enough to prevent a number of them taking advantage of the safety net which the Minister has erected. I wonder whether this Bill will ultimately achieve the saving of £3 million which the Minister hopes for. Every time previous Ministers have tried this whittling away, they have finished up not having made the saving intended.

The Minister may be seeking to plan for hospitals by cutting back some of these ancillary services, but I beg him not to become too institution-minded, especially at a time when medicine is moving towards more domiciliary treatment. We are grateful that he has realised that the hospital service has suffered from neglect for so long.

Mr. Speaker

I find it difficult to relate what the hon. Member is saying to the Bill.

Mr. Pavitt

The £3 million which we are saving is to be used to underpin the Health Service, to use the Minister's expression, and one of the ways in which he hopes to be able to underpin it is to plan for hospital development. What I am saying is that he should not do so at the expense of the services mentioned in the Bill. We welcome the fact that he is belatedly converted to planning—a number of Ministers now seem to be converted to planning—but I hope that he will bear in mind the changing patterns of treatment even in hospital institutions. During the last ten years there has been a complete change in the use of antibiotics, and so on, and as many of the scourges of the past have been eliminated there has been an increase in mental stress and psychological disorders. I am asking the right hon. Gentleman not to be too institution-minded and to be more mundane and less Emergency Ward 10 glamour-minded, and to remember the importance of things like teeth and spectacles rather than building monumental institutions.

The right hon. Gentleman fails to realise that the Health Service as a whole is not static. It is something which should be growing and advancing, but the arrangements proposed in the Bill are regressive and static. The right hon. Gentleman is trying to impose barriers where there should be freedom. We were hoping that we should have from a new Minister that creative leadership which has not yet come in the Health Service since the last Labour Minister. The Ministry of Health seems to be a hot seat occupied by people only in order that they can advance elsewhere, or occupied for only a short time. We hope that at some time the Government will give the Service that kind of consideration and permanency which we feel it deserves.

Mrs. Slater

Would my hon. Friend agree that when the Health Service was started by the Labour Party there was creative leadership and that that is the kind of leadership which we want to keep?

Mr. Speaker

That would not be in order.

6.33 p.m.

Mr. Kenneth Lewis (Rutland and Stamford)

Hon. Members opposite have assumed throughout these debates that my party is against the National Health Service, because of the proposal which my right hon. Friend has made. That is a strange outlook when one considers that we have kept it going for the long time that we have been in office and, indeed, have sought to develop it. I am sure that the hon. Member for Willesden, West (Mr. Pavitt) will agree that Members from both sides of the House have contributed to or assisted in the development of the Service. Many hon. Members on both sides have played their part in this work over the years.

I am especially interested in Clause 2 of the Bill, which not only enables charges to be increased, but permits the Minister in future years to increase the charges by Order or to abolish or vary them. I should like to pose two or three questions. What will be the position if the charges have to be increased in future? What is the possibility of the charges having to be increased if the cost of the Service goes up in the next few years, as it has done in the past few years? What can we do to ensure that these charges are temporary and that they even disappear—for indeed it is implied that they can disappear?

All along the Minister has emphasised that he wants the Service to develop. He has said that again and again, and hon. Members on this side of the House support him in that. To judge by the sound and fury which we have had from the Opposition, one would think that the Minister had taken an axe to the Service. All he has done is to lop off a few inches from the tree, and it is certain that the few inches of increased cost which he has lopped will grow again in the next two or three years.

Mr. Marsh

Does not the hon. Member agree that £65 million is a pretty hefty inch?

Mr. Lewis

When related to the whole cost of the Service, it is not enormous. I confess that I would like to see a National Health Service without charges other than perhaps a graduated contribution. I am inclined towards a graduated contribution in due course, but this Bill has been introduced simply as a matter of priority, and it is important to remember that.

It seems to me that it has been decided, not by the Minister of Health but by the Government as a whole, that people should pay for their teeth and spectacles, as they should for their drugs, which are outside the scope of the Bill, rather than that something else which the State provides should be charged for.

In the economic debate earlier this week, the noble Lord the Member for Dorset, South (Viscount Hinching-brooke) suggested that it might be desirable to apply a charge of 5s. a week for secondary education. I believe that the Government are wholly right to say that we should have free education and that, if necessary, there should be certain charges in the Health Service in order to keep education free.

Nevertheless, if my right hon. Friend and his successors continue to take advantage of the powers which the Bill provides and if there are further increases in charges for spectacles, teeth and drugs and/or other things, we have to accept the fact that we will gradually get away from a free or near-free Health Service. If the Minister intends to develop the Service as he wishes, and as I am sure he does wish, especially in the hospital service, then we must consider the results financially. It must be remembered that the hospital service is the most expensive branch of the Health Service. Hon. Members on both sides of the House have a sort of phobia about the cost of drugs, but, relatively speaking, that is only a small pan of the total cost of the Service.

The most expensive part and the part which has increased most in the last few years is the hospital service. If we are to expand that service, we have either to continue to use the provisions of the Bill to increase the charges year by year, or else stop the development of the service, or develop it at the cost of expenditure on other social services—education, housing, or some other important service which the people need. That is clearly the situation.

Having considered the present priorities, it has been decided that the National Health Service is to have certain imposts. I confess that I should like to see the charges disappear altogether. How can this be achieved? How can we develop this Service without killing the taxpayer? I know that this is arguable, but I believe that it can be done only by allowing those who want to opt out of the Service to do so. It can be done if we create and deliberately encourage an independent Health Service.

I am sorry that the hon. Member for Cannock (Miss Lee) is not here. She told us yesterday that her mother had been trying to get into a hospital and had found that she could not do so for many weeks. The hon. Lady, although giving great praise to the National Health Service, was pointing out a great deficiency in it. The Service is overworked. The hon. Lady was able to get her mother into a private hospital because that sector is not at the moment overworked because it is too costly.

I should like to see the development of a private service that is not too costly—not a service that requires the payment of £20, £30 or £40 a week, but one that is reasonable and that many people can afford to use. Indeed, the bones of such a service exist already, because various insurance schemes such as the British United Provident Scheme, and so on, have developed in recent years and are now receiving more and more support, not merely from rich people but from people of modest means.

Mr. W. Griffiths

The hon. Gentleman is making a plea for the extension or greater use of the private sector. He will be aware, of course, that at the moment part-time consultants are receiving very handsome sums indeed. Although under contract under the National Health Service Scheme, they are allowed to practise privately. Is the hon. Gentleman aware that a lot of people are very apprehensive about the consequences of this two-tier system? They suspect that access to beds is often obtained by fee-paying patients at the expense of National Health Service patients.

Mr. Lewis

A consultant cannot officially get a private bed within the National Health Service. It is completely out of order, and against the present law, for a consultant to charge a fee if the patient is in a National Health Service bed.

Mr. Speaker

I am concerned about the other kind of order. We seem to be getting a long way away from charges for optical appliances and teeth.

Mr. Lewis

Mr. Speaker, I am trying to get my teeth into the subject without your having to put on your spectacles to see that I am not going beyond the borders of order. I shall try to keep within them. I was being drawn away by the interventions.

The trouble with the sector of health that is under private control is that it is not really stimulated by official recognition. It will probably be necessary to permit people to opt out of paying their National Health Service contributions before we get a real exercise of will towards the private sector. I do not want to discuss the development of a private health service tonight because you have said, Mr. Speaker, that that is not within the terms of this Bill.

What I want to suggest is that the kind of charges in the Bill might be unnecessary if it were possible to reduce the cost of the National Health Service by encouraging some people to go outside it. It may be said that this suggestion will damage or destroy the National Health Service. In my view, it will do nothing of the sort. It will revitalise the Service, because the people who come out will leave more room for those who want to use it. Also, it will enable the present professional set-up within the National Health Service—the consultants and auxiliary medical people and others—to have a further outlet.

At the moment there is virtually only one employer in health matters. We are dealing with a monopoly Service and there are only a few doctors who can get a living outside it.

Mr. Pavitt

Can the hon. Gentleman explain how, with the present shortage of school dentists, if this alternative Service were extended and more people outside the Service were using dentists, this would help us to provide good dental services in schools within the terms of the Bill?

Mr. Lewis

The hon. Gentleman has mentioned one aspect of the Service in which there happens to be a shortage of experts. In contrast, consultants and registrars are unable to find jobs. Registrars and senior registrars are unable to get senior appointments within the hospital service for the simple reason that such appointments are not available.

Mr. Speaker

I cannot find anything in the Bill relating to surgeons or registrars. They have not the remotest connection with the Bill.

Mr. Lewis

I am sorry, Mr. Speaker. This contributes to empire-building within the Service.

I have always taken the view, both as regards health and welfare, that a State service is important for those who want and need it, but I consider that the State service could be improved if we had a yardstick by which to judge its efficiency. At the moment, if the cost of the Service increases we can pay for those increases only by putting up the charges as we are doing in the Bill. Because we have no yardstick at the moment, it is difficult to say that people responsible for the Service are not working economically and that they should save on this department or the other. If, however, we encourage in the private sector another scheme to run parallel with this one, into which people can voluntarily pay to insure themselves, assisted perhaps by industry, we should without doubt have a yardstick. If we found that in the private sector there was efficiency at less cost, we should know that in the public sector there would have to be an improvement and a tightening up.

I congratulate the Minister on taking what I believe are temporary steps. The Minister had been criticised by hon. Members opposite, but I believe that he intends to take an imaginative and wide view of health, which is what is required. He may not agree with my suggestions, but I hope that, within the next year or so, he will be able to make proposals for improving the whole of the nation's Health Service.

6.50 p.m.

Commander Harry Pursey (Kingston upon Hull, East)

For the first time I must say that I hope that the hon. Member for Rutland and Stamford (Mr. K. Lewis) will forgive me if I do not follow his arguments. I can sum them up in one word—"Nonsense". He is advocating two National Health Services. He might as well advocate two Post Offices, two Armies, two Navies, two Air Forces, two kinds of council organisation, two Civil Services, and two educational systems.

Mr. K. Lewis

rose ½

Commander Pursey

Wait a minute. The hon. Member has only just resumed his seat. I hope that he will give me a chance. I am not very good at this. His argument can be summed up in a nutshell—one system for the rich and another for the poor, and the devil take the hindmost.

Mr. Lewis

I am sorry that I interrupted the hon. and gallant Member before he had finished opening his argument. All I want to say is that I believe that in this Service, as in many other services, a total monopoly is a bad thing. He must agree that we should not care to have one-party Government. We have the Government and the Opposition. Therefore, it might be reasonable if, besides the National Health Service, we gave some encouragement to the private health sector.

Commander Pursey

While the hon. Member was making his speech I was unable to understand what his argument was about. After his last interruption I am even less clear about it, because it has nothing to do with the subject of the debate.

I rise to add my protest to the many which have been made by my hon. Friends, although not one has come from the Tory side of the House. I protest against these monstrous and unnecessary new charges for essential requirements under the National Health Service, which was originally free to all. The Bill increases the charges for dentures and spectacle lenses, but there is another important point to be considered. The Minister is out to obtain power to vary the charges in future by way of regulations and not by the introduction of another Bill. He would have no trouble with us if he wanted to abolish the charges Much nonsense has been talked by hon. Members opposite of his power to abolish. I can assure them—and here I am speaking only for myself—that he will never have any difficulty with the Opposition if he tells them that he wants to abolish the National Health Service charges lock, stock and ruddy barrel. We would be 100 per cent. with him on that. There is no question of his doing that, however.

He went this far only because he wants to make further increases. Then, instead of having a Second Reading debate on a Bill from four o'clock until ten o'clock, with the further Committee, Report and Third Reading stages, there will simply be a Prayer against a regulation, which will come on after ten o'clock, so that the debate wall be limited to an hour or so. To pretend that this Measure is taken to bring this part of the scheme into relation with the other is mere camouflage, like many of the other things he has said.

The increases for prescriptions, dentures and spectacle lenses are monstrous, not only because of the individual items but also because of the total amounts involved and the cumulative effect of several other reductions in the income of those who, though in the lower wage group, are not entitled to National Assistance. In spite of all the statements about the average wage being £14 or £15, many people are still earning only about £10 a week. They consequently have difficulty in obtaining the necessities of life, especially in view of the increased rent charges and other items, and the newly increased charges for National Insurance.

One of my constituents wrote to me as follows: I think you would be interested to know of the contents of a National Health Service prescription which I received this week for my baby. 'Tablets: One to be taken four times a day.' My chemist had only five left in stock, so for these I had to pay 1s. She paid 1s. for one day's supply. These tablets were about a quarter of the size of the ordinary aspirin. She does not say whether she asked the chemist if she could have the balance by going along to him the next morning, and I do not know whether the balance would have amounted to fifty tablets, or what it would have been, but it was a case of sheer robbery by the chemist. She goes on to say: Also on the prescription were a small bottle of medicine and a tiny tube of ointment for which I had to pay 1s. each.

Mr. Speaker

I am sorry to have to interrupt the hon. and gallant Gentleman. I can understand his point if, somewhere in the prescription, there is going to be reference to an optical appliance, but unless there is the hon. and gallant Member is out of order.

Commander Pursey

I was simply building up my argument about the prescription charge without debating it at length. Then I wanted to take the case of dentures and spectacles.

Mr. Speaker

I shall be content if the hon. and gallant Member will leave out the medical part and deal with dentures and teeth.

Commander Pursey

I will cease to discuss the prescription. I will simply say that this lady made the point that her husband is a bus conductor: and after he has paid his N.H.S. stamp each week we cannot afford, for dentures, spectacles and other charges, such luxuries as doctors' prescriptions. I hope that something can be done to stop the Tories from killing us all off. I want to deal briefly with the increased charges for dentures. If the Minister is claiming that one can get a complete set of upper and lower dentures for £5—the new maximum—instead of £4 5s., I can assure him that he is quite wrong. He is talking nonsense. He is not giving a true picture of the situation. To start with, when the patient goes to the dentist he pays £1 for examination and treatment. Three months after fitting, the National Health Service allows for re-examination for relining, which costs another £1. That makes the new total £7, and not £5. I challenge either Minister to argue that a person can get a complete set of dentures for less than £7. I will give way if either Minister will take me up on that point.

It may be argued that with two dentures there will be no more charges, but that is not strictly true. In time the dentures may again need attention or even renewal.

I wish to take the example of one full upper denture provided for a constituent of mine. Last summer he required extractions and one new upper denture. The scale of charges was, 1, 2 or 3 teeth £2; 4 to 8 teeth, £2 5s.; more than 8 teeth, £2 10s. Actually, his denture had 13 teeth and he was charged £3 5s. though why the extra 15s. I do not know. I am giving the figures from the Ministry document.

He was also encouraged to have a 5-tooth lower denture replaced to match the upper one. The charges were, examination and treatment £1; dentures, £3 5s.; examination and relining three months later £1—making a total of £5 5s. After a further three months he was entitled to his six months examination and two X-rays and scraping, etc. One filling was defective and had to be drilled out and replaced. So another charge of £1 was made for this treatment. The result was that in the first six months this man paid £6 5s. He still has some of his own teeth which will cause further trouble and expense to him in the future.

This idea of the Minister and of Tory Members of Parliament who argue that these charges represent only 1d. or 2d. or even a few shillings is just nonsense. It took the mutiny of Invergorden in 1931 to bring home to the Admiralty that naval married men and their wives were budgeting in pennies; and one of these days the Tory Government, if they go on with this campaign of attacking the sick, of attacking the near-blind, of attacking those who need dentures and who are budgeting in pennies, will create an explosion which they will be unable to control. No hon. Member opposite who has spoken has a clue about how the £10 a week man and his wife and children live today.

In future every patient requiring a new pair of dentures will have to pay these new charges of £4 15s. 0d. instead of the present £4 10s. 0d. Moreover, these same expenses may be involved in respect of his wife. There is always that chance. This total of £4 10s. 0d. for a single denture is a lot of money for poor people with a low wage. As has been said by hon. Members on this side of the House it will result in failure to use the scheme, to increase ill-health caused by defective teeth and consequent ill-health which may have a far greater effect than is appreciated.

I will now deal with spectacles, I am more conversant with them even than dentures, and I know one or two things about dentures. What we need is a Private Member's Motion on the subject of dentists and dentures and then we shall be able to "spill the beans" about them. A year ago, on 27th February, I moved a Private Member's Motion on the subject of the Supplementary Ophthalmic Service. I have no intention of repeating the speech which I made on that occasion, or even parts of it—[HON. MEMBERS: "Hear, hear"]—Hear, hear, hear. I can say that. The reason is that it stands for all time, and, though I say it who should not, it was a good speech on the ophthalmic service. It stirred up a lot of trouble and drew attention to a lot of rackets.

My present argument about spectacle charges is that, again, the Minister is not giving the full picture about the increases. The idea is that charges can be increased only by means of a Bill introduced in this House. Admittedly, that is true regarding lenses but it is not true of frames. Whenever the trade considers that it has a case for increasing charges it is put to the Minister for his approval or otherwise. A year ago the charge for a 524 H.J. frame such as I am wearing was 10s. 3d. According to the "Statement of Fees and Charges for the Testing of Sight and the Supply or Repair of Glasses" published by the Stationery Office, price 9d., that 10s. 3d. has since been increased to 10s. 8d.

At present the price of lenses, including bifocals, is 10s. each with 10s. 8d. for the frame, making a total charge of £1 10s. 8d. for a pair of National Health Service spectacles. For the first time, bifocals are now to be charged extra—another imposition on the low-wage earner. Let me deal with the argument of the Parliamentary Secretary that the individual who gets bifocal lenses has the equivalent of two pairs of glasses for the cost of one. So what? The manufacturer produces the equivalent of two pairs of glasses for the cost of one.

I am prepared to agree that there is a little more expense over bifocals, but let me make the point that, before he was prevented from doing so by the provisions of the Opticians Act, which I am not criticising, there was in Uxbridge a free-lance optician producing spectacles, including bifocals, at half the price of the National Health Service spectacles. So there is a big racket in the production of these spectacles, and if the Minister dealt with it he could more than secure his saving from the manufacturer, particularly in large orders, instead of on individual orders by individual opticians.

If these new charges are approved, bifocal lenses will cost £1 each, double the previous price, and the present £1 10s. 8d. for a pair of National Health Service spectacles like mine will be increased to £2 10s. 0d. Consequently, it will be all the more necessary for the Minister to arrange for increased publicity to ensure that the public fully appreciate what they can obtain through the National Health Service and so keep down their expenses and not be rooked of their guineas by opticians.

The sight test is free and the lenses will be £1 10s. 0d., or £2 0s. 0d. if they are bifocal. The snag is the frames. There are three methods of obtaining spectacles. One is by a completely private arrangement, having a private test, private lenses and private frames, with the sky the limit in the amount of guineas which have to be paid. I hold no brief for people who wish to throw their money away in that way and pay twice the value of the frames at the rate of, say, 15 or 20 guineas for their spectacles.

The second method of obtaining spectacles is to use the National Health Service scheme throughout—test, lenses and frames, which I have already described. The full cost will be 35s. plus, or 50s. plus for bifocals. What is not fully appreciated is that with complete National Health Service spectacles there are reduced charges for replacements and repairs for both lenses and frames. That is lost if one goes outside the scheme.

The third method of obtaining spectacles is what is known as the hybrid scheme. That is, National Health Service lenses at the fixed price previously given and private frames, again with the sky the limit in guineas. There opticians exploit the financial advantage of the patient being able to get National Health Service lenses at a low price.

Anyone who decides on private frames is not only rooked by unnecessarily high prices, but also he loses the advantage of reduced National Health Service charges for replacements and repairs and has to pay the full repair charges at the mercy of the optician. The Ministry refuses to accept any responsibility for hybrid spectacles even with National Health Service lenses and local executive councils refuse to deal with any complaints about them.

Last year, in the debate to which I have referred, the Parliamentary Secretary made the point that there had been very few complaints about sight tests and about opticians. Of course that is so, but what is the number of private transactions in frames? It could be fifty-fifty; it could be one-third, or two-thirds; we do not know and cannot find out. It could be guessed at, but for all those spectacles which are made with private frames, the Ministry and the local councils refuse to accept complaints, and that is where the majority of complaints arise. The idea put over in the House last year that there were very few complaints and that everything was "fine and dandy" is another misrepresentation.

Opticians bamboozle patients even into discarding National Health Service lenses and thus exploit the free National Health Service sight test with high-powered salesmanship for private lenses, and so take advantage of the Service. The Minister might consider that, if both private lenses and a private frame are decided upon, the whole transaction should be private and the patient should pay for the sight test. That would be one way of cutting down expenditure on the Service without overcharging low wage-earners. As an example of high-powered salesmanship over lenses as well as frames, I quote a statement by an optician: If you do not feel happy with the look of your specs, I suggest that you discuss it with your optician because you may find he will be able to reshape and transfer your lenses to a frame that is really becoming. That means to reshape National Health Service lenses. This raises the question, are National Health Service lenses tampered with and patients thus forced out of the Service scheme into a private transaction? Has the Minister considered these recommendations about lenses and frames? I again quote from the statement: A short face needs a shallow frame; long faces look better in deeper frames. … Look along the benches opposite at the long faces which need deeper frames. The statement goes on: It is easy to cater for anyone with an oval face. … There are two or three on the benches opposite— They can wear one of the new, rather oblong, squarish frames that are so fashionable, with very broad sides. Are they altering spherical National Health Service lenses to square lenses because round lenses cannot be fitted into square frames? The statement continues: There is plenty of scope for variety with the colour of the frame; one can relate it to the hair, the eyes or even the clothes. Generally, I like to put fair people into darkish-toned glasses and dark-haired people into either lightish or medium, or even bright colours. With evening dress I prefer an indefinate colour … Needless to say, this is a statement by one of the dispensing opticians. These are the plumbers of the trade who do not test eyes but get the prescription from a doctor and provide National Health Service lenses in exorbitantly priced private frames. The speaker was Penney Whit-taker in Woman's Hour on the B.B.C. Light Programme, and this was reported in the Listener of 2nd February. Yet opticians are forbidden to advertise.

I ask the Minister what steps he will take to stop this high-powered salesmanship and exploitation of National Health Service patients over lenses and frames. The more important question is, did the Ministry consider increasing the range of lenses as well as frames in last year's survey, and when is the new range of frames to be announced and displayed in this House as the old range was displayed last year? I shall not go on to debate the merits of the better frames, and so forth. It is possible to produce a better range of frames, particularly for young children, for practically the same charges as are made now. There is no reason why there should not be better National Health Service frames for the ordinary patient as well as for children.

The challenge to the Minister and to opticians is in the fact that for years Woolworths have sold a quarter of a million spectacles annually—and the price was 6s. 9d. If that is divided into the cost of the lenses and frames, we find that for each lens, sale price, the cost was 2s. 3d., and for the frame the cost price was 1s. The frame had the same hinges as a National Health Service frame. By mass production, it ought to be possible to produce National Health Service frames for a very few shillings.

Despite all the criticism and publicity last year in the debate on the ophthalmic service, and a long series of Questions, opticians still do not show in their windows the full range of National Health Service lenses and frames. They do not show the notice nor inform patients that the sight test is free, that lenses which were £1 will now be 25s. and that all the remainder of fifteen or more guineas is for the frame, which is simply costume jewellery. Nor do opticians state the National Health Service charge for frames, which is only 10s. plus, and that a pair of National Health Service glasses need cost only 30s. plus.

Therefore, I wish to ask the Minister what new action he intends to take about these serious new charges. It is not the increases. It is the totals. He should produce a new notice and ensure that it is displayed where it can be seen, in dentists' waiting rooms and opticians' shops, to show patients what they are entitled to under the National Health Service.

To sum up, the result of these increased charges will be to force more married women to go out to work and take jobs which men should have and also to leave children at home unattended when they should be attended, which will increase juvenile delinquency, probation work and recovery services. All this will be caused for a paltry saving of £1¾ million by the Minister of Health, which may well be largely offset by an increased charge on the Home Office Vote for juvenile delinquency and, later, further crime.

Moreover, the reduced use of doctors, dentists and opticians will result in increased ill-health, absence from work and reduction in production. What does this add up to? An increase in sickness and other benefits for unemployment and so on, so that the loss may even exceed the gains. The whole procedure is another Tory Government move to force down the standard of living of the lower-wage group and to force more and more poor people to the means test of the National Assistance Board for the essential requirements of their health, teeth and spectacles. The whole thing is quite monstrous and a disgrace to a Tory Government in this great country of Great Britain in what are supposed to be the affluent 1960s.

7.22 p.m.

Dr. Alan Glyn (Clapham)

I hope that the hon. Member for Kingston upon Hull, East (Commander Pursey) will forgive me if I do not follow him, certainly into the mutiny of Invergordon, for two reasons. First, I was not there at the time. Secondly, you, Mr. Speaker, would probably rule me out of order if I did.

However, I go a long way with the hon. Member on one or two of the points he raised. It is true that opticians are extraordinarily reluctant to display National Health Service frames in their windows. The answer is obvious—other frames cost more. If he has the power, my right hon. Friend would be well advised to compel opticians not only to display Health Service frames, but also to draw the attention of patients to the price which they have to pay for those spectacles.

I know of many instances of people going to fairly reputable opticians and the matter going by default. It is not that patients are not shown the frames. It is perhaps that they do not fully realise that there is a great deal of difference between the National Health Service frame and the frame that can be supplied at an extra cost. I hope that something can be done about that.

We on this side have our views, and we are just as sincere in them as hon.

Members opposite are in their views. My memory takes me back to working in hospitals before the war. One knew then that one of the greatest fears which any family had was illness, whether it was sight or anything else. The fear arose from the fact that the man was insured, but his wife and dependants were not. The same is true in America today. Many people will not go for essential medical treatment, whether it is for spectacles or anything else, simply because they fear the cost. That was true in this country before the war.

I do not think that that is so today. In the 1960s there is a great changing pattern in our economy. We cannot possibly compare these cuts, as some hon. Members, from genuine motives, have compared them, with workhouse conditions and various things like that. I do not think that those are fair comparisons. The hon. Member for Kingston upon Hull, East made a very valid point when he drew attention to the enormous sale of spectacles which Woolworths used to have. I have always believed that spectacles should be sold only by opticians, because a man's sight can be irreparably damaged simply because he goes to a non-qualified person and obtains spectacles, such as picking spectacles from a line of them on a counter at Woolworths.

When I was a small boy I used to see queues of people at the counter choosing their own lenses and frames. I hope that in future the Minister will see fit to bring in a Measure—Regulations or a Bill—which will cover this point. I am sorry that it cannot be covered in this Bill.

Mr. W. Griffiths

It must have escaped the hon. Gentleman's memory that this practice is now prohibited by law under the Opticians Act, 1958. When the appropriate Regulations are laid before the House, such practices will cease.

Dr. Glyn

Although the practice is illegal, it is still fairly widespread. Although the Act has been passed, it is not observed in the letter of the law. I hope that the public's attention will be drawn to what the hon. Member has so correctly said.

One of the great advantages of the Bill is that it gives the Minister some powers of marginal relief. I do not deny that there is a category of person for whom any additional charges would be difficult. That is the person who is just under National Assistance level. I understand that it is possible in the Bill, as in all Bills, for the National Assistance Board to give relief to that very category of person. In that respect, I welcome it. Further, the Bill will give the Minister the power in future to put the emphasis in the case of dentistry on what I believe to be the more important side, namely, repairing the teeth, especially in the case of young children. The power to vary is contained in the Bill. I hope that my right hon. Friend will have time to bring that point out.

Turning now to the general issues, this is an increase in cost to the patient. Everyone dislikes paying. I dislike paying. Like the hon. Member for Kingston upon Hull, East, I have a perfectly good pair of National Health spectacles. I am delighted to have them for nothing, but I could well have afforded to pay for them if I had wanted to. There are many people in the same position. We should look at it in the wider context.

The cost of the Health Service is rising. We have to provide for the increased cost somehow or other, either by charging for drugs—we are not permitted to discuss that today, though I should like to make some comments about it—or by some other means. The salaries of doctors and nurses and the cost of conditions of service are all mounting. Our object should be to endeavour to produce a Service second to none in the world and to continue building, not only the hospitals, but also on the domiciliary side.

I am certain that in the years ahead. and not in the too distant future, my right hon. Friend will use every endeavour to ensure that the Service is expanded and increased. I am not entirely satisfied that throughout the Service there are not many fields in which an equal saving could be made. I support the Bill, but I still think that other economies could be made which, if they were discovered, would enable us once more to spend much larger sums on the whole of the Service in general.

I am not at all sure that in the 1960s it might not be a good thing for those who can afford to pay to pay—and I want to make it very clear that people who could not afford it should not pay—an increasing amount for this Service. For that suggestion I have one reason only—by doing so they could make the Service better for those who cannot afford to pay. We may well have to look, in the 1960s—when people are very much better off—for other ways by which those members of the community who could afford it would subscribe towards the Service.

Economies could be made in the expenditure on drugs, and in very many other ways, but I cannot enlarge on that now as it is outside the scope of this debate. I hope that the debate will bring to a large number of people the knowledge that, for those who are just below National Assistance level, there is available this marginal relief by means of which, so I understand, some sort of repayment can be obtained.

I hope that as a result of economies we may see in the future an increase in that part of the dental service that is so vital—the school dental service. There is no question that the mother, and proper care and attention in the early days of childhood, build up the child's teeth. It is quite useless to come along for false teeth—"snappers", or whatever one likes to call them. It is far better to spend the money in the child's early days at school. That is when the foundations of good teeth are laid.

In addition to the economies that are to be effected, I hope that we shall seek further economies so that this Service may be ever expanding, giving benefit—and I mean this very sincerely—to those who need it. There are other directions in which economies can be made. For instance, we cannot deny that there is some waste in hospitals. That should be examined. At the same time, as I say, we should go further, and see whether there are not other spheres in which we can impose charges on those who can afford it and use the resultant money to provide an even bigger and better Service.

7.33 p.m.

Mr. W. Griffiths (Manchester, Exchange)

I have two special reasons, Mr. Speaker, for being grateful for catching your eye. First, I had the privilege of serving Aneurin Bevan when he was Minister of Health. Secondly, I am an optician by profession—a profession about which certain remarks have been made by my hon. and gallant Friend the Member for Kingston upon Hull, East (Commander Pursey), though I shall not deal with them now.

Running through the speeches of hon. Members opposite have been repeated examples of the curious love-hate relationship that the Conservative Party have for the National Health Service. They have, and they always have had, a kind of Jekyll and Hyde attitude towards it. As we know—and as we keep reminding them—they voted against the first great National Health Measure on Second Reading and again on Third Reading. They were, therefore, totally opposed to the principle of the National Health Service. However, when it very quickly became clear that many people, including Conservative supporters, were all for the Service and its benefits, they suddenly switched their ground and claimed that they had invented it.

We have had this afternoon speeches, like that of the hon. Member for Clapham (Dr. Alan Glyn), recommending the hiving off, as it were, of medical care into the private sector—

Dr. Alan Glyn

The hon. Gentleman is mistaken. My hon. Friend who recommended that has left the Chamber. What I recommended was that within the Service those who could afford to pay for part of their treatment might well be advised to do that, thereby making available more money for the extension of the Service. That is not a private service.

Mr. Griffiths

I do not think that there is much difference between what the hon. Gentleman says and what I say. He must realise that that would inject into the Service a two-tier system. It would mean that those who could afford to buy service would be entitled, in the private sector, to hope for a better service.

Dr. Glyn

That is the whole fundamental difficulty about the service at the moment. We have consultants looking at patients in public hospitals, half of whom are private patients and half public. I say that it would be far better if a patient went into a public bed, paid part of the cost and had the same service and treatment.

Mr. Griffiths

I must not pursue this matter, Mr. Speaker, or I shall be in trouble with you, but, briefly, I am totally against having part-time consultants in the Service. They should either be in it full-time or should engage entirely in private practice.

Returning to this love-hatred relationship in the party opposite, I have never forgotten the observations of the right hon. Gentleman's predecessor, the present Colonial Secretary, who once stated his attitude to charges. He has always been a very close associate of the Minister of Health. He described his attitude towards charges in these words: I have always believed in charges, not only on financial grounds "— not only, that is, when the economy is supposed to need them, as has been the argument today— but I have always been in favour of charges on social and ethical grounds. Those were the words of the present Colonial Secretary, and were the Minister of Health now present I believe that he would endorse those sentiments.

I have been looking at the speeches made by the right hon. Gentleman when he was a back bencher, and particularly at one made in 1951, when there was before this House a Bill to impose charges for dentures and spectacles. I can at least agree with him when he said that that former Measure marked an important change of principle. He said: What this Bill does is to take the National Health Service out of the class of unconditionally free social services. He recognised it to be a fundamental change in principle—as it was.

We had perfectly reputable reasons for bringing forward that Bill, although I did not vote for it. I was strongly against it, as was Aneurin Bevan and others of my hon. Friends. After all. however, that was only for a limited period. By this Bill, the Government take powers making it unnecessary for them even to introduce a Bill to vary the charges. They will be able to alter the charges by regulation at any time without the need for new legislation.

What is the Minister's justification for that? He says that he is underpinning the Service. He argues that without these charges we cannot have the hospitals. He boasts of the greatly expanded capital programme for hospitals. We all recognise the need for a vast expansion of the hospital building programme, but I suspect that this is a bogus argument.

I will illustrate it by reference to the City of Manchester. In 1955 the then Minister of Health announced in his capital allocations that a new hospital was to be built in Manchester. The newspapers told us that £2½ million had been allocated for the new hospital. People said, "Now we are to get the new hospital in Manchester, and about time too". But this was six years ago. The other day, I asked the Minister of Health when he expected the hospital to be completed, and his answer was. "In 1967", twelve years later. Not a brick has been laid.

I suspect that these plans of which we have heard for a vastly expanded hospital building programme will be like so many of the other programmes in past years. They will remain on paper so long as the Government refuse to do anything about controls in the building industry, stopping people going in for building office blocks, and all the Test. Incidentally, this delay already will cost the taxpayer £500,000. The Minister said that when the hospital is completed, if it is completed in 1967, it will cost £500,000 more than the estimated £2½ million of 1955.

The charge for bifocal lenses is a particularly mean one. What the Government are doing is to double the existing charge. At the moment, the charge is £1 whether the patient has single-sight lenses or bifocals. It is now to be £2 for bifocals, admittedly a more expensive lens to produce. There is some merit in what the Parliamentary Secretary says, that bifocals are the equivalent of two pairs of spectacles, but it is the fact that people who need either two pairs of spectacles or bifocal lenses are people at least over 45 years of age. What the Government are doing is to inflict upon older people the greatest burden in the ophthalmic charges. The Minister is doubling the charge for that section of the community least able to bear it.

As my hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) said today, now that the patient will have to pay 25s. instead of £1 for the ordinary single-sight pair of spectacles, he will pay overwhelmingly the greater proportion of the cost of the whole transaction. I will illustrate it in this way. The vast majority of spectacle lenses, about 75 per cent., I think, cost, at prices fixed by the Ministry after negotiation with the industry, about 10s. 6d. per pair. This amount is recoverable by the optician from the executive councils. The price for the vast majority of lenses is 10s. 6d. The optician has his dispensing fee—a euphemism for profit—of 24s. The 24s. added to the average cost of a pair of lenses at 10s. 6d. makes 34s. 6d. Out of that the patient will pay 25s. This means that the contribution from the Ministry of Health will be very considerably reduced.

For some years now the Ministry of Health has been deliberately hiving off a growing proportion of the ophthalmic service into the private sector. Both my hon. and gallant Friend the Member for Kingston upon Hull, East and the hon. Member for Clapham have referred to the need for opticians to exhibit National Health Service frames to patients. I agree that they should. I do so in my own practice. If the Minister wants to do something about it, he can, as he perfectly well knows, make regulations to compel the optician to do so. So far he has refused.

The frames in the National Health Service range are the same frames that we began with in 1948. It is all very well for my hon. and gallant Friend the Member for Kingston upon Hull, East to talk about high-pressure salesmanship. I practise in a working-class area of Manchester. Over 50 per cent. of the people who come to me will not have Health Service frames at all. They think that they are unattractive.

What we ought to have done a long time ago was to bring within the schedule of National Health Service frames some modern, attractive, up-to-date frames, with prices fixed in the schedule. This would have stopped any tendency to racketeering on the part of the disreputable elements about whom my hon. and gallant Friend speaks. However, the Minister does not such thing. He and his Department are cleverly content to leave the old-fashioned frames in the scheme because the Ministry is perfectly happy for the patient to go out and pay for private frames. The burden on the Ministry is much lessened thereby. This is why I say that, quite apart from the charges, the Ministry has for several years now, by a deliberate act, been channelling off into the private sector an increasing amount of work which should properly have been paid for through the National Health Service.

This party is united in its attitude towards the National Health Service. We are unanimous in following the inspiration of Aneurin Bevan who saw the National Health Service as a great service available to everyone on the basis of need, without the intrusion of financial barriers. It is our determination to campaign against the Government and to expose their mean and miserable attitude towards the people of this country. We shall see the results of our campaign in by-elections and municipal elections later this year. The Minister of Health and the Parliamentary Secretary will go down in history as people who have done a little more to destroy something of which the whole British nation was once very proud.

7.44 p.m.

Mr. Anthony Kershaw (Stroud)

I find it difficult to follow the hon. Member for Manchester, Exchange (Mr. W. Griffiths) in making these charges a matter of principle. I know that he quoted words of my right hon. Friend, but they were said the first time that charges were made. If the principle really does exist, which I beg leave to doubt, it has been breached before. After all, I am sure the hon. Gentleman will admit that, presumably, what was fair in 1946 is fair now. The size of contributions—

Mr. K. Robinson

Not at all.

Mr. Kershaw

If I may continue my line of thought for a moment, I shall return to the observations of the hon. Member for St. Pancras, North (Mr. K. Robinson). Presumably, what was fair in 1946 is fair now, and the same proportion of the Service should be paid for by contributions and charges as is paid now. If it was reasonable to put a ceiling on the Health Service in 1951 and impose charges then, in exactly the same arithmetical circumstances, if I may say so, it is fair today.

We have heard from hon. Members opposite that it was the Korean War which caused the charges to be imposed. That is not true. The ceiling of £400 million was fixed before the Korean War was thought of and before there was any inkling of it. It is said by the hon. Member for Manchester, Exchange and by the hon. Member for Willesden, West (Mr. Pavitt) that the charges were imposed for only a short time and, therefore, what was done was something which people could agree to for a short time, though against their will, in the hope that it would be changed later.

In my view, knowing the way public affairs are conducted in this country, that was a sop put into the Bill at that time in order to induce a reluctant party to vote for it. The principle has been breached in the past, and I believe, therefore, that we are not doing anything now which has not been done before in similar circumtances.

We are only attempting to hold current costs at the present level. This is exactly the same operation to which we were driven before when current costs reached a comparable figure. We are doing so, not in order to undermine the Service but to be able to devote a large proportion of the resources which can be devoted to the Service to the capital costs which we know will be very expensive in future. In their turn, the capital costs, as large capital costs are designed to do, will give a better and, in a way, cheaper and at least a more efficient service in the long run. I am sure that no one would deny that.

The hon. Member for Manchester, Exchange referred to a projected hospital in Manchester. He cannot have heard the speech of my right hon. Friend the Minister when he was introducing the Bill in which he set out the achievements in hospital building during the last few years. He said that 190 major schemes have been announced. Thirty-one have been completed, 27 are in progress and 140 are in various stages of planning. This includes 36 new hospitals. By any standard that is a formidable achievement, and, as building costs go on rising, that standard will be maintained only by devoting a larger part of our resources to building in the future than we have done in the past.

It was not the Korean War which caused the increased charges to be made. The cause went back before Korea. It was what Aneurin Bevan called the cataracts of medicine being poured down the British throats. There is no doubt that the current costs of any scheme can be the enemy of the future. That is a conclusion to which both parties in their day have been driven.

The hon. Member for St. Pancras, North asked why in these affluent days we cannot avoid imposing these charges. Our answer from this side of the House is quite simple and short. If the days are affluent, more people can afford to pay for what they are getting. This party is, in principle, against general subsidies, which we believe are unnecessarily bad. We are restrained, by sheer costs and also by a feeling of inappropriateness, from giving to rich people as much as the poor people require

Mr. K. Robinson

Before that last sentence, the hon. Member went a little further. Is he enunciating the doctrine that in his view and that of many of his right hon. and hon. Friends, a social service should be constructed on the basis that everyone who can afford to pay for any benefit should be required to pay for it?

Mr. Kershaw

Within the limitations of hardship, that is so. I am sure that I would even carry the hon. Gentleman with me by saying that if a person can afford to pay something towards a service it is perfectly right and just that he should do so. We have been over this argument about subsidies so often that I hesitate to weary the House with it. In the food subsidies the usual argument was that it was absurd to subsidise the bread of the millionaires and the Ritz Hotel. We have the same argument now. No doubt if we concentrate the resources of the country on those who need them most, we achieve a higher standard of satisfaction and a higher standard of living and are more merciful and appropriate in the treatment of the problem before us.

I do not think that the sneers which we constantly hear against the affluent society carry a great deal of weight in the country. I believe that people who feel that they are in a position, through their own efforts, to pay for some or all of the services which they need are proud to do so. I think that mostly the sneers come from Left-wing intellectuals who do not undergo any particular physical hardship themselves.

I now turn to the matters which we have before us. Let me deal with the dental charges. The hon. Member for St. Pancras, North quoted The Times of last Thursday in which it was said that the object of these changes is not to improve the Service. I think that the hon. Member and the writer in The Times overlooked that there will be an improvement in the dental arrangements, because expectant and nursing mothers and children under 16 will be able to get dentures free of charge in future. This is not the case at present. Furthermore, they overlooked the change, which has been commented on, in the type of spectacles which will be made available to school children after they have reached the age of 9.

The amount of money with which we are concerned is £26 million or £3 million. Perhaps in relation to the total cost of the Health Service it is not very large, but in common with some other of my hon. Friends I express a certain anxiety about those who are just outside the National Assistance limits. The Minister has said that anyone who at any time is in receipt of National Assistance is entitled to ask the National Assistance Board to meet the extra cost of dentures and spectacles. No doubt that will be very helpful, but the people who are just outside the limit and who up to now have never been to the National Assistance Board, either because they knew that they were not qualified for assistance or because of a reluctance to do so, will suffer to a certain extent because of the increased charges. My right hon. Friend has said that he will keep a very close eye on how this goes. I have no doubt that he will do so.

The first thing which can be done—and I hope that it will be done—is to give greater publicity to the possibility of people getting help from the National Assistance in paying for the extra appliances which they require. Despite the number of years that the National Assistance Board has been operating, it is astonishing to find that there are still people who are ignorant of their rights. I am sure that hon. Members on both sides of the House have had experience of this, even in the last few months. In rural areas particularly, where the matter of going to the National Assistance Board is not so easily arranged and where people perhaps are not aware that the National Assistance officials will come to see them if only they let them know that they need assistance, we need a campaign to make sure that people are fully aware of their rights. I therefore hope that my right hon. Friend will tell everyone who can benefit in this way how he can receive the help which we all want him to have.

I do not believe that these charges are a breach of the principle of the National Health Service. I believe that, like the others which we shall have to consider in the coming days, they will in the long run redound to the great benefit of the people. They will find that they have a better Health Service, one which is better equipped capitally and one in which we can have the same pride that we have in the Service today.

7.59 p.m.

Dr. Horace King (Southampton, Itchen)

If I do not answer the hon. Member for Stroud (Mr. Kershaw) in detail, it is because my hon. Friends the Members for Ebbw Vale (Mr. M. Foot) and Stoke-on-Trent, North (Mrs. Slater), like myself, have sat in the Chamber ever since half-past three yesterday afternoon vainly endeavouring to follow every hon. Member who spoke from the Government benches. I should be distressed if I were to prevent my colleagues speaking in the debate after they have waited so long. I will deal with only one point that he made.

We agree with him that everyone who can afford to pay for a service should do so. But to that we add two other principles. First, people should pay according to their capacity to pay. This is fundamental to us. And, secondly, people should pay for the benefits of the Health Service whether or not they are sick.

When the present Minister of Health resigned from the Treasury, many of us admired his courage and sincerity, even though we were absolutely opposed to the principles for which he resigned his office. Knowing the right hon. Gentleman as we do, we knew that his return to the Government would by no means mean that he had sacrificed any of his principles and succumbed to a desire for office, but that he was maintaining his principles and had persuaded the Government to accept some of the things on which previously he had resigned.

The whole country has been waiting since the right hon. Gentleman's appointment for the Measures we debated yesterday and the one that we are debating today. Knowing the right hon. Gentleman, we are not surprised that he has turned out to be a hachet man of the Service that it should be his duty to defend and that the Bill we are discussing today, like the two Measures that we debated yesterday, takes us further away from the basic principles of the Health Service.

I regret that. There are other social service Ministers whom I have watched on the Government side who seem to have caught inspiration and to have been caught up by the humane work of their Departments. I think, for example, of the Minister of Pensions and National Insurance. Apart from his unfortunate graduated pensions scheme, which will hit the workers early in April, the Minister of Pensions and National Insurance has achieved a fine set of reforms in the great pensions Department. The present Colonial Secretary, after a lamentable start at the Ministry of Health, did some excellent work there.

The new Minister of Health, however, starts by putting back the clock in his Department. His motto seems to be: Thou shalt not kill; but need'st not strive Officiously to keep alive. In this House, we usually think of the Treasury as the villain of the piece bullying the spending Ministers. Today and yesterday, the rô les are reversed and the only begetter of these new reactionary changes in the National Health Service is the Minister who should be resisting them if they have come from the Treasury. Great tributes were paid from both sides of the House today and yesterday, and rightly so, to our great National Health Service, which is the pride of the world. It is worth interpolating here that it is served loyally and enthusiastically by voluntary workers, in great numbers, of all political parties. On some other occasion, we might discuss the virtues of this great experiment in socialised medicine, as the Americans call it. Tonight, however, we debate a serious divergence of opinion.

Surely, the basic principle of the Health Service is that there should be no artificial barrier between the patient and the best remedy available. All that is best—the best hospitals, the best medicine, the best nursing, the best surgical skill, the best medical skill, in ophthalmics and chemistry—should be available to all who need them, and the only test should be whether a patient needs the service.

In the past, one of the barriers was undoubtedly money. Many people of my generation and of my father's generation went without medicine and treatment, without proper spectacles and without any dental care, simply because they could not afford them. Many who did afford these things had added to the anxiety of illness the additional anxiety of wondering where the money was to come from to pay for the remedies or the appliances that they needed.

Today and yesterday, the Government's tactics are to play down the present bitter struggle which exists between both sides of the House over the new charges. The Government either do not know, or profess not to know, that last night's anger was real and that it was based on our personal experience and on experience of the kind of constituents whom we represent in the House of Commons, on the one hand, and, behind it, our own deep Socialist convictions, which the party opposite does not share, on the other. There are thousands of old folk who have got their first properly tested and properly fitted spectacles under the Health Service instead of buying them cheaply and nastily from Woolworths.

Of course, the National Health Service has to be paid for. The most fallacious argument that was advanced yesterday and during today's debate as justification for the Bill and for yesterday's reactionary measures is that they will check the rising cost of the National Health Service. The cost of the Service, however, has nothing to do with today's Bill. Both sides agree that the Health Service must expand and that we must provide the hospitals, medicine, treatment and spectacles and teeth that are to be provided under the Bill and that we must provide medical, ophthalmic and dental care for our citizens.

The battle of which the Bill is an indication is over who is to pay and how we are to pay for expenditure on the Health Service, which will continue to increase Which ever way we pay for it. I refuse to believe that we cannot have the hospitals that we need unless we impose a new swingeing penal poll tax of 10d. a week on everybody, that we must make the diabetic sick and the chronic sick carry an even more savage penal tax for being ill and that we must collect the miserable £1¾ million to £3 million that the Bill seeks to provide from those who need treatment, teeth or spectacles.

The cost of the National Health Service is not the issue. The cost to the Treasury is what the fight is about. We are fighting in this debate, as in yesterday's debate and in all next week's debates, about how we shall share the cost which, both sides of the House admit, is necessary and how we shall share it between richer and poorer citizens and between healthy and weak citizens. Although the Minister is particularly responsible for the Bill, all he is doing in his reactionary measures is carrying on spectacularly and in a particularly inhumane way a policy which the Tories have been pursuing ever since they came into power. This is merely part of the process. It has nothing to do with health, but is a means of redistributing the national income as between the richer and the poorer people.

Today's Bill, last night's Ways and Means Resolution, the flat-rate charge and the prescription charges, which we shall debate next week, all fall into line at the end of a series of Measures—the handing back of nationalised industries to rich people, the Rent Act, the racket in land, the high interest rates, the cutting down of direct graduated taxation and the stiffening of flat-rate taxation in Budget after Budget and Measure after Measure. All these things widen the gap between the richest and the poorest of our citizens instead of doing what ought to be done, narrowing the gap still further. They will help to secure for those who live by owning a much greater share of the national income than those who work for wages.

If this Measure tonight is only a redistribution of a mere £3 million it is part of the steady process which has been whittling away the Welfare State as far back as the Tories dare cut it without losing the support of the millions of ordinary people who return them to power at each General Election. Every flat-rate contribution—and this is a flat-rate contribution of a particularly evil kind—is an instrument of this redistribution. I am not very good at figures, but I should like to give the House two significant sets of figures. In 1950, direct graduated taxation amounted to £2,000 million. These figures are from Government publications. The flat-rate contribution in taxation was £436 million.

Mr. Deputy-Speaker (Major Sir William Anstruther-Gray)

I am sorry to interrupt the hon. Member, but he should keep more closely to the Second Reading of the Bill.

Dr. King

With respect, Mr. Deputy-Speaker, I am not endeavouring to wander away from the point. I am endeavouring to place the £3 million flat-rate taxation of this Bill in relation to the change in the rates of flat-rate and non-flat-rate taxation which has taken place during the last six years. I shall not argue the point at great length. I want to make simply passing reference to it and I hope that I may be excused.

In 1950, there were £2,000 million raised by direction taxation levied according to income and flat-rate contributions of £436 million. In 1959, the figures were £2,758 million in direct taxation, an increase of 35 per cent., and various flat-rate contributions had gone up to £898 million. While the graduated tax element had gone up by 35 per cent., the poll tax element of the contribution which we are making to the Health Service and National Insurance had gone up by 110 per cent., and this without the new flat-rate increase of April, without the increase of 10d. that will be made as a result of last night's Measure, and without the £30 million already imposed for teeth and spectacles and medicine by the earlier charges and the sum of £3 million that we are adding tonight. This is clearly a redistribution of national income in favour of the richer people. We on this side of the House believe that people ought to pay according to their capacity to pay.

The hon. Member for Ilford, South (Mr. A. E. Cooper) said early this morning that he thought that the new charges had reached the limit. We believe that this poll tax element, this special tax that we are putting on sick people who need medicine or appliances had already passed the limit of social justice. I confess that I am an absolutist and would take the whole cost of the Health Service out of taxation. I believe that would be the fairest way and that all in this way would pay according to capacity to pay.

It is true that we compromised when we set up the National Health Service, as my hon. Friend the Member for Cannock (Miss Lee) said in her moving speech yesterday, and that we introduced an element of poll tax. Any poll tax is bad, for under it the widow with a large family pays the same amount as the rich newspaper owner, the rich land or property owner and the rich speculator—the people who have already had such benefits from this Government that they do not mind the extra cost that the Bill will impose on their spectacles.

But if a poll tax is bad because the same amount represents a burden on the poor person which is very different from that which it imposes on the rich, a poll tax on health itself is even less justifiable morally. Charges that we make on prescriptions, teeth and spectacles are a painfull poll tax on unfortunate people. We punish people for having to have their teeth out. I should have thought that having teeth out was punishment enough inflicted by the Almighty, without having that punishment added to. I am reminded of Butler's "Erewhon", where the sick people were gaoled and sinners were given treatment. The millionaire will pay under the Bill exactly the same extra charge as all who come under the Bill except the very poorest people, the 1½ million people who are protected by the other great achievement of the first Labour Government, the great National Insurance, and National Assistance coverage.

As one of a number of hon. Members who sat throughout yesterday's debate to address himself to the much more general question than the specific items involved in this Measure, I wish to protest against the gagging which prevented many of us from speaking early this morning. Today's debate is confined to a much narrower field, but these £3 million, like yesterday's £12 million on prescriptions, and like the £50 million on flat-rate contributions, are part of one particularly mean exercise by a Government who know that they will be hurled out of power if they try to demolish the Welfare State and destroy the Health Service which they tried to prevent from being established when Labour was in power. It is a Service which commands the admiration, love and affection of people in all parts of the country. The Government, however, will go on steadily nibbling away at the Health Service and the Welfare State—and this is one nibble—as long as they can persuade enough voters to return them to power.

We have been reminded in the debate of the Act which we passed two years ago designed to prevent people from indulging in the practice of getting spectacles for which their eyes had not been properly tested—spectacles from Wool-worths. I well remember the Woolworths lobby on that occasion, but the House was almost unanimously of the opinion that we wanted people to get their spectacles in the best possible way.

One of the effects of this Bill, however, is to undermine the very things that we tried to do in that Act. Above all, it is an undermining, not an underpinning of one of the cardinal principles of the whole Health Service, and one of the principles of the good society, which is that the rich should help the poor, that the strong should help the weak, and that the healthy should help the sick.

In this case, what ought to matter to the Minister of Health is whether a man needs spectacles or dentistry, not whether it should be paid for by that person himself. I bitterly regret this Bill very much, as I regret those measures which we were discussing yesterday. I am glad that our party will fight them solidly on every possible parliamentary occasion.

8.17 p.m.

Mr. R. W. Elliott (Newcastle-upon-Tyne, North)

I share quite a number of things with the hon. Member for Southampton, Itchen (Dr. King), including the fact that I, too, have been sitting here during Parliamentary hours since 3.30 p.m. yesterday. It may be that we both sit too far back to catch your eye, Mr. Deputy-Speaker, and that we ought to move further forward on the benches on a future occasion.

I also share the hon. Member's desire to see the best possible National Health Service and, consequently, I approve what we are doing now in increasing these charges, the contributions and the prescription charges which we are to discuss next week. I agree with these measures, because I am anxious to see the Service continue to expand. But I come to a point of disagreement with the hon. Member when he suggests that the whole cost of the Health Service should come out of general taxation.

I propose to say a little about preventive medicine, and I hope to speak about the care of the teeth of the young and the care of eyes, both of which are in the sphere of effecting the greatest possible saving later on within this Service. In answering the hon. Member's point about the cost coming out of general taxation, it is my honest belief that to get the maximum understanding of this Service there should be some amount of individual contribution.

On another occasion my right hon. Friend the Minister of Health said that contributions to the Health Service should be considered in the context of the whole economic position of the country and of the earnings of those who pay the contributions. We should not be too hide-bound in our approach to the future cost of the whole Health Service.

In the general context of seeking the best possible Service, it may well be that in future there will be better methods of ensuring expansion. I believe that we should look at the relationships of the social services within the general aim of effecting the most efficient society.

The extra costs imposed by the Bill will be fairly generally borne—not least by the employers. It is generally appreciated that increased costs of all kinds almost automatically help to lead to a general appeal for increased wages. It may well be that in future years the suggestions made yesterday and today about the possibility of a social service tax may be found to have a great deal in them.

We have the German experience to study. There, employers are meeting directly a great amount of social service charges. In the years ahead, we ourselves may have to look very hard at the part which employers are playing within the economy. It may be that we may need to use our employed force in this country to better advantage. It may well be that more intensive thought should be done by the employers about more intelligent employment. The German system of greater social service contributions by the employers may well be worthy of consideration.

In common with the hon. Member for Itchin and practically every other hon. Member who has spoken yesterday and today, I seek to effect the greatest possible easing of the burden of the new increases on those who are least able to bear them, but I suggest that here the Government are doing the maximum possible. In my constituency I have a great number of people who can be described as "proud pensioners". I share the hope that the propaganda of this debate will be great in its effect, and that we shall be able to bring home to everyone the fact that if they are in need they should seek the assistance—which is to hand.

There is much that could be done in publicising preventive medicine. Constant research into preventive medicine can do so much to improve the Health Service in the years ahead. In my own City of Newcastle-upon-Tyne, as long ago as 1947 Sir James Spence initiated a very valuable research, which is still going on. It is called the "Thousand Families Survey". A thousand families were chosen and have been studied since the birth of children during 1947.

The survey was founded in the need for an accurate report on the incidence of illness in infancy. The lessons are many and varied. Housing conditions are an effective factor on happy and enlightened family life. The first report about the research emphasised not only the need for better medical facilities, but also that these things must essentially be linked with moral and spiritual values in family relationships.

This report also stressed the importance of the infant welfare services. It is unfortunate that still only a minority of mothers use the infant welfare centres. Again, it is my hope that the propaganda value of this debate may help to publicise those centres. We should encourage them. We need more of them, not only in dealing with health generally but in the care of teeth and eyes. We need to consider them more in terms of a closer connection between them, the domiciliary services and the general practitioner. We need to do more in persuading all mothers to use these centres.

They are excellent places. My wife, with her two children, uses our local centre to great advantage. Here we have an excellent means of saving future costs in the care of teeth and eyes.

In preventive medicine there seems to be need for increased research into accidents. I recently had the sad experience at looking at some very young children some of whose eyes were closed and covered with scars. I went to the Burns Ward of the Fleming Memorial Children's Hospital in Newcastle-upon-Tyne. Here were to be seen innocent victims of unguarded electrical appliances, unguarded fires, or the teapot—which seems always to have been too near the edge of the table. In a developing National Health Service there is need for an increasing study of prevention, which, in turn, would bring an increasing possibility of a widening service. The nation deserves the very best Health Service it can afford. Yesterday and today we have moved firmly towards obtaining it.

8.30 p.m.

Mr. Michael Foot (Ebbw Vale)

For those who believe in a real National Health Service, if there could be anything more alarming than the measures which the Minister is introducing it would be found in almost every one of the speeches which we have had from the other side of the House during this debate. We have had a whole series of speeches from back bench Members opposite not merely applauding what the Minister is doing but revealing that they do not understand the principles of a National Health Service at all. We had a speech from one hon. Member a few minutes ago in which he said that these charges do not involve any breach of principle at all. I can understand the argument that because of economic circumstances we may have to impose charges although we do not like doing so, but for anyone to say that the imposition of these charges does not imply any infringement off the principle is completely to misunderstand the whole basis on which the National Health Service was introduced.

The Minister is much more clever. He knows what he is doing. That is proved by the quotation cited by my right hon. Friend earlier when charges were first imposed and when the Minister said that this was a fundamental change in principle and that he welcomed the change. His hon. Friends have become so familiar with these charges being imposed on the Health Service that they do not understand that their imposition is injuring the whole basis of the Service and that it is something quite different from the original conception. The Minister knows the difference, because he is now carrying into fulfilment the philosophy about the National Health Service which he has always preached. He has always been against the Service.

The other thing that is so curious about this debate is the extraordinary way of running our affairs. We have had almost six hours of debate on this Bill which involves the £3 million extra attraction of money from the patients. Last night we were discussing an extra £50 million which were to be raised and the Government, in proposing the Measure for raising that sum, thought its introduction worth only a five-minute speech. The whole thing is out of proportion. It partly arises from the deliberate action of the Government in trying to separate the discussions on the National Health Service, and the charges on the National Health Service, from the discussions about the Budget generally.

There has been a lot of talk about 1951 and I will not continue raking that over. However, in 1951 there was at least the difference that when the charges were imposed they were announced at the time of the Budget and the Measures imposing the charges followed in Bills produced after the Budget. That made a considerable difference because it meant that Members of this House could at least compare the charges that were being imposed, and the measures that were being taken under the National Health Service, with the other figures which the Government were proposing.

No doubt precedents can be produced to show that former Governments, even Labour Governments, may have introduced Measures of this kind prior to Budgets which involved forms of taxation. The Minister has, at least, had the candour to call it "taxation" when it is taxation. I can understand that there may be precedents, but it is still an abuse of the procedure of this House because that is what a Budget is for.

One cannot talk about priorities in the National Health Service and whether it is right that this £3 million should be raised from people when needing spectacles or their teeth to be dealt with. One cannot discuss whether a priority is correct unless one has the other priorities in perspective. If the Minister had wanted this to be dealt with in order of priority he would have asked that this Measure be introduced after the Budget and not before so that we could then compare the proposals which the Government are making for raising money from contributions or from sick people as proposed in this Measure, or from the Measure involving prescriptions which we shall have later. We should then have had a proper comparison.

The Minister speaks of priorities inside the National Health Service, as he is entitled to do, but the much bigger issue that this House has to decide is the whole question of priorities in the Budget as a whole. It is impossible for us to discuss that here because the Budget will be introduced later. In this way the Minister is not doing his job of protecting the National Health Service. We do not think he was put there for that purpose anyhow, but if he were doing his job of protecting the National Health Service, even for the purpose of trying to carry through the hospital programme about which he claims to be so enthusiastic, he should have said to the Prime Minister or the Chancellor of the Exchequer, "I think it would be much better for my Bills for increasing taxation to come after the Budget and we will see how the House of Commons like it". If the Minister had said that he would have got much more money from the Treasury. Perhaps he was not put there to get money out of the Treasury. I suppose he is the first Minister of Health to be popular with the Treasury, but that is not a very great achievement of which to boast.

The significant part of his speech yesterday—and it refers precisely to what we are discussing today—came in a long passage about the National Assistance Board. He made great play with it and he said that people did not know how to use it properly. We have had many speakers from the benches opposite emphasising how more people ought to go to the National Assistance Board when in hardship.

The Minister was talking about people who were not normally covered by the Assistance Board regulations but who, according to his announcement, would still be able to get assistance in respect of spectacles, caring for their teeth, or other provisions affected by the new charges, and he said: It is in the public interest that these arrangements should be as widely known as possible. They make it clear that for a great many people who may be involved, by these charges, in some degree of hardship, but who are not within the normal limits of the National Assistance Board standards repayment of the charge can be obtained. The more widely that is known the better."—[OFFICIAL REPORT. 8th February, 1961; Vol. 634, c. 442.] Of course, in one sense it is better that it should be widely known that people can get the money if they cannot afford to meet the charges, but here is a clear declaration from the Minister that what he is seeking to do, and what he will achieve, is to drive people out of the ambit of the Health Service and into that of the Assistance Board.

The Assistance Board is an institution very different from the other social services which were established or expanded by the Labour Government. Everyone wants to see the Health Service expanded in the sense that it is made larger and more able to deal with more people. Everyone wants to see the National Insurance Scheme expanded so that it covers more people and covers them better. But the purpose of social legislation should be to do away with the National Assistance Board. Its whole object was that it should be a safeguard for people who could not be covered by the other forms of insurance and social services.

It is appalling for a Minister deliberately to set out, which is what the Minister is doing, to drive people out of his care into that of the Assistance Board and to step up the numbers receiving National Assistance when every authority which has studied the matter has said that the object should be to provide such a system of social services and such a form of society that nobody should have to go to the Assistance Board.

I pay full credit to the way in which many of the Board's officers do their job. but however courteous they are and however delicate and dignified they may be in discharging their duties, one can never escape from the fact that their work involves an invasion of the privacy of the people concerned. They cannot help it, but the Minister of Health is deliberately saying that he wants more people to be sent to the Board and that he prefers that under his operation of the Health Service more people should have to go to the Assistance Board.

Mr. Powell

Prefers it to what?

Mr. Foot

Prefers it to doing his job of trying to protect the Health Service. How many people would have been saved from the Assistance Board had the right hon. Gentleman fought for this £3 million? He has been fighting not on that but on the other side. He has been fighting for the Treasury, and that was why he was appointed.

I do not blame only the right hon. Gentleman. I blame the Prime Minister, because it was an elaborate kind of joke for the Prime Minister that he should appoint as Minister of Health one who had always been savagely opposed to the Ministry of Health and the Health Service and that at the same time he should appoint to a spending Department an hon. Member who had made his reputation by attacking public expenditure. I have no doubt that the Prime Minister and his cronies had many joyful evenings cracking jokes about it. It shows the Prime Minister's flippancy in dealing with this great national service. It shows that he does not care a snap for it that he should appoint an hon. Member whom he knew perfectly well to be dedicated to the idea of changing the Service into something entirely different.

When the Minister gets up and says that he is a devoted friend of the National Health Service, and when some of his hon. Friends say how much they cherish the Service, I am reminded of the case of the lawyer in the nineteenth century who claimed to be a great defender of the British Constitution. It was said of him that he was prepared to sacrifice a part, if not the whole, of the Constitution in order to preserve the remainder. That is what the right hon. Gentleman does in respect of the National Health Service.

He is prepared to ditch and destroy the National Health Service in the pretence that he is protecting it. But he is not protecting it, because he understands what he is doing. But the others do not even understand what they are undermining. They do not seem to understand the principles of the National Health Service which they are destroying under this Bill and others associated with it.

There are three main principles of the Service, all of which hon. Gentlemen opposite deny. The first principle is that the resources of the community should be mobilised by the community to help the sick. Hon. Gentlemen opposite do not believe that. They have been shedding parts of the National Health Service, as was shown by my hon. Friend in the case of the ophthalmic services.

The second principle is that everybody should get the same treatment. We shall get the best service for everybody only when we provide the same service for everybody. What is happening now is that the two-tier system is already operating in the Service, and pretty well every speech made by hon. Gentlemen opposite emphasised that they wanted to press this much further. That was the whole moral of the case outlined by my hon. Friend the Member for Cannock (Miss Lee). It was not solely an individual case. It was showing how hon. Gentlemen opposite are trying to drive this division into the National Health Service, and the right hon. Gentleman is in favour of it, and always has been.

The third principle of the National Health Service, a medical principle, is that prevention is better than cure. If we removed from this Service the whole taint of commercialism and profit-making the doctors would be the more able to apply themselves to the real problem of keeping people healthy. Jonathan Swift said many generations ago that in his day doctors invented imaginary dis- eases for which they also invented imaginary cure. This is now an industry, a vast industry in this country, and the right hon. Gentleman is quite prepared to let it go on. He does not mind if that undermines the Service, because he does not believe in the principle that all the people should be included in the same Service. That explains why he does not believe in it because if the principle works successfully over the whole field of dealing with the people's health, then why not extend it over many other things?

The original attacks on the National Health Service were not made because the Service was failing. They were made because the Service was proving a success. When the Service was introduced, its opponents said: "It will collapse. It will not work. Patients will not come in. Doctors will not play. The thing will not operate." When that was disproved and the Service worked, they said, "It is too successful. We must not allow this to go on. We must not allow it to be shown and proved that by collective action, by making one common service, by applying Socialist principles, we can do the job better." That is what they often complain about in talking of Socialism generally, They said it about the Russians. Before the Russians started they said that their system would never work. When it worked efficiently they said, "It is much too dangerous."

The Minister of Health is very astute and intelligent. He has had many no doubt justified tributes paid to his character during the past few days, but he would have been more candid if he had said right at the beginning that he was carrying out the philosophy that he had enunciated ten years ago, that he hated the National Health Service, and that he hated the system under which we were to have a universal all-embracing National Health Service on the principles laid down by Aneurin Bevan. If he did not hate those principles, why did he attack as fiercely as he did for many years the Minister who made the National Health Service? He did it because he is an enemy of the National Health Service. He ought to have the courage to say it.

This makes so absurd the Minister's statement, at the end of his speech, that what he wants to do is to command enthusiasm throughout the whole National Health Service and to recruit the support of all the elements in the Service to make it work successfully. That is what he says he wants, but the measures that he has taken will injure that possibility. They will make people feel sour about the Service. The best service he could do to make the National Health Service a great success would be to resign before he carries these measures any further.

8.45 p.m.

Mr. Ian Fraser (Plymouth, Sutton)

It is a real pleasure to me to follow the hon. Member for Ebbw Vale (Mr. M. Foot), because his family bears a very honoured name in Plymouth, and in the constituency which I have the honour to represent. He has great political experience of life in that part of the country. But he and I are sundered by a very large gap in our respective attitudes to the National Health Service and to the charges which it is the object of the Bill, to raise, with certain well-conceived exceptions.

It seems to me that the underlying question about the Bill—and what has split both sides of the House both today and yesterday—is whether it is right to raise charges of this kind. If we want to obtain a sensible answer to this question we must ask ourselves whether such charges are right in our present society. The Opposition would go further than that and would ask, "Is it right to have charges at all? "To go into that question would be to go a little wide of the terms of the Bill.

I am sorry that the hon. and gallant Member for Kingston upon Hull, East (Commander Pursey) is not in his place.

Commander Pursey

Oh yes, he is.

Mr. Fraser

He said in terms that hon. Members on this side of the House simply do not understand how those who live on £10 a week or £500 a year really live. Much of the debate which has raged over the last two days has been concerned with that point. It is simply not true that hon. Members on this side of the House are one of two nations. It may once have been true, but it is not true today. It is wrong to say that we do not know how large sections of the people live. If we did not, we should not be here. I know that I certainly should not.

I was brought up in two big industrial towns in the North, but I now represent a constituency in the far South-West, and in that constituency I spend a great deal more of my time among people who do not vote for me than I do among those who I am sure do vote for me—and I am extremely proud and glad to do so. The real division between the two sides of the House arises over the question of the kind of society we are living in, and that must be vital to the other question whether it is right to raise these and similar charges.

We cannot get away from the fact that the average industrial earnings are now about £750 or £800 a year. That is to say—

Mr. Thomas Swain (Derbyshire, North-East)

Is the hon. Member aware that there are 400,000 men in the mining industry who earn less than £10 a week, and that that industry is the basis of our national economy?

Mr. Fraser

I am aware of that and I thank the hon. Member for his intervention. I represent a constituency where the average level of earnings is considerably below the average in the rest of the country. I know the problems which arise from that, and how careful one has to be when using an average figure.

My point is clear. This is not a static situation. The average earnings have been rising steadily over the years under Governments of both parties. I hope that the average will go on rising in the mining industry and I am sure that it will go on rising in my constituency which is very different from the mining constituencies. But, even at the level at which wages now are, the average represents the "middle-class" income as it used to be termed. I hate these terms, working-class, middle-class and upper-class, but this represents, for the purposes of rational thought, the middle-class income as it used to be termed.

Mr. John McKay (Wallsend)

I have been looking over the figures of the Revenue Account and I am wondering whether the hon. Member is aware that 7,400,000 people, after paying tax, have left a wage of only £6 17s.; and that after they have paid their insurance their net money is £6 6s. Is the hon. Gentleman aware that those people really represent about 11 million people, when one takes into account their wives and children, and that that is equal to about one-fifth of the population? We are proposing to impose these extra charges on those people. Could not the money be obtained in some other way?

Mr. Fraser

I thank the hon. Member for his intervention, which assists me to make my point. I entirely accept that his figure represents one-fifth of the population, but we have to consider the other four-fifths as well and that is the whole problem. In this matter we have a dynamic situation in which the prosperity of this country is steadily rising. It will not be long before average earnings in industry are over the £1,000 a year mark. Once more—

Mr. A. V. Hilton (Norfolk, South-West)

The hon. Member said that many workers are in the middle-class salary range. Does he consider that farmworkers are in that range, bearing in mind that the national minimum wage for farmworkers is £8 9s. 0d. a week?

Mr. Cyril Osborne (Louth)

What are their average earnings?

Mr. Fraser

The average earnings of farmworkers are considerably more than that, as any hon. Member who is a farmer will know.

We have to find what should be the pattern for the National Health Service in relation to these charges, in a society in which the general level of prosperity is not only already high—in what we would call the middle-class—but steadily rising, as it is for others in the lower income levels as well.

Mr. W. A. Wilkins (Bristol, South)

What is the average wage of the hon. Member?

Mr. Fraser

The hon. Member for Ebbw Vale accused my right hon. Friend of being an enemy of the National Health Service, but there is no ideal pattern for the National Health Service laid up in Heaven. Right hon. and hon. Members opposite have no prerogative to say what the National Health Service should be in its ideal form. Hon. Members on both sides of the House are trying to work out what that form should be—

Mr. Arthur Lewis (West Ham, North)

The hon. Member voted against it twice.

Mr. Fraser

We are now trying to find a form which will suit the society in which we live and in which it will work. Those are two important considerations.

I have very little time and must rush on with my speech. I can go by my own political experience only—short as it is. It is not my experience that the people of this country as a whole dislike standing on their own feet—as it has been called in this debate—that they dislike paying their way and paying for the advantages and benefits they have. I do not believe that as a people they dislike that. Although I absolutely accept that hon. and right hon. Members opposite are completely sincere, I do not believe that these measures which the Government are taking will be anything like so unpopular in the country as hon. Members opposite obviously believe they will be.

I think it true, as has been said time and again on this side of the House today, that there is a class of people about whom we have to be very careful indeed. Those are the people in the range just above the National Assistance Board scales earning something around £10 a week, such as the hon. and gallant Member for Kingston upon Hull, East mentioned. I confess to my right hon. Friend that when I was considering—as any hon. Member, on either side of the House, must consider—what attitude to take towards these measures, I had to search my conscience very hard when I thought of that band of people.

We certainly should not, and I do not think we would, under-estimate the social pressures which would come from disregarding that very considerable section of the population. A number of hon. Members opposite have made that point tonight. The truth is, and must be, that none of us, on either side, can say with any sort of conviction how these proposals will affect those people. I can see nothing for it but rigorously to inquire into individual cases.

Mr. A. C. Manuel (Central Ayrshire)

When, in connection with the Health Service, the hon. Member is applying this principle of people paying when they can afford to do so, will he agree that if that principle is to be applied among the lower-income groups he should apply it also to the higher-income groups, where standards are also rising and where vast subsidies are given every year without the application of any means test?

Mr. Fraser

I see no objection to that principle, although I am surprised that the hon. Member for Central Ayrshire (Mr. Manuel) who, after all, is a Socialist should raise it. To me there is nothing wrong at all with what he has advocated, that we should try to avoid subsidising the higher-income groups.

Returning to my point, I think that the most rigorous investigation of individual cases will be needed in this lower-income group. That is what I am asking of everyone who writes to me about it in a controversial sense today, although I have not had much of that kind of correspondence.

I end by saying this. We on this side of the House are charged with the task of governing the country. We have got to find a pattern for the National Health Service which will not only suit it but which will work. It has to suit the dynamic and increasingly prosperous society at all levels. Why I am poles apart from hon. Members opposite is that I do not believe that their ideal pattern for the National Health Service would either suit or work. I do not believe that they succeeded in making it work when they were in power. That is why they were led into adopting measures similar to those which we are advocating. I do not make too much of that.

There has been a great deal of talk about the affluent society, but, just because this society is becoming increasingly prosperous, we have to find a pattern for the National Health Service which will work. I believe that that pattern is of a Service buttressed by modern and reasonable charges in relation to the actual state of society at any given time. I believe that this Bill and the measures connected with it are a reasonable framework in which such a Health Service can be, and will be, built up.

9.0 p.m.

Mrs. Harriet Slater (Stoke-on-Trent, North)

I sat here all yesterday and again today wondering whether we are to have a National Health Service, because it is obvious from the speeches of hon. Gentlemen opposite that they have no conception of what a National Health Service means. I was glad that my hon. Friend the Member for Ebbw Vale (Mr. M. Foot) spoke tonight, because he spoke as passionately as the man whom he has followed, the founder of the Health Service, would have spoken.

After the speeches made yesterday and today by hon. Members opposite we at long last know that there is a fundamental difference between ourselves and the Tory Party—not only on the Health Service, but on all the social services. This is borne out by their latest pamphlet, which bears the marvellous title, Principles in Practice. In it the Tories say that in this expanding and prosperous society one big trend of Tory opinion is that we have to make a distinction between the freedom of the individual and what they call the paternalism of the State. It is the same thing as they put on the posters at the last three general elections.

All the speeches by hon. Gentlemen opposite showed a trend towards the gradual whittling away of the paternalism of the State in the social services for which the State should be responsible. The Tories go on to say that in this age, because children are bonnier and people are healthier, we must look again at the question of the means test, because—they put it in brackets—some people who have the social services mis-spend the provisions made for them.

As I said yesterday, we have heard this story over and over again. We heard it yesterday from the hon. Lady the Member for Plymouth, Devonport (Miss Vickers), and we heard it repeatedly from the present Parliamentary Secretary to the Ministry of Health when she was at the Ministry of Pensions and National Insurance. Very likely, she will continue to use the phrase.

I will try to answer some of the things said last night by explaining why we on this side are bitterly angry. We do not treat this matter with glee. We have not treated yesterday's and today's debate—nor shall we treat next week's debates—with a sense of being full of glee and fight. We treat this matter very seriously and with righteous indignation, because we know from long experience how much we have had to fight, not only during the last ten years, but during the last thirty or fifty years, for the Health Service that we now have.

My hon. Friend the Member for Stoke-on-Trent, Central (Dr. Stross) and I serve on the Stoke-on-Trent City Council. We had to fight for a maternity and child welfare service, a school dental service, a school medical service, and for a service to care for mentally-retarded children. We had to fight the Tories, who did not want us to spend the money. We know that in their hearts they have always been against the Service. They dare not do away with it now, but in their heart of hearts they do not like it.

We have the fear, and it is re-emphasised by the Bow Group pamphlet, that they wish to attack not only the Health Service, but education. They put it quite clearly. The Minister of Health spoke of building up the hospitals, but in this pamphlet the Tories talk more and more of making people pay to go into the hospitals. Is that social service? No. As has already been said today, the Tories are once more seeking to create two classes of people—those who can afford to pay, and those who cannot.

It is hard to reconcile a Bill that increases the charges for dentures and spectacles with what one reads in this morning's newspapers. We read in the financial columns of the vast sums made by the breweries. That money is not made by our people—it is made by the Tories. I do not talk about the people who drink the brewers' products, but of those who make their money out of them—they are not necessarily the same people. Day after day the speculation goes on, yet, while it is going on we cannot, in an expanding society—the Bow Group calls it a prosperous society—find £3 million to make sure that everybody needing dental or optical care gets it.

It is said that those who can pay do not want these services. Well, they do not need to have them. One hon. Member said that his wife went to the welfare clinic. She has no need to go. She can contract out by going to a private doctor. What we want, however, is to make sure that these services are built in to the very structure of our society.

We want to be absolutely certain that in no case, in any way at all, is there any danger of people being prevented from getting the attention they ought to have.

Earlier in the debate, I interrupted on the question of the supply of children's glasses. Why should a child under nine be forced to wear metal-framed glasses? Children of that age are very conscious, once they start to go to school, of their looks, and of what other people think of them. We should start instilling into them a sense of respect and dignity. Why should we force them to have steel-framed spectacles? In any case, the saving will be such a miserable amount.

There is only one thing in the Bill that I find really encouraging—the expectant mother, the woman who has had a child within the last twelve months, is not to be charged for dentures. We fought for that for years; that the expectant mother should be cared for and should be able to have her teeth attended to. That is vitally important. The hon. Lady the Parliamentary Secretary spoke of preventive treatment, but that begins when the woman is carrying her baby. It does not begin after the baby is born. This is why it is essential that she should have milk, orange juice and the necessary vitamins not only after the child is born, but during those earlier months for her own protection and that of the child.

My hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) read some very telling statements from the Guillebaud Report which set the priorities. Dentures and glasses should be one of the first priorities in the Health Service. Time and time again, committees are set up to inquire into what should be done. It seems a terrible thing that we should not now be able to find enough money, £3 million in a full year, following the recommendations of the last Guillebaud Report, to make these provisions free for all, instead of imposing the ridiculous charges now suggested.

Unfortunately for me, I have to wear bifocal glasses. If I may say so, it is very much easier to wear bifocal glasses than to have to fumble for reading glasses at one moment and for ordinary glasses the next. But, because I and thousands of others have to wear bifocals, we shall have to pay more money for them. This is a niggling saving—that is the only word I can find—at the expense of welfare and the status of our Health Service. The hon. Member for Stroud (Mr. Kershaw) made a cheap sneer about the only people opposing these proposals being, in the main, Left-wing Socialists. All kinds of Socialists have spoken today, but the fundamental fact is that we are all Socialists. [Laughter.] The hon. Lady the Parliamentary Secretary should not laugh. She has worked in the welfare services. She ought to be on this side of the House, not that.

This party, because of our past experience—I hope that no one will laugh at this—because of the poverty which has eaten into our hearts, because of our knowledge of the struggles that we and others have had, and because of our fear of what is expressed very clearly in the new Bow Group pamphlet—which we cannot and will not forget in the speeches which we shall make during the next few months—looks upon this Bill and the other provisions which the Minister is putting forward as unworthy of people calling themselves citizens of Great Britain.

9.14 p.m.

Mr. Denys Bullard (King's Lynn)

I apologise for not being present throughout the whole of the speech of the hon. Lady the Member for Stoke-on-Trent, North (Mrs. Slater). I know her very broad sympathies. I have been present during nearly all the debate and I hardly expected to be called after all. I apologise for returning in the middle of her speech.

I am an admirer of what my right hon. Friend wants to do with the National Health Service, particularly concerning the expansion of the hospital service. I do not think that it can be said that he is an "axe man". Rather the reverse is the case. I am not, however, a great believer in the payment for prescriptions, glasses and the other charges which it is proposed to increase—[Interruption.]—I hope that hon. Members opposite will give me a chance to speak. I was saying that I am not a great lover of the prescription charges and the charges which are being increased by the Bill. At the same time, I know that finance for the Health Service has to be found, and I am with the Minister in increasing the charges, but only provided I am satisfied that hardship cases are adequately dealt with.

This matter has been touched on by several hon. Members. I am not entirely happy about the arrangements for those who are already within the National Assistance scales, nor about the arrangements for those who are near to the National Assistance scales. I believe that this problem is especially acute in the rural areas, where it is a very great undertaking, for people who are not well and who may be old, to go through the performance of attending the doctor's surgery, the optician, the National Assistance Board and the Post Office.

Since all these funds come from the same source in the long run, although I know that the National Assistance Board is a separate institution from those we are considering, I cannot think that it is beyond the wit of man to devise some scheme whereby this parade from one office and place to the other can be avoided. I sincerely hope that my right hon. Friend will give very serious consideration to means of avoiding this parade.

If that requirement is satisfied, I cannot think that the charges proposed in the Bill and those to be imposed elsewhere will bear unduly hard upon the rest of the community. I am particularly concerned about the fringe area of hardship cases just above the National Assistance level. I cannot see how the system operates. Does the patient first initiate the process of drawing a refund of the charge? If so, how does he go about it? Does he first have to go to the Board or to the doctor?

Mr. William Hamilton (Fife, West)

He buys a farm.

Mr. Bullard

I do not know why the hon. Gentleman should wish to provoke me on the question of farm subsidies. The hon. Member for Willesden, West (Mr. Pavitt) also referred to the fact that some economies might be made in the farm subsidy instead. I would remind hon. and right hon. Members opposite that one of the subsidies particularly concerned is that for welfare milk.

Mr. Speaker

Order. I have great difficulty in relating welfare milk to optical appliances.

Mr. Ballard

With respect, Mr. Speaker, I should have thought that milk had a great bearing concerning teeth and that it might, therefore, be relevant. I will not pursue the matter except to say that it can always be suggested that the money for necessary advances in this service and in other services should come from other places. I shall support my right hon. Friend, but on condition that he makes more easy the processes which I have deplored and which I have tried to describe.

9.21 p.m.

Mr. Thomas Fraser (Hamilton)

I have heard all but two of the speeches which have been made today and I listened to a good many of the speeches made yesterday. The one thing that comes clearly out of these debates is that when we talk about the National Health Service, Members on the Government side are talking about something quite different from that which we on this side refer to as the National Health Service.

In talking about this great National Health Service, hon. and right hon. Members on this side have in mind a service that will be available to the people at the time they need it and for the purpose for which they need it and irrespective of whether they have the cash at the time to pay for the service which may be required. We believe that this national State Service should be financed according to ability to pay—most certainly—but we propose that that should be done by having it done out of taxation. That is the only sure way of providing that this Service will be paid for according to ability to pay. Incidentally, to have the Service paid for in that way is the only sure way of ensuring that it will be put at the disposal of our fellow citizens at the point at which they require it.

It will be generally recognised—it certainly is on this side of the House—that there has been no better investment in post-war Britain than the National Health Service. I have listened to speeches, including the speech from the Minister, about the desirability of having a viable Health Service. I do not know what he is talking about. He has not described chat to us. I hope that when the Secretary of State for Scotland replies—incidentally, at twenty minutes to ten; that is when I shall sit down— he will tell us what the Government mean by a viable Health Service.

How do the Government measure the social and economic benefits of a healthier population? How do they put into the balance the saving in human life and misery by the great advances in our Health Service over the years by the saving in life and by the considerable reduction in deaths from killing diseases? How do they measure that? We have been proud of the health of our children in recent years. In these years since the war, visitors from many countries have come to these shores and have commented on the extraordinary health of the children. This is due to our National Health Service. How do the occupants of the Treasury Bench weigh all these matters in the balance when considering whether we have a viable Health Service?

I have heard speech after speech today from the Government side about the desirability of encouraging preventive medicine. What about the welfare foods? What about the cod liver oil and the orange juice?

Mr. Speaker

I may be doing an injustice to the hon. Member, but I did not hear those speeches. Had I heard them, I should have been compelled to point out that the substance of the Bill is optical appliances and teeth.

Mr. Fraser

You put me in some difficulty, Mr. Speaker, because I was endeavouring to reply to the debate. I am bound to say that I had thought that there were no better preventive health services than this extra nourishment given, with the aid of subsidy, to the children. This has now been taken away as part of this operation. [HON. MEMBERS: "Go on."] I find that I have another note about something that might be a little out of order, Mr. Speaker. [HON. MEMBERS: "Oh."] Yes, but only out of order because Mr. Speaker is in the Claim. [HON. MEMBERS: "Hear, hear."] Hon. Members opposite should have heard some of the speeches made and points to which I was about to reply, but I must now take up another point.

Some hon. Members opposite, and particularly the hon. Member for Stroud (Mr. Kershaw), argued that because we are all better off now we can all pay individual charges. I want the Secretary of State for Scotland to let us in on what is the Government's appreciation of what we should be doing. Is it the Government's policy or their philosophy that because we are better off and because our national wealth is greater we do not need this State Service that we have had before and that in the circumstances we should now get rid of this apparatus of a centrally provided State Service and allow each man and woman to purchase the service he or she requires?

It has been said over and over again today that we should give help only where help is needed, and hon. Members have been so pleased to see that provision is made in the Bill to give help where help is needed. It has been said today—and I hope I shall not be out of order in referring to it—that years ago when we had food subsidies it was right to get rid of them because they meant that the millionaire dining at the Ritz was enjoying the subsidies too. Hon. Members opposite know that agricultural subsidies today amount to as much money as the food subsidies of twelve years ago. They defend them on the ground that they cut down the cost of food, but they never admit now that the millionaire at the Ritz is having his dinner subsidised by the agricultural subsidies.

The hon. Member for Rutland and Stamford (Mr. K. Lewis) anticipated that these charges were temporary. He was sure that they were, and he referred to the provision in Clause 2 (2) which states: The power to vary a charge conferred by this section shall include power to direct that it shall not be payable. I wonder whether the Secretary of State will tell us that it is the Government's intention that these increases in charges or these charges at all are temporary. [An HON. MEMBER: "Till the next election."]

The hon. Member for Rutland and Stamford said that he wanted a completely free Health Service financed by graduated contributions. I merely say "Good", and the best graduated type of contribution is a contribution by taxation. But I am afraid that he and many of his hon. Friends went a little astray, having made a point like that, in saying that there should be a considerable extension of the private sector to enable those who can afford to buy their own services to go outside the State Service and do so.

The hon. Member for Weston-super-Mare (Mr. Webster) dwelt at great length on the proposition that 70 per cent. of the cost of this Service should be mat from Exchequer funds and that that had been accepted by all Governments. That is absolute nonsense.

Mr. Webster

rose —

Mr. Fraser

I shall not give way to the hon. Gentleman just now.

Mr. Webster

rose —

Mr. Speaker

Order. If the hon. Gentleman who has the Floor of the House does not give way, the hon. Member for Weston-super-Mare (Mr. Webster) must not remain on his feet.

Mr. Fraser

The Exchequer contribution has seldom been as low as 70 per cent. As recently as four years ago it was 80 per cent. It is a great pity that the Beveridge Report recommended that 8½ d. of an employee's National Insurance contribution should go to the Health Service. It has never been admitted by the Opposition that the contribution by the employed person towards the National Health Service should remain in any particular proportion. We believe, on the contrary, that it should be varied and reduced.

I ask the Secretary of State to tell us why it is, at a time when the Government boast that it is increasing, that our prosperity should be accompanied by a decrease, proportionately, in the social benefits available to our people. It is within the knowledge of the right hon. Gentleman and his colleagues that other countries, including the United States, Germany and France, which are also enjoying a considerable increase in prosperity, are finding that this is exactly the time when they can afford greatly to increase social benefits. They find that when their people are well and working they are able to make their contribution to these great services and so get the benefit of services such as health and pensions when they need them.

That is the civilised way of doing it, but the Government's policy is running contrary to what is going on in many parts of the world. What is happening elsewhere is merely following what we sought to introduce here after the war. We sought so to order our national life that we might live more and more like one family. I thought that we were becoming more and more civilised, but the Tories have always had a longing for the jungle.

Commander J. S. Kerans (The Hartle-pools)

rose—

Mr. Fraser

Tory philosophy is the philosophy of the survival of the fittest. We believe that we should pay when we are well and working, but the Tories put the burden on the sick.

Commander Kerans

rose —

Mr. Fraser

As we have listened to the proposition that we should give more help where it is most needed, and as a great deal has been said about savings, I wonder if the Government can tell us of the savings which they are to make and how they are to make them. Does it involve a saving to the taxpayer because extra charges are to be imposed? Or is there to be a reduction in demand?

Who will be discouraged from using these dental and optical services by the extra charges? It will surely be the poorer people, not the richer. It will be the people least able to afford these charges who will be discouraged from using the Service. If that is so, would the Secretary of State say whether it is a good thing? Surely this is going to be the result of this; surely this is exactly what the Guillebaud Committee said in its Report four years ago. It said that the first priority should be to remove these charges on the dental service when we had the resources and that the second priority should be to remove the charges on the optical service when we had the resources, for the simple reason that poor people are discouraged from using these services. Rich people are not discouraged. So what happens as a result is that we give help where it is least needed and fail to give help where it is most needed.

A lot has been said about advertising the services of the National Assistance Board. What did the Minister himself say in 1951 when these charges were first introduced? I quote from HANSARD: Now from the point of view of the potential recipient, the people who are not going to be helped, who are not going to pass this means test, are precisely, in many cases, the most deserving. They are the people, the old-age pensioners, people just on a living wage, who are going to say, ' This is a pretty stiff sum I have got to pay, but I will be dashed if I am going to the National Assistance Board to argue the case about it.' Those are the people who are going to suffer most from these charges, if we leave this method of assessment in the Bill."—[OFFICIAL REPORT, 24th April, 1951; Vol. 487, c. 314.] That is what the present Minister said when speaking from the back benches ten years ago.

In every speech today his supporters have been saying that justification for this Measure is that the poor can be helped by the National Assistance Board.

Commander Kerans

rose —

Mr. Fraser

I know that the hon. Member for Putney (Sir H. Linstead) in the course of his speech, to which I listened with some interest, said that 80 per cent. of the workers would find no difficulty at all in paying all these extra charges. All I want to say in reply to that is that official figures show that about 47 per cent. of the wage earners of this country have less than £10 a week. That is almost half our working population. Is it a serious suggestion that this half of our working population will find no hardship in these new imposts? The Minister was right in 1951. These are precisely the people who will be denied the advantage of the Service, who will be caused hardship by the provisions of this Bill and by all the other measures with which this Bill is accompanied.

I wonder whether the Ministers realise how far they are putting the clock back. Dates have been mentioned today which go back to 1945. I came to this House in 1943 and before that for seventeen years I worked in a coal mine. During the whole of that time I paid my National Health Insurance contributions and I received my doctor's services and prescriptions free. I paid 6d. a week, which brought me free treatment for my wife and family; I paid 1d. a week and received hospital services free. I had to pay no charges when I went for any of those services, and when I needed glasses I went to the approved society and they helped me to buy my glasses. Do hon. Members opposite know how far they are putting back the clock?

In the years after the war, we took those various umbrellas which different sections of the population had erected over themselves and created one major umbrella to cover the nation as a whole. The Minister of Health—I do not know why the Secretary of State for Scotland should be left out of this and not get any of the credit, but no one has paid tribute to him and all the tributes have been paid to the Minister for the great Measures he has introduced—has put a lot of holes in that umbrella which replaced all the smaller umbrellas which had existed before 1948.

The Tories have been boasting of tax concessions, amounting to hundreds of millions of pounds in recent years. After tonight's debate, they will presumably be going back to the hustings boasting to their supporters and the country at large of putting £3 million increase on the charges for teeth and specs.

I wish to goodness that hon. Members opposite would get a sense of proportion. I wish that they would realise that there are many millions of people, many of whom, no doubt, vote Tory, who are suffering hardship now because of the charges already obtaining and who will suffer greater hardship as a result of these imposts on which we shall divide in a few minutes.

I ask hon. Members opposite to believe that there are many of us in the House and throughout the country who felt terribly proud of a Service which we believed would be expanded and enlarged and improved into something of which every Britisher would be proud. As a result of the operations of this Administration, lopping an inch off here and there, as the hon. Member for Rutland and Stamford said earlier, and with other countries building up their services, once again we shall be left far in the wake of other nations.

9.42 p.m.

The Secretary of State for Scotland (Mr. John Maclay)

The debate has been puzzling. I could have understood the genuine emotion which has been evident in the speeches of hon. Members opposite were it not the case that practically every speech which they have made has been a replica of speeches made in 1952 when comparable legislation was being discussed. All the terrible things which they said were to happen to the National Health Service and what the hon. Member for Hamilton (Mr. T. Fraser) said in his moving peroration were things which were said in 1952. What has happened since 1952? I will tell hon. Members as my speech goes on, in the time available to me.

I realise, Mr. Speaker, that we are confined, so far as we reasonably can, to discussing false teeth and spectacles.

Mr. W. Hamilton

See that you keep to them.

Mr. Maclay

I will try, but if I do I will be the only hon. Member to have done so. My intentions are strictly honourable, at the start any way.

I quote the speech made by the right hon. Member for Middlesbrough, East (Mr. Marquand) in March, 1952, when, referring to the dental service, he said: As for a charge for dental treatment, that never entered my head. I never thought that anyone could think of anything so insane."—[OFFICIAL REPORT, 27th March, 1952; Vol. 498, c. 887.] That was said all those years ago, but let us look at what has happened to the dental service in those years. Honourable and English Members will forgive me if I use the Scottish figures. The figures for Great Britain are comparable. In 1950, the year before charges were introduced, about 65 per cent. of the £5 million dental bill in Scotland went on false teeth and only 35 per cent. on other forms of dental treatment. In 1960 only 30 per cent. went on false teeth, and 70 per cent. went on other forms of dental treatment.

In those ten years we have had in the general dental service a most remarkable switch towards dental treatment and away from the provision of false teeth. Ever since 1951 it has been our aim to give priority to the conservation of teeth, especially those of children and adolescents because, as everybody knows, in the long run dental fitness for the nation can be secured only by providing proper dental health for the younger generation.

Scottish hon. Members will have heard of the pilot scheme on dental health education being organised in Dundee with the support of my Dental Health Advisory Committee. From this scheme we hope to learn lessons as to how best to persuade both children and parents of the best methods of looking after their teeth from the early stages. Apart from our efforts in dental health education, it is the case that in Scotland children are receiving more dental treatment than ever before.

Since the switch away from the provision of false teeth under the general dental service began in 1951, the number of children receiving treatment has risen progressively, and by 1960 about half a million treatments were provided to children under 16 at a cost to the Exchequer of over £1 million. It is estimated that in 1950 about 120,000 treatments were provided to children under 16, so that in those ten years we had almost a fivefold increase.

This is an example of the tragic effects which the right hon. Member for Middlesbrough, East forecast. I am singling him out because his quotation was most striking. There is no doubt that this transfer from the provision of dentures to the provision of treatment has been repaid by what has been done over these years. It is quite wrong—[Interruption.]

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

rose —

Mr. W. Hamilton

rose —

Mr. Speaker

Order. I am suffering from a double intervention. I hope that if the Minister does not give way hon. Members will not persist. I am not certain whether the Minister has given way.

Mr. Maclay

I have not, because I asked for only a short time in which to reply so to allow the maximum number of hon. Members to speak. However, I give way to the right hon. Gentleman.

Mr. Marquand

The right hon. Gentleman is pointing to the increase in dental treatment for children and apparently saying that this justifies a charge for treatment. There is no charge for dental treatment for children, and there never has been.

Mr. Maclay

Perhaps the right hon. Gentleman did not hear what I said at the beginning. The point of my remarks is to deal with all the horrible things that he forecast. I am dwelling on this, because this is the only argument which has been advanced against the Bill throughout the whole debate. There has been no other argument. I have listened to practically every speech, except those during an interval of about an hour.

The whole charge against the Bill has been made on this point. Hon. Gentlemen have talked about the destruction of the National Health Service. That is absolute nonsense. All these things were said before. The National Health Service has not gone back, but has improved steadily.

I deal now with the provision of glasses. [Interruption.] Whenever I take hon. Gentlemen up on something that matters, they do not want to listen. We must get it clear that there is no other charge against the Bill.

When the charges for spectacles were first introduced in 1951 there was an immediate fall in the use of the ophthalmic service by the general public, but this effect soon wore off. Today, more people are having their eyes tested with a view to having spectacles than in 1950, the year before the charges were introduced for spectacles. In 1950, just over 500,000 people had their eyes tested, and that number fell by about two-fifths, to just over 300,000, in 1952. I make no apology for using the Scottish figures. Following the introduction of the charges, the figure has risen progressively, and in 1960 the number of sight tests provided was 525,000. It is clear that the present charges are not preventing people from using the ophthalmic service, and I do not believe that the adjustments in the charges which are now being made will affect the upward trend in the demand for this service. In 1951, bifocal lenses were rarely supplied by that service. In those early days most people obtained two pairs of glasses. Charges in this respect are quite understandable, and have been explained by my right hon. and hon. Friends.

The point is that in relation to both subjects which have very properly been discussed under the Bill—spectacles and dentures—none of the fears forecast by the party opposite eight years ago has been realised in relation to the development of the Service. Their arguments today have no more likelihood of realisation than they had at that time.

Mr. K. Robinson

Will the right hon. Gentleman deal with the special case that I quoted, in which, under the new charges, a person requiring a second pair of spectacles would have to pay a charge which is more than the cost to the Ministry?

Mr. Maclay

That is an extremely complex sum, I know all about it. I suggest that if ever there was a Committee point that is one.

Another charge made by hon. Members opposite is that we are erecting barriers, or heightening them, through the increase in these charges. Let me now give the relevant figures for Great Britain. In 1952, dentures were supplied to 1,568,000 people. In 1959, they were supplied to 1.653,000 people. The number of pairs of glasses supplied in 1952 was 3,700,000, and that figure is now up to 5,193,000. Items of dental treatment have risen from 6,062,000 to 9,913,000. Where is the evidence, in these figures, that these charges are harming the Service and harming people's health? Where is the evidence that any of the charges made by hon. Members opposite are valid?

Hon. Members on both sides of the House have shown considerable concern about what might be described as the marginal cases—the people for whom there might be real hardship. The Minister yesterday and the Parliamentary Secretary today explained in detail what steps are possible to prevent hardship, and I commend hon. Members to study carefully what they said. To recapitulate very briefly, the arrangements which exist now, and have existed for a long time, will continue. It should be more widely known that those who find difficulty in meeting the charges should not hesitate to apply for a refund if the payment of the charges would put them in need by National Assistance Board standards. In 1960, about 40,000 people out of 500,000 obtaining spectacles received assistance in the payment of the charges, and about 16,000 of those incurring charges for dentures or dental treatment obtained refunds.

Very simple arrangements have been worked out by the Board to avoid inconvenience to people who wish to apply for a refund, which may be made even to people in full-time employment if their commitments are such that under the Board's standards, it is felt they may need help with the charges. I am glad to associate myself with the undertaking which my right hon. Friend gave yesterday, to consider what can be done to make these arrangements more widely known.

In answer to a question from my hon. Friend the Member for King's Lynn (Mr. Bullard), if a person who is not in receipt of National Assistance applies for a refund and sends his form and receipt to the Board, an officer of the Board will visit him at his home to assess need.

We are working against time and so I do not propose to go into detail but I wish to say this. The hon. Member for St. Pancras, North (Mr. K. Robinson) referred to the image of the country. I wonder whether it occurs to hon. Members opposite what that image really is. It is one of a country which in these latter years has enjoyed a steadily rising standard of living. It is a country with a great National Health Service and a great record in education, and it has a great record over the whole range of social services. What is more, it is an image of a country which is admired because it has a Government with the courage to take steps which they believe essential to keep these social services moving forward in the way we all desire.

The trouble with right hon. and hon. Members opposite is that they are still badly out of date. The hon. Member for Stoke on Trent, North (Mrs. Slater) made a rather revealing remark. She said that my hon. Friend the Parliamentary Secretary should be on the opposite side of the House because she had worked in welfare work. Until hon. Members opposite learn that they have no monopoly in human feelings; until they learn that throughout history there have been people from every walk of life in this country who have devoted themselves to doing what is best to improve the lot of their fellow human-beings—until they learn those lessons hon. Members opposite will remain hopelessly out of date, and the nation will realise—[Interruption.]—I could go on for another half-hour but for the clock—

Mr. Marcus Lipton (Brixton)

Let us have the Closure.

Mr. Maclay

My right hon. Friend went through many of the other developments in the social services and in the National Health Service which have taken place in recent years. I come now to the end of my speech—[HON. MEMBERS: "Hear hear."]—but I wish to say that, had it been in order to do so tonight, we could have gone through a whole range of things which have happened in the years since 1951.

Right hon. and hon. Members opposite have been saying that we have been killing, hacking, emasculating the National Health Service—and a number of other expressions were used—during

those years. But, in fact, we have been creating and improving a National Health Service of which we are very proud, and I have every confidence in saying that, if the House will vote unanimously for this Bill, the same good progress will be made in the years to come as in the years since 1951.

Question put, That the Bill be now read a Second time:—

The House divided: Ayes 303. Noes 228.

Division No. 42.1	AYES	[10.0 p.m.
Agnew, Sir Peter	Deedes, W. F.	Hooking, Philip N.
Altken, W. T.	de Ferranti, Basil	Holland, Philip
Allan, Robert (Paddington, S.)	Digby, Simon Wingfield	Hollingworth, John
Amery, Rt. Hon. Julian (Preston, N.)	Donaldson, Cmdr. C. E. M.	Hopkins, Alan
Arbuthnot, John	Doughty, Charles	Hornby, R. P.
Ashton, Sir Hubert	Drayson, G. B.	Hornby-Smith, Rt. Hon. Patricia
Atkins, Humphrey	du Cann, Edward	Howard, Hon. G. R. (St. Ives)
Balniel, Lord	Duncan, Sir James	Howard, John (Southampton, Test)
Barber, Anthony	Duthie, Sir William	Hughes Hallett, Vice-Admiral John
Barlow, Sir John	Eden, John	Hughes-Young, Michael
Barter, John	Elliot, Capt. Walter (Carshalton)	Hutchison, Michael Clark
Batsford, Brian	Elliott, R. W. (N'wc'stle-upon-Tyne, N.)	Irvine, Bryant Godman (Rye)
Baxter, Sir Beverley (Southgate)	Emery, Peter	Jackson, John
Beamish, Col. Sir Tufton	Emmet, Hon. Mrs. Evelyn	James, David
Bennett, F. M. (Torquay)	Errington, Sir Eric	Jenkins, Robert (Dulwich)
Bennett, Dr. Reginald (Gos & Fhm)	Erroll, Rt. Hon. F. J.	Jennings, J. C.
Bevins, Rt. Hon. Reginald (Toxteth)	Farey-Jones, F. W.	Johnson, Dr. Donald (Carlisle)
Bidgood, John C.	Fell, Anthony	Johnson, Erio (Blackley)
Biggs-Davison, John	Finlay, Graeme	Johnson Smith, Geoffrey
Bingham, R. M.	Fisher, Nigel	Jones, Rt. Hn. Aubrey (Hall Green)
Birch, Rt. Hon. Nigel	Fletcher-Cooke, Charles	Joseph, Sir Keith
Bishop, F. P.	Foster, John	Kaberry, Sir Donald
Black, Sir Cyril	Fraser, Ian (Plymouth, Sutton)	Kerans, Cdr. J. S.
Bossom, Clive	Freeth, Denzll	Kerby, Capt. Henry
Bourne-Arton, A.	Galbraith, Hon. T. G. D.	Kerr, Sir Hamilton
Box, Donald	Gammans, Lady	Kershaw, Anthony
Boyd-Carpenter, Rt. Hon. John	Gardner, Edward	Kimball, Marcus
Boyle, Sir Edward	Gibson-Watt, David	Kirk, Peter
Braine, Bernard	Glover, Sir Douglas	Kitson, Timothy
Brewis, John	Glyn, Dr. Alan (Clapham)	Lagden, Godfrey
Bromley-Davenport, Lt.-Col. SirWalter	Glyn, Sir Richard (Dorset, N.)	Lambton, Viscount
Brooke, Rt. Hon. Henry	Godber, J. B.	Lancaster, Col. C. G.
Brooman-White, R-	Goodhart, Philip	Langford-Holt, J.
Browne, Percy (Torrington)	Goodhew, Victor	Leavey, J. A.
Bryan, Paul	Gower, Raymond	Lewis, Kenneth (Rutland)
Bullard, Denys	Grant, Rt. Hon. William	Lilley, F. J. P.
Bullus, Wing Commander Eric	Grant-Ferris, Wg Cdr. R.	Lindsay, Martin
Burden, F. A.	Green, Alan	Linstead, Sir Hugh
Butler, Rt.Hn.R.A. (Saffron Walden)	Gresham Cooke, R.	Litchfield, Capt. John
Campbell, Sir David (Belfast, S.)	Grimston, Sir Robert	Longbottom, Charles
Campbell, Gordon (Moray & Nairn)	Grosvenor, Lt.-Col. R. G.	Longden, Gilbert
Carr, Compton (Barons Court)	Gurden, Harold	Loveys, Walter H.
Channon, H. P. G.	Hall, John (Wycombe)	Low, Rt. Hon. Sir Toby
Chataway, Christopher	Hamilton, Michael (Wellingborough)	Lucas-Tooth, Sir Hugh
Chichester-Clark, R.	Hare, Rt. Hon. John	McAdden, Stephen
Clark, Henry (Antrim, N.)	Harris, Frederic (Croydon, N.W.)	MacArthur, Ian
Clark, William (Nottingham, S.)	Harris, Reader (Heston)	McLaren, Martin
Clarke, Brig. Terence (Portsmth, W.)	Harrison, Brian (Maldon)	McLaughlin, Mrs. Patricia
Cleaver, Leonard	Harvey, Sir Arthur Vere (Macclesf'd)	Maclay, Rt. Hon. John
Cooper, A. E.	Harvie Anderson, Miss	Maclean,Sir Fitzroy (Bute&N.Ayrs.)
Cordeaux, Lt.-Col. J. K.	Hastings, Stephen	Macleod, Rt. Hn. lain (Enfield, W.)
Cordie, John	Hay, John	MacLeod, John (Ross & Cromarty)
Corfield, F. V.	Heald, Rt. Hon. Sir Lionel	McMaster, Stanley R.
Costain, A. P.	Henderson, John (Cathcart)	MacMllan,Rt.Hn.Harold (Bromley)
Coulson, J. M.	Henderson-Stewart, Sir James	Macmillan, Maurice (Halifax)
Courtney, Cdr. Anthony	Hendry, Forbes	Macpherson, Niall (Dumfries)
Craddook, Sir Beresford	Hicks Beach, Mal. W.	Maddan, Martin
Critchley, Julian	Hiley, Joseph	Maitland, Sir John
Crosthwaite-Eyre, Col. O. E.	Hill, Dr. Rt. Hon. Charles (Luton)	Manningham-Buller, Rt. Hn. Sir R.
Crowder, F. P.	Hill, Mrs. Eveline (Wythenshawe)	Markham, Major Sir Frank
Cunningham, Knox	Hill, J. E. B. (S. Norfolk)	Marlowe, Anthony
Currie, G. B. H	Hinchingbrooke, Viscount	Marples, Rt. Hon. Ernest
Dance, James	Hobson, John	Marshall, Douglas
d'Avigdor-Goldsmid, Sir Henry		Marten, Neil
Mathew, Robert (Honiton)	Quennell, Miss J. M.	Temple, John M.
Matthews, Gordon (Meriden)	Ramsden, James	Thatcher, Mrs. Margaret
Mawby, Ray	Rawlinson, Peter	Thomas, Leslie (Canterbury)
Maxwell-Hyslop, R. J.	Redmayne, Rt. Hon. Martin	Thomas, Peter (Conway)
Maydon, Lt.-Cmdr. S. L. C.	Rees, Hugh	Thompson, Richard (Croydon, S.)
Mills, Stratton	Rees-Davies, W. R.	Thornton-Kemsley, Sir Colin
Montgomery, Fergus	Ronton, David	Tlley, Arthur (Bradford, W.)
More, Jasper (Ludlow)	Ridley, Hon. Nicholas	Tilney, John (Wavertree)
Morgan, William	Ridsdale, Julian	Turton, Rt. Hon. R. H.
Mott-Radclyffe, Sir Charles	Rippon, Geoffrey	Tweedsmuir, Lady
Nabarro, Gerald	Roots, William	van Straubenzee, W. R.
Neave, Airey	Ropner, Col. Sir Leonard	Vane, W. M. F.
Nicholls, Sir Harmar	Royle, Anthony (Richmond, Surrey)	Vaughan-Morgan, Sir John
Nicholson, Sir Godfrey	Scott-Hopkins, James	Vickers, Miss Joan
Noble, Michael	Seymour, Leslie	Vosper, Rt. Hon. Dennis
Nugent, Sir Richard	Sharples, Richard	Wakefield, Sir Wavell (St. M'lebone)
Oakshott, Sir Hendrie	Shaw, M.	Walker-Smith, Rt. Hon. Sir Derek
Orr-Ewing, C. Ian	Shepherd, William	Wall, Patrick
Osborn, John (Hallam)	Simon, Rt. Hon. Sir Jocelyn	Ward, Dame Irene (Tynemouth)
Osborne, Cyril (Louth)	Skeet, T. H. H.	Watkinson, Rt. Hon. Harold
Page, John (Harrow, West)	Smithers, Peter	Watts, James
Pannell, Norman (Kirkdale)	Smyth, Brig. Sir John (Norwood)	Webster, David
Partridge, E.	Soames, Rt. Hon. Christopher	Wells, John (Maidstone)
Pearson, Frank (Clitheroe)	Spearman, Sir Alexander	Whitelaw, William
Peel, John	Speir, Rupert	Williams, Dudley (Exeter)
Percival, Ian	Stanley, Hon. Richard	Williams, Paul (Sunderland, S.)
Pickthorn, Sir Kenneth	Stevens, Geoffrey	Wills, Sir Gerald (Bridgwater)
Pike, Miss Mervyn	Steward, Harold (Stockport, S.)	Wilson, Geoffrey (Truro)
Pilkington, Sir Richard	Stodart, J. A.	Wise, A. R.
Pitman, I. J.	Stoddart-Soott, Col. Sir Malcolm	Wolrige-Gordon, Patrick
Pitt, Miss Edith	Studholme, Sir Henry	Woodhouse, C. M.
Pott, Percivall	Summers, Sir Spenoer (Aylesbury)	Woodnutt, Mark
Powell, Rt. Hon. J. Enoch	Sumner, Donald (Orpington)	Woollam, John
Price, David (Eastleigh)	Talbot, John E.	Worsley, Marcus
Price, H. A. (Lewisham, W.)	Tapsell, Peter	TELLERS FOR THE AYES:
Prior, J. M. L.	Taylor, Sir Charles (Eastbourne)	Mr. E. Wakefield and
Prior-Palmer, Brig. Sir Otho	Taylor, Edwin (Bolton, E.)	Colonel J. H. Harrison
	Profumo, Rt. Hon. John	Taylor, W. J. (Bradford, N.)
Proudfoot, Wilfred	Teellng, William
NOES
Abse, Leo	Dempsey, James	Holt, Arthur
Alnsley, William	Diamond, John	Houghton, Douglas
Albu, Austen	Dodds, Norman	Howell, Charles A.
Allaun, Frank (Salford, E.)	Donnelly, Desmond	Hoy, James H.
Allen, Scholefield (Crewe)	Driberg, Tom	Hughes, Cledwyn (Anglesey)
Awbery, Stan	Ede, Rt. Hon. C.	Hughes, Emrys (S. Ayrshire)
Bacon, Miss Alice	Edelman, Maurice	Hughes, Hector (Aberdeen, N.)
Baird, John	Edwards, Rt. Hon. Ness (Caerphilly)	Hunter, A. E.
Baxter, William (Stirlingshire, W.)	Edwards, Robert (Bllston)	Hynd, H. (Accrington)
Beaney, Alan	Edwards, Walter (Stepney)	Hynd, John (Attercliffe)
Bellenger, Rt. Hon. F. J.	Evans, Albert	Irvine, A. J. (Edge Hill)
Bence, Cyril (Dunbartonshire, E.)	Fernyhough, E.	Irving, Sydney (Dartford)
Blackburn, F.	Finch, Harold	Janner, Sir Barnett
Blyton, William	Fitch, Alan	Jay, Rt. Hon. Douglas
Boardman, H.	Fletcher, Eric	Jeger, George
Bowden, Herbert W. (Leics, S.W.)	Foot, Dingle (Ipswich)	Jenkins, Roy (Stechford)
Bowen, Roderio (Cardigan)	Foot, Michael (Ebbw Vale)	Johnson, Carol (Lewisham, S.)
Bowles, Frank	Forman, J. C.	Jones, Rt. Hn. A. Creech (Wakefield)
Braddock, Mrs. E. M.	Fraser, Thomas (Hamilton)	Jones, Dan (Burnley)
Brockway, A. Fenner	Gaitskell, Rt. Hon. Hugh	Jones, Jack (Rotherham)
Broughton, Dr. A. D. D.	Galpern, Sir Myer	Jones, J. Idwal (Wrexham)
Brown, Alan (Tottenham)	George,LadyMeganLloyd (C'rm'rth'n)	Jones, T. W. (Merioneth)
Brown, Rt. Hon. George (Belper)	Ginsburg, David	Kelley, Richard
Butler, Herbert (Hackney, C.)	Gordon Walker, Rt. Hon. P. C.	Kenyon, Clifford
Butler, Mrs. Joyce (Wood Green)	Gourlay, Harry	Key, Rt. Hon. C. W.
Callaghan, James	Greenwood, Anthony	King, Dr. Horace
Castle, Mrs. Barbara	Grey, Charles	Lawson, George
Chetwynd, George	Griffiths, Rt. Hon. James (Lianelly)	Ledger, Ron
Cliffe, Michael	Griffiths, W. (Exchange)	Lee, Frederick (Newton)
Collick, Percy	Grimond, J.	Lever, Harold (Cheetham)
Corbet, Mrs. Freda	Gunter, Ray	Lever, L. M. (Ardwick)
Craddook, George (Bradford, S.)	Hale, Leslie (Oldham, W.)	Lewis, Arthur (West Ham, N.)
Cronin, John	Hall, Rt. Hon. Glenvll (Colne Valley)	Lipton, Marcus
Crosland, Anthony	Hamilton, William (West Fife)	Loughlin, Charles
Crossman, R. H. S.	Hannan, William	Mabon, Dr. J. Dickson
Cullen, Mrs. Alice	Hart, Mrs. Judith	McCann, John
Darling, George	Hayman, F. H.	MacColl, James
Davies, G. Elfed (Rhondda, E.)	Healey, Denis	McInnes, James
Davies, Harold (Leek)	Henderson, Rt.Hn.Arthur (Rwly Regis)	McKay, John (Wallsend)
Davies, Ifor (Gower)	Hewltson, Capt. M.	Mackle, Jonn
Davies, S. O. (Merthyr)	Hill, J. (Midlothian)	McLeavy, Frank
Deer, George	Hilton, A. V.	MacMillan, Malcolm (Western Isles)
de Freitas, Geoffrey	Holman, Peroy	Mallalieu, E. L. (Brigg)
Delargy, Hugh		Manuel, A. C.

Mapp, Charles	Rankin, John	Thompson, Dr. Alan (Dunfermline)
Marquand, Rt. Hon. H. A.	Redhead, E. C.	Thomson, G. M. (Dundee, E.)
Marsh, Richard	Reid, William	Thornton, Ernest
Mason, Roy	Reynolds, G. W.	Timmons, John
Mayhew, Christopher	Roberts, Albert (Normanton)	Tomney, Frank
Mellish, R. J.	Roberts, Goronwy (Caernarvon)	Ungoed-Thomas, Sir Lynn
Mendelson, J. J.	Robinson, Kenneth (St. Pancras, N.)	Wade, Donald
Millan, Bruce	Ross, William	Wainwright, Edwin
Milne, Edward J.	Royle, Charles (Salford, West)	Warbey, William
Mitchison, G. R.	Shinwell, Rt Hon. E.	Watkins, Tudor
Monslow, Walter	Silverman, Julius (Aston)	Wells, Percy (Faversham)
Moody, A. S.	Silverman, Sydney (Nelson)	Wells, William (Walsall, N.)
Morris, John	Sheffington, Arthur	White, Mrs. Eirene
Mulley, Frederick	Slater, Mrs. Harriet (Stoke, N.)	Whitlock, William
Neal, Harold	Slater, Joseph (Sedgefield)	Wigg, George
Noel-Baker,Rt.Hn.Phillp (Derby, S.)	Small, William	Wilcock, Croup Capt. C. A. B.
Oram, A. E.	Smith, Ellis (Stoke, S.)	Wilkins, W. A.
Oswald, Thomas	Snow, Julian	Willey, Frederick
Owen, Will	Sorensen, R. W.	Williams, D. J. (Neath)
Padley, W. E.	Soskice, Rt. Hon. Sir Frank	Williams, Ll. (Abertillery)
Paget, R. T.	Spriggs, Leslie	Williams, W. R. (Openshaw)
Panned, Charles (Leeds, W.)	Steele, Thomas	Willis, E. G. (Edinburgh, E.)
Pargiter, G. A.	Stewart, Michael (Fulham)	Wilson, Rt. Hon. Harold (Huyton)
Parker, John (Dagenham)	Stonehouse, John	Winterbottom, R. E.
Parkin, B. T. (Paddington, N.)	Stones, William	Woodburn, Rt. Hon. A.
Pavitt, Laurence	Strachey, Rt. Hon. John	Woof, Robert
Pearson, Arthur (Pontypridd)	Strauss, Rt. Hn. G. R. (Vauxhall)	Wyatt, Woodrow
Peart, Frederick,	Stross,Dr.Barnett (Stoke-on-Trent,C.)	Yates, Victor (Ladywood)
Pentland, Norman	Swain, Thomas	Zilliacus. K.
Prentice, R. E.	Swingler, Stephen	TELLERS FOR THE NOES:
Price, J. T. (Westhoughton)	Sylvester, George	Mr. G. H. R. Rogers and
Probert, Arthur	Symonds, J. B.	Mr. Short.
Proctor, W. T.	Taylor, Bernard (Mansfield)
Pursey, Cmdr. Harry	Thomas, George (Cardiff, W.)

Bill accordingly read a Second time.

Motion made, and Question put, That the Bill be committed to a Committee of the whole House. [Mr. Bowden.]:—

The House divided: Ayes 223, Noes 299.

Division No. 43.]	AYES	[10.12 p.m
Abse, Leo	de Freitas, Geoffrey	Hewitson, Capt. M.
Ainsley, William	Delargy, Hugh	Hill, J. (Midlothian)
Albu, Austen	Dempsey, James	Hilton, A. V.
Allaun, Frank (Salford, E.)	Diamond, John	Holman, Percy
Allen, Scholefield (Crewe)	Dodds, Norman	Holt, Arthur
Awbery, Stan	Donnelly, Desmond	Houghton, Douglas
Bacon, Miss Alloe	Driberg, Tom	Howell, Charles A.
Baird, John	Ede, Rt. Hon. C.	Hoy, James H.
Baxter, William (Stirlingshire, W.)	Edelman, Maurice	Hughes, Cledwyn (Anglesey)
Beaney, Alan	Edwards, Rt. Hon. Ness (Caerphilly)	Hughes, Emrys (S. Ayrshire)
Bellenger, Rt. Hon. F. J.	Edwards, Robert (Bilston)	Hughes, Hector (Aberdeen, N.)
Bence, Cyril (Dunbartonshire, E.)	Edwards, Walter (Stepney)	Hunter, A. E.
Blackburn, F.	Evans, Albert	Hynd, H. (Accrington)
Blyton, William	Fernyhough, E.	Hynd, John (Attercliffe)
Boardman, H.	Finch, Harold	Irvine, A. J. (Edge Hill)
Bowden, Herbert W. (Leics, S.W.)	Fitch, Alan	Irving, Sydney (Dartford)
Bowen, Roderic (Cardigan)	Fletcher, Eric	Janner, Sir Barnett
Bowles, Frank	Foot, Dingle (Ipswich)	Jay, Rt. Hon. Douglas
Braddock, Mrs. E. M.	Foot, Michael (Ebbw Vale)	Jeger, George
Brockway, A. Fenner	Forman, J. C.	Jenkins, Roy (Stechford)
Broughton, Dr. A. D. D.	Fraser, Thomas (Hamilton)	Johnson, Carol (Lewisham, S.)
Brown, Alan (Tottenham)	Gaitskell, Rt. Hon. Hugh	Jones, Rt. Hn. A. Creech (Wakefield)
Brown, Rt. Hon. George (Belper)	Galpern, Sir Myer	Jones, Dan (Burnley)
Butler, Herbert (Hackney, C.)	George, LadyMeganLloyd (C'rm'rth'n)	Jones, Jack (Rotherham)
Butler, Mrs. Joyce (Wood Green)	Ginsburg, David	Jones, J. Idwal (Wrexham)
Callaghan, James	Gordon Walker, Rt. Hon. P. C.	Jones, T. W. (Merioneth)
Castle, Mrs. Barbara	Gourlay, Harry	Kelley, Richard
Chetwynd, George	Greenwood, Anthony	Kenyon, Clifford
Cliffe, Michael	Grey, Charles	Key, Rt. Hon. C. W.
Collick, Percy	Griffiths, Rt. Hon. James (Llanelly)	King, Dr. Horace
Corbet, Mrs. Freda	Griffiths, W. (Exchange)	Lawson, George
Craddock, George (Bradford, S.)	Grimond, J.	Ledger, Ron
Cronin, John	Gunter, Ray	Lee, Frederick (Newton)
Crosland, Anthony	Hale, Leslie (Oldham, W.)	Lever, Harold (Cheetham)
Crossman, R. H. S.	Hall, Rt. Hon. Glenvil (Colne Valley)	Lever, L. M. (Ardwick)
Cullen, Mrs. Alice	Hamilton, William (West Fife)	Lewis, Arthur (West Ham, N.)
Darling, George	Hannan, William	Lipton, Marcus
Davies, G. Elfed (Rhondda, E.)	Hart, Mrs. Judith	Loughlin, Charles
Davies. Harold (Leek)	Hayman, F. H.	Mabon, Dr. J. Dickson
Davies, Ifor (Cower)	Healey, Denis	McCann, John
Davies, S. O. (Merthyr)	Henderson, Rt.Hn.Arthur (Rwly Regis)	MacColl, James
Deer, George		McInnes, James
McKay, John (Wallsend)	Prentice, R. E. Taylor,	Bernard (Mansfield)
Mackie, John	Price, J. T. (Westhoughton)	Thomas, George (Cardiff, W.)
McLeavy, Frank	Probert, Arthur	Thompson, Dr. Alan (Dunfermline)
MacMillan, Malcolm (Western Isles)	Proctor, W. T.	Thomson, G. M. (Dundee, E.)
Mallalieu, E. L. (Brigs)	Pursey, Cmdr. Harry	Thornton, Ernest
Manuel, A. C.	Rankin, John	Timmons, John
Mapp, Charles	Redhead, E. C.	Tomney, Frank
Marquand, Rt. Hon. H. A.	Reynolds, G. W.	Ungoed-Thomas, Sir Lynn
Marsh, Richard	Roberts, Albert (Normanton)	Wade, Donald
Mason, Roy	Roberts, Goronwy (Caernarvon)	Wainwright, Edwin
Mayhew, Christopher	Robinson, Kenneth (St. Pancras, N.)	Warbey, William
Mellish, R. J.	Ross, William	Watkins, Tudor
Mendelson, J. J.	Silverman, Julius (Aston)	Wells, Percy (Faversham)
Millan, Bruce	Silverman, Sydney (Nelson)	Wells, William (Walsall, N.)
Milne, Edward J.	Skeffington, Arthur	White, Mrs. Eirene
Mitchison, G. R.	Slater, Mrs. Harriet (Stoke, N.)	Whitlock, William
Monslow, Walter	Slater, Joseph (Sedgefield)	Wilcock, Group Capt. C. A. B.
Morris, John	Small, William	Wilkins, W. A.
Mulley, Frederick	Smith, Ellis (Stoke, S.)	Willey, Frederick
Neal, Harold	Snow, Julian	Williams, D. J. (Neath)
Noel-Baker, Rt.Hn.Philip (Derby,S.)	Sorensen, R. W.	Williams, LI. (Abertillery)
Oram, A, E.	Soskice, Rt. Hon. Sir Frank	Williams, W. R. (Openshaw)
Oswald, Thomas	Spriggs, Leslie	Willis, E. G. (Edinburgh, E.)
Owen, Will	Steele, Thomas	Wilson, Rt. Hon. Harold (Huyton)
Padley, W. E.	Stewart, Michael (Fulham)	Winterbottom, R. E.
Paget, R. T.	Stonehouse, John	Woodburn, Rt. Hon. A.
Pannell, Charles (Leeds, W.)	Stones, William	Woof, Robert
Pargiter, G. A.	Strachey, Rt. Hon. John	Wyatt, Woodrow
Parker, John (Dagenham)	Strauss, Rt. Hn. G. R. (Vauxhall)	Yates, William (The Wrekin)
Parkin, B. T. (Paddington, N.)	Stross, Dr.Barnett (Stoke-on-Trent,C.)	Zilliacus, K.
Pavitt, Laurence	Swain, Thomas
Pearson, Arthur (Pontypridd)	Swingler, Stephen	TELLERS FOR THE AYES:
Peart, Frederick	Sylvester, George	Mr. G. H. R. Rogers and Mr. Short.
Pentland, Norman	Symonds, J. B.
NOES
Agnew, Sir peter	Cordeaux, Lt.-Col. J. K.	Grant-Ferris, Wg Cdr. R.
Aitken, W. T.	Cordle, John	Green, Alan
Allan, Robert (Paddington, S.)	Corfield, F. V.	Gresham Cooke, R.
Amery, Rt. Hon. Julian (Preston, N.)	Costain, A. P.	Grimston, Sir Robert
Arbuthnot, John	Couleon, J. M.	Grosvenor, Lt.-Col. R. G.
Ashton, Sir Hubert	Courtney, Cdr. Anthony	Gurden, Harold
Atkins, Humphrey	Craddock, Sir Beresford	Hall, John (Wycombe)
Balniel, Lord	Critchley, Julian	Hamilton, Michael (Wellingborough)
Barber, Anthony	Crosthwalte-Eyre, Col. O. E.	Hare, Rt. Hon. John
Barlow, Sir John	Crowder, F. P.	Harris, Frederic (Croydon, N.W.)
Barter, John	Cunningham, Knox	Harris, Reader (Heston)
Batsford, Brian	Currie, G. B. H.	Harrison, Brian (Maldon)
Baxter, Sir Beverley (Southgate)	Dalkeith, Earl of	Harvey, Sir Arthur Vere (Macclesf'd)
Beamish, Col. Sir Tufton	Dance, James	Harvie Anderson, Miss
Bennett, F. M. (Torquay)	d'Avigdor-Goldsmid, Sir Henry	Hastings, Stephen
Bennett, Dr. Reginald (Cos & Fhm)	Deedes, W. F.	Hay, John
Bevins, Rt. Hon. Reginald (Toxtoth)	de Ferranti, Basil	Heald, Rt. Hon. Sir Lionel
Bidgood, John C.	Digby, Simon Wingfield	Henderson, John (Cathcart)
Biggs-Davison, John	Donaldson, Cmdr. c. E. M.	Henderson-Stewart, Sir James
Bingham, R. M.	Doughty, Charles	Hendry, Forbes
Birch, Rt. Hon. Nigel	Drayson, C. B.	Hicks Beach, Maj. W.
Bishop, F, P.	du Cann, Edward	Hiley, Joseph
Black, Sir Cyril	Duthie, Sir William	Hill, Dr. Rt. Hon. Charles (Luton)
Bossom, Clive	Eden, John	Hill, Mrs. Eveline (Wythenshawe)
Bourne-Arton, A.	Elliot, Capt. Walter (Carshalton)	Hill, J. E. B. (S. Norfolk)
Box, Donald	Elliott,R.W. (N'wc'stle-upon-Tyne,N.)	Hinchingbrooke, Viscount
Boyd-Carpenter, Rt. Hon. John	Emery, Peter	Hobson, John
Boyle, Sir Edward	Emmet, Hon. Mrs. Evelyn	Hocking, Philip N.
Braine, Bernard	Errington, Sir Eric	Holland, Philip
Brewis, John	Erroll, Rt. Hon. F. J.	Hollingworth, John
Bromley-Davenport, Lt.-Col. Sir Walter	Farey-Jones, F. W.	Hopkins, Alan
Brooke, Rt. Hon. Henry	Fell, Anthony	Hornby, R. P.
Brooman-White, R.	Finlay, Graeme	Hornsby-Smith, Rt. Hon. Patricia
Browne, Percy (Torrington)	Fisher, Nigel	Howard, Hon. G. R. (St. Ives)
Bryan, Paul	Fletcher-Cooke, Charles	Howard, John (Southampton, Test)
Bullard, Denys	Foster, John	Hughes Hallett, Vice-Admiral John
Bullus, Wing Commander Eric	Freeth, Denzil	Hughes-Young, Michael
Burden, F. A.	Galbraith, Hon. T. G. D.	Hutchison, Michael Clark
Butler, Rt.Hn.R.A. (Saffron Walden)	Gammans, Lady	Irvine, Bryant Godman (Rye)
Campbell, Gordon (Moray & Nairn)	Gardner, Edward	Jackson, John
Carr, Compton (Barons Court)	Gibson-Watt, David	James, David
Channon, H. P. G.	Glover, Sir Douglas	Jenkins, Robert (Dulwich)
Chataway, Christopher	Glyn, Dr. Alan (Clapham)	Jennings, J. C.
Chichester-Clark, R.	Glyn, Sir Richard (Dorset, N.)	Johnson, Dr. Donald (Carlisle)
Clark, Henry (Antrim, N.)	Godber, J. B.	Johnson, Eric (Blackley)
Clark, William (Nottingham, S.)	Goodhart, Philip	Johnson Smith, Geoffrey
Clarke, Brig. Terence (Portsmth, W.)	Goodhew, Victor	Jones, Rt. Hn. Aubrey (Hall Green)
Cleaver, Leonard	Gower, Raymond	Joseph, Sir Keith
Cooper, A. E.	Grant, Rt. Hon. William	Kaberry, Sir Donald

Kerans, Cdr. J. S.	Neave, Airey	Stevens, Geoffrey
Kerby, Capt. Henry	Nicholls, Sir Harmar	Steward, Harold (Stockport, S.)
Kerr, Sir Hamilton	Nicholson, Sir Godfrey	Stodart, J. A.
Kershaw, Anthony	Noble, Michael	Stoddart-Scott, Col. Sir Malcolm
Kimball, Marcus	Nugent, Sir Richard	Studholme, Sir Henry
Kirk, Peter	Oakshott, Sir Hendrie	Summers, Sir Spencer (Aylesbury)
Kitson, Timothy	Osborn, John (Hallam)	Sumner, Donald (Orpington)
Lambton, Viscount	Osborne, Cyril (Louth)	Talbot, John E.
Lancaster, Col. C. G.	Page, John (Harrow, West)	Tapsell, Peter
Langford-Holt, J.	Pannell, Norman (Kirkdale)	Taylor, Sir Charles (Eastbourne)
Leavey, J. A.	Partridge, E.	Taylor, Edwin (Bolton, E.)
Lewis, Kenneth (Rutland)	Pearson, Frank (Clitheroe)	Taylor, W. J. (Bradford, N.)
Lilley, F. J. P.	Peel, John	Teeling, William
Lindsay, Martin	Percival, Ian	Temple, John M
Linstead, Sir Hugh	Pickthorn, Sir Kenneth	Thatcher, Mrs. Margaret
Litchfield, Capt. John	Pike, Miss Mervyn	Thomas, Leslie (Canterbury)
Longbottom, Charles	Pilkington, Sir Richard	Thomas, Peter (Conway)
Longden, Gilbert	Pitman, I. J.	Thompson, Richard (Croydon, S.)
Loveys, Walter H.	Pitt, Miss Edith	Thornton-Kemsley, Sir Colin
Low, Rt. Hon. Sir Toby	Pott, Percivall	Tiley, Arthur (Bradford, W.)
Lucas-Tooth, Sir Hugh	Powell, Rt. Hon. J. Enoch	Tilney, John (Wavertree)
McAdden, Stephen	Price, David (Eastleigh)	Turton, Rt. Hon. R. H.
MacArthur, Ian	Price, H. A. (Lewisham, W.)	Tweedsmuir, Lady
McLaren, Martin	Prior, J. M. L.	van Straubenzee, W. R.
McLaughlin, Mrs. Patricia	Prior-Palmer, Brig. Sir Otho	Vane, W. M. F.
Maclay, Rt. Hon. John	Profumo, Rt. Hon. John	Vaughan-Morgan, Sir John
Maclean,Sir Fitzroy (Bute & N.Ayrs.)	Proudfoot, Wilfred	Vickers, Miss Joan
Macleod, Rt. Hn. Iain (Enfield, W.)	Quennell, Miss J. M,	Vosper, Rt. Hon. Dennis
MacLeod, John (Ross & Cromarty)	Ramsden, James	Wakefield, Sir Wavell (St. M'lebone)
McMaster, Stanley R.	Rawlinson, Peter	Walker-Smith, Rt. Hon. Sir Derek
Macmillan, Rt.Hn.Harold (Bromley)	Redmayne, Rt. Hon. Martin	Wall, Patrick
Macmillan, Maurice (Halifax)	Rees, Hugh	Ward, Dame Irene (Tynemouth)
Macpherson, Niall (Dumfries)	Rees-Davies, W. R.	Watkinson, Rt. Hon. Harold
Maddan, Martin	Renton, David	Watts, James
Maitland, Sir John	Ridley, Hon. Nicholas	Webster, David
Manningham-Buller, Rt. Hn. Sir R.	Ridsdale, Julian	Wells, John (Maidstone)
Markham, Major Sir Frank	Rippon, Geoffrey	Whitelaw, William
Marlowe, Anthony	Roots, William	Williams, Dudley (Exeter)
Marples, Rt. Hon. Ernest	Ropner, Col. Sir Leonard	Williams, Paul (Sunderland, S.)
Marshall, Douglas	Royle, Anthony (Richmond, Surrey)	Wills, Sir Gerald (Bridgwater)
Marten, Neil	Scott-Hopkins, James	Wilson, Geoffrey (Truro)
Mathew, Robert (Honiton)	Seymour, Leslie	Wise, A. R.
Matthews, Cordon (Meriden)	Sharples, Richard	Wolrige-Gordon, Patrick
Mawby, Ray	Shaw, M.	Woodhouse, C. M.
Maxwell-Hyslop, R. J.	Shepherd, William	Woodnutt, Mark
Maydon, Lt.-Cmdr. S. L. C.	Simon, Rt. Hon. Sir Jocelyn	Woollam, John
Mills, Stratton	Skeet, T. H. H.	Worsley, Marcus
Montgomery, Fergus	Smithers, Peter
More, Jasper (Ludlow)	Smyth, Brig. Sir John (Norwood)	TELLERS FOR THE NOES
Morgan, William	Soames, Rt. Hon. Christopher	Mr. E. Wakefield and
Mott-Radclyffe, Sir Charles	Spearman, Sir Alexander	Colonel J. H. Harrison.
Nabarro, Gerald	Stanley, Hon. Richard

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