HC Deb 03 April 1962 vol 657 cc413-24

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Peel.]

1.14 a.m.

Mr. Frank Allaun (Salford, East)

When I was 17 I worked for a short time on a steam trawler based on Fleetwood and fishing in the far north, off the Faroe Islands. Every fish that was caught was ripped open, and the liver was torn out and used for the making of cod liver oil. The proceeds were part of the crew's "perks", which supplemented their very meagre wages. That was the producing end; this evening we are dealing with the receiving end.

During one of the toughest winters we have known for many years, two out of every three mothers who were taking cod liver oil, A and D vitamin tablets and orange juice have stopped taking them. Why is that? The reason is that in one of the most miserable cuts in the social services since before the war the Government have imposed charges for them. Cod liver oil, which was formerly free, now costs 1s. a bottle. A and D tablets, which were also formerly free, now cost 6d., a packet, and orange juice, previously 5d. a bottle, now costs 1s. 6d. a bottle.

For orange juice alone—and this is the real stuff, not the valueless orange drink one gets from the milk man—a mother with three children under the age of 5 years now has to spend 4s. 6d. for a week's supply, compared with 1s. 3d. It is not generally realised that the unborn child's first tooth buds start forming when the mother is only six weeks pregnant, so that even from that early age diet has a marked effect on the baby. A bottle of orange juice, it is worth noting, contains as much vitamin C as seven oranges.

There are many homes in Britain today where every penny counts, and where people really do go short of food—particularly of fruit and green vegetables. It is precisely those families whose health is being hit by these skinflint charges. For a mother with only a small wage or a pension coming into the house the extra cost has stopped these welfare foods, so that the very people who most need these supplements to their diet are now least likely to get them.

There is no doubt about the effect since the Minister clapped on the charges on 1st June. Questions from this side of the House have extracted the following figures from the Minister. I come from Lancashire, and we are not blessed with too much sunshine. Because of our climate, these vitamin foods are even more vital than they are, possibly, in the South. In Lancashire, where the number of bottles of orange juice taken in the last quarter of 1960 was 176,000, the number had fallen to 63,000 in the last quarter of 1961. In the same period, the take-up of cod liver oil had dropped from 29,000 bottles to 9,000 bottles. The number of packets of vitamin tablets went down from 23,000 to 10,000.

For the country as a whole, comparing the last quarters of those two years we find that orange juice consumption went down by 61 per cent.; cod liver oil by 64 per cent., and vitamin tablets by 48 per cent. There has been an outcry throughout the country from the men who know—the medical officers of health. Here is a letter I have received from the Medical Officer of Health for Salford, Dr. J. L. Burn. He writes: The Ministry have urged that health visitors educate the mothers on the value of orange juice. Education is a long-term process—we need this—but we need much more immediate action to increase the uptake of the wonderful Welfare foods now and in the immediate future. Price is a governing factor. Rose Hip Syrups are sugary and therefore harmful as regards dental health and the dangers of obesity. They are attractive and easily prepared, in some ways, unfortunately. I fear that the first-class foods like orange juice will be 'squeezed' out to the detriment of the health of the babies. Another serious and unsuspected effect which I have not heard previously referred to is that because the welfare foods are no longer freely available, fewer mothers are attending the postnatal clinics for advice. During the 1950s two authoritative inquiries were held into the reasons why mothers attended clinics. These were conducted by Dr. George, of the Public Health Department of Birmingham, and Dr. Chalk, Medical Officer of Health for Camberwell. In both cases it was revealed that a considerable proportion of the mothers replied that they went to the clinics for the welfare foods and, of course, received advice at the same time.

The Ministry of Health's Report for 1959 stated: Clinic staffs will still have an important rôle to play in advising mothers, not only about infants in the first year of life, but also about the developing child from one to five years. Mothers should be encouraged to bring these pre-school children to the clinic regularly. Despite the higher birth rate, there has been a decrease between 1959 and 1960 of 19 per cent. in the number attending post-natal clinics in London. In Edinburgh, eight of the 37 distributing centres have been shut down since September. This further discourages mothers from attending the clinics, particularly if they have to travel five or six miles and spend money on bus and train fares.

Ironically, having cut the consumption of welfare foods in this disastrous way, the Minister is now spending large sums of money on posters and circulars to local authorities asking them to publicise Che value of these foods. If these foods are not valuable, why spend money advertising them? In any case, the figures show that the publicity has failed. And all this is to save a miserable £1½ million a year. How mean can the Government get?

Does the Minister think that people drink cod liver oil for fun? If he does, he must have a very odd sense of humour. They take it, of course, because they need it. I maintain that the Minister of Health is pandering to the backwoodsmen of the Conservative Party who think that these foods are far too good for the working class. This imposition is in keeping with the 2s. per item prescription charge of last April and it shows that the Government are slaughtering the welfare services.

When the extra charge was imposed last April the Opposition demanded that, if a fall in demand resulted, the matter would be reconsidered. The Parliamentary Secretary, on 19th April, gave a clear promise that, while no such fall was likely, if it did occur the matter would be looked into. The worst has happened. The two-thirds reduction is admitted by the Government. On 26th February, the Minister, replying to a Question, said: There is no evidence at all that any price is being paid in terms of health."—[OFFICIAL REPORT, 26th February, 1962; Vol. 654, c. 933.] That was quite a different point and the right hon. Gentleman was obviously dodging the question. By their promise to reconsider the charges it was clearly understood that that reconsideration would be carried out with a view to removing them. This the Minister is refusing to do. It is the most blatant breach of a promise I have seen since I came to the House.

The Minister does not really know whether the necessary vitamins are being obtained because it will be some time before the signs become evident. On another occasion the right hon. Gentleman said that the problem was one of individual and particular families. How does he know that these families are not among those who are no longer receiving the welfare foods? There are vast undistributed stocks of these foods. At 31st December last there were 2,760 tons of bulk concentrated orange juice, 1,823,000 bottles of orange juice, 481,000 bottles of cod liver oil and 357,000 packets of vitamin tablets. If the charges were taken off, they would soon be distributed.

I should like to make an additional proposal. Whilst these foods are primarily intended for mothers and children, nevertheless they would also benefit old-age pensioners. In 1957, a high-powered committee, including experts in nutrition, medicine and allied sciences and headed by Lord Cohen, published a report which recommended that the scheme should be continued. I am urging that the Minister should listen to their advice.

1.25 a.m.

Mr. Kenneth Robinson (St. Pancras, North)

My hon. Friend the Member for Salford, East (Mr. Frank Allaun) has expressed anxieties which are widely felt on this side of the House and probably amongst hon. Members opposite, too. The experience of the fall in take-up of these vitamin supplements precisely reflects what we forecast a year ago when the changes in price were made by the Minister,

We cannot understand the apparent complacency of the Minister and of the Parliamentary Secretary in the face of these severe falls. Their attitude is comprehensible only on the assumption that these vitamin supplements are either worthless or unnecessary, but that is not what the Minister says. Indeed, not only did the hon. Lady, when we debated the Order making these changes a year ago, go out of her way to say how valuable they were and what a contribution they had made to child health, but, as my hon. Friend has said, the Ministry is embarking on a publicity campaign to stimulate the consumption of orange juice and cod liver oil.

It is not only the very poor to whom my hon. Friend referred whose children are not getting these supplements. No doubt, the hon. Lady will say that there are arrangements with the National Assistance Board which can take care of that. I am equally, if not more, concerned about the children of the mothers who are not, perhaps, on National Assistance level, but who are not very intelligent mothers, who do not feed their children intelligently, who perhaps are rather feckless or careless. These are the people whose children need these vitamin boosts and those are exactly the mothers who will be deterred by price increases of the order that were introduced.

The Minister says that he has no evidence that children are not getting adequate vitamin intake. I want to know what evidence he has that they are, because in the absence of evidence of that kind, I believe that the time has come for the hon. Lady to reconsider the position and to restore the subsidy.

1.28 a.m.

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

I am glad of the opportunity which this debate gives of discussing the changes that were made in the welfare food services last year. During the debate on 19th April, as the hon. Member for Salford, East (Mr. Frank Allaun) has reminded us, I said that I should be surprised if changes occurred in the take-up of the welfare foods. The position was that, on the one hand, the changes might be expected to reduce demand, but that, on the other, the rationing of quantities ceased with the changes except for free supplies and restrictions to particular beneficiaries were lifted at the same time. For instance, orange juice was extended to nursing mothers and to children up to the age of 5—for which there had been some demand, as hon. Members know—and extended to handicapped children.

It was difficult to quantify those changes, but welfare supplements at cost price represented good value and 1 expected that mothers would seek the best value for their money, as I myself had wished to do. The extent of the rise or fall in demand could not be known in advance, but I promised that the Government would consider the matter again should there be any fall in uptake. Such a fall has occurred and has been maintained, and sales remain well below their previous level. My right hon. Friend has. therefore, reviewed the position and is keeping it under review.

Two things need to be borne in mind when we discuss this subject. First, there is the question whether welfare supplements should be subsidised, not whether they should be available. We are continuing to provide them, and they are still a cheap source of vitamins. Secondly, there is the importance of health in mothers and young children. and, therefore, their vitamin intake from all sources, not only the intake of welfare foods.

The welfare food service was introduced in war time when diet generally was poor. Even at that time, the service was regarded as an insurance, and it was recognised that it might possibly be an over-insurance. Charges were made for the foods: orange juice was 5d. and cod liver oil and vitamin tablets were 10d. The service continued when the war ended, and it was then that cod liver oil and vitamin tablets were provided free.

As my hon. Friend the Under-Secretary of State for Scotland pointed out in the debate on this subject on 13th February, it has never been the case that all the welfare foods which could have been taken up have been taken up, neither when a charge was made for all of them nor when cold liver oil and vitamin tablets were free. We must not mislead ourselves by thinking that welfare foods alone have been responsible for the disappearance of vitamin deficiency diseases during the last twenty years.

In I960, these were the figures: of the possible beneficiaries, 39 per cent. took up the orange juice available; 8 per cent. took up the cod liver oil; and 31 per cent. took up the vitamin A and D tablets. It is important to bear these matters in mind, when considering the welfare food supplements, to keep the subject in perspective.

Now, when the picture has changed so considerably since wartime and the immediate post-war years, we must recognise that in this country a wholesome and varied diet is very readily available, and that most mothers have the means to buy it.

I am far from suggesting that welfare foods are valueless. I have already said that they are good value for money, and they make a valuable contribution to diet. We continue to provide them. But we should try to see clearly the part they have played in the past and treat the welfare foods scheme not as something sacrosanct in its every detail but as something to be reviewed and adapted to present-day needs and requirements.

The hon. Member for Salford, East said that changes in the scheme had meant a reduction in attendances at the clinics. I do not know where he obtained his figures, but I have made inquiries and found that the figures for 1961 are not yet available. They are expected shortly and will, of course, be included in the Annual Report of my Department. I have been given the figures for the London County Council for the September quarter of 1961, which show that attendances of children of all ages from 0 to 5 were up.

In fact, the figures were higher in every age group. I am told that the figures for the December quarter are much the same. I imagine that the figures for the London County Council would be fairly representative of what is happening in the country generally. Certainly, the population covered by the London County Council must be representative of every kind of mother in whom we are interested in this context.

As I have said, what matters is the health of mothers and children and, therefore, in this context, their vitamin intake. There is no evidence that the health of mothers and children is suffering. We are keeping careful watch on the indices which could reflect any deterioration in their health, and we are taking other steps to keep ourselves informed on the subject.

So far as vitamin intakes are concerned, not only must we take into account the more varied diet available, but we must also take into account the fact that there are plenty of sources of supplementary vitamins which are within the means of the vast majority of mothers. The Cohen Committee saw no need for the special provision of vitamin A beyond including it with vitamin D where this could conveniently be done.

In 1960, my Department collected data with the aid of health visitors—and, again, we all agree that health visitors are probably best placed to keep us informed on these subjects. The data made it clear that young children were obtaining vitamin D from a wide range of preparations and food other than cod liver oil, which played a minor part only in the total intake. The survey showed that the intake of this vitamin was on average well above nutritional requirements.

Data such as that obtained on vitamin D are not available for intakes of vitamin C. but there are indications that increasing use has been made of sources other than welfare orange juice for some time, and fresh oranges are easy to get. There is, therefore, no cause for anxiety generally.

So long as mothers are kept aware of the importance of a varied diet and the need of young children for extra vitamins, there is no reason to suppose that most will not continue to find suitable sources of vitamins available and continue to use them wisely and effectively. This calls for a carefully directed and sustained effort in health education, and I should like to return to this subject in a moment.

This is not to say that there is no problem. We recognise that there is a problem, but it is not one to which the reintroduction of the indiscriminate subsidy which was abolished last year provides the right answer. It is the problem of those—relatively few—mothers who cannot afford to get the vitamins which they and their children need even at the low prices charged in the Welfare Foods Scheme, and those individual mothers who might not be sufficiently reached by general measures of health education and publicity. The hon. Member for St. Pancras, North referred to the "feckless and the careless" and to "not very intelligent mothers". I think that that is a little sweeping. I prefer my own expression for mothers who have not the capacity to plan and to provide adequately. I agree that this is a problem.

First, we have had very much in mind the position of those who cannot afford the welfare foods. Information obtained for the Sub-Committee on Welfare Foods—the Cohen Committee—which reported in 1957, suggested that at that time the uptake of welfare foods—not only orange juice, which cost 5d. a bottle, but also cod liver oil and vitamin A and D tablets which were free—was lowest among people in the lowest income groups. We have, therefore, continued the provisions which enable people on National Assistance, and those to whom payment would mean hardship by National Assistance standards, to get the foods free with tokens issued by the National Assistance Board.

We have done more than this. With the finding of the Cohen Committee in mind, we wanted not merely to maintain but to increase the use made by these people of the service. We therefore gave fresh publicity to the facilities for getting the food free. The National Assistance Board, for its part, simplified the procedure for issuing tokens. The signs are that we are succeeding in this important object.

Free supplies of orange juice have been taken in greater quantity since 1st June last year than were taken up previously. Free issues of orange juice were 23,170 bottles in the September, 1960, quarter and 109,070 bottles in the September, 1961, quarter. The figures for the December quarters were 22,345 bottles in 1960 and 97,193 bottles in 1961.

Comparisons cannot be made for cod liver oil and vitamin tablets because these were free to everyone before 1st June, 1961, but the obvious conclusion is that the neediest people are today making fuller use of all these facilities than they were a year ago. For those who can afford a varied diet and adequate vitamin supplements I have said that what is needed is that they should be constantly reminded of the importance of these in good nutrition, and, of course, of the availability of a range of supplements in the Government's welfare foods scheme.

Advice and information on this is an integral part of health education material that we are constantly putting out. This publicity is not costly. I cannot put a figure on it, but I think that when I illustrate publicity to the hon. Gentleman he will realise that I am justified in saying that it is not expensive. What is important is that it is directed at those concerned, the mothers.

Leaflets encouraging the use of vitamin supplements and drawing attention to the welfare foods service are sent out with milk token books issued to expectant mothers and children. These leaflets have also been issued to appropriate voluntary organisations and hospital boards, executive councils and local health authorities for distribution to doctors, midwives, nurses and others concerned with the care of mothers and young children. Posters and coloured leaflets have been provided for display in clinics, distribution centres and other suitable places by local health authorities. Welfare foods have been mentioned in the health advice notes sent to magazines, the Press and broadcasting authorities and in the official announcements on the radio.

I should not like the House to infer from the fall in uptake of the Government's welfare foods that this publicity has proved and is proving ineffective. It is through this publicity that we have sought to advertise more widely and thoroughly the arrangements that are made for people in need to get supplies free of charge, and I have indicated the very satisfactory response there has been to our efforts in this direction. There is no reason to suppose that our publicity has been any less successful in its other object—to keep mothers aware, as one aspect of their health education generally, of the value of vitamin supplements, whether these are obtained through the Government's scheme or from other sources.

There remains the second group, the problem of those mothers who might not be sufficiently reached by publicity of this sort, however carefully it is directed. For these an individual approach is by far the most effective means of health education, and it is one of the great merits of the National Health Service that this kind of approach is by no means beyond its resources. Indeed, it is probably true to say that the most important form of publicity in the matter of nutritional needs is the advice that mothers receive from doctors, midwives and health visitors as part of the care they give to the mother and her child before and after the baby is born.

The health visitor calls personally at almost every home in which there is a young child. She can see where health education on diet and the use of vitamins is particularly required. The health visitor and the midwife and the family or hospital doctor can give advice in a form understandable to the mother, with an authority she will respect.

To sum up, the important thing is the health of mothers and children, and, therefore, vitamin intakes generally. There is no evidence that health is suffering or that vitamin intakes are inadequate. Other sources of the vitamins are available besides the Government's welfare foods service. We are, nevertheless, aware that there is a real health problem in this field, and this is being tackled not by a general subsidy but by continuous, carefully directed publicity as a part of health education generally, and by a concentration of additional effort and resources in those particular areas where there is special need.

Mr. Frank Allaun

The hon. Lady said that her right hon. Friend is keeping the situation under review. Does that mean that if the figures remain at their present low level for, say, another six months, the charges will be reviewed?

Miss Pitt

No, Sir. It means what I said, that we will continue to watch the nutriment obtained by mothers and babies.

Question put and agreed to.

Adjourned accordingly at sixteen minutes to Two o'clock.