Commons Sitting of 19 December 1963

Preamble
The House met at half-past Two o'clock
PRAYERS
[Mr. Speaker in the Chair]
ORAL ANSWERS TO QUESTIONS
  EDUCATION

    Sunderland Technical College
    Mr. P. Williamsasked the Minister of Education if he will detail the costs of the various extensions and additions to the Sunderland Technical College in each of the last 10 years; and how much of these costs has been provided from the Exchequer.
    The Minister of Education (Sir Edward Boyle): The total value of major building work at the college during this period was £1,127,327. The total value of other projects closely associated with the college during the same period was £557,660. I am sending the hon. Member a detailed breakdown of the projects and their cost.
    Roughly 70 per cent. of the loan repayments and interest up to 1958–59 were made from the Exchequer. Since 1959–60 Exchequer assistance has been through the general grant, and it is not possible to specify the proportion which it represents of the cost of a particular project.
    Mr. Williams: I thank my right hon. Friend for the detail which he is to send me. Against this background, the college being a leader of educational advance in the North-East, can he say why it has not been possible yet to recognise it as a college of advanced technology?
    Sir E. Boyle: I explained the difficulty when I was in the North-East a fortnight ago. In the light of the Robbins Report, it would not be possible at this time to designate another C.A.T. because this would be, in effect, to designate a new
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    university, and the Government must be influenced by the advice of the University Grants Committee. But I was careful to pay tribute to the large quantity of degree level work done at this very important regional college.
    Mr. Willey: Does the Minister realise that, while we appreciate his present position, the reply which he gave on his visit to the North-East was very disappointing? If special consideration is to be given to the North-East, as has been promised by the Government, the provision of a college of advanced technology is an urgent priority. We want priority for technological and technical education.
    Sir E. Boyle: I realise that my Answer was bound to be disappointing. That was why I was careful on television to lay emphasis on degree work done at this college. I have always emphasised that, just as there is an overlap between the colleges of advanced technology and the universities, so there is an overlap between the colleges of advanced technology and the regional colleges.

    Students. Wales (University and Training College Places)
    Mr. G. Thomasasked the Minister of Education how many students in Wales were unable in 1963 to gain admission to university college or to training college, respectively, although they had obtained the necessary qualification to be admitted.
    Sir E. Boyle: Two hundred and fifty-nine applicants from Wales with the minimum academic qualifications did not get admission to training colleges this year. Twenty of these were classified by the Clearing House as acceptable, the remainder as borderline. So far as applications to universities are concerned, information is not at present available.
    Mr. Thomas: Is the right hon. Gentleman aware that, if he had the information from the universities, it would be still more disturbing? Is it not ironic that, while there is a shortage of 10,000 teachers in recruitment each year, as he well knows, there are people clamouring to be trained as teachers and he has failed to make provision for them? Will the position be better next year?
    Sir E. Boyle: Over England and Wales as a whole last year, 814 acceptable candidates failed to gain admission. This year the total is down to 290. Therefore, the supply of training college places has been more than keeping in line with the number of really good applicants.

    School Building Programme
    Mr. Loveysasked the Minister of Education whether local authorities have to guarantee to him that they are ready and able to proceed with projects which have been allocated to them under the major school building programme.
    Sir E. Boyle: I ask for no formal guarantee of an authority's ability to start its projects. But when settling the programme, one of the factors which I take into account is the likelihood of its being able to start the projects concerned in the appropriate year.
    Mr. Loveys: Would my right hon. Friend agree that, if local authorities are unable to fulfil their projects, rather than allow capital allowances for school building to go by default because of difficulties concerning the availability of land or for any other reason, it would be better to reallocate the funds to authorities which already have the land and which are seriously in need of new school building and raring to go?
    Sir E. Boyle: I assure my hon. Friend that there is no question of capital allowances going by default. In the last year for which we have figures, actual starts slightly exceeded authorised starts. There is no question of capital which is available not being used for a project.

    Further Education
    Mr. Iremongerasked the Minister of Education if, in the light of the report of the Robbins Committee, he will introduce legislation to remove further education from the sphere of local authorities' responsibility.
    Sir E. Boyle: No, Sir. I do not think this would be desirable, nor indeed was it recommended by the Robbins Committee.

    Primary School Education
    Mr. J. P. W. Mallalieuasked the Minister of Education when he expects
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    to receive the report of the Plowden Committee on primary school education.
    Sir E. Boyle: The Central Advisory Council for Education had its first meeting under the chairmanship of Lady Plowden on 7th October. I understand that it is at present aiming to complete its report by the summer of 1966.
    Mr. Mallalieu: Will the Minister assure the House that he will not wait until then to start tackling the very urgent problems of primary education?
    Sir E. Boyle: In school building—and the hon. Member has a Question down about this—I have already announced my intention from 1965–66 onwards to devote some millions of pounds every year to primary school replacement projects. There will be no question here of a standstill in educational improvement. This is, however, the first major thorough inquiry into primary education for 30 years and I do not blame the Plowden Committee for wanting to do a thorough job of it.
    Mrs. White: Can the Minister give us some enlightenment on this? As the Plowden Committee is concerned with the age of school entry and the date of transfer from primary to secondary schools, what advice is the Minister giving to local authorities about the shape of their building programme if they have to wait until 1966 for the report?
    Sir E. Boyle: In many cases of primary school replacement, it is hard to see why this need in any way wait for the Plowden recommendations. If, however, the hon. Lady is thinking particularly about the age of transfer—from the age of 9 to 13, and so on—this is a matter which I shall consider most carefully when deciding which projects can be included in future programmes.

    Primary School Places
    Mr. J. P. W. Mallalieuasked the Minister of Education how many new primary school places he expects to be provided between 1964 and 1968; and what increase in the primary school population is forecast for 1968 compared with 1964.
    Sir E. Boyle: The estimated increase in the numbers of pupils in primary

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    schools between January, 1964, and January, 1968, is about 450,000. Within the same period about 275,000 new primary places will be provided by projects in building programmes already announced. The programmes for 1965–68, whose details I shall announce next year, will provide substantially more primary places than the extra 175,000 needed to keep pace with the rising population, since as the hon. Member knows, it is my intention in future programmes to approve a number of projects for the replacement and improvement of old primary schools. Also many secondary reorganisation projects will give primary schools more room by enabling the senior children to be removed.
    Mr. Mallalieu: Is the Minister aware that that Answer will relieve some of the anxiety that is being felt and that I am grateful for it? Will he assure the House that he realises that primary education is probably the most important part of all education, and will he see that primary education is not overlaid by Robbins and Newsom?
    Sir E. Boyle: I am grateful to the hon. Member. I have on many occasions tried to make plain my view that primary education is the foundation of the system. That is why we give priority to the supply of teachers, for example, for the schools. This is obviously of the greatest importance. Having more than one year's programme at once will be helpful to authorities which will have a rising level of primary school children during the next two or three years.
    Dr. King: Is the Minister certain that his teacher training programme will provide by 1968 enough teachers to ensure that the size of primary school classes gets down to the statutory maximum?
    Sir E. Boyle: I should be very unwise to make rash forecasts about that size, since, as the hon. Member knows, the biggest problem is early retirement from schools. I have never made any secret of the fact that infant departments of primary schools will be heavily pressed during the next few years.
    Sir C. Osborne: Will my right hon. Friend undertake that the rural areas which have great need of new primary schools will be well looked after?
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    Secondly, has he enough power to see that local authorities get on with the schemes once they have been agreed to?
    Sir E. Boyle: I shall certainly see to it that all local authorities as far as possible get a fair share of the available total. My hon. Friend may be thinking specifically of a minor works programme, in which priorities are the responsibility of the local authority.

    Friarswood School, Newcastle-under-Lyme
    Mr. Swinglerasked the Minister of Education if he will include the replacement of Friarswood School, Newcastle-under-Lyme, in the school building programme forthwith.
    Sir E. Boyle: I have nothing to add to the reply I gave the hon. Member on 24th October.
    Mr. Swingler: Is not this a crass example? Does not the Minister's Department admit that this school, which is more than 130 years old, is totally obsolete? Is it not a shocking scandal that teachers and children should be compelled to go on trying to make use of such hopeless buildings and equipment? Cannot the Minister do something urgently, because here is a case where primary education cannot advance in such conditions?
    Sir E. Boyle: On 11th July, I undertook to the hon. Member to look sympathetically at any project to replace this school which the authority might submit with a high priority for the 1965–66 programme. If I remember rightly, this was the runner-up last year in Staffordshire for a replacement project. It is up to the authority to give it a high priority in submitting its list for future years.

    National Recreation Centre, Cardiff
    Mr. Boxasked the Minister of Education what plans he has to establish a national recreation centre in Cardiff on the lines mentioned in the Wolfenden Committee Report on Sport, 1960.
    Sir E. Boyle: No proposal for such a centre has been made to my Department.
    Mr. Box: Is my right hon. Friend aware that the only existing national recreation centre in Wales is in Snowdonia, 200 miles from Cardiff, and that there is appropriate accommodation in Cardiff at Maindy Barracks, to which the War Office is hanging on like grim death? There are adequate playing fields and the barracks are occupied for only a small part of each year. If the matter is submitted to my right hon. Friend's Department, will he consider setting up a national recreation centre at Maindy Barracks?
    Sir E. Boyle: In answer to the first part of my hon. Friend's supplementary question, I was not aware of all those facts. In answer to the second part, I would be prepared to consider for inclusion in the youth service building programme any proposal by the local education authority to provide additional sports facilities for young people in Cardiff.
    Mr. G. Thomas: Will the Minister say who would bear the expense? The hon. Member for Cardiff, North (Mr. Box) is absolutely right that the facilities are there if the Minister would pay for them.
    Sir E. Boyle: If a project is put up to me for the youth service building programme, the cost will be met in the normal manner.

    Teachers
    Mr. Frank Allaunasked the Minister of Education if he will make a statement on the working of the quota system for teachers; and to what extent authorities are employing unqualified teachers.
    Sir E. Boyle: I would refer the hon. Member to my reply to the hon. Member for Sunderland, North (Mr. Willey) of 13th December. With regard to the last part of the Question, in October, 1963, there were nearly 5,000 unqualified full-time temporary and occasional teachers in service, representing 1·7 per cent of all full-time teachers.
    Mr. Allaun: Does the Minister think it fair to children that they should be taught by boys and girls who themselves have just left school and have no qualifications? Is he aware that in some of the industrial working-class areas the
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    authorities are actually having to increase substantially the number of completely unqualified and untrained teachers?
    Sir E. Boyle: As the hon. Member knows, we are expanding the training colleges more rapidly than any other part of our higher education system. There are some areas where the authorities need helps to assist in the schools and where this arrangement works extremely well. I would not like to take too dogmatic a stand on this point.
    Mr. Willey: When can we expect a further report from the National Advisory Council on the supply and training of teachers?
    Sir E. Boyle: I should not, at this stage, like to say when the next report can be expected. As the hon. Member knows, the Advisory Council is fully at work.
    Dr. King: Is the Minister aware that while the quota system has some defects, which he himself is endeavouring to remedy, as long as teachers are in short supply the quota system secures for places like Birmingham their fair ration of teachers, and will he resist any attempts to scrap the system?
    Sir E. Boyle: As a Birmingham Member, as well as Minister, I am obliged to the hon. Member for what he has said. Since the quota was introduced, the difference in staffing standards between the best and the worst placed areas has been nearly halved. The quotas for January, 1965, which I shall announce tomorrow in a circular, should enable all local authorities to make a small improvement in staffing standards. The circular will show that I have decided to extend to two years the period of exemption from the quota of married women returning to teaching after a break. That is a reasonable concession.

    Nursery Schools
    Mr. Boydenasked the Minister of Education how many new nursery schools have been established so far this year; and how many are planned for 1964 and 1965.
    Sir E. Boyle: The answer to the first part of the Question is one new school

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    and three replacements. I have had no proposals so far for new schools in 1964 and 1965.
    Mr. Boyden: Is that surprising in view of the long stop which there has been on nursery schools? In view, however, of the evidence which has now been brought forward in the Kelsall Report, will the Minister look again at this matter and see whether he cannot encourage the setting up of more nursery classes or schools in places where there is a likelihood of more married women teachers entering service in the schools?
    Sir E. Boyle: The hon. Member is quite right in the latter part of what he has said. The one exception which I can make is where a local authority can enable married women to return to teaching by providing nursery classes. I spoke on this matter recently in the light of the Kelsall Report and I am considering what more can be done to encourage authorities to set up nursery classes in these circumstances.

    Day Training Colleges
    Mr. Boydenasked the Minister of Education how many day training colleges were established in 1963; and how many are planned for 1964 and 1965.
    Sir E. Boyle: Four more day training colleges were established in 1963 and another is to open early in 1964, making 13 in all. I do not rule out the possibility of some addition to this number. But current expansion plans involve a very substantial increase in the numbers of day students in the training colleges generally.
    Mr. Boyden: Ought not the Minister to look at this again? Is there not a case for having some more day training colleges, if only on a temporary basis, in order to achieve much further recruitment among older students?
    Sir E. Boyle: I will certainly consider it again and also any other points which the hon. Gentleman would care to put to me. It ought, however, to be remembered that there are more than 10,000 day students in the colleges today compared with 7,000 a year ago, so that the number has gone up substantially. I recognise that we should not close our minds to this.

    Solicitors' Articled Clerks (Courses)
    Mr. Abseasked the Minister of Education whether he is aware of the hardship caused to solicitors' articled clerks wishing to attend courses at the College of Law by the refusal of many local authorities to pay full grants for tuition fees, examinations fees or maintenance; and if he will take action to remedy this situation.
    Sir E. Boyle: I have no evidence that local education authorities generally are not in thin matter acting on the advice given in paragraph 64 of my Ministry's Circular 9/62, a copy of which I am sending to the hon. Member.
    Mr. Abse: If evidence is submitted to the Minister that there are wide variations of practice between one local authority and another, would he be prepared to consider the matter and, if necessary, cajole and encourage laggard local authorities to do something about it?
    Sir E. Boyle: I cannot promise an alteration of the legislation—Section 2 of the 1962 Act—but I should be prepared to look into any individual cases which the hon. Gentleman might like to bring to my notice.

    Students (Dependants' Allowances)
    Mr. Abseasked the Minister of Education whether he is aware of the hardship caused to the dependent children of university students by the existing university award regulations; and whether he will amend the regulations to give local authorities discretionary powers to make awards for the support of children whose parents are students.
    Sir E. Boyle: These cases are few and usually arise when the student, despite the clear and long standing rule that dependants' allowances will not be payable in such circumstances, marries after his course begins. The awards regulations are at present under review by my Department and the local authority associations.
    Mr. Abse: Is the Minister aware that, irrespective of the regulations, children are sometimes born, and that, since children are born, they can suffer very severely if awards are not made? Since

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    even the Minister of Education cannot prevent children being born, perhaps he would at least indicate that some changes can be made in the regulations in order to give discretion to local authorities in these matters?
    Sir E. Boyle: I think I had better not comment on part of what the hon. Gentleman has asked me. The point is that any change would involve a general change in the rules regarding independent status. I do not necessarily rule this out, but I cannot at this moment anticipate the results of the review which is going on at the present time.
    Mrs. White: When are we to have the results of the review? Does the right hon. Gentleman appreciate that this is something for which the Opposition have pressed consistently both during the latest legislation and since? Will he not now agree that the time has come to look again at the alteration in social habits which makes a change in the regulations necessary?
    Sir E. Boyle: I cannot say today when the review is likely to be completed, but I will bear in mind the feeling on this matter which has been expressed.
    Mrs. Hartasked the Minister of Education what reply he has made to the request from the National Council for the Unmarried Mother and her Child that he should consider giving local authorities discretionary powers to make dependants' allowances to students receiving university and other awards.
    Sir E. Boyle: I have sent the hon. Lady a copy of my reply to this organisation.
    Mrs. Hart: May I say how grateful I was to have it? Is the right hon. Gentleman aware that the Council has sent another letter raising a particular point on the need for help for unmarried women students who have babies? I know that this subject bristles with difficulties, but has the right hon. Gentleman seen some of the reports over the last year of the studies into this problem? Will he make certain in the reconsideration of this whole grant question that full attention is given to this point so that a new policy may be determined?
    Sir E. Boyle: Certainly I am very ready to consider this and I will write
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    both to the Council and to the hon. Lady again when I have had time to consider these new points.

    Gypsies (Dorset, Essex and Kent)
    Mr. Doddsasked the Minister of Education, in view of the importance of education for the children of gypsies and other travellers residing in caravans, and the statutory obligation that all children of the required ages shall attend school, what special action has been taken by each of the local education authorities in the counties of Dorset, Essex and Kent to ensure that the children of school age attend school at least during the winter months and early spring when farm work is not available and the caravans are static if sites are available.
    Sir E. Boyle: In each case the authority is successfully operating its normal arrangements for securing school attendance. These include visits by school welfare officers and the making of school attendance orders, and court proceedings where necessary.
    Mr. Dodds: Does not the Minister appreciate that he has a statutory obligation to ensure that children go to school? Will he inquire into the situation, bearing in mind that many of the traditional camps are closed down and that the families are being chased around on the main roads? How can the children go to school in these circumstances? How can we ever hope to solve this human problem unless the children go to school, and what children need schooling more than these do?
    Sir E. Boyle: The legal duty to send the children to school rests on the gypsy parents, and the authorities do everything they reasonably can to ensure that gypsy children go to school. The hon. Member tables a great many Questions on this subject. I can assure him that I correspond and inquire into it every time he raises the matter. But there are real difficulties in the case of caravan sites.
    Mr. Dodds: If I give the right hon. Gentleman information about specific places where the children are not going to school despite what is done by the local education authorities, will he add his weight to that of the Minister of

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    Housing and Local Government in an effort to get something done, because this is a disgrace to the country?
    Sir E. Boyle: If the hon. Gentleman would care to refer a specific case to me, I should be glad to know about it, and I am sure that the local education authorities would be, too.
    Mr. Doddsasked the Minister of Education how many children of school age residing in caravans in the counties of Dorset, Essex and Kent, respectively, were not attending school at the latest convenient date; and how many, in each of the counties, are not attending school because of the failure to secure camping places within the law.
    Sir E. Boyle: I understand from the local education authorities that there are 14 children in Dorset and two in Kent at present out of school. In neither county is this due to a failure to secure a camping place. The Dorset authority is trying to persuade parents to send their children to the appropriate schools in Poole. Kent is dealing with its two children who are probably new arrivals. No cases are known to the Essex authority.
    Mr. Dodds: Is the right hon. Gentleman aware that that situation is not correct? Is he not aware that last week there were on the A.2 seven caravans with 11 children of school age, and that these gypsies had been pushed on by the police; and if they had not moved they would have been fined £1 a day while they were there? How can children go to school in these circumstances? When are we going to do something about it? When is the right hon. Gentleman going to do something about it?
    Sir E. Boyle: I do not want to be discourteous, but if the hon. Gentleman worked for a local education authority he would find that it is a great deal more difficult than he sometimes makes out. I gather that the parents of the 14 children in Poole want them all to attend the same school. Unfortunately, we do not have all-age schools in Poole, and so it is not easy. We all do our best about this, I can promise the hon. Member.

    Apprenticeship Courses
    Mr. Prenticeasked the Minister of Education how many full-time first year apprenticeship courses and recognised pre-apprenticeship courses are now being conducted in local colleges; what were the comparable figures a year ago; and what steps he is taking to expand these provisions.
    Sir E. Boyle: Figures for the current session are not available. I am now considering, taking the Industrial Training Bill into account, in what form information can best be collected in future, and whether it should be asked for as part of the Ministry's regular annual statistics. On the last part of the Question I would refer the hon. Member to the Answer I gave him on 4th July.
    Mr. Prentice: On 4th July the Minister was saying that it was up to the local education authorities. Now he is talking about getting statistics. Is it not time that he took more positive steps to expand the number of courses of this sort? Does he not feel that, with the Industrial Training Bill, there is a need for a much larger number of these courses than there is at present?
    Sir E. Boyle: I referred specifically to this matter when winding up the Second Reading debate. Within the limit of the building programme, I would certainly be ready to entertain applications for special buildings for first year integrated courses where there is evidence of a long-term demand.

    Technical Colleges (Degree Courses)
    Mr. Prenticeasked the Minister of Education what short-term steps he is taking, pending the implementation of the proposals in the Robbins Report, to assist those who fail to secure admission to universities to obtain places in technical colleges offering degree courses.
    Sir E. Boyle: Schools and local education authorities are always ready to help boys and girls to find places in suitable technical college courses, and it was with a view to assisting them that earlier this year I issued the Ministry booklet Further Education for School Leavers. My Department is discussing with the Universities Central Council on Admissions ways in which the Council may be able to help in this matter.
    Mr. Prentice: Does the right hon. Gentleman expect these discussions to produce any results by next summer? Does he recall that I drew his attention to difficulties in certain areas last year? Does he think that these can be overcome by next year? It is an urgent problem for these young people.
    Sir E. Boyle: My answer is, "I very much hope, yes". As soon as the colleges of advanced technology achieve university status they will automatically be eligible to participate fully in the U.C.C.A. arrangements.

    Teaching Machines
    Mr. Gresham Cookeasked the Minister of Education what progress is being made in the use of teaching machines; how many schools and colleges have installed them; and what encouragement he is giving to local authorities to acquire and use them.
    Sir E. Boyle: In October 1962 I carried out a survey of developments in programmed learning and teaching machines. I am sending my hon. Friend a copy of my circular letter summarising the results and giving my own views. A further survey is now in progress, and results so far point out a substantial increase in activity.
    Mr. Gresham Cooke: While thanking my right hon. Friend for sending me a copy of the circular, may I ask whether he agrees that these teaching machines can be a great addition to the powers of teachers and really should be greeted with enthusiasm? Would he also consider whether they should not be placed in teacher training colleges?
    Sir E. Boyle: My hon. Friend may be interested to know that last year's survey showed that 14 local education authorities, five area training organisations and three colleges of advanced technology were carrying out or proposing to carry out experiments. I have accepted for support from my research funds two further research projects, at Sheffield and Birmingham. Progress here is going as fast as one could reasonably expect.

    School Transport, Cardiff
    Mr. Boxasked the Minister of Education what reply he has given to
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    Cardiff Trades Council's letter of 5th December dealing with the provision of school transport in the City of Cardiff.
    Sir E. Boyle: A reply was sent to Cardiff Trades Council on 17th December, 1963, informing it of the measures taken by Cardiff Education Committee and a joint sub-committee of the Tran-port and Education Committees of Cardiff City Council. These include the staggering of attendance hours at certain secondary schools for an experimental period and the provision of special buses and extra buses on service routes additional to those already provided to serve the requirements of school children.
    Mr. Box: Is my right hon. Friend aware that this has become a very serious problem not only in the City of Cardiff but, I imagine, in other big towns throughout the United Kingdom? Will the Ministry of Education liaise more closely with the local authority to find a satisfactory solution? Despite the meetings and despite the answer which he has given, the fact remains that many parents are deeply concerned because their children have to hang about, particularly in the winter months, for long hours waiting for buses? This is a national problem which needs a national solution.
    Sir E. Boyle: I have consulted my Welsh Office about this. There is a particular local problem here. The rebuilding of some local secondary schools has meant that they have had to be sited on the outskirts of the city. I am in close touch with the matter, I assure my hon. Friend.
    Mr. Callaghan: Is the right hon. Gentleman aware that since I and the hon. Member for Cardiff, North (Mr. Box) tabled Questions on this subject I have been informed that there are to be eight extra services in the morning and 11 at night, and that we shall watch this carefully to see if this great problem will be overcome? Without doubt, it has caused a great deal of anxiety.
    Sir E. Boyle: I am grateful to the hon. Gentleman for being more up-to-date than I am. There was a deputation only the day before yesterday and I have not yet learnt the full results.
    Mr. G. Thomas: Is the right hon. Gentleman aware that he has not

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    followed his usual courtesy? Is he aware that I sent him a letter about this matter? I sent it in English and in plenty of time.
    Mr. J. Griffiths: Perhaps it was in the mail bag.
    Mr. G. Thomas: One hopes that the reply will be better than the transport service. When am I likely to get an answer to forward to Cardiff Trades Council? We all realise that the staggering of school hours will be a major contribution towards the solution of this problem.
    Sir E. Boyle: I apologise to the hon. Gentleman and I will see that he gets a letter to read in Christmas week on this subject.

    School Leaving Age
    Mr. Lubbockasked the Minister of Education whether he will make a further statement on the raising of the school leaving age from 15 to 16 and also on the other recommendations of the Newsom Committee.
    Mrs. Whiteasked the Minister of Education if he will now announce the Government's intentions concerning the recommendation of the Crowther and Newsom Reports that the age of school leaving be raised to 16 years.
    Mr. Willeyasked the Minister of Education whether he will make a statement on the raising of the school leaving age.
    Sir E. Boyle: I intend to make a statement on the raising of the school leaving age during the current Session. With regard to the second part of his Question, I would refer the hon. Member for Orpington (Mr. Lubbock) to the Answer I gave to the hon. Member for Newcastle-under-Lyme (Mr. Swingler) on 5th December.
    Mr. Lubbock: Is the right hon. Gentleman aware that the longer he delays making an announcement the more difficult it will be? Provision has to be made for the additional teachers who will be required and for the variations in capital expenditure programmes of local education authorities. Is he further aware that, if he does not accept the recommendation of the Newsom Committee, it will be very much more difficult to im-
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    plement later on, because the minimum number of children entering secondary schools will be in 1965?
    Sir E. Boyle: Of course, I recognise the great importance of this matter. I have quite deliberately not prejudged this in the school building programmes I have announced for the future. We are proceeding as fast as we can in order to make up the teacher supply.
    Mrs. White: Can the right hon. Gentleman explain his reasons for not being able to make a statement now? This Session may, conceivably, end in March. What new facts are likely to be drawn to his attention between now and then?
    Sir E. Boyle: As the hon. Lady knows, evidence relevant to this matter has come in quite recently. For example, no one can deny that the Kelsall Report is really relevant. I repeat that I shall make a statement in the current Session.
    Mr. Willey: Is the right hon. Gentleman aware that it is now four years since the Crowther Committee said that a statement on this should be made? Is he aware that, for the past three or four years, I have been saying that a statement will be made on the eve of the General Election? Does this mean that the General Election has been postponed from March? Does not he realise that in any case the statement will still prove useless electorally?
    Sir E. Boyle: I had a feeling that we would get on to the subject of the General Election with the hon. Gentleman. It is true that in 1960, when we debated Crowther, my predecessor accepted this recommendation in principle. There is no dispute that this is a good thing to do. But I must take account of the needs of, and my responsibility for, the education service as a whole. Here, one must bear in mind the teacher supply aspect. I repeat that I will fulfil my pledge, many times given, to announce the Government's policy during the present Session.
    Mr. Lubbock: Will the right hon. Gentleman answer my supplementary question? Does not he realise that, if this decision is delayed beyond 1965, the problem of teacher supply and of capital expenditure in schools will be very much more acute?
    Sir E. Boyle: I do not know what the hon. Gentleman means by "beyond 1965".
    Mr. Lubbock: Entry.
    Sir E. Boyle: No one has suggested that this could take place in 1965. I assure the House that I accept the urgency of the matter and will make a statement as soon as I can.

    Newsom Committee (Recommendations)
    Mr. W. Hamiltonasked the Minister of Education when he will make a statement on Her Majesty's Government's policy on the proposals contained in the Newsom Report; and what estimate has been made of the total cost of the full implementation of the recommendations made.
    Sir E. Boyle: In reply to the first part of the Question, I would refer the hon. Member to the Answer I gave the hon. Member for Newcastle-under-Lyme (Mr. Swingler) on 5th December. In reply to the second part, it is not practicable to give any such estimate.
    Mr. Hamilton: How, then, can the Chancellor give, in the White Paper, a specific figure of a £310 million overall increased expenditure on education over the next five years? Has the right hon. Gentleman not been able to separate the amount of expenditure needed to implement the new proposals of Robbins? Can he confirm or deny the figures, given by Mr. Newsom himself and reported in the Economist of 7th December, that the capital cost of implementing the Newsom Report would be £120 million with a recurrent cost of £60 million?
    Sir E. Boyle: The figures in the White Paper relate to the position up to and including 1967–68 before it is proposed that the school leaving age should be raised. Those figures do assume not only much higher school building programmes but a rising improvement element in secondary schools in terms of the movement in the direction of 16 as the leaving age.
    I think that the estimate that Mr. Newsom has given for capital cost is approximately correct, but I would rather not commit myself about the figure for
    1428
    recurrent cost because this must depend so much on our success in recruiting teachers.
    Mrs. Slater: Is the right hon. Gentleman aware that there is feeling among teachers and others interested in education that there is a tendency to lose Newsom in the desire to achieve Robbins? If we are to achieve Robbins in the future we must implement Newsom in order to provide the people who can take advantage of Robbins. Does not the Minister think that at least a more definite statement should be made and some estimate given of how much the Chancellor is prepared to put into this programme, and that the right hon. Gentleman should not go on deferring this, possibly until after the General Election?
    Sir E. Boyle: If the hon. Lady will look at the White Paper on Government expenditure she will see that there is specific reference to the Newsom Report. As I have said several times, we are planning to spend £250 million more on secondary schools over the next five years at a time when the secondary school population is remaining stable. That means more in real terms per head of secondary school children.

    Schools (Political Pamphlets)
    Mr. W. Hamiltonasked the Minister of Education if he is aware that Conservative Party pamphlets have been used for teaching at primary and secondary schools in many parts of the country; and what steps he has taken to stop this practice.
    Sir E. Boyle: I have received no complaint that political pamphlets have been used for teaching purposes.
    Mr. Hamilton: Is it not the case that the National Union of Teachers has made an official protest to the Conservative Party, following complaints from head teachers in various parts of the country that Conservative pamphlets have been sent to them at their school addresses, and that only today we have had a report from Canterbury that a grammar school is being used by the Tory Party for its own political purposes?
    Is the right hon. Gentleman further aware that this follows the use of school children in the Prime Minister's own by-election in Kinross, also for political

    1429
    purposes? Whilst we know that the morale of the Tory Party is desperately low, surely it is not as low as all that.
    Sir E. Boyle: I may be very simple but it seems to me that the question of teachers receiving party literature is rather different from a Question on political pamphlets being used for teaching purposes.
    I wish to apologise at this point to the hon. Member for Sunderland, North (Mr. Willey). I have been somewhat discourteous to him in not replying sooner on this point but the letter has gone off to him today.
    Mr. F. Harris: Since there is to be a General Election next year, is there not a good case for sending these pamphlets to all right hon. and hon. Members opposite?
    Mr. Willey: In view of what happened at the Simon Langton Grammar School yesterday—perhaps the incident explains the absence today of the Parliamentary Secretary, since I understand that he was involved—will the right hon. Gentleman make a statement about the undesirability of political intrusion into schools? Will he give proper advice to ensure that what happened yesterday does not happen again?
    Sir E. Boyle: I am not sure that this arises from the Question on the Order Paper. What the hon. Gentleman calls "political intrusion" for the making of films seems to me to be a matter for the local authorities and for the schools themselves, using commonsense. I understand that the London County Council has no objection to political films being made both outside and inside schools provided that the children are not themselves asked to speak in them.
    Sir G. Nicholson: Is it not possible to take this whole question a little too seriously? I have had complaints of Labour Party pamphlets being distributed in schools but, as far as I am concerned, the more there are the better, since they defeat their own object.
    Sir E. Boyle: I am grateful to my hon. Friend. It is a mistake for too many people to be "holier than thou" on this subject.
    Mr. Hamilton: Can the right hon. Gentleman give an undertaking, in view
    1430
    of the official protest from the N.U.T., that the Conservative Central Office will stop sending these pamphlets to the teachers at school? Will he ensure that, if the Conservative Party must send them, it sends them to home addresses?
    Sir E. Boyle: I agree that it is best if they are sent to private addresses and not to the schools. But, in fairness, I would add that I had a complaint earlier this year of pamphlets being sent by the Labour Party to head boys and head girls. In my letters to the hon. Member for Sunderland, North (Mr. Willey) I have tried to set out a method on which we could all agree.
    Several Hon. Members rose—
    Mr. Speaker: I think that we had better get on with educational topics.

    Youth Services, Lindsey County Council
    Sir J. Maitlandasked the Minister of Education if he will state the number and amount of grants made to Lindsey County Council for youth services building in 1961, 1962, and 1963; and what grants are proposed for the immediate future.
    Sir E. Boyle: As the Answer contains a number of figures, I will, with permission, circulate it in the Official Report.
    Sir J. Maitland: Is it not a fact that these figures will show that the local authority concerned is getting less than its proper share? Will my right hon. Friend comment on that?
    Sir E. Boyle: With respect, I do not think that that is true. The total allocation for Lincolnshire (Lindsey) over the period 1960–65 is about the average of the whole country on the basis of the youth population. I do not think that it is getting less than its fair share.
    Sir C. Osborne: Is not my right hon. Friend aware that those of us who represent Lindsey are interested not in the figure for 1965–66, but the figure for this year, and that we think that we are being treated meanly?
    Sir E. Boyle: The figures show that four projects costing £23,000 are in this year's programme and that for next year

    1431
    one project costing £19,000 has already been included, and I am considering a second.
    The information is as follows:
    County Council projects are not specifically grant-aided. Youth service projects in the area of the Lincolnshire (Lindsey) local education authority have been included in building programmes as follows:

    1961–62–3

    costing

    £25,000.

    1962–63–7

    costing

    £56,000.

    1963–64–4

    costing

    £23,000.

    One project costing £19,000 has already been included in the 1964–65 programme, and I am considering an appeal to add a second project.

    Public Libraries
    Mrs. Whiteasked the Minister of Education when he proposes to introduce legislation on public libraries.
    Sir E. Boyle: I have nothing to add to the Answer which my hon. Friend the Parliamentary Secretary gave to my hon. Friend the Member for Chigwell (Mr. Biggs-Davison) on 12th December.
    Mrs. White: Will not the right hon. Gentleman acknowledge that, without the legislation mentioned, he has no powers to ensure that the provision of public libraries is adequate for meeting the very much increased demand of students in further and higher education in the next few years? If he cannot find time in this place, could he not take the advice of his right hon. Friend about starting it in another place?
    Sir E. Boyle: I am very keen that this legislation should be introduced as soon as possible and I will certainly consider all ways and means.

    Handicapped children
    Mr. Wainwrightasked the Minister of Education if he will now introduce legislation so that parents of handicapped children will have the right to apply for a maintenance grant when the child reaches the age of 15 years.
    Sir E. Boyle: I do not expect to be able to introduce legislation on this subject during the present Parliamentary Session.
    Mr. Wainwright: Does not the right hon. Gentleman realise that the parents of these children suffer a great deal of hardship and that a boy of 15 may
    1432
    cost as much to keep as most adults? Is it not essential that these boys and girls should be as well clothed as possible while attending school so that the discrimination against them is as little as possible?
    Sir E. Boyle: I appreciate that. On the other hand, children in special schools benefit from preferential treatment in other ways, and if they attend boarding school no financial contribution from the parents is expected. However, I have not closed my mind on this matter.

    Educational Cruises
    Dr. Kingasked the Minister of Education whether in view of the success of educational cruises on chartered liners like the "Dunera", he will seek powers to make grants towards such cruises earmarked for children who otherwise are too poor to take advantage of the cruises.
    Sir E. Boyle: No, Sir. Local education authorities already have the power to assist pupils in the circumstances mentioned.
    Dr. King: Is the right hon. Gentleman aware that these cruises, which are of inestimable educational value, are financed entirely by the children themselves and that the 1944Act lays down that nothing which is of educational value shall be kept from a child merely because of the poverty of its parents and that some local authorities are subsidising poor children? Could he not think seriously about himself making the kind of provision suggested?
    Sir E. Boyle: I think that there would be difficulties about this. I am impressed with what many local education authorities do. If the hon. Gentleman wishes to refer the practice of any particular authority to me, I shall be happy to consider it.

    World Citizenship
    Mr. G. M. Thomsonasked the Minister of Education if he will allocate to members of Her Majesty's Inspectorate responsibilities for encouraging studies in world citizenship in the school curriculum.
    Sit E. Boyle: It is already one of the responsibilities of H.M. Inspectors to give advice on this topic.

  SOUTH PACIFIC (FRENCH NUCLEAR TESTS)
  Mr. Dribergasked the Prime Minister if he has now been informed whether, and when, the proposed French nuclear tests in the South Pacific are to take place; and what representations on the health hazards to the population of British territories arising from such tests have now been made by Her Majesty's Government.
  The Prime Minister (Sir Alec Douglas-Home): I have had no communication on these points from the French Government, but from published information it seems that any tests in the South Pacific will not take place before some time in 1965. As for the second part of the Question, I have nothing to add to the reply I gave to the hon. Gentleman on 3rd December.
  Mr. Driberg: While we are certainly relieved by the Prime Minister's announcement about the probable timing, can I ask him whether he will none the less make representations, since, obviously, it would be no good leaving these until the last moment before the tests? It is better to make representations well in advance.
  The Prime Minister: The French Government is perfectly well aware of our wish that it should sign the nuclear Test Ban Treaty and of the anxiety which we share with New Zealand and Australia. But whether we should make representations now about possible tests which may take place in two years' time is a much more doubtful proposition.

  MINISTERS
  Mr. Loughlinasked the Prime Minister if he will make it a condition of accepting Ministerial office in future that the office holder undertakes on relinquishment of office not to engage in any firm or section of industry or commerce which is in receipt of Government subsidies, grants or loans.
  The Prime Minister: No, Sir.
  Mr. Loughlin: Is the Prime Minister aware that I imply no personal criticism of any Minister by this Question? However, is it not rather scandalous that Ministers of the Crown can pursue policies from which firms and industries can gain financial benefit when the same Ministers may later be employed by the firms which received the benefits of their policies? Would it not be wise to ensure that public office should not be abused in this way?
  The Prime Minister: I think that this must be left to the discretion and common sense of Ministers. I should not like to deprive industries of the benefit of the advice of people who had been Ministers—not necessarily the industries with which they had been closely associated.
  Mr. Ridley: Would not my right hon. Friend agree that this is a ridiculous suggestion and that, if it had been adopted, Lord Robens would have been unable to undertake the chairmanship of the National Coal Board?
  Mr. Lawson: Is the Prime Minister suggesting that his Ministers are more honourable than Labour councillors who happen to be local authority tenants? Will he not apply to his Ministers who happen to be benefiting from the public purse the same rule as is applied to Labour councillors who are local authority tenants?
  The Prime Minister: The Question deals with what a Minister may do on the relinquishment of his office. I was saying that I did not think that there should be any rule about this and what I was saying would apply to Ministers of a Labour Government as much as to our own.
  Mr. H. Wilson: While it is clear that much of this problem needs to be settled on the basis of the good sense and discretion of the individuals concerned, will not the Prime Minister at least make it clear that the most rigid rules are still enforced in respect of Ministers while in office having no connection of any kind with business undertakings? Secondly, while the Question refers to subsidies, grants or loans, is the right hon. Gentleman aware of the great concern expressed in the House not long ago about Ministers who, on

  1435
  ceasing to be Ministers, go into firms which are in receipt of very big Government contracts, especially defence contracts? Would not the Prime Minister agree that there is a case for very careful behaviour, where Government defence contracts are concerned, by Ministers immediately on resigning?
  The Prime Minister: There is certainly need for great care and that is what I meant when I spoke of exercising discretion and common sense. For Ministers in office there are the most rigid rules that they must not be connected with industry.

  SOUTHERN RHODESIA
  Mr. Stonehouseasked the Prime Minister what consultations he is now proposing to have with Commonwealth Prime Ministers about the future of Southern Rhodesia.
  The Prime Minister: Commonwealth consultations are confidential. I cannot at present go beyond my right hon. Friend's statement in the House on 15th November.
  Mr. Stonehouse: May I ask the Prime Minister whether he is aware that Sir Roy Welensky has just made another blistering attack on Conservative Party hypocrisy in regard to the Federation, and that this comment on Tory duplicity is entirely justified? Will the Prime Minister avoid further mistakes in Rhodesia by taking into consultation the Commonwealth countries so that the Constitution can be broadened and the country can move towards democratic rule which will represent the aspirations of the majority of the population?
  The Prime Minister: The hon. Gentleman's Question is about Southern Rhodesia, and possible consultations on the future of that country. I understand that Sir Roy Welensky was making a speech about the Federation, but I hope that the hon. Gentleman, as well as everybody else in the House, wants to see a solution of the Southern Rhodesia problem which is acceptable to the Commonwealth, to the United Nations, and to both sides of the House.
  Sir J. Eden: Will the Prime Minister consider very carefully before inviting other Commonwealth countries to share
  1436
  in a decison which is wholly the responsibility of Her Majesty's Government?
  The Prime Minister: It was never suggested that other Commonwealth countries should share in that decision, and my right hon. Friend was suggesting that they might be able to help towards a solution.
  Mr. P. Noel-Baker: Is it not a fact that the settlement in Rhodesia is a matter of the highest possible importance to the whole Commonwealth, and may it not well be the case that a meeting of Commonwealth Prime Ministers might assist in securing a satisfactory solution, which is what the Prime Minister wants?
  The Prime Minister: I think that I answered a supplementary question to the same effect the other day by saying that I did not think it was justifiable to call a Commonwealth Prime Ministers' Conference for this particular purpose.

  SOUTH AFRICA (SUPPLY OF ARMS)
  Mr. Gordon Walkerasked the Prime Minister (1) what steps he has taken to co-ordinate the work of the Departments concerned in carrying out Her Majesty's Government's policy in regard to the export of arms to South Africa;
  (2) in view of the Security Council resolution of 4th December on the supply of arms to South Africa, what changes have now been made in the policy of Her Majesty's Government on this matter.
  Mr. Mayhewasked the Prime Minister if he is satisfied that adequate co-ordinating arrangements have been made between the Ministry of Defence, the Foreign Office and the Board of Trade regarding the sale of spare parts for tanks and armoured cars to the Union of South Africa; and if he will make a statement.
  The Prime Minister: All applications to export arms and spare parts for arms to other countries are carefully scrutinised by the interested Departments. This is so in the case of South Africa and I am confident that the machinery is adequate. As my right hon. Friend the Foreign Secretary explained to the House on 25th

  1437
  November, it is our policy not to export arms to South Africa which would enable the policy of apartheid to be enforced.
  Mr. Gordon Walker: May I ask the Prime Minister whether he is aware that there is increasing scepticism—and not only in political circles—aboutthe feasibility of this distinction between arms for internal use and those for external use? Can the Prime Minister tell us whether spare parts for Saracen tanks and Wasp helicopters are still being exported to South Africa, both of which could be used, if necessary, for the suppression of internal protests and disorder?
  The Prime Minister: We supply spare parts for the Saracens under existing contracts, but we intend to make no new contracts. The helicopters in question are naval Westland Wasp helicopters. They are used for anti-submarine purposes, and are not equipped with machine guns or missile launchers.
  I agree with the right hon. Gentleman that we must keep this policy constantly under review, but one must remember that, under Article 51 of the United Nations Charter, a nation has the right to arm itself for self-defence, and the Simonstown Agreement is very valuable to the United Kingdom as well.
  Sir J. Duncan: Would the Prime Minister agree that the safety and freedom of the sea round South Africa is a British interest? Will he do nothing to discourage South Africa from keeping the Simonstown Agreement?
  The Prime Minister: Yes, Sir; I have been aware of that ever since the crisis in Suez.
  Mr. H. Wilson: Does the Prime Minister recall that when we made a strong declaration on this question last March we were subjected to continuous attacks from Ministers? On the question of an arms embargo on South Africa, is the Prime Minister aware that we support the partial conversion of the Government, under United Nations and American pressure, on this matter; but is he aware that we are still very worried that the Government, who up to a few months ago said that no embargo could be carried out, are not fully honouring the spirit of what is intended by the United Nations Resolution?
  The Prime Minister: I think that an arms embargo would be wrong, and I hope the right hon. Gentleman will agree, because this would involve the Simonstown Agreement to which I think I remember him saying he attached considerable importance. Within our licensing system we are able to control the export of arms, and they will not be exported if, in our judgment, they can be used to suppress the African population.
  Mr. Wilson: Since we are doubtful about the approach of the Government to the carrying out of this in view of their rather belated conversion, will the Prime Minister say why, on the debate on the Whitsun Adjournment, a Minister was put up to attack the Opposition's view on this and to oppose the idea of any restrictions whatsoever on shipments of arms to South Africa? Will the Prime Minister say why, when he was Foreign Secretary and we put Questions to the Foreign Office, we could get no assurance at all about the control either of tear gas or tear gas equipment? Are teargas and tear gas equipment controlled now?
  The Prime Minister: I should like to see that Question on the Order Paper. I have always been against an arms embargo. I am not against using our licensing system to control arms so that they will not be used against the African population.

  HOUSE OF COMMONS PROCEEDINGS (TELEVISION)
  Mr. Donnellyasked the Prime Minister whether he will now publish the technical report on the implications of the televising of the proceedings of the House of Commons that was prepared at the request of his predecessor.
  The Prime Minister: No, Sir.
  Mr. Donnelly: May I ask the Prime Minister, first, whether he is aware that it states in the report, and subsequent technical advances have confirmed further, that no new form of lighting would be required if there were any televising of proceedings in the House of Commons?
  Secondly, may I ask the Prime Minister again the question which he did not

  1439
  answer last week? How long does he think this Chamber can go on ignoring the new mass medium of communication? How long does he think it will take to obtain the necessary information?
  The Prime Minister: I am largely in the hands of the House in this matter. It is clear that the House is not unanimous on it. I think that it would do nothing but mislead everybody to undertake technical experiments before the House has made up its mind on this matter.

  JORDAN AND SYRIA (BOYCOTT OF BRITISH COMPANIES)
  Mr. A. Hendersonasked the Prime Minister what steps he is taking to co-ordinate the activities of the various Government Departments affected by the official blacklisting of 49 British companies by the Governments of Jordan and Syria.
  The Prime Minister: Constant contact on the boycott, as it affects this country, is maintained between the Departments concerned.
  Mr. Henderson: May I ask the Prime Minister whether there is any precedent for Governments which have friendly relations with Britain black-listing British firms for carrying on their legitimate trading interests with a third country such as Israel? Is not the action of these Governments quite inconsistent with the principles of the United Nations Charter?
  The Prime Minister: I think that it is inconsistent and deplorable, and that has been made clear; but the right hon. Gentleman was asking about the coordination of action by Government Departments, and I am satisfied that we can give the firms all the help that they need.
  Mr. W. Yates: Would not the Prime Minister agree that this question concerning the companies also involves Israel's interest to extract the waters of the Jordan shortly, and that this is part of the propaganda before it?
  The Prime Minister: That is another question.
  Mr. Snow: May I ask the Prime Minister whether he has considered the desirability of consultation with other nations who may be equally affected, for instance, the United States of America, since there appears to be some evidence that there is an incipient move towards a boycott of companies in that country as well?
  The Prime Minister: I shall consult my right hon. Friend the Secretary of State for Foreign Affairs on this matter of consultation with other countries. So far, this boycott has been directed against us.
  Mr. S. Silverman: May I ask the Prime Minister whether he recalls that the Minister of State, when dealing with this matter the other day, without condoning it, nevertheless thought it right to remind the House that this problem arose out of the Arab States' contention that there is in existence a state of war with Israel? Does not the right hon. Gentleman consider that this nonsense of an unreal state of war being used as a foundation for all kinds of mischief all over the world is one which the Government might take some step to endeavour to bring to an end?
  The Prime Minister: I have deplored many times in this House, and in other places, mixing up politics and economic relations.

  CROWTHER REPORT AND BUCHANAN REPORT
  Mr. W. T. Rodgersasked the Prime Minister what steps he intends to take to co-ordinate the policy of Her Majesty's Government arising from the recommendations of the Crowther Steering Group to the Buchanan Committee, in view of the Departmental responsibilities of the Minister of Transport, the Minister of Housing and Local Government, and the Secretary of State for Industry, Trade and Regional Development.
  The Prime Minister: The Ministers concerned and the officials of their Departments are in close consultation on all matters raised by both the Crowther and Buchanan Reports.
  Mr. Rodgers: Is the Prime Minister aware of the very widespread view that

  1441
  the proposal for regional agencies, which was a central feature of the Crowther Report and which had the support of the Minister of Transport, has, in Sir Geoffrey's own words, been turned down flat by the Government at the instance of the Minister of Housing and Local Government? In view of the very great blaze of publicity with which the Crowther and Buchanan Reports were launched, will he take steps to ensure that they are not now allowed to gather dust due to Departmental rivalry?
  The Prime Minister: I will certainly see that nothing gathers dust in Whitehall.

REMUNERATION OF MINISTERS AND MEMBERS OF PARLIAMENT (REVIEW COMMITTEE)
Mr. H. Wilson(by Private Notice) asked the Prime Minister if he will make a statement arising out of the discussions which have been held on the remuneration of Ministers and Members of Parliament.
The Prime Minister (Sir Alec Douglas-Home): Yes, Sir. The remuneration of Members of the House of Commons and salaries of junior Ministers were raised in 1957, and, at the same time, an expenses allowance was introduced for Members of the House of Lords. The basic salary of a senior Minister has remained unchanged since 1831.
After consultation with the leaders of the main political parties in both Houses, we have decided that the time has now come for a fundamental review of the remuneration of Ministers of the Crown and of Members of the House of Commons and also for the reconsideration of the allowance for Members of the House of Lords.
Her Majesty's Government have, therefore, appointed Sir Geoffrey Lawrence, Mr. H. S. Kirkaldy and Professor W. J. M. Mackenzie to be a Committee with the following terms of reference:
"To review, and to recommend what changes are desirable in, the remuneration of Mr. Speaker, Ministers of the Crown and Members of the House of Commons and also the allowance for Members of the House of Lords, having regard to their responsibilities, to the place of Parliament in the national life and to the changes which have taken place, since
1442
the existing emoluments were fixed, in general standards of remuneration, and to the increases in expenses borne by Members of both Houses in the discharge of their duties."
The Committee will, of course, take evidence from whatever sources it wishes, but in order to assist it in carrying out its task, Her Majesty's Government, in consultation with the other parties, have appointed an Advisory Panel with which the Committee will be able to consult and from which they will be able to obtain advice on parliamentary matters.
The following have agreed to serve on the Advisory Panel: Lord Tweedsmuir, Chairman, Lord Champion, the hon. Member for Bebington (Sir H. Oakshott), the hon. Member for Bradford, West (Mr. Tiley), the hon. and learned Member for Ilkeston (Mr. Oliver), the hon. Member for Ashton-under-Lyne (Mr. Rhodes), and the hon. Member for Huddersfield, West (Mr. Wade).
The Government consider that the Committee should be asked to report as soon as possible after the General Election and that whatever action seems appropriate in the light of its report should then be taken without delay.
Mr. Wilson: Is the right hon. Gentleman aware that, although we would have preferred immediate action, we very much welcome the approach that he has shown to these discussions during the past two or three weeks? Is he further aware that it is the desire of all of us that this matter should be taken out of party politics; that, speaking for my own party, I would express the very strong view that this should be regarded as a matter for the House as a whole, and that, between now and the General Election, and during the election campaign, this should not be regarded as another party matter, or related to other questions?
Finally, am I right—I think I am—in taking the last sentence of the right hon. Gentleman's statement as meaning that if, at the end of the General Election, we find a Government under his leadership—[Hon. Members: "Hear, hear."] All right. There is a little more of the sentence to follow. Am I right in thinking that if this were to occur he would feel that something does need to be done, and that the Government would take action quickly in the

1443
life of the new Parliament just as, on behalf of my party, I give a similar pledge that if the result of the election were to be a Labour Government we would equally regard it as essential that something should be done quickly? [An. Hon. Member: "What about the Liberals?"] Is the Prime Minister further aware that I had proposed to leave a supplementary question to the Leader of the Liberal Party?
The Prime Minister: I am obliged to the right hon. Gentleman for the help that he has given me in this matter during the last few weeks. I think that we both feel it desirable that these matters should be taken out of party politics, and should play no part in the election campaign. I am sure that that is the feeling on both sides of the House.
The answer to the last part of the right hon. Gentleman's question, with the possible substitution of "when" for "if", is "Yes, Sir".
Mr. Grimond: Is the Prime Minister aware that I, also, welcome this statement? May I assure him that if called upon to form a Government after the election I shall be only too happy to follow his excellent example? May I also thank him for coming to a speedy decision in this matter? It seems to me that there is something to be said for having a few lapsed Peers in the House of Commons, so that they can bring a new look to these difficult problems. I hope that this is the beginning of the end of the very unhappy and nagging negotiations, very unsatisfactory to everybody, which have always had to precede any change in our salaries.
Mr. Renton: I welcome my right hon. Friend's statement. Is he aware, however, that there is a feeling on both sides of the House—and that there has been such a feeling for a long time—that the differential as between Ministers and junior Ministers has not been quite right, to the disadvantage of junior Ministers? Will he give us an assurance that the Committee to be set up will not be bound by the present differential?
The Prime Minister: I think that all this will go into the melting pot. I hope that something more satisfactory for junior Ministers will come out.
Mr. Mason: I thank the Prime Minister for the pleasing statement that he has made, and especially upon the break-through that we have achieved in allowing, for the first time, a few independent assessors to make recommendations. Are the terms of reference of the Committee such as to allow the assessors to make recommendations to this House offering ways and means whereby this difficult problem could be solved for all time, so that we did not have to go through this periodical rigmarole again?
The Prime Minister: There is no reason why the Committee should not make a recommendation if it sees fit, but this matter must be kept under the authority of the Government of the day.
Mr. Maxwell-Hyslop: How does it come about, Mr. Speaker, that this Question arises as a Private Notice Question? Under the rules of order such Questions are normally asked in respect of a matter which has suddenly arisen and which has to be determined either today or tomorrow.
Mr. Speaker: The hon. Member need not be anxious. The custom is to allow a Private Notice Question to be asked by the Leader of the Opposition, because, by custom, he does not put Questions on the Order Paper.
Mr. Shinwell: In view of the fact that we should have had an increase a long time ago, will the Prime Minister so frame the terms of reference of the Committee as to ensure that whatever decision is reached by the Committee it will be made retrospective?
The Prime Minister: I know of the right hon. Gentleman's interest in this matter, but I am not sure that I am in the same category as he is.
Mr. More: Will my right hon. Friend consider enlarging the terms of reference in one important respect? The terms of reference refer to the general standards of remuneration. Could not they refer to a specific increase in the standards of remuneration of the permanent officials of the Ministries to which Ministers are attached?
Several Hon. Members rose—
Mr. Speaker: I must have the indulgence of the House in putting a stop

1445
to further discussion of this matter. It so happens that we have a terrific lot to do before we come to our formal work today.

ADEN (DETAINED PERSONS)
Mr. Bottomley(by Private Notice) asked the Secretary of State for the Colonies whether he will name the three men now charged in connection with the bomb outrage in Aden, and what steps he is taking to obtain the release of other detainees against whom no charges are being made.
The Secretary of State for Commonwealth Relations and for the Colonies (Mr. Duncan Sandys): No charges have yet been preferred. The answer to the second part of the question is "None, Sir".
Mr. Bottomley: Since the leaders of nine trade unions, the leaders of the T.U.C. in Aden and the leaders of the People's Socialist Party are all detained, does not the right hon. Gentleman realise that this leaves a political vacuum and encourages terrorism? Will he not consider releasing these leaders and give consideration to the sending out of a judicial committee to investigate the matter; or is he content to leave the position as it was stated by the Minister of State in another place, that this is a matter for the security forces?
Mr. Sandys: This action was taken by the Federal Government under a declaration of a state of emergency. The Federal Government are responsible for internal security. The British High Commissioner has power to override any decision of the Federal Government, but he did not consider that he was justified in intervening in this matter, and I fully support him in the view which he took.
As regards any reference to any judicial authority, provision is made in the state of emergency decree that detainees may have their cases reviewed if they so desire by a special tribunal.
Mr. Kershaw: In coming to a decision on this very difficult matter will my right hon. Friend remember that in Aden there are many thousands of Service men's wives and children who,
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if a difficult situation should arise, might be in great danger?
Mr. Sandys: Of course, I am well aware of that.
Mr. Oram: Is there not sufficient in the record of the Federal Government about civil liberties to make people who are interested in this problem very apprehensive of the treatment that the prisoners may now be receiving? Will the right hon. Gentleman do everything in his power to see that proper treatment is being given to them?
Mr. Sandys: I have no reason to suppose that proper treatment is not being given to them.
Mr. Grimond: Can the Secretary of State assure us that the detainees are aware of their right to appeal? Can he say whether it is true that their relatives are not being allowed to visit them, and, if so, is this restriction necessary?
Mr. Sandys: I am not responsible directly for the arrangements for the detention of these people, but a British medical officer visited the place of detention and I have with me a full report. He visited the place on three different days and held a clinic. [Interruption.] I mention this because I have seen reports in the newspapers of torture and accusations of that kind. I would like to take this opportunity to make the position clear to the House. I have the report from the British medical officer with me. He examined all the detainees and, apart from minor ailments of a normal character, found no signs of ill-treatment of any kind whatever.
I am not in a position to make a statement about visits by persons from outside to the detainees. But I can say that if they wish to have legal advice from outside they are perfectly at liberty to see solicitors in their place of detention.
Mr. W. Yates: Will my right hon. Friend tell the House how long this emergency is to last? Are these 400 people to stay permanently in prison without trial? How many of them have been released in the last fortnight?
Mr. Sandys: It has been going on for only a few days. How long it will go on, I cannot say.
Mr. Grimond: May I again ask the right hon. Gentleman whether he will make inquiries to discover whether or not it is true that relatives are not being allowed to see the detainees? Will he inform the House of the reason for this, if it turns out to be true?
Mr. Sandys: I will inquire.
Mr. Brockway: How does the right hon. Gentleman explain that if no charges have been made in this case of bomb outrage, trade union and political leaders and 51 persons have been placed in detention, and a Cabinet Minister has resigned? How is it that this grave crisis in Aden has arisen from an outrage about which even no charges have yet been made?
Mr. Sandys: It seems to be clear that the hand grenade was thrown from a window in an office in the airport building. Three people are known to have been in that office and are being detained as suspects separately from the others. I have no doubt that some charges will be made; inquiries are at present being made.
I would like to impress upon hon. Members the fact that this is not just a matter of one grenade being thrown at the airport. A regular, concerted effort has been made recently to try to provoke trouble and bloodshed in Aden. I would like to tell hon. Members what has been going on. It is mainly being directed from Sana, over the Yemeni Radio. On 25th November, before this incident, Sana Radio urged workers in Aden to carry and use arms. The broadcast said that the aim should be to exterminate their enemies as quickly as possible. "The rights of the workers", it said, "should be taken by force". It called upon the workers in Aden
"…to go ahead, strike, destroy, carry arms and obtain their rights by force".
On 10th December, the day of the bomb incident, this is what Sana Radio said:
"This is not the last bomb. Our brothers in the South are prepared to throw other bombs, and will do so in Britain itself if possible."
On 13th December Sana Radio issued a statement by the Aden T.U.C. and the P.S.P. Party—the party to which reference has been made. It called on all Arabs to support the struggle of the T.U.C. and the P.S.P. and demanded
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"death for colonialist traitors and stooges".
Mr. W. Yates: Really!
Mr. Sandys: I have been quoting. It is all very well to say "Really", but this is a serious situation.
Mr. W. Yates: What about the United Nations resolution?
Mr. Sandys: That is all very well but I know perfectly well that the hon. Member would like to see the British driven out of Aden. [Hon. Members: "Oh."] He would be happy to see Aden swallowed up by the Yemen and ruled from Cairo.
Mr. W. Yates: On a point of order. The Minister has just made an accusation that I would be prepared to support another country known as the Yemen to the detriment of British interests. Is a Minister allowed to say that without any foundation whatever?
Mr. Speaker: I do not think that it is strictly out of order, but I deplore the use of strong language of that kind in any part of the House.
Several Hon. Members rose—
Mr. W. Yates: The Minister should withdraw that remark.
Mr. G. M. Thomson: Does not the information which the Minister has just read to the House add a great deal of force to the request made by my right hon. Friend the Member for Middlesbrough, East (Mr. Bottomley) that a judicial commission should be set up, under a judge from the United Kingdom, to investigate exactly what the position is in the Southern Arabian Federation? Will the Secretary of State give an assurance that if hon. Members from either side of the House are able to visit Aden during the coming Recess they will have access to the detainees?
Mr. Sandys: On the question—[HON. MEMBERS: "Withdraw."] With regard to my remarks—[Hon. Members: "Apologise."] I should be very happy for any objective person to study my hon. Friend's earlier remarks and speeches on this subject. I think that it would fully bear out my impression

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of his attitude to this matter. [Hon. Members: "Withdraw."] As for a judicial tribunal—
Mr. W. Yates: On a point of order. It is clear, Mr. Speaker, that the Minister did not hear what you said to the House about remarks of an offensive nature which he made to me. I now ask him in courtesy, and in courtesy to the House, to withdraw them.
Mr. Sandys: I did not understand that you, Mr. Speaker, asked me to withdraw. You said that you deplored strong language.
Mr. Speaker: I told the House just what the situation is. I deplore the use of strong language of that kind on the part of anybody, because it does not assist our progress. I did not ask the Minister to withdraw, because in the context I did not think that the remark was out of order. I did not understand that when the hon. Member for The Wrekin (Mr. W. Yates) rose to a point of order he was going to ask a question of the Minister, which is a different matter. Can we now get back to the more regular situation, which is the Minister's answer to a question?
Mr. C. Pannell: On a point of order. It is perfectly true that you, Mr. Speaker, did not ask the Minister to withdraw. You deplored what was said. Is it in order for a Minister, using the privileged position he has at the Dispatch Box, to persist and proceed after you have deplored what he has said? Surely no other hon. Member in this House would do that. We expect the same courtesy to be given to the Chair by Ministers as we expect to give to you.
Mr. Speaker: I am glad about that, that I am to have the same respect as my fellow Members here, but the fact is this was not, in my view, out of order. It is not out of order, despite the fact that I deplore it, for the Minister to continue in order. Now can we have an answer to the question asked by the hon. Member for Dundee, East (Mr. G. M. Thomson)? We have a lot to do.
Mr. Sandys: The hon. Member—[HON. MEMBERS: "Withdraw."]—asked me two questions. One was in regard to a judicial tribunal. As I have explained, the detainees can have their cases referred to a tribunal. It would
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not, of course, be proper for a British tribunal to look into the conduct of affairs by the Federal Government. But I have no reason to suppose—I am not trying to shelter behind the constitutional position of the Federal Government—that in the very inflammatory state of affairs in Aden, which, as I have indicated, is largely provoked from outside, the precautionary measures taken by the Federal Government were excessive.
I should be very happy to consider the suggestion which the hon. Member has made about visits by hon. Members, but it would be a matter for the Federal Government to decide about visits to their prisoners.
Several Eton. Members rose—
Mr. Speaker: Order. We really must get on.
Mr. Bellenger: On a point of order. I wonder, Mr. Speaker, whether you considered your Ruling in the context of what the Minister said about the efforts being made by people outside this territory to drive the British out by force? In that context is it not possible that the Minister's words against his hon. Friend could be construed in that way? If that is so, is that not against our rules of order?
Mr. Speaker: I did not construe them in that fashion. Of course, I shall be able to lock at what the words were when I read Hansard, but, to indicate to the House the principle upon which I was going, I thought that what was being said was that the hon. Member for The Wrekin (Mr. W. Yates) represents a point of view which, in these circumstances, would have the result which the Minister was indicating. [Hon. Members: "No."] We can all look at the words which were used about that. It will then be apparent whether the view I took was right or wrong. What I think we should do now is to proceed, because there is so much to do.
Mr. Wigg: On a point of order. Would you be good enough to reconsider what you have just said in the light of your decision last week, when you ruled that if you read some remarks in Hansard it would be too late to do anything about it? If the words I heard

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just now mean anything, as I think they do, the Minister was charging the hon. Member for The Wrekin (Mr. W. Yates) with treason.
Mr. Speaker: I have indicated my view. The House can deal with me if it is wrong.
Mr. W. Yates: On a point of order. I should never think that the Minister would accuse me of treason. He was asking me about my point of view. But I give notice to you, Mr. Speaker, that at a suitable time I shall seek to move the Adjournment of the House under Standing Order No. 9. I am quite satisfied with what the Minister said.
Mr. Speaker: I am obliged to the hon. Member. I will give him an opportunity when we get there.

STEEL PLANT, PORT TALBOT (DISPUTE)
Mr. Hooson(by Private Notice) asked the Minister of Labour if he will intervene and offer his good services to try to resolve the industrial dispute at the Steel Company of Wales plant at Port Talbot.
The Minister of Labour (Mr. J. B. Godber): I am, naturally, concerned that this situation should have developed. The agreed negotiating arrangements provide that, in the event of disagreement, questions may be referred to arbitration with the consent of both sides. My officers are exploring this possibility.
Mr. Hooson: In view of the fact that closure of this great plant is now imminent and that if there is closure it will inevitably mean closure of complete plants in other parts of the country and that, therefore, the livelihood of tens of thousands of families is threatened, would the Minister not agree that he should intervene at this stage rather than allow the situation to deteriorate, as it seems to be doing at present?
Mr. Godber: I have said that I am concerned about the situation. I do not think that it would help if I were to comment at length on it in the House at the present time.
Mr. J. Morris: Although it is sometimes forgotten that when hon. Members intervene in matters affecting another hon. Member's constituency it is both traditional and good manners that every practical step is taken to inform the hon. Member concerned, may I take this opportunity of thanking the Minister for his reply in the somewhat early stages and saying that the Minister's good offices have been appreciated in the past? Will he please give an assurance that he will keep the matter—as undoubtedly he will—under close supervision and that if it became necessary or useful to see me during the Recess he would do so?
Mr. Godber: I am grateful to the hon. Member. As he knows, I am concerned and we have spoken about this matter. I shall gladly keep in touch with him about it.
Mr. J. Griffiths: The right hon. Gentleman knows that many of us could be affected if these works closed and that we are concerned. Is he aware that the Mayor of Port Talbot has offered his good offices in an effort to bring the parties together? Can he say whether his officers in Cardiff will be available if the mayor's initiative looks like meeting with some success?
Mr. Godber: I am grateful to the right hon. Member.
Mr. Hooson: Is the Minister aware that this is more than a constituency matter, that it is a national matter? Is he also aware that I did inform the hon. Member for Aberavon (Mr. J. Morris), before the meeting of the House this afternoon, that I intended to raise the matter?
Mr. Godber: I have no further comment to make.

BUSINESS OF THE HOUSE
Mr. H. Wilson: May I ask the Leader of the House whether he will state the business of the House for the first week after the Adjournment?
The Lord Privy Seal (Mr. Selwyn Lloyd): Yes, Sir. The business for the first week after the Christmas Recess will be as follows:
TUESDAY, 14TH JANUARY—Motion to approve the British Broadcasting Corporation Licence and Agreement.

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WEDNESDAY, 15TH JANUARY—Supply [5th Allotted Day]: Report stage of the winter Supplementary Estimates, which subject to the wishes of the House, it is hoped to obtain formally, to allow debate on an Opposition Motion on Commonwealth Trade.
THURSDAY, 16TH JANUARY—Second Reading of the Export Guarantees Bill, and of the Shipbuilding Credit Bill, and Committee stage of the Money Resolutions.
FRIDAY, 17TH JANUARY—Private Members' Bills.
MONDAY, 20TH JANUARY—The proposed business will be: Second Reading of the New Towns Bill, and Committee stage of the Money Resolution.
Remaining stages of the Defence (Transfer of Functions) Bill.
Mr. H. Wilson: Will the Minister say whether during that week we can expect a statement on, or a debate on, the Monopolies Commission's Report on the electrical equipment for mechanically propelled land vehicles, about which there has been great concern? Is he aware that this reference went to the Monopolies Commission more than six-and-a-half years ago, in April, 1957; that the Report was received in February of this year and that the Board of Trade has sat on it for 10 months?
Would the right hon. and learned Gentleman now tell us whether, in his responsibility to this House, he will see that a more urgent approach is made and that we have a chance to deal with this matter during the week when Parliament reassembles after the Christmas Recess?
Mr. Lloyd: I cannot possibly promise that we can deal with the matter during the week when we come back from the Recess. I have announced the business for that week. So far as it affects me, I will carefully consider what the right hon. Gentleman has said.
Mr. Wilson: Since "carefully consider", in this case, has taken a period, first, of six-and-a-half years and then 10 months, will the right hon. and learned Gentleman accept that this is a point of urgency, and give an undertaking that there will be a statement on the attitude of the Government to this long-delayed Report? Secondly, will
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he arrange for a statement to be made to this House explaining why the Board of Trade has sat on the Report for so long?
Mr. Lloyd: I will certainly bear in mind what the right hon. Gentleman has said. I am not in a position to give an undertaking
Sir C. Osborne: May I ask my right hon. and learned Friend to try to find time at an early date to discuss a problem dear to his own heart, that is, the prodigious expenditure proposed in the latest White Paper on Public Expenditure, coupled with the enormous increase in wages, and the effect that these are likely to have on production and the great social injustice to holders of War Loan and Government securities?
Mr. Lloyd: I am certain that within the normal processes there will be opportunities for these matters to be ventilated.
Mr. C. Pannell: Is the leader of the House aware that this week the Ministry of Public Building and Works has put out a White Paper showing the complete reorganisation of that Ministry, and the tremendous advance in its size, which is so much that almost one in eight of the working population is affected? Is he seized of the necessity for a debate on that subject and, if so, can he give a day of Government time to it, bearing in mind that also under that Ministry comes the controversial questions of the rebuilding of the Foreign Office, the Government building extension in Whitehall and the Parliamentary buildings that we want to get on with as soon as possible?
Is not it right that the House should be given an early opportunity to debate this matter? Will the right hon. and learned Gentleman also consider the urgency of the need to set up an Accommodation Committee, comprising Members of all parties in the House, to get an opinion on these new buildings on behalf of the House of Commons?
Mr. Lloyd: I intend, very soon after we return from the Christmas Recess, to move in the matter of setting up a Committee to advise on accommodation. The matter referred to in the first part of the hon. Gentlemen's question may be discussed through the usual channels.
Mr. F. Harris: Does the Government intend to issue a statement in the near future about what financial assistance they may consider giving to help Kenya, which has now become an independent country?
Mr. Lloyd: That does not arise on my statement about the business. But I will convey what has been said by my hon. Friend to my right hon. Friend who is responsible.
Mr. A. Lewis: Has the Minister seen Motion No. 31 on the Order Paper, about decontrol and creeping decontrol under the Rent Act? If he cannot arrange for a debate during the first week when Parliament returns from the Christmas Recess, can he make a statement along the lines of the Motion and invite the Leader of the Opposition to join him in that statement? Cannot we be given some idea of the view of the Government on that question?
[That this House notes with alarm the serious difficulties being created for tenants by the operation of the Rent Act, 1957, with particular reference to evictions resulting from decontrol and creeping decontrol, and calls upon Her Majesty's Government to make a declaration now that they will not, either during the lifetime of this Parliament, or in the unlikely event of them being returned to power at the next General Election, take any action towards further decontrol and urges the Leader of Her Majesty's Opposition, as the potential Prime Minister, after the next General Election, to declare that any government which he intends to form will not introduce any measure for further decontrol.]
Mr. Lloyd: I think that the hon. Gentleman is trying to tempt me into making a statement of policy when dealing with business matters.
Mr. Wigg: Is the right hon. and learned Gentleman aware that on 9th December I placed a Question on the Order Paper asking the Minister of Aviation to explain how it came about that on 12th March, 1962, he made a statement in this House which was at variance with a statement he made to President Kennedy, and which has now been publicised on a world-wide basis? Is he aware that I wrote to the Minister and gave him these particulars so that he
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would know exactly what was in my mind? Is he aware that he did not answer the letter and that on Wednesday—
Mr. Speaker: Order. I cannot relate this to the question relating to the next available week's business, and I do not think that we can discuss it on that question.
Mr. Wigg: With respect, Mr. Speaker, in order to explain, I have to give these facts to the House. After all, I have given them privately to the Leader of the House. The point is this. The Minister has transferred the Question. Will the right hon. and learned Gentleman take steps to ensure that, before the House rises, the Minister of Aviation makes a personal statement because, clearly, the conflict of these statements affects his personal honour? If the right hon. and learned Gentleman will not do that, will he move to set up a Select Committee to inquire how these statements came to be made?
Mr. Lloyd: The hon. Gentleman gave me notice of this, but it was not very long notice. So far as I am aware, it was a Question asked of the Minister of Aviation and it was transferred to the Secretary of State for Air because it was considered that the Minister of Aviation's alleged statement was a matter affecting the responsibility of the Secretary of State for Air. I understand that the normal procedure in these cases, if the statement of a Minister is questioned—a statement made on a matter not within the confines of his Department—is to put down a Question to the Prime Minister.
Mr. H Wilson: Since this involves a statement by a Minister—he went out of his way to make it; it was in reply to me on 12th March, 1962—and since there is clear evidence to suggest that he misled the House on this occasion—very clear evidence, if the Norstad Report is to be believed—will not the right hon. and learned Gentleman ensure, at any rate since the "buck" has been passed by the transference of the Question, that in the week when Parliament returns from the Christmas Recess an opportunity will be taken by the Minister of Aviation to clear his position in a statement to this House? We cannot leave in this way a situation

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—it is bad enough leaving it over the Recess-—where there is strong prima fade evidence of the House having been misled. This must be cleared up at the earliest possible opportunity.
Mr. Lloyd: Of course, an allegation against the honour of a Minister is a grave matter, both for the Minister and for those who make it. I will certainly consider how best to deal with the situation.
Dr. Stross: In view of the fact that the Leader of the House has said that conversations will be held through the usual channels with reference to the possibility of a debate on the Ministry of Public Building and Works and the redevelopment of the area in Whitehall, including the Foreign Office, will he please bear in mind that if agreement is come to for a debate for only half-a-day it will be useless and the House will be embarrassed, because many back bench Members who wish to contribute will be unable to do so?
Mr. Lloyd: I am aware of the considerable interest in this matter among hon. Members on both sides of the House.
Mr. Pavitt: Would the Leader of the House try to find time to debate a Motion in my name concerning another way in which there is dissatisfaction about how Ministers are answering Questions? Is he aware that an Oral Answer which I received from the Minister of Health to a Question on 9th December was substantially the same as that which I read in the Press on 29th November? In view of the difficulty, which I appreciate, of finding time for a debate during the first week when Parliament returns from the Christmas Recess, which will be a busy week, will the right hon. and learned Gentleman consider whether this matter could be referred to the Select Committee on Procedure?
[That this House is of the opinion that Answers to Oral Questions asked by Members should not be given to the Press for publication before the Member receives such Answers; and urges that a Select Committee should be set up to look into the matter.]
Mr. Lloyd: My recollection is that the hon. Member has a Question down
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to my right hon. Friend the Prime Minister on this matter. We had better await the answer to that.

NATIONAL MEMORIAL TO PRESIDENT KENNEDY (COMMITTEE)
The Prime Minister (Sir Alec Douglas-Home): With permission, Mr. Speaker, I will now make a statement.
On 5th December I made a preliminary statement about a National Memorial to President Kennedy.
I have since had further discussions with the right hon. Gentleman the Leader of the Opposition and with the right hon. Gentleman the Leader of the Liberal Party, and with their agreement I have invited Lord Franks to be the chairman of a small committee to consider the suggestions that have been and may be made and to recommend what form a Memorial might take.
It seems to me right that we should reach agreement on the form of a Memorial before an appeal for funds is launched.
I intend to have further consultations with the right hon. Gentlemen opposite about the membership of the committee and will arrange for an announcement to be made as soon as possible.
Lord Franks is at present abroad on a private visit, but will embark upon this task immediately on his return to this country in the new year.
Any communication in connection with a Memorial should be addressed to the Secretary, The President Kennedy Memorial Committee, Cabinet Office, Great George Street, S.W.1.

MR. HERMAN WOOLF (COMMITTEE OF INQUIRY)
The Secretary of State for the Home Department (Mr. Henry Brooke): I will, with your permission, Sir, and that of the House, make a statement about the case of Mr. Herman Woolf.
On the instructions of the Commissioner of Police a thorough investigation was carried out by Detective-Superintendent Axon, whose report I

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have studied with great care, together with some further information which I requested.
There have been two grounds of concern about this case.
The first was that, although Mrs. Woolf had reported to the police that her husband was missing, she received no information about him until after his death. This occurred through a failure of co-ordination within the Metropolitan Police organisation for which the Commissioner has already expressed his deep regret. The procedure for dealing with inquiries about missing persons has been reviewed, to safeguard against any similar failure in future.
The second ground of concern was whether Mr. Woolf, after being knocked down by a car, might have received any further injuries during the time when he was at West End Central Police Station. For my part, I would have welcomed the holding of a fresh inquest at which any such allegations could have been tested; and my right hon. and learned Friend the Attorney-General gave his authority for an application for a fresh inquest to be made to the High Court.
On 13th November the court, to which all the information in the hands of the police was made available, refused the application. In delivering judgment, the Lord Chief Justice said that the evidence before the court fell far short of enabling the court to say that there was any real risk that justice was not done at the inquest.
From my own study of Detective-Superintendent Axon's report and of the statements which he took from every available witness, I am in much doubt whether further inquiry will throw any fresh light on what happened. But in the circumstances of this case, with its tragic end, I am anxious that no possible point of doubt should remain unresolved, if further inquiry can resolve it.
I have, therefore, decided to set up an inquiry into the actions of the Metropolitan Police in relation to the case of Mr. Herman Woolf, from the time of the road accident in which he was involved on 10th November, 1962, until
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the time of his death in the Atkinson Morley Hospital on 23rd November 1962.
Mr. Norman Skelhorn, Q.C., the Recorder of Portsmouth, has agreed to hold the inquiry and the Secretary will be Mr. W. Middle mass. Any communication about it should be addressed to him at the Home Office. I shall publish Mr. Skelhorn's report.
Miss Bacon: Is the right hon. Gentleman aware that his decision to hold an inquiry will be generally welcomed in view of the very grave public anxiety which there has been about this case? Is he further aware that this anxiety was not allayed by the decision of the court not to hold another inquest and that, in fact, the anxiety was heightened by subsequent events at the West End Central Police Station? Could the right hon. Gentleman say whether or not Mr. Skelhorn will have all the power that he needs with respect to witnesses and the giving of evidence?
Mr. Brooke: I am grateful to the hon. Lady for the welcome she has given to my decision, which I think is the right one. I think that she will be aware that until the Police Bill, which is now being considered in Standing Committee, becomes law there is no statutory power to compel the attendance of witnesses at an inquiry of this sort. I think that that is a shortcoming and that is why I introduced the proposal in the Bill, but I feel quite sure that all those who can throw light on the matter will be willing to do so.
So far as the police are concerned, I can give an undertaking that they will appear and give evidence.
Mr. Fletcher: Will the right hon. Gentleman confirm that Mrs. Woolf will be able to be represented by counsel, if she so desires, at the inquiry and that her representative will be able to cross-examine any witnesses who give evidence?
Mr. Brooke: The hon. Gentleman will recognise that the question of legal representation will be one for Mr. Skelhorn, but I have no doubt at all that he will agree to Mrs. Woolf being represented. I think that she should be.
Mr. Swingler: May I thank the Home Secretary for responding to the request

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for an independent inquiry in the Woolf case? May I also ask him whether he will direct the attention of Mr. Skelhorn to the question of how it was that an injured man was held in custody and by hospital authorities for a period of nearly a fortnight without any action being taken to contact relatives or the next of kin?
Quite apart from the administrative failure, for which an apology has been issued, in the Missing Persons Bureau, will the right hon. Gentleman pay attention to the fact that no action was taken to contact the next of kin and see that the terms of reference of the inquiry are wide enough not only to investigate the police action, but also the action of the hospital authorities—the people at St. George's and at the Atkinson Morley?
Mr. Brooke: It is for Mr. Skelhorn, who is conducting the public inquiry, to say what is relevant or not. However, I can assure the hon. Gentleman that there is nothing in the terms of reference to exclude medical evidence of relevance to the inquiry. I hope that the House will agree that I should not respond to the hon. Gentleman's request and give directions to Mr. Skelhorn. It is far better, when I have taken this decision, that Mr. Skelhorn should exercise his own discretion.

MIDDLE EAST
Mr. W. Yates: I beg to ask leave to move the Adjournment of the House under Standing Order No. 9 for the purpose of discussing a definite matter of urgent public importance, namely,
"the immediate threat to international peace and security in the Middle East and to British interests, people and property in Aden and Jordan".
My first duty, Mr. Speaker, is to satisfy you and the House that the matter is, first, definite. I would have thought that the remarks made by the Secretary of State for Commonwealth Relations and for the Colonies this afternoon would have convinced the whole House that as far as Aden is concerned the matter is certainly definite, and that, as far as the report of the proceedings in the General Assembly of the United Nations is concerned, it is quite clear that that authority thought the situation was one which would threaten international peace
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and security. Therefore, there is a definite threat to peace and security in that area, and it is for that reason that the authorities in Aden have moved and have enforced emergency regulations.
As regards Jordan, I must, again, satisfy the House that the matter is definite. This can be done by referring to column 924 of Hansard of 19th June, 1961, where the then Joint Undersecretary of State for Foreign Affairs realized that the extraction of Jordan water by the Israeli Government without international agreement had inherent dangers. He said:
"Yes, I realise that there are dangers inherent in this question…",—[Official Report, 19th June, 1961; Vol. 642, c. 924.]
It would not be quite definite unless there had been a categoric statement of a threat from an Israeli Minister or a member of the Israeli Government, and, just in case there is any doubt that the threat is nut definite and real, it can be found in the statement issued in Tel Aviv:
"The Israeli Minister of Labour said last night that Israel would go ahead with her plans to pump water from the Jordan even in the face of Arab bullets."
That would appear to me to show that there is a danger of conflict and hostilities in the Holy Land at the present time. The threat is definite, and it involves Her Majesty's Government because of our signature to the Tripartite Declaration of 1950, which insists on the armistice being observed.
Secondly: is the problem urgent? It is obviously urgent. The House will rise tomorrow for the Christmas Recess, and if Israel carries out her threat there will be hostilities in the Holy Land shortly after Christmas—during the first week in January. I realise that by Standing Order No. 117 the House can be recalled, but I have never known the House to be recalled in such circumstances.
Thirdly: are these matters of public importance? Taking into account the fact that Ministers, and Commanders-in-Chief of the Arab armies are now meeting in Cairo, and are endeavouring to decide what action they will take towards Israel's threat of unilateral breach of the armistice agreement—[Interruption.] Hon. Members are wrong; there is only an armistice,

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guranteed by the United Nations, and by Great Britain, the United States and France.
In view of all these matters, Mr. Speaker, I ask you and the House—and I apologise to the Opposition, whose day I know this is—to consider that this is a definite matter of urgent public importance for us to deal with now. I do not like to think of going home for the Christmas Recess when there is this risk of conflict.
Mr. Speaker: The hon. Member asks leave to move the Adjournment of the House under Standing Order No. 9 for the purpose of discussing a definite matter of urgent public importance, namely,
the immediate threat to international peace and security in the Middle East and to British interests, people and property in Aden and Jordan.
I could not, on existing Rulings, leave that matter to the House. It is really couched in such general terms that it covers a whole range of countries and matters, and that would exclude it from the Standing Order.

BUSINESS OF THE HOUSE (SUPPLY)
Ordered.
That this day Business other than the Business of Supply may be taken before Ten o'clock.—[Mr. Hughes-Young]

ORDERS OF THE DAY

  SUPPLY
  [4TH ALLOTTED DAY]
  Considered in Committee.
  [Sir WILLIAM ANSTRUTHER-GRAY in the Chair]

  CIVIL ESTIMATES, SUPPLEMENTARY ESTIMATES, 1963–64
  Resolved,
  That a Supplementary sum, not exceeding £40,084,000, be granted to Her Majesty, to defray the charge which will come in course of payment during the year ending on the 31st day of March 1964, for the services included in the following Supplementary Estimates, viz.:

  Civil Estimates, Supplementary Estimates, 1963–64

  £

  Class II, Vote 6, Colonial Office

  1,323,000

  Class II, Vote 7, Colonial Grants and Loans

  954,000

  Class II, Vote 10, Central African Office

  2,785,000

  Class III, Vote 4, Scottish Home and Health Department (Civil Defence Services)

  212,000

  Class III, Vote 12, County Courts

  117,000

  Class III, Vote 13, Legal Aid Fund

  780,000

  Class IV, Vote 5, Export Credits (Special Guarantees, etc.)

  1,000

  Class IV, Vote 11, Roads, etc., England and Wales

  9,000,000

  Class V, Vote 8, Food (Strategic Reserves)

  270,000

  Class VI, Vote 5, General Grants to Local Revenues, England and Wales

  23,750,000

  Class IX, Vote 3, Public Buildings Overseas

  700,000

  Class XI, Vote 5, Supplements to Pensions, etc. (Overseas Services)

  192,000

  Total

  £40,084,000

  Resolution to be reported.
  Report to be received Tomorrow;
  Committee to sit again Tomorrow.

  NATIONAL HEALTH SERVICE
  4.25 p.m.
  Mr. Kenneth Robinson: I beg to move,
  That this House regrets the failure of Her Majesty's Government to adopt, in relation to the National Health Service, policies which would secure improved standards of service to the patient and permit the abolition of health service charges.
  It is, in a sense, unfortunate, though inevitable, that our censure, for that is what this Motion is, should fall on the Minister after his being barely two months in office, because we are complaining, not of the failure of a few months or even of a year or two, but of a continuing failure over 12 years, and of an attitude of mind that has persisted throughout the whole period of Conservative Government. Indeed, I think that the right hon. Gentleman, during his short tenure of office, has shown himself unusually receptive to ideas that have come from this side, and if he only had time, which he obviously has not, and if he continued to adopt Labour policies, he might even end up with a better record than any of his predecessors.
  I shall not dwell at length on the latter part of the Motion, because I am sure that my hon. Friend the Member for Cannock (Miss Lee)—who I am sure the whole House is glad to see sitting in her unaccustomed place—will wish to say rather more about it.
  The National Health Service was conceived as essentially a free service to the patient at the time of need. That is how it began. That is the kind of service that we on this side believe in, and that is the kind of service we intend to restore when we take over the government of the country. I only ask the right hon. Gentleman: will he tell us why, amid the shower of pre-election blessings that we have witnessed during the last few weeks, the sick have been omitted? Is it because the Government do not think that the sick, too, have a case, particularly at this time of year, or is it, perhaps, because of this basic difference between the two sides of the House on the question of National Health Service charges—a difference in political philosophy—which is one of the reasons why we shall divide the House?
  1466
  Nearly everyone associated with the National Health Service must know that all is far from well with it. Not only has the service to the patient failed to improve as it should have done, but, in certain respects, standards are deteriorating. Many of those who are working in the Service are getting steadily more disheartened, and we believe that, for this situation, much responsibility rests with the Government and successive Ministers of Health—right hon. Gentlemen who, in the past, have never seemed to see a critical situation approaching, and who have acted, when they have acted at all, only when the crisis was upon them, and usually toe late to make action really effective.
  I have a fairly good idea of what the right hon. Gentleman and the Parliamentary Secretary will do, because Ministerial replies in Health Service debates have become almost common form. The Ministers will drench us in figures. They will produce a large number of statistics demonstrating that we now have more doctors, more nurses, more physiotherapists, and more dentists than we had 12 years ago.
  It will be, as it always is, a calculated effort to lull the House into a sense of complacency and into a belief that there is nothing serious to worry about. I have no doubt that these statistics will be reasonably accurate, if, perhaps, somewhat selective, but they are really no answer to our charge. There is, of course, more of this and more that after 12 years I would remind the right hon. Gentleman and the House of the situation that existed when the Health Service came into being.
  What did the Service inherit when the Bevan Act became operative in July, 1948? First, it inherited a network of largely out-of-date hospitals. I believe that their average age was between 60 and 70 years. They were hospitals upon which only the absolute minimum of maintenance had been carried out over the previous ten years. It inherited an acute shortage of almost every kind of staff needed to start a Health Service and a medical profession divided and bewildered and whose perhaps natural anxieties in the face of change had been systematically exploited by sections of the Conservative Party and a handful

  1467
  of medical politicians in an effort to strangle the Health Service at birth.
  Indeed, that the Service was successfully launched at all was in my view, and that of most of my hon. Friends, due to the determination, the patience and the negotiating skill of one man, Aneurin Bevan. Would it not indeed be remarkable if we had not got more doctors, more nurses and more staff of every kind than we had in 1948? The first three years from 1948 were in the nature of a rescue operation carried out at a time when the national economy was still suffering from the ravages of the Second World War, at a time when we were still undergoing shortages of every kind. They were the years of make-do and mend, but despite the fact that very limited sums of capital were available to the Service it was a surprisingly successful operation.
  When Labour left office in 1951 the Health Service was poised for a great push forward towards the full realisation of the ideals upon which it was founded. But the Government changed and that thrust never came. Never since that time has the Health Service enjoyed under Conservative Governments anything like the special priorities which were accorded to it by the Labour Government that set it up.
  I expect that the Parliamentary Secretary or the Minister, who, I understand, is winding up the debate, will try to deny this and will point to the Hospital Plan, the 10-year building programme of which the Minister's predecessor was so proud and with which I think he hoped to wipe out all past sins of omission. We had our reservations about that plan which we expressed in debate on it in the House, but we welcomed it in principle. Indeed, we welcomed a number of reforms which the previous Minister, the right hon. Member for Wolverhampton, South-West (Mr. Powell), tried to bring in when we thought it was right. On those occasions, we supported him sometimes when political expediency might have dictated otherwise, but on the Hospital Plan we said, and I believe that it is no less true today, that the right hon. Gentleman always claimed too much for it. Somehow, he tried to oversell it.
  1468
  I want to try and put the Hospital Plan and the capital development of the Health Service into some kind of perspective today. At first glance, the size of the programme is formidable—close to £700 million over 15 years. It is perfectly true that compared with the pitiful hospital building record of the previous 10 years the programmes for the next 10 years are substantial, but let us look closer at this matter. Ten years ago capital expenditures on the Health Service and on the roads were roughly the same—about £20 million a year. Next year the capital expenditure on the Health Service will have gone up four-and-a-half times over the 1955 figure and will be about £91 million, but the capital expenditure on the roads will have gone up more than nine times over 1955, to £186 million, and it will be seen from the Government White Paper on Public Expenditure in 1963–64 and 1967–68, which was published yesterday, that the same kind of relativity will be maintained over the next four years, to 1967–68.
  The Post Office, next year, will get twice as much capital provided for it as will the Health Service. Education will get two-and-a-half times as much, and the electricity boards seven times as much. These figures, therefore, hardly suggest that the Health Service is receiving an over-generous share of the capital expansion that is taking place.
  We were told by the Prime Minister on the opening day of this Session, at the beginning of the debate on the address, that
  "…a new hospital is now being started every 19 days."—[Official Report, 12th November, 1963; Vol. 684, c. 41.]
  That statement, which is untrue, is now blazoned on Conservative posters all over the country. I am quite sure that the Prime Minister would not wish deliberately to mislead the House. I can only assume that either his arithmetic is a little rusty or that he failed fully to understand the brief with which he was provided.
  I have obtained from the Minister and the Secretary of State for Scotland the actual figures, and I am only helping the Prime Minister by including Scotland. The figures are that precisely 10 new hospitals have been or will be started during 1963. That is not one in every 19 days, but one in every 36½ days. I

  1469
  hope that the Prime Minister will apologise at some convenient moment for this inadvertent slip and, equally, that the Conservative Central Office will hastily cover up the posters which have been displayed and quietly pulp the rest of the stock.
  But patients and the public in general are rather more interested in hospitals that are finished rather than hospitals that are starting. They want hospitals they can make use of, and I should like to look at the whole record of the Conservative Government in this respect.
  If, in the 12 years 1951–63, they had been successful in starting one new hospital every 19 days we should be today better off by about 170 new hospitals. In fact, during those 12 years precisely four new hospitals and one dental hospital, without any beds, of course, have been completed in England and Wales. That is not even one in every 19 months. Scotland has done relatively better with four new hospitals, but they seem to be very small, because the total number of beds they represent is 475. I thought it worth putting the Prime Minister's statement in perspective and getting the facts on the record.
  I should like to turn now from capital to revenue expenditure. I think that some hon. Members, and certainly some people outside the House, have the impression that the National Health Service is an enormously expensive service. In fact, it costs just about 4 per cent. of our national income, and, again looking at the White Paper on Public Expenditure, it seems likely to remain at about that figure of 4 per cent. One would expect a Service which is comprehensive in a sense which is not true of the health service of any other Western country to cost a good deal more than others, but we have some I.L.O. figures—I think that they are the most recent available—which show that New Zealand, Norway, Canada, the United States and France all spend a substantially higher proportion of their national income—about 4½ per cent—than we do.
  The figures show, also, that Belgium spends slightly more than we do, and of the Western countries cited only Holland and Denmark spend less in terms of national income. One cannot see in those figures any justification for the financial straitjacket which was imposed
  1470
  on the Service about two years ago by the right hon. Member for Wolverhampton, South-West.
  We told the right hon. Gentleman at the time, protesting about it, that the 2 per cent limit which he tried to impose on hospital development could result only in either reduced service to the patient or postponement of essential maintenance—or possibly both. Hon. Members will know that, at that time, many hospitals had to cease the recruiting of nurses, and some had to close down wards for lack of staff. But the right hon. Gentleman seemed not to be impressed by the warning which we gave.
  Now, however, the chickens are coming home to roost. Official Ministry figures show that there was a fall last year in hospital maintenance of about 11 per cent. over the previous year, and figures which I have been able to obtain suggest that the fall in the current year will be nearer 15 per cent. over last year. What does this mean in actual terms? It means that there is no painting of the walls of hospital wards, the postponing of roof repairs, no replacement of defective window frames or worn-out flooring, and no replacement of worn equipment. For a hospital these are dangerous omissions or postponements.
  At last, this desperate situation has been acknowledged by the Minister He is now making a special allocation of money for 1964–65 designed to cover these arrears of maintenance. Of course, the trouble is that it is a totally inadequate sum even to catch up with one year's arrears, let alone to cope with the accumulated arrears of two or more yean;. This is something which has been happening all over the country, and the Minister or his predecessor cannot say that he was not warned in terms by this side of the House.
  I turn now to three Reports which have all been published in recent months, since our last debate on the Health Since. All are critical in tone, and all, I think, support, either directly or indirectly, the case which we are making against the Government and which is embodied in the Motion. The first is the AnnisGillie Report on the Field of Work of the Family Doctor, the Minister's own Report though,

  1471
  unhappily, not published as a Parliamentary Paper. The second is the Report of the Survey on Perinatal Mortality. The third is the Report on Food in Hospitals by the Nuffield Provincial Hospital Trust.
  Each of these Reports bears out our assertion that standards of service to the patient are unsatisfactory and in some respects declining. Each Report deserves a debate to itself because of its importance. In the time which I have, I must be content to deal only with the main features of each, and I hope that some of my hon. Friends will be able to expand on the points which arise.
  First, the Gillie Report on the general practitioner service. This is a remark able document. It discloses with unusual frankness for a Government report a picture of frustration, disillusion and depression among family doctors, feelings which are undoubtedly having the most serious effects on the Service and on patients. If the state of general practice is unhealthy, as all the indications show it to be at present, there will be repercussions on every branch of the Health Service because the general practitioner is the vital link between those branches.
  The Gillie Report unfolds a sorry tale, and the tale is very much confirmed by another document which I and, I think, some other hon. Members received this morning from the Medical Practitioners' Union entitled "Blueprint for the Future". The fact is that, after 15 years of the National Health Service, the general practitioner finds that his traditional rôle is radically changing and his new rôle is somewhat uncomfortable and ill-defined. He finds that his relationship with the hospital service is generally rather unsatisfactory. He finds that he can offer the better facilities which he would like to offer to his patients only at a direct cost to his own pocket because of the ridiculous system we have of reimbursing practice expenses on a capitation basis.
  In this connection, I am glad that the new Minister has, at last, come round to tackling the problem, after all the locust years during which his predecessor, to use his own words, found the
  1472
  problem a little baffling. It is early days yet, but I should like the Minister to tell us what progress has been made in the discusisons he has been having with the General Medical Services Committee of the B.M.A.
  The Gillie Report shares our view, which we have urged from this side of the House for many years, that the most satisfactory form of general practice for both doctor and patient is group practice. The present Government or, perhaps, more likely, the next Government will have to do a great deal more than has been done in the past to encourage and facilitate the setting up of group practices in urban areas.
  Above all, the Gillie Report echoes another charge which we have frequently made, that general practitioners are overworked, that they are too few in number and that their lists are too large. One inevitable result of this situation is that they cannot give the service which they want to give to their patients, and the other result is that recruitment in general practice is at a dangerously low level. It is alarming to compare the number of applications for practice vacancies now with what was happening ten or even five years ago. The Government's record on the whole subject of medical staffing throughout the Health Service during their term of office has been appalling. Far from trying to stimulate the training of more doctors, for a time they did the precise opposite and actually limited the entry of students into the medical schools. I think that the Minister will now admit that that was a very foolish action indeed from which we are now suffering.
  Mr. Geoffrey Johnson Smith: The hon. Gentleman is being a little less than fair in making that charge against the Government. After all, that policy was merely carrying out the recommendations of a Royal Commission, was it not?
  Mr. Robinson: No, it was not carrying out the recommendations of a Royal Commission. It was carrying out the recommendations of a Departmental Committee under the chairmanship of Sir Henry Willink, but Sir Henry Willink and Lord Cohen of Birkenhead have claimed that the Committee gave the wrong answer because it was given

  1473
  the wrong statistical information by the Government. The hon. Gentleman can sort out the blame as best suits him. I like to place it on the shoulders of the Government.
  In this connection, I was very interested to read an article in last Sunday's Sunday Times in which we were told that the new Minister was face to face with a crisis of medical staffing. The right hon. Gentleman is quoted as saying:
  "This is one of the most urgent decisions which has to be taken. We have got to make jolly sure that we have sufficient doctors to staff the new hospitals".
  I think that we can endorse that. But it is no new crisis. For years, it has been obvious that we needed more doctors, and, for the last three years, at least, we have pressed time and again for action to deal with a situation which was already serious and was fast deteriorating.
  The Sunday Times report goes on to say about the Minister:
  "He is also ready to admit the profession relies far too heavily on young trainee doctors from overseas, mainly India and Pakistan, to man junior hospital posts. They fill 40 per cent, of such posts on the average and in provincial non-teaching hospitals the average is 52 per cent."
  I understand that in the Sheffield region it is about 60 per cent. Here again his predecessor was warned, and I do not recall that we ever got any admission from the right hon. Gentleman the Member for Wolverhampton, South-West that he found the situation at all worrying. Indeed, there has been an atmosphere of frightening complacency about this question of medical staffing from the very beginning.
  I should like to ask why was nothing done long before this, and why have no new medical schools been planned yet. This is another issue that we have tried to raise, only to see it bounce from the Ministry of Health to the Treasury, to the University Grants Committee and even to the Robbins Committee. It is very difficult to see where responsibility can possibly be placed for the opening of a new medical school. There is a very real urgency about this because it will be more than ten years from the taking of a decision to expand medical education and establish new medical schools before the benefits accrue to the
  1474
  National Health Service in the shape of additional newly-trained doctors.
  There is no shortage of candidates, as hon. Members who read the correspondence columns in The Times today will see. There is a letter which states that two London medical schools have between 2,000 and 2,500 applications each for place; when there are, in fact, approximately 100 places available in each of the two hospitals. In other words, for each vacancy in the medical school there are roughly 20 applicants.
  Sir John Vaughan-Morgan: The hon. Gentleman is usually very fair. I think he will recognise that in some cases in the teaching hospitals people apply more than once.
  Mr. Robinson: I think that is perfectly true, but all the indications are that there would be no difficulty in finding suitable candidates for something like double the present number of medical schools. I hope that the right hon. Gentleman will be in a position to make some announcement during the debate about the setting up of new medical schools.
  I see in the Robbins Report, in a footnote, that the U.G.C. estimated that there would be a 25 per cent, increase in the number of medical students by 1980. We may well need more than that and need them sooner. I should like to know where these students are going to train.
  I turn to the second Report—the Perinatal Mortality Survey. I hope that other hon. Members will deal with this very important Report more thoroughly than I can. Very briefly, it shows that, although maternal mortality in child birth has fallen very satisfactorily in recent years, infant perinatal mortality has declined far less speedily. In actual percentages, it has come down from 3–8 in 1948 to about 3–1 last year. Statistics of this kind are apt to be very impersonal, but this means that there are three dead babies for every 100 women in childbirth. Put in another way, it means that some 25,000 babies per year are either born dead or die within a week of birth.
  According to the survey, a considerable proportion, perhaps 100 a week or more, of these infant deaths could be prevented. They could be prevented by

  1475
  better ante-natal care, by having more confinements in hospital, and, what is equally important, a better selection of high risk cases to go into hospital maternity beds. They could be prevented by closer consultant supervision, which means more consultant obstetricians, and, above all, they could be prevented if we had more midwives. If we are to avert these avoidable tragedies, we must have more hospital maternity beds.
  The right hon. Gentleman knows that his predecessor's hospital plan slipped up rather badly in its calculations for maternity beds. A hasty reassessment was made at the end of the first year, and my own guess is that even the revised figures will prove seriously inadequate. We must do something to induce more nurses to take up midwifery. I do not know whether it is still true—I believe that it probably is, and it certainly was a year or two ago—that a State registered nurse taking her midwifery course after registration,—it is, of course, optional—had to revert to a student's rate of pay while she was on the course. If this is still true, as I believe it to be, it is difficult to devise any more powerful disincentive to nurses taking up midwifery, I hope that something can be done about it, and indeed about the remuneration of midwives. It seems that in this society which has emerged after twelve years of Conservative Government the least rewards go to the most socially valuable members of the community.
  The last report that I want to refer to is the Nuffield Report on Food in Hospitals. I should like first to examine the credentials of this Report. It was a survey which was carried out by Professor Platt, who occupies the Chair of Human Nutrition at the London School of Hygiene, assisted by two lecturers in his Department. The method he used was to take a random sample of all types of hospitals in different areas of England and Wales. The total number of hospitals coming under survey was 152. Each hospital had one ward selected, also at random, and the catering arrangements were surveyed. In that ward a single patient's diet was studied for 24 hours and the survey team visited each hospital without prior notice. The findings of the Committee were endorsed
  1476
  by an advisory committee, comprising professors of biochemistry, epidemiology and medicine and a consultant who specialises in gastroenterology. It was presided over by a chairman of great experience in hospital work. I think no one can doubt the authenticity of this Report. What did they find?
  First, they discovered that the best food and the best catering were to be found in the smaller hospitals, particularly those with 60 beds or less, and that, in general, the larger the hospital the lower the quality of food, the lower the efficiency of the catering administration and the higher the percentage of waste. Their criticisms fall under three broad headings. The first refers to a low standard of hygiene especially in the ward kitchens. This is quite unpardonable. It makes nonsense of the hospitals' efforts to control cross infection. After all, there is little point in maintaining a high standard of cleanliness in a ward if we get in an adjoining ward kitchen the kind of unhygienic conditions described in this Report.
  The second criticism relates to the food itself. The members of this group found that there was an unsuitable choice of food of doubtful nutritional value. They found that there was poor preparation of it and poor cooking and that in most cases vegetables were overcooked to the point at which Vitamin C was lost to the extent of 75 or even 100 per cent.
  Lastly, they criticised something which will be familiar to any hon. Member who is or has been an hospital in-patient—the unattractive presentation of the food to the patient.
  These things, it was thought, were due to failures to make proper use of the dietitian in the hospital and to study a patient's normal food requirements and to cater for those and not some imaginary requirements that someone had thought up in an office. They attributed them to old-fashioned kitchens with out-of-date equipment and old, badly planned hospital buildings. Also, although this was not so much stressed in the Report, I think that they are largely due to the salaries and wages which the hospital authorities are allowed to pay to the catering officers and the cooks that they employ. On

  1477
  these wages it is impossible for the hospitals to compete with the catering trade or large scale industry.
  The third broad category of criticism refers to waste. The Report found that only 55 to 60 per cent, of the food prepared for patients in the larger hospitals was eaten and that the bulk of the rest went into the pig swill. I should like to quote a remark which came to me in a letter from a correspondent about his experience in a London teaching hospital. He said:
  "I suggested to Matron that she could save £1 a day"
  —in one ward alone—
  "by issuing out the food on an 'as required' basis. It was not well received. She said, 'We make money by selling the swill' ".
  He said that he
  "could not contend further with that sort of economics."
  At Question Time the other day the Minister seemed to think that the Press rather exaggerated the extent of waste and the money it represented. I will make my own estimate, and I think that it is a fairly conservative one. On the evidence of this Report, I think that the overall waste is probably about 33⅓ per cent. I agree that some waste is inevitable, but I would estimate that, of that 33⅓ per cent., about 20 per cent, is unnecessary. The total amount spent on food in hospitals is roughly£50 million a year. Twenty per cent. of this represents a potential saving of £10 million.
  The Minister of Health (Mr. Anthony Barber): As the hon. Member has been very fair, and as I shall not be speaking until later, I should like to say that I agree entirely with him that if we could avoid most of the waste which is avoidable we would save a considerable amount of money. I will not trouble to quote what I said in an Answer the other day, but the point which I was seeking to make was that there are some very old hospitals with appalling kitchens—I have been round some of them myself—which, nevertheless, produce pretty good food. In fairness to that type of hospital, I did not want to fall into the error of lumping it with the others where there is not the slightest doubt that there is room for considerable improvement and very great savings.
  Mr. Robinson: I am glad to hear the Minister say that, but I think that he will agree that the case is very fairly presented in this Report. It is acknowledged in the Report that some good catering is done even under very difficult circumstances. I ask the right hon. Gentleman to reflect on what he could do with £10 million to modernise these kitchens and even to increase the catering wages. In the past his Department has not paid enough attention to food, and I do not think it has been seized of the importance of this matter.
  I wish to quote the experience of a hospital at Kingston-upon-Thames, where, in 1951, the management committee began to discuss the idea of an experimental kitchen and dining suite. Eight years later, in 1959, the Ministry of Health experimental team visited the hospital and put forward a precise proposal for siting within the hospital grounds a truly experimental unit where every modern technique of catering could be tried. The hospital management committee jumped at this proposal and accented it on the spot. That was in 1959.
  In 1961, the Minister's predecessor made a public announcement to the effect that this experimental kitchen would be set up. Today, four years after the decision was taken to set it Up, the hospital management committee has not even seen the plans. However quickly people move now, this kitchen cannot be in operation for a further two years at best, which means that it will be about twelve years from the time that it was first mooted by the hospital management committee.
  I have spent some time on this Report and I make no apology for that, because meals and visitors are about the only things which patients in hospital can look forward to in the course of the daily hospital routine.
  I should like, in conclusion, to sum up our attitude. We believe that the National Health Service is still a great social service, although it has been damaged and diminished by Government policy over the last 10 years. We think that it is a service which has yet to realise its full potential for good. It is a service which is directed and staffed, in the main, by devoted men and women whose only wish is to see patients better

  1479
  served and better cared for, but their efforts have been met with frustration and disappointment over the years. The Minister, who is, I suppose, in a sense one of the largest, if not the largest, employers of skilled and unskilled labour in the land, should be a better employer than he is.
  Despite the pre-election spurt about which we have heard recently, we do not believe that the Tory Government will ever nourish this Service as it needs to be nourished, because, basically, it runs counter to their political philosophy. It is no coincidence that two past Ministers of Health, who happened to leave the Front Bench for the back benches together a week or two ago, wrote a pamphlet some years ago from which I should like to quote the following brief passage:
  "…the general presumption must be that they"—
  that is, the social services—
  "will be rendered only on evidence of need, i.e. of financial inability to provide each particular service out of one's own or one's family's resources. The question which, therefore, poses itself, is not 'Should a means test be applied to social services?' but 'Should any social service be provided without a test of need?'."
  To those who believe that, the National Health Service will always bean extravagant waste of Government resources. They will, as successive Conservative Governments have done, quietly stimulate and encourage private medical practice to the detriment of the public Health Service because they believe in the two-class system of medical care.
  We do not believe in that, and nor, I believe, do the vast majority of medical practitioners. This is why the National Health Service cannot be entrusted any longer to right hon. Members opposite, and this is why we shall go into the Lobby against them tonight.
  5.9 p.m.
  The Joint Parliamentary Secretary to the Ministry of Health (Mr. Bernard Braine): I beg to move, to leave out from "House" to the end of the Question and to add instead thereof:
  "welcomes both the considerable expansion of the National Health Service which has taken place in recent years and the further improve-
  1480
  ments which will be brought about by the policies of Her Majesty's Government".
  My right hon. Friend and I welcome this debate. It is right that attention should be focussed in this way upon our arrangements for promoting the nation's health. It is helpful to discuss freely and frankly the problems and difficulties which confront us in this field and to argue about the priorities which we should apply. We on our side are just as anxious as the hon. Member for St. Pancras, North (Mr. K. Robinson) to improve standards of service to the patient. Indeed, we can justly claim, as I hope to show, that not only have we been able to secure considerable improvements to the service in recent years, but we have for some time been engaged in a massive, comprehensive programme of development and expansion of which any country could be proud. It is unfortunate, to say the least, that the Motion makes no acknowledgment of the great improvement that recent years have seen in the nation's health, and it is unfair as well as wrong in its implication that the Government are failing to get their priorities right to the detriment of the patient.
  It might be helpful, therefore, if I begin by putting this matter in perspective. The truth is that whatever the imperfections of our arrangements, the British people are fitter and longer-living than ever before. [Interruption.] Many of the diseases which used to carry off young children and men and women in their prime have been checked or mastered, and I claim that our medical services are the envy of the world. [Interruption.]
  Before hon. Members starting interrupting on the subject, let us consider some of the facts. In the decade between 1951 and 1961, the average expectation of life at infancy rose from 66 to 69 years for a man and from 71 to 74 for a woman. Infant mortality has steadily declined, and in this we overtook the United States in the1950s. Similarly, there has been a striking fall in maternal mortality. I would be the first to say that none of us can be satisfied with the present figures. It is the fact that the number of mothers who die through child-bearing is little more than one-third of what it was only ten years ago.
  Mr. Richard Marsh: In fairness, since the hon. Gentleman has raised this argument, could not one make the same comparison and show the same improvements in comparison in almost every African State? Is it not a fact that Britain pays a smaller proportion of its national income on health than most other European countries?
  Mr. Braine: I listened with close attention and, I hope, courtesy to what the hon. Member for St. Pancras, North said from the Opposition. There were many moments when I could have risen to check some of his statements. I did not do so because I was anxious to hear what he said, whereas the hon. Member for Greenwich (Mr. Marsh) is not anxious to hear the case which I am deploying. [Interruption.]
  I want, first, to get the facts on the record. During the same ten years—and I do not know why hon. Members opposite should seek to denigrate—[Hon. Members: "Nobody is denigrating."]—these figures, because improvements in health, measured in terms of human happiness, are very substantial things—our children grew taller, sturdier and heavier. By 1961, the average boy of 14 was nearly 1 in. taller and 5 lb. heavier in weight and the average girl was ½ in. taller and 3 lb. heavier. Both of them were far less prone to illness than were their counterparts only ten years previously.
  Diphtheria and tuberculosis, once killers, have been brought under control. Deaths from diphtheria are now rare. Between 1951 and 1961, deaths from respiratory tuberculosis dropped by over 75 per cent. Deaths from polio have fallen from a yearly average of 481 in 1946–51 to 126 in 1956–61 and to a total this year of only 45. While only ten years ago absence from work due to tuberculosis caused a loss of 23 million days, this has been reduced to 9½ million days by 1961. These are all marked improvements. They are a reflection in part of a continuously rising standard of living. Better housing, better nutrition, better clothing and speedier educational advance have all combined to improve the nation's health and well-being. There have been striking advances in the diagnosis and treatment of disease, in the use of new and powerful drugs and in
  1482
  the application of new surgical techniques.
  The most exciting advances of all have been in the treatment of the mentally ill and the chronic sick. Perhaps I may be permitted to say that progress has come as much from attention to social factors and a growing awareness of needs as from the use of new drugs.
  I would not wish to suggest—and this is the answer to the hon. Member for Greenwich—that all these improvements are due solely to the National Health Service, and I would be perfectly ready to concede that other countries have registered marked improvements in their health standards over a comparable period. It is, however, the case, and I hope that hon. Members will agree with me, that the National Health Service has been the instrument whereby the benefits of modern medical science have been brought to bear more quickly, more effectively and more fairly to the whole nation and not just to one section of it.
  It is not surprising that Professor Almont Lindsay, an American social historian who made an eight-year study of the Service, has described it as one of the notable achievements of the twentieth century,
  "magnificent in scope and almost breathtaking in its implications".
  [Interruption.]
  Mr. John Hynd: Who opposed the National Health Service?
  Mr. Braine: Hon Members opposite must make up their minds what they are cheering. I reject, therefore, the suggestion of the hon. Member for St. Pancras, North that standards have not improved. Anyone who has had anything to do with our hospitals over the last ten years could not subscribe to that view.
  There have been substantial improvements in the scale of the services provided. In the last decade, the number of family doctors has increased and they have become more evenly distributed. Similarly, for every four hospital doctors, there are now five and there are 25,000 more full-time nursing staff and 32,000 more part-timers as well as 3,000 more full-time midwives and 1,100 more part-time midwives.

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  Having said that, I recognise that although a great deal has been achieved, much remains to be done. The reason for this, as the House will recognise, is that there is no finality, and there never can be, in the war against ill-health. Both medical men and lay administrators must constantly seek to devise ways of waging that war more effectively by doing things better and more humanely and doing new things that previously lay beyond their powers.
  Moreover, it should be recognised that we have to plan in the knowledge that the population pattern is changing. The nation is growing at both ends. More babies are being born and the elderly are living longer. In the last five years, more than ½ million more babies were born in Britain than might have been expected from the birthrate in the early 1950s, and it is by no means certain that this trend has reached its peak. In addition, over the next twenty years the number of those aged 65 and over will be at least 30 per cent, greater than it is today, while the number of those aged 75 and over will be 40 per cent. greater. This, of course, is obliging us to make greater quantitative provision in our health and welfare services for both young and old, and our other social services, too. It is spurring us on to raise standards as well. Indeed, as national prosperity increases, it is inevitable that the exceptional provision of today will become the commonplace of tomorrow. Since one or two things have been said, quite unjustifiably, about the philosophy of my right hon. Friends and hon. Friends on this side of the House, let me say that in our view that is as it should be.
  It is surely one of the marks of a civilised community that human beings matter, that the strong should be glad to help the weak, that we should strive to do all we can to reduce suffering and mitigate physical handicap and so to improve the quality of life and thereby enlarge the sum of human happiness. That is why it is so essential to get the priorities right now.
  As to whether we have been devoting adequate resources to health and welfare, I can only say that the proportion of the gross national product devoted to the National Health Service has risen
  1484
  from 3·8 per cent.—where it was when the hon. Gentleman's party left office in 1951—to 4·1 per cent. of a very much larger national income last year.
  Mr. K. Robinson: Would the hon. Gentleman also tell the House that after the Conservative Government came into power the percentage dropped to reach an all-time low of 3½ per cent. in 1955?
  Mr. Braine: That was a higher proportion and a higher figure in absolute terms than was the case when the Labour Party left office. In money terms we are spending more than twice as much today as when the hon. Gentleman and his party last had responsibility for the Service.
  As the House knows, we have embarked upon two massive long-term programmes—one for the development of the hospitals and the other for health and welfare services in the community.
  I am sure that it was right in the earlier part of the last decade to concentrate, as we did, on improving and staffing the existing hospitals. But by 1955 we felt able to embark upon the first post-war hospital building programme. In 1962 we launched the ten year plan which envisages the spending of some £670 million over the next ten years. This includes the building of no less than 151 completely new hospitals, the rebuilding of 138 others and the carrying out of nearly 400 major schemes of improvement.
  Already this great programme is well under way. So far, including those built before the plan was launched, eight completely new hospitals have been put into commission. A further 76 entirely new or substantially remodelled hospitals are now under construction. The pace is accelerating.
  Each year the plan is reviewed; where necessary new instalments are added. The first review took place last April and another £100 million worth of work was added. As the plan takes shape, its momentum grows. Many of our older hospitals are in the wrong places to serve existing populations. Some are ill-designed for the practice of modern medicine. Others are too small to carry all the specialist staff and services now required. Indeed, in recent years there has been not only a trend towards greater

  1485
  interdependence of the various branches of medicine but, happily, there are now many more specific remedies for a whole range of illnesses for which previously little could be done. Quick and accurate diagnosis is essential if these new treatments are to be used to the best advantage.
  That is why it becomes increasingly important to bring together in a single hospital the full range of facilities for diagnosis and specialist treatment. That is why we are aiming to provide large new general hospitals so sited that every part of the country will be served on a basis of 600 to 800 beds per 100,000 to 150,000 population.
  Admittedly, we should be on guard against making too many assumptions about the way in which the hospital service will develop, for if we look back over the last decade we can see that the pattern of hospital care has been changing quietly but continuously. Some of our hospitals, for example, have changed in use. Many more patients are being examined and investigated as out-patients rather than as in-patients. The average length of stay in hospital is decreasing due to changes in medical techniques such as the use of new drugs and the practice of getting patients on their feet earlier and also to increased facilities such as new X-ray departments and operating theatres. In the psychiatric and geriatric fields we have seen the establishment of day hospitals which are proving to be a most valuable development.
  However the service may develop in the years ahead we are faced, as the hon. Gentleman rightly reminded us, with certain immediate problems. In regard to these it might be helpful if I made known the Government's views and intentions.
  First, there is the general concern about the running costs of an expanding hospital service and the need to ensure adequate maintenance of existing buildings.
  Second, there is the special problem of maternity accommodation which has arisen, at least in part, from the somewhat unexpected but continuing rise in the birth rate.
  Third—the hon. Gentleman did not mention this, but it is of major impor-
  1486
  tance—there is the pressing need to reduce over-long waiting lists.
  As regards running costs, I want to make it plain that the Government are determined to see that the hospital service develops at the maximum rate consistent with the availability of resources.
  For some time we have been increasing our allocation of funds to the hospital authorities at the rate of about 2 per cent. per annum in real terms, and over the years this adds up to a substantial total increase. This is exclusive, of course, of the funds to meet increases in wages and salaries and certain other costs. Even that is not the full measure of the additional help available since, as might be expected, the hospital service itself is steadily improving the efficiency with which it uses its resources, and we should take this opportunity to give credit to it for its achievements.
  We are anxious to encourage this progress. I am glad to tell the House, therefore, that my right hon. Friends propose to assist the service still further next year by supplementing the additional funds which would ordinarily be available to the extent of a further £4½ million.
  We are, of course, well aware that a great deal needs to be done to improve the state of maintenance of many of our existing buildings. Accommodation is still in use which should be upgraded to a standard which patients today are entitled to expect. Some equipment, both medical and non-medical, needs to be replaced. We hope to get very shortly the hospital boards' proposals for the use of the additional funds in tackling these important tasks.
  I do not suggest for one moment that the money we shall be providing next year will be sufficient to meet all the needs that might be presented to us, but I expect it to make an appreciable impact and my right hon. Friend will certainly keep in mind what remains to be done when. considering his plans for the future. At this point I would like to make it plain that additional money will be allotted to hospital authorities to meet the cost of extra staff that may be required to permit shortening of hours of work.

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  I now turn to the special problem facing the maternity services. Our policy on this can be stated quite simply. It is that sufficient maternity beds should be available to enable every mother whose age or health involves a risk to her or her child at birth, to have the baby delivered in hospital.
  In drawing up the Hospital Plan we accepted the recommendations of the Cranbrook Committee on Maternity Services which, the House may recollect, calls for the provision of a sufficient number of beds to permit a national average of 70 per cent. of confinements to take place in hospital with a stay of 10 days after a normal confinement. In doing so, we were aware, of course, of two imponderables, which might tend to cancel one another out—the trends towards a greater rate of hospital confinements and to a reduced length of stay in selected cases.
  Nevertheless, as I have already said, flexibility is of the essence of the Hospital Plan and when we came to make the first annual revision last April, we were able to increase the additional 6,500 maternity beds by a further 1,200. With each bed able to deal with 30 or more births a year, these are substantial additions to the programme. We also have in reserve several thousand beds in hospitals due to be replaced and which, if the need should arise, could be kept in use.
  Besides the actual addition to the number of beds to be provided, boards have been asked to bring forward the starting dates of building schemes, to consider the temporary use of other beds in hospitals for maternity purposes (for example, for ante-natal patients), and to consider the provision of additional labour accommodation where this is a limiting factor in the maximum use of beds.
  My right hon. Friend is also about to send to hospital authorities, local health authorities and local medical committees a note which emphasises the need for local co-operation to ensure the best use of available resources and the planning of the arrangements to be made where, in particular areas, the services are working under strain.
  I feel, therefore, that the House will see that we have already taken urgent
  1488
  steps to help resolve this problem, and I can give an assurance that my right hon. Friend is determined to watch the situation closely and consider what more should be done.
  Mr. Maurice Edelman: The hon. Gentleman has just said that it is intended to make beds available for every maternity case for which they are suitable. But did not the Minister say to a maternal and child welfare conference this year that it was the Government's intention to provide beds for 70 per cent. of the potential mothers by 1972? Does that not contradict what the hon. Gentleman has just said?
  Mr. Braine: I think not. This is a very important subject and my right hon. Friend will be going further into it. He will be able to explain what was said on that occasion. I do not wish to sound complacent in the least. Like so many other problems in our Health Service, this situation must be watched closely. The arrangements we are making will bring a great easement.
  Mrs. Judith Hart: Clarification on this matter is very necessary. Did not we understand from the perinatal survey that a little under 50 per cent, of mothers had their babies in hospital? Did not the survey recommend that, in order to avoid avoidable perinatal deaths, the proportion should go up to 70 to 80 per cent.? Does not this mean that half as many beds again should be provided? Is that what the hon. Gentleman is undertaking to do?
  Mr. Braine: I think that the figure is higher than 50 per cent. I am anxious that the House should be satisfied that the arrangements we are making are adequate. My right hon. Friend when he comes to wind up the debate will deal with that point.
  Now I come to the question of waiting lists. These are regularly, and rightly, the source of criticism in the House and in the country. They must be reduced. There are bound to be waiting lists for less urgent cases, since truly urgent cases must be admitted without delay and hospital authorities must be able to determine the proper order of need when allocating their beds.
  It is only right that I should say here that my right hon. Friend the Member

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  for Wolverhampton, South-West (Mr. Powell) made a determined effort to get waiting lists reduced. The House may be interested to know what action has been taken. Last year we advised hospital authorities on the best ways of using, reviewing and preparing waiting lists. Last March we issued further advice on reducing surgical and general waiting lists and called for a concentrated attack. We suggested a variety of methods, all of which had been endorsed by the Joint Consultants Committee.
  These included more use of theatres at present partly idle by means of co operation between hospitals; transfer of patients, with their consent, to surgeons with shorter waiting lists; keeping patients in hospital for shorter periods; dealing with more as out patients and properly organising the call system so that substitutes are found for patients who, for one reason or another, cannot enter hospital when a bed has been found for them.
  Mr. H. Hynd: Is the Minister doing something to deal with the well-known habit of people jumping the queue by offering a 5 guineas fee?
  Mr. Braine: That sounds to me a highly improper practice. All I can say is that we are not neglecting any opportunity to bring home to hospital authorities our view of how waiting lists can be reduced. In fact, we urged hospitals to make reductions in waiting lists a major objective in the current year.
  Mr. James Dempsey: Are the Government taking effective action to deal with the problem caused by paying patients? In Lanarkshire, where there is a nine months' wait for certain operations, one can be dealt with within weeks if one is willing to pay. Is the Minister dealing with that situation?
  Mr. Braine: If the hon. Gentleman has evidence of something taking place which he regards as improper, I hope that he will send the details to me or to my Scottish colleague. As I say, we urged hospitals to make the reduction of waiting lists a major objective during the current year. How far these efforts have been successful we shall not know until the returns showing the figures
  1490
  of waiting lists at the end of this month are available and have been analysed. But I can assure the House that on every possible opportunity, particularly through professional channels, hospitals are being stimulated to reduce their waiting lists.
  I am sensitive to the feeling of the House on this subject. In all these matters, both now and in the future, we must never for one moment allow ourselves to forget that we are providing a service for people, for sick and worried people at that. I think that it is true to say that in recent years we have seen a growing and welcome recognition that the hospital service must cater not only for the purely medical needs of the patient but for his welfare generally, for clearly this has an important bearing on his recovery.
  Increasing attention, therefore, has been paid to all aspects of human relations in hospitals. Three examples spring to mind. First, the introduction of more liberal visiting arrangements, secondly, the provision of accommodation where mothers can be admitted with their sick children, and, thirdly, efforts to raise standards of hospital catering.
  The hon Member for St. Pancras, North was quite right to focus attention upon tie Nuffield Report on hospital catering, This is a most useful document. It sets out the difficulties fairly, it covers nothing up, it offers valuable advice as to how improvements can be effected, and it should provide, as my right hon. Friend said earlier this month,
  "…a further stimulus to hospital authorities to secure universally high standards".
  In fairness, however, it should be said that the Report was based on a survey carried out; between 1960 and 1962. Considerable improvements have been made since then and are continuing to be made. Indeed, the vital importance of improving hospital catering was yet another matter to which my right hon. Friend the Member for Wolverhampton, South-West gave his vigorous personal attention, in his address to the annual meeting of the Hospital Caterers' Association last April, he said that hospital food is an integral part of the patient's treatment. As he put it:
  "There is no more telling way of indicating to a person one's respect…for his personality

  1491
  than the manner in which one invites him to eat, and there are few matters in which people can be so sensitive or susceptible. The hospital service owes to its patients the same consideration that a host owes to his guest. 'Respect me, respect my food' is the silent injunction of the patient to the service."
  I think that the House would agree with that.
  Part of the difficulty has been the poor layout of kitchen accommodation in so many of our older hospitals. We fully recognise this. But at the time my right hon. Friend was speaking, no fewer than 12 schemes for the provision of new catering facilities in hospitals, amounting to over £800,000 and ranging in cost between £30,000 and £200,000 were in progress and many smaller adaptations and improvements were in hand.
  As to what is being done to raise the standard of hospital meals—the hon. Member for St. Pancras, North seemed to suggest that nothing was being done—the House might like to know that my Department attaches the highest importance to proper qualifications and training of hospital catering staff, and in this we have been greatly helped by the training courses provided by the King Edward VII's Hospital Fund for London. We provide hospital authorities with expert advice on all aspects of catering, and in January, last year, we published a handbook, which some hon. Members will have seen, providing up-to-date information and guidance on hospital diets, preparation and cooking of meals, costing, staffing, food hygiene and, above all, service to patients. I am sure that the hon. Member has seen it and equally sure that he approves its content.
  In the hospital building programme we are paying particular attention to the design and layout of kitchens and dining rooms. Our own Ministry design team is working at present at the hospital in Kingston-upon-Thames, to which the hon. Member referred, planning a model kitchen, dining room and store. This is a scheme which will reflect all that is best in modern thinking and practice on the subject and which will provide a practical example for hospital authorities of the standard at which they should aim.
  I should like now to turn to the equally important subject of the health and welfare services outside the hospitals,
  1492
  important because these are aimed at the prevention of illness or, if prevention is impossible, at care in the home and within the community. In planning an improved hospital service, we took into account the need for care being provided for all who did not require the specialised treatment which a hospital could give. We were concerned not merely to modernise the whole pattern and content of the hospital service, but to integrate it more closely with the general services which provide care and treatment outside the hospitals.
  Here the importance of the family doctor is self-evident. For the greater part of the population, the family doctor is the Health Service, providing, as he does, the patient's first line of defence against ill-health. My right hon. Friend will be saying something about general practice and the Gillie Report, but at this stage I want to say that it is of the utmost importance that hospitals should provide the family doctor with access for his patients to diagnostic facilities, especially in pathology and radiology. Our aim must be to ensure that, as need dictates, the doctor can call to his aid the supporting services—the home nurses, home helps, meals-on-wheels, health visitors—which it is the function of the local authorities and the voluntary organisations to provide.
  It is true that the Plan for Health and Welfare, which we published last April, is uniquely comprehensive, embodying as it does for the first time the proposals of all the local health and welfare authorities in England and Wales and setting out the aims and standards which should govern their development. But I doubt whether it is sufficiently realised to what extent the local authority services for the elderly, for mothers and young children, for the physically handicapped and the mentally disordered, have developed in recent years. Revenue expenditure on these services in England and Wales alone increased from £48 million in 1951–52 to £103 million last year, an increase of nearly 115 per cent. The rate of capital expenditure has been rising even faster. In the last four or five years, it has almost doubled. It will be about £19 million this year and next year is expected to rise to £23 million.

  1493
  This is the other side of the Health Service to which the hon. Gentleman did not refer, but this massive investment and expansion is part of the same picture, because the objective of a good health service should be to keep the sick person out of hospital or, if he has come out of hospital, to ensure that supporting services are so adequate that he does not go back into hospital.
  The first revision of the local authorities' long-term plans, covering the decade 1964–75 will soon be coming forward. That revision is now in progress and I hope that it will not be long before detailed proposals are in our hands.
  In the plan as it now stands, an increase of 45 per cent. in the numbers of trained staff is envisaged. We hope to increase the number of health visitors, social workers and home nurses by about 2,000 in each category, training staff for sub-normals by about 3,000, staff for residential establishments by about 10,000, and home-helps by more than 11,000. [Hon. Members: "When?"] This is over a ten-year period. [Interruption.] Hon. Members should wait. There is nothing terribly dramatic in these figures. It is true that they are large increases, but they should be capable of attainment because not only are the absolute numbers themselves not great, but the increases are in line with experience. There has been an increase of about 20 per cent. in the last five years. Training facilities are being rapidly developed. I am not surprised that the hon. Member for St. Pancras, North made no mention of these matters, but this is where progress is taking place at an extremely rapid rate.
  The Council for the Training of Health Visitors—[Interruption.] These are matters of the greatest importance to those people who need the supporting services outside the hospitals, and I hope that hon. Members will allow me to go on without interruption. The Council for the Training of Health Visitors and the Council for Training in Social Work, which were set up just over a year ago, are making good progress. A training council for the staff of training centres for the mentally sub-normal is in process of being constituted and will shortly begin work. The staffing
  1494
  of residential establishments is being studied by it committee, set up by the National Council of Social Service, under the chairmanship of Professor Lady Williams.
  The plans of the local authorities provide for capital expenditure over the ten years of some 4,000 new buildings, some of which, of course, will be replacements for existing buildings, costing altogether £220 million. In addition, new needs are likely to emerge, especially as local authorities press on with the closing of ex-Public Assistance institutions and provide more suitable and home-like accommodation for the elderly.
  Up to 1958–59, the figure for loan sanctions was averaging about £4 million a year. In the last three years, it has risen to an average of £15 million a year. As in the case of hospital building, the programme is already well under way. Last year, some 76 new old people's homes and similar residential accommodation, 64 clinics, 67 training centres and 21 hostels for the mentally disordered were opened. This year the same momentum has been maintained.
  In the last year, I myself have opened a number of these new buildings, and I want to tell the House what an inspiration it has been to see the encouragement that new purpose-built accommodation has given to devoted staffs and the pleasure and delight of old folk, whom one meets in the new homes, in the degree of comfort and privacy which they find there. On average, over the next ten years we shall be opening two to three new old people's homes, the same number of clinics, and one new training centre every week, and one new hostel for the mentally sub-normal and one new ambulance station nearly every week.
  Mr. Eric Lubbock: I am sure that we would all like to congratulate the progressive local authorities on improving facilities in the way the hon. Gentleman has described. Can he tell the House how the Government are to ensure that the improvements in Part III accommodation, home helps and home visitors and so on, are uniform all over the country? Is it not true that in some areas much better improvements than in others are being made?
  Mr. Braine: Of course, local authorities are carrying out these works—with Government help and approval. A substantial part of the money comes from the Government. [Interruption.] I sometimes wonder whether hon. Members are really interested in the subject. The hon. Member for Orpington (Mr. Lubbock) asked a question, to which I am endeavouring to reply. It is true that when we came to look at the plans submitted by 146 local health and welfare authorities there was disparity. The whole object of publishing their plans in juxtaposition was to bring home to them the fact that disparity in their provision existed. The first revision is now coming forward. We have no reason to believe that local authorities will be backward in revising their plans on a realistic basis to provide for their people in the years ahead a standard of service of which they can be proud. In the last year I have been engaged in many talks with local authorities on this subject, and I found them extremely alive to the need to raise their standards.
  Finally, I come to the key question raised by the hon. Gentleman, the future supply of doctors. Concern about this was voiced in last week's debate in another place on the Robbins Report, and again today by hon. Gentlemen. In 1957 the Willink Report recommended that the annual intake of British medical students to British medical schools should be 1,760. It was soon recognised that this figure was too low and should be increased, and in the last few years the number has risen substantially. In 1960 it was 1,788. In 1961–62 it was 1,896. In 1962–63 it was 2,047, and the improvement is continuing. Last October the entry was 2,153. Thus we can see, on this basis at any rate, a steadily increasing supply of doctors.
  We have been reviewing what more needs to be done and in this we have taken account of many factors. These have included the recommendations in the Gillie Report on the future of general practice, and on the larger part which family doctors should play in the hospital service. They have included the reports of hospital medical staffing which hospital boards have made in the light of the Platt Report, and these Reports are being studied with representatives of the profession.
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  In the light of our review, the University Grants Committee has been asked to advise my right hon. and learned Friend the Lord President of the Council and Minister for Science, as the Minister responsible for university grants, what provision should be made. The Committee has recommended that at least one new medical school should be planned, and that at the same time the possibilities of further expansion of existing medical schools should be examined. My righthon. and learned Friend has authorised me to say that he has accepted that advice, and that the University Grants Committee is considering the question of location.
  As the House will appreciate, I have not sought to deal with every point raised by the hon. Gentleman. He said that he would leave the subject of charges, which looms so large in the Motion, to his hon. Friends, and I hope that the House will forgive me if I follow the hon. Gentleman and leave that subject to be dealt with by my right hon. Friend.
  What I have endeavoured to do is to set out for hon. Members what has been achieved, and what we are planning to do. I do not claim that our arrangements for health are ideal, and that our plans are incapable of improvement. This, above all others, is a field in which we can never be satisfied, and where medical men themselves are certain that the morrow will bring fresh challenge. Many years ago a wise man said:
  "The ideal is never here, it is always over there; it is not an inn at which one can put up but a journey one must undertake."
  But I do claim that the record is one of solid achievement and real expansion, and that further improvement and expansion is possible precisely because the Government have got their priorities right, and that is why I feel justified in asking the House to accept our Amendment.
  5.55 p.m.
  Mr. Charles Morris: In the unhappy circumstances in which the vacancy in the Openshaw constituency arose, I wonder whether I might start today by paying a tribute to the late Member for the constituency, Bill Williams, who was respected and beloved on both sides of the House. I think that to him we can

  1497
  truly apply the words spoken by Pericles, 2,000 years ago, in his funeral oration for the Greeks who were killed in the Peloponnesian war. He said:
  "For the whole earth is the sepulchre of famous men; and their story is not graven only of stone above their native earth—but lives on far away, without visible symbol, woven into the stuff of other men's lives."
  It is fitting, and in keeping with the deep and abiding interest which the late Bill Williams had for those whom he represented, that today, in this my maiden speech, I should seek to direct the attention of the House to at least some of the health problems which affect the lives of the people of Openshaw constituency and the City of Manchester, of which they form such an important part.
  I should, perhaps, explain that the Openshaw constituency includes the delightful semi-rural Urban Dirstrict Council of Failsworth and goes on to cover the three wards Newton Heath, Bradford, and Openshaw which together form possibly one of the most heavily industrialised areas of Manchester. I think that one can accept what one distinguished correspondent of The Times said about the people of Openshaw during the recent by-election. He described them as "worthy and level-headed." I do not know whether that was before he knew the result or after, but I would endorse it, in any event. They are a particularly industrious people.
  The vogue in recent times has been for hon. Members to seek to determine which section of the community produces the nation's wealth. I would seek to advance the claims of the workers of Openshaw and the north of England. But as residents of a constituency and of a city where industry and atmospheric pollution abound, they seem obliged to suffer some health hazards to which I should like to draw attention.
  At this festive season of the year, with the advent of Christmas and its religious and joyous significance, it is, perhaps, appropriate that I should focus attention on infant mortality and address myself to explaining the shocking, indeed squalid, housing conditions in which so many people in my constituency are obliged to live. Of 19,000 houses owned by landlords, the local authority has determined that 7,400 have deteriorated to the state where the only
  1498
  solution is their complete demolition. That is the state of housing conditions in an area where infant mortality is a serious problem.
  My hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) referred to the question of infant mortality and the recent perinatal report. The right hon. Gentleman took pleasure in the fact that there had been a reduction in infant mortality in recent years, but I would refer him to an article in the British Medical Journal of Saturday, 7th December, because the pleasure which the right hon. Gentleman expressed—and which to some extent I share—is not entirely reflected in the contribution to this eminent medical journal.
  The article is headed "Too Many Infant Deaths". In the context in which the right hon. Gentleman spoke, it appears almost as an addendum. It says:
  "For some years satisfaction at the falling perinatal mortality rate has tended to obscure the fact that in Britain the rate is reported to be higher than in many countries with comparable living standards. In one list of 18 countries only five had worst rates than England and Wales and only Italy, Portugal and Japan showed rates worse than Scotland's."
  That is a situation which causes anxiety to many of my hon. Friends.
  But the situation is slightly more ominous than that, because whereas these comments were written against the background of an infant mortality rate for England and Wales of 20–7 per 1,000 births, the infant mortality rate in Manchester in 1962 was30–43 per 1,000 births. It was 0·59 higher than in 1961. I am mindful of the detailed study and the attention that is being given to this problem by the city's medical officer of health and the medical authorities generally, but I must draw the attention of the House to the seriousness of this problem.
  The Chief Medical Officer of Health for Manchester carried out a detailed study from which it has emerged that there seems to be no one single discernible cause for this unfortunate position. My hope is that the right hon. Gentleman will give consideration to the need for improve educational facilities for the expectant mother, because it seems that here is a reluctance among

  1499
  expectant mothers to start prenatal care early enough.
  I now turn to the problem of cancer in Manchester. The statistics for 1962 show that 2·42 per 1,000 of the population died of cancer in one form or another, compared with a rate of 1·68 per 1,000 for the whole country. Naturally, as a Mancunian, I therefore ask, "Why?" When we hear of so much public money being spent in many directions we question why the existing situation obtains at the Christie Cancer Hospital in Manchester. Many hon. Members will be aware of the high reputation that that hospital enjoys. It was no less than staggering for me to learn that of the funds available for research into cancer at this hospital, only 10 per cent. came from Government sources. The rest came entirely from private sources.
  I want, next, to refer to a health hazard from which I and all other city dwellers suffer. It is a peculiar complaint—almost a city sound. It is discernible when one listens to people talk who are obliged to live in cities. I do not want hon. Members to confuse this city sound with any other sound, such as the "Liverpool sound"—that delightful cacophony of noise made by our current entertainment idols. The sound to which I am referring is easily discernible, in the rather heavy nasal catarrhal intonations of the human voice, which seems to emanate from everybody living in a city.
  I hope that this problem of sinus, catarrh and nasal trouble will be tackled. I hope that the right hon. Gentleman will consider whether further research should be carried out into the problem.
  I want to quote from a speech made in this House by the late Member for Ebbw Vale, Aneurin Bevan, on 9th February, 1948. "Nye"Beyan—one of the most illustrious Ministers of Health that his country has ever had—in welcoming the coming into force of the National Health Service, referred to it as something
  "which offers comprehensive medical care and treatment and lays for the first time a sound foundation for the health of the people…"—[Official Report, 9th February, 1948; Vol. 447, c. 35.]
  1500
  People viewed the introduction of the National Health Service in different ways. I viewed it as a declaration of war on disease and the conditions which give rise to disease—a war where the only sacrifice asked of us was the acknowledgment that we are our brothers' keepers, and that we should have a willingness to accept the financial obligations involved.
  The foundations having been laid in 1948, I ask the right hon. Gentleman to have done with parsimony and financial stringency and the like, so that the great British medical profession to which we all owe so much can establish in these islands a health service which is not only the envy of the world, but which will develop and expand to meet the changing health needs of our people.
  6.9 p.m.
  Mr. Anthony Kershaw: The hon. Member for Manchester, Openshaw (Mr. C. Morris) has paid a moving tribute to the late "Post Office" Williams, as we used to call him, and I know that that tribute will be accepted by hon. Members on both sides of the House and by everyone in his constituency.
  I can assure the hon. Member that even people who do not live in Manchester get very nasty colds. Whatever The Times may have said about his constituents being level-headed and worthy, the House will judge from the hon. Member's speech that he is level headed, and I have no doubt that he will also prove himself very worthy of his constituents. I look forward, with pleasure, as I am sure do other hon. Members, to hearing from him again on numerous occasions in the future.
  I also wish to raise a matter which concerns my constituency rather more, perhaps, than the general ambit of the Health Service, although I make no excuse for so doing because I believe that this matter also has a bearing on the whole of the Service. This is not the first time that I have raised it. My hon. Friend the Joint Parliamentary Secretary will remember with a certain amount of pain that the last occasion on which we discussed the matter was at five o'clock on the morning of 26th June last. In case my hon. Friend has forgotten, I will remind him that the

  1501
  matter concerns the possible closure of three hospitals in and around my constituency at Tetbury, Berkeley and Stroud, and what will be the position if they are closed.
  I am sorry to say that since the debate in June the position has not improved. In fact, it has worsened. Since then we have had news that the casualty department at the Stroud Hospital, with 52 beds, is likely to be closed. I wish to make clear that neither I, nor anybody else, so far as I know, who is concerned in this matter opposes the whole pattern of hospital services set out in the Command Paper published in January, 1962. I agree, as who would not, that a large hospital of 800 beds is able to provide better equipment and in many ways better services than a smaller hospital. But I say that these great hospitals are not an adequate substitute in rural areas in general, and in the Stroud district particularly, for our present medical facilities.
  I will summarise my arguments, because I know many hon. Members wish to speak and the time for our debate has been curtailed. I believe that these great hospitals lie too far away from some areas—particularly the Stroud area—to be able adequately to cope with accidents for both medical reasons and industrial reasons, because of the time taken to get to diem. Secondly, large hospitals which are far away make visiting much more difficult and expensive. Thirdly, there is the problem of nursing. The small hospitals may be staffed adequately in almost every case at the present time by part-time nurses. But these ladies will not be available in a bigger hospital because they are not able to travel to the hospital in the time available to them.
  Although it is not the case everywhere, there are some very large hospitals where the standard of nursing provided is not the same as that which smaller hospitals provide. That is inevitable. It does not mean to say that nurses are less skilful, but that the organisation is more difficult to run. Recently, a constituent of mine in the Southmead Hospital after a motoring accident was three times threatened with a syringe containing the wrong sort of "wallop" and wielded by a young doctor or nurse. On one occasion, had
  1502
  she not been alert and refused the injection, the consequences might have caused serious trouble. This can happen more easily in a large hospital than a small hospital.
  Mr. Braine: It ought not to happen in any hospital.
  Mr. Kershaw: Yes, it ought not to happen in any hospital, but it can happen more easily in a large hospital than in a smaller one.
  Mr. W. A. Wilkins: Does the hon. Member recognise that in a hospital such as the one he mentioned, which I know extremely well, there is the problem of a lack of staff and the nurses are under extreme pressure all the time? There is, therefore, a great deal of excuse, and until we provide staff in numbers which are more adequate for such a hospital, there will be a liability for mistakes to be made?
  Mr. Kershaw: I take the hon. Gentleman's point and I agree with him. I say, without there being any fault on the part of anyone, that the difficulties are greater n a bigger hospital.
  Possibly the most important point relates to the general practitioner service at large hospitals. In a town the doctors can and, so far as I know, do attend the big hospitals. But in the country they cannot follow their family patients all the way to a hospital which may be 30 miles away. The doctors have not the time to do this. Their patients are taken away and dealt with without the doctor being au fait with the situation, which depresses their morale and the standard of doctoring. I believe that my hon. Friend would not disagree when I say that one of the main problems facing him today relates to the general practitioners. I believe that the local hospital is one place where the standard of medical knowledge and the enthusiasm of local practitioners may be improved and maintained.
  While I accept the pattern of the hospital scheme, I believe that in some areas it has to be modified. Local hospitals in rural areas should be kept open. In turn, I recognise that if I demand they should be kept open I must accept that extra expense will be incurred because large hospitals also must be built.

  1503
  Turning more particularly to the local problem, we knew in June last year that Stroud Hospital might be closed in due course if something better could be provided to replace it, and one could not complain if something better had been provided. But since that time we have been much disheartened to hear that the regional hospital board proposes to close the casualty department, with all that that means regarding the depression of the standard of the hospital, the danger that accidents may not be dealt with and the annoyance caused by the distance which visitors to the hospital may have to travel.
  A local committee has been formed to deal with this problem, headed by the noble Lord, Lord Robertson of Oak-ridge, who lives in that area. They sought and obtained an interview with the regional hospital board at Bristol, and were received most courteously. But I cannot do other than admit that, locally, there is a feeling that the strong enthusiasm for a local hospital is being entirely disregarded by the regional hospital board.
  The alternative set before us is that every facility will be available in Gloucester and Bristol. But, there are reasons, which it is perhaps a little invidious to state—though I feel it my duty to mention the fact—why, we are not entirely satisfied that the services available there at present are adequate to meet our needs. This is exactly the problem which faces other rural communities. Last week, a little boy aged 5, was knocked down in the street in Stroud at a quarter-to-four in the afternoon. He was taken to Gloucester and it was not until half-past one the next morning that his broken leg was set. There was no one to do anything for him. He was not given any drugs, although he was in great pain, because adequate medical staff facilities were not available. We cannot blame people if they ask why they should give up a hospital, which they trust and like for another hospital about which they have certain misgivings. It would seem sometimes that the regional hospital board, acting of course, under the guidance of the Government scheme, has a rather empire-building frame of mind.
  There is another institution, the physiotherapy centre in Dursley, where, I would
  1504
  have my hon. Friend know, I go for treatment for my lumbago. There facilities are available to industrialists and certain ailments may be treated which would mean many hours off work if the workers had to go elsewhere for treatment. We hear that this is to be closed down unless more help can be given from the regional board. I do not think that that is a reasonable course of conduct. Local people may be wrong, but they have not so much confidence in the way in which the regional board is running things at present.
  I plead with the Minister to take a long, hard look at the way things are going and decide whether 50,000 people, who live in the Stroud area—which is so typical of areas with hospitals in many of the rural districts of this country—are right or whether a few members of a regional hospital board, who disagree with them, are right. I know of no one locally who agrees with the hospital board. After all, this is a democratic service in which the voices of those who use the Service should be listened to. I ask my right hon. Friend to look at that matter most closely in future.
  6.20 p.m.
  Mr. H. Hynd: I promise that I shall not detain the House for more than five minutes. I want to follow a remark made by the hon. Member for Stroud (Mr. Kershaw) about nurses who have to transfer to other hospitals for training, because in my constituency there is a case to which I want to call public attention.
  The Minister will be glad to hear that, strangely enough, I am not criticising him. It is a case of a staff nurse at Victoria Hospital, Accrington, who wanted to extend her training in midwifery. For that purpose she terminated her employment at that hospital to go to Preston and gave notice that she would do so. Unfortunately, before she could do so she was taken ill and put off duty by the hospital doctor, as she was suffering from German measles. Because she was a patient in hospital she missed the course at Preston, but arranged with her own hospital to carry on there. When she recovered, after about a month, she carried on with her duties, but, believe it or not, the local hospital committee deducted her salary

  1505
  from the date when her original notice expired to the date when she actually resumed.
  The hospital management committee wrote to the Ministry for a ruling and the Minister replied, quite properly, that, technically, she had given notice, but he suggested that the committee ought to make a concession and that he would be glad to give further advice. That was a straight tip to the committee to be reasonable, but the committee turned it down. Incidentally, the regional hospital board made a recommendation to the same effect, but that was turned down. Since then, I understand the Minister has written to the committee suggesting that it should make an ex gratia payment. The committee met yesterday and, by a vote of 6 to 5 turned down the Minister's recommendation. This is absolutely disgraceful.
  At a time when we are trying to attract nurses and to get staff to give the best possible service as mentioned by the Motion this is just the sort of case which can have the worst possible effect on the morale of staff. I raise this case deliberately in this public way—and I am sure the Minister will be glad that I do so—to make the local hospital management committee thoroughly ashamed of its decision. I hope that the Minister will find some way of allowing this nurse to get her pay for the short period when she was ill.
  As I am well within my five minutes, Mr. Deputy-Speaker, perhaps I may be allowed one minute more in which to emphasise a point I made in an interruption. That is about patients being told that they may have an operation, but that they will have to wait for some months, or that if they attend hospital as a private patient they can have the operation next week. I assure the Minister that this is generally the case. I have had many complaints about it. When I raised this matter before the Minister asked me to bring forward a definite case and said that he would look into it. It is not easy to find a definite case.
  I have tried, with the co-operation of a constituent who needs to have an operation, to provide a definite case. This constituent went to his doctor and was told the usual thing. He asked the doctor for a receipt for the money and
  1506
  the doctor asked why he wanted a receipt. He replied that he wanted it for Income Tax purposes, but he did not get a receipt. Doctors are "too fly" for that; they do not give receipts. It is not easy to give details of definite cases, but every hon. Member will support me in saying that many people are told this formula. It is something which must be stopped.
  6.25 p.m.
  Sit Hugh Linstead: I followed with much interest the opening speech by the hon. Member for St. Pancras, North (Mr. K. Robinson). I understood why, for the purpose of this debate and as part of the duty of the Opposition, he found it necessary to underline the defects of the National Health Service, but I feel that from time to time it would not do any harm if this House were to look at the Service from the point of view of what it has accomplished and what it has to offer today, as well as looking at its defects.
  I, and I suppose other hon. Members, have had on occasion to speak in North America about the Service. There, I never have any difficulty in defending the National Health Service of this country, particularly in comparison with what is nationally available in Canada and the United States of America. It is probably true that in other countries those who can afford to pay for medical attention get better medical attention. Possibly they get quicker medical attention than is available in this country. But, if we are to make a proper comparison with what the National Health Service here offers we have to look at what it offers to the community as a whole.
  If we look over the whole of our Health Service we see that something is offered here which is superior for the whole range of the population to anything which can be offered in any other country. I am sure that when the hon. Member was putting forward his criticisms of the Service he was not seeking in any way to depreciate the great advantages that it has to offer in comparison with conditions which obtained before it existed.
  I want to discuss for a moment the proposal in the Motion for the abolition of charges under the National Health Service. As one who was in this House

  1507
  at the time when the Service was first introduced and remembers the Willink White Paper as well as the energy and enthusiasm of Mr. Aneurin Bevan, I was always sympathic to the original conception of a Service without charges.
  We have to face the fact that today the charges bring in something like £64 million a year. The problem a Minister of Health has to face in relation to those charges is whether, if he has that sum of money available to spend on the Service, that is the precise point at which he should expend the £64 million. When one listens, as one is bound to in a debate like this, to weaknesses in the Service being developed, to the need, for example, for more attention to be paid to mothers and children at the time of childbirth, one asks whether, if £64 million is available, the best place to apply that money would be in removing the charges. Personally I doubt it, sympathetic though I would be to that being achieved.
  We are bound to be realistic and to say let those who can afford to pay the charges pay them and let those who cannot afford to pay them be relieved of them.
  Mr. Denis Howell: How can one do that?
  Sir H. Linstead: I was about to develop that point, because I have a criticism to make of the present method.
  We are all aware of the National Assistance Board provisions whereby someone who cannot afford to pay out of his own pocket can obtain the money from the Board. In theory, that is a satisfactory method, but, in practice, it is not. I have no doubt that between the level at which the Assistance Board's help is applied and the level at which someone who is sick can readily afford the charges there exists a band of people in the community who are seriously affected by charges which they cannot afford. I am not saying that this is general. It would be a mistake for people who can afford the charges to be relieved of them, but the present method does not give the relief that should be given.
  I meet many pharmacists who tell me of the problems with which they are
  1508
  faced individually when talking to patients who collect their medicines or leave their prescriptions. The patients say, "I cannot get the money from the Assistance Board. I am doubtful whether I can afford, say, 6s. for three items. Will you tell me which one of the three I should take and which two I can afford not to take?" That is an intolerable position in which to place a pharmacist or anyone else.
  In chemists' shops, particularly in industrial areas, many stories of people being unable to take every item on prescriptions can be told. My right hon. Friend is fresh to his office and all of us welcome him there. I want him to believe that there is a case for further easing the Assistance Board's rules. We have not yet coped with this question of hardship.
  This is an occasion when I could briefly mention one or two features of the pharmaceutical service more closely, for I have been the secretary of the Pharmaceutical Society of Great Britain for many years, and, although I have nothing to do with the administration of the National Health Service or negotiations for remuneration, I am closely in touch with what the pharmaceutical service is doing. The one thing that is noticeable about the manufacturers, the hospital pharmacists and the pharmacists in general practice is that all three are at cross-purposes with the Minister. That is an unhappy state of affairs. Basically, it is a question of finance, but one does not like to see a whole professional group of people at cross-purposes with the one person with whom they should be working in the closest collaboration. I hope that we will not have an indefinite continuation of what is, in effect, a cold war that is doing no one any good, least of all the Service and its patients.
  We have had many discussions about the difficulties of the manufacturers with the Minister and I will not develop this facet of the argument. Something should be done to break the cold war in that sector. We have the most clumsy method of discussing the prices which the Minister pays to the manufacturers for the drugs they supply to the Service. The negotiations take place between the Ministry and the manufacturers, while the Treasury remains

  1509
  in the background. The Treasury takes its own part at second-hand in these discussions. The Public Accounts Committee and the Comptroller and Auditor-General also come into the picture, but again at second-hand, and at no point does the Public Accounts Committee, which is the most stalwart of the critics of the manufacturers, ever have the opportunity of meeting the manufacturers face to face and discussing directly with them the problems that worry the Committee.
  I would have thought that it should have been possible to devise some method—if necessary, by an alteration of the standing Orders of the House—whereby the Public Accounts Committee could directly call as witnesses the people whose conduct it is criticising so that it did not fall on the accounting officer of the Ministry of Health to defend or, if necessary, attack that group of people criticised by the Public Accounts Committee.
  The hospital pharmacists are at present about 25 per cent, below establishment. The answer which my right hon. Friend's predecessor gave was that the establishments represented an artificial figure. If so, it is high time that the establishments were redrawn and made realistic. The hospital service is being kept going only by the loyalty and public spirit of a comparatively small number of senior pharmacists. When they retire there will be a substantial gap in the hospital pharmaceutical service. It is said that recruitment is going well, but if that is so I doubt whether recruitment will be permanent, since a great deal of it is the recruitment of women who are likely to marry and leave the Service, at least for a time.
  The present feeling of hospital pharmacists is that they are a neglected section of the hospital service. Anything that my right hon. Friend can do to assure hospital pharmacists are not being left out in the cold, but that their position in the Service is recognised—and that usually means recognised by remuneration at the right level—will be very helpful to the service and him.
  Some years ago it was proposed that assistants to pharmacists should be used in the hospital service. The Ministry has issued circulars on this
  1510
  subject, but has never pushed this staffing conception home. A study within the Ministry of the possibility of the pharmacist being aided by skilled technicians might well help towards solving the staffing problem. This matter should not be neglected, for we are now in danger of a breakdown in the pharmaceutical service in some hospitals.
  The other day I came across a large teaching hospital which because of a shortage of staff, was buying its sterile injectable solutions. Anything more un-remunerative than carrying around large quantities of sterile water it would be difficult to imagine. The cost of having those sterile solutions made at a distance and sent by a firm to a hospital is so substantial that the cost of paying for a pharmacist scarcely enters into the picture in these circumstances.
  The grievances of the pharmacist in general practice probably date back to the time when a swingeing cut in his remuneration was imposed by the Minister and when, at the same time, a claim for increased remuneration was rejected. I will not argue the merits today, but the speed with which that was done and the effect it had on the standard of living of pharmacists was substantial and it is that which has soured the relations of that group of people in the pharmaceutical service.
  I suggest that the Minister has some responsibility for the general practice of pharmacy. His Department is inclined to take the chemist's shop as it finds it, but my right hon. Friend's responsibility is deeper and wider than that. He should not be content with using the chemist's shop merely as a convenient way of getting his medicines distributed. Because of historical necessity, the chemist's shop in this country has had to base a great deal of its economy on the sale of things that are not pharmaceutical, and the pharmacists themselves dislike it intensely.
  Unfortunately, that helps the Ministry—the Ministry sees its overheads spread over a larger range of things sold—but, basically, I do not believe that it is right that pharmacists should be required to subsidise the National Health Service by sales of completely non-pharmaceutical products, it divides the interests of the proprietor, it divides the interests of the

  1511
  staff, it spoils the atmosphere of the business by turning it into a purely commercial atmosphere, and it encourages the public to regard drugs as ordinary articles of commerce instead of, as we are learning more and more nowadays, as things to be taken with great care and attention. I am sure that the result of my right hon. Friend's just accepting the chemist's shop as he finds it is that he is inhibiting the development of professional pharmacy as we would all like to see it, and as it is, for example, in Scandinavia.
  I therefore ask my right hon. Friend to say that he is interested in the future development of pharmaceutical practice in this country. I should like to see him, in any action he takes, particularly in regard to remuneration or the question of contracts with executive councils, encouraging the development of professional pharmacy, and discouraging the reliance the pharmacist now has to place on his other commercial activities. I believe that, somewhere in the Ministry, inquiries are now going on into the possibility of comprehensive legislation on medicine. If, when those inquiries are completed—during the next Parliament, perhaps—a new piece of pharmaceutical legislation is brought forward, I urge that it be not only legislation dealing with poisons, but legislation dealing with medicines, and to help pharmacy develop professionally in pharmacies, just as it has in the hospital and manufacturing branches.
  It is a weakness in the National Health Service that the three sections of the pharmaceutical service—the manufacturer, the hospital and the pharmacist in general practice—are all at cross-purposes with my right hon. Friend. I hope that he will consider that position seriously, and will feel that he has some obligation to try to improve his public relations with pharmacy. In that way. he will render a great service to his own National Health Service.
  6.43 p.m.
  Mr. Laurence Pavitt: The hon. Member for Putney (Sir H. Linstead) always interests the House when he talks of the drug industry and its relations with the National Health Service. Although he has made a number of constructive proposals, I submit that—although in the most cour-
  1512
  teous way, as is customary with him—he has supported our Motion in saying that the Minister has failed to adopt policies in connection with the provision of drugs that would benefit the Service. I agree very much with the hon. Gentleman that the National Health Service is second to none, but we on this side do not regard that as a ground for complacency. Although we are proud of what has been done, we believe that Ministerial failure has prevented the greater achievement we think is possible.
  The hon. Member referred to the £64 million raised in increased charges. When that charge was made in February, 1961, the whole basis was that it would satisfy the grand new ten-year hospital plan. In 1961–62 we spent £30·8 million, and in 1962–63, £35·5 million, but if my calculations and those of the hon. Gentleman are correct, the Exchequer took in nearly £200 million in the last three years. The main purpose of the prescription charges was to raise £12½ million in a full year towards that £64 million. We think that there has been a great gap between all the promises and professions of this and the previous Minister and what is being done in practice. The Parliamentary Secretary said that the Government were now, at this late stage, very much in favour of the idea that the strong should help the weak, but nowhere is that idea so much stood upon its head as in these prescription charges. The average person sees his general practitioner 5·5 times a year. If the person is over 65 or under 5 years of age, he sees his general practitioner ten or eleven times a year. That means that a person over the age of 65 pays twice as much in prescription charges as the person in middle age, and so does the man with a large family.
  The more sick the person, the more he pays. If it is only a matter of a bottle of cough medicine once a year, he pays 2s. 0d., but if the trouble is a colostomy or he is a diabetic the cost is probably 10s. or 12s. each fortnight. The Parliamentary Secretary may talk of the strong helping the weak, but this is not working out in practice, because the weaker the person the more he pays to help the strong.
  The extra charge for welfare foods raised only the paltry sum of £1¾ million. After that decision was taken,

  1513
  a number of my hon. friends tried to find out how it worked. In questions about their own constituencies which ranged throughout the country, they found that there was a 60 per cent. drop in the take-up of cod liver oil, Vitamin A and orange juice for babies. There was an immediate drop; but I wanted to know what had happened in the years since then. I found that, in my locality, 10,790 bottles of cod liver oil were being taken up before the charges were imposed, but that the figure had dropped during the following six months to 3,779 bottles. We have risen slightly since then, and in the last half year the figure has risen to 4,582 bottles. That is still less than half the amount taken up before the charges were raised. The same applies to the other items.
  This has happened at a time when more babies are being born—the Parliamentary Secretary has referred to this fact which has recently been called a "birth quake". The index has risen from 100 in 1957 to 138 in 1962 in the area covering my constituency. That being so, we cannot see how the Government's policy has succeeded in helping the weak at the expense of the strong, for while more babies are being born, only half the 1961 take up of welfare foods takes place. In industrial areas, areas of difficulty, areas of acute housing shortage, problem families and social difficulties make these welfare foods essential, to ensure some balance of diet.
  I want to follow the point made by my hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) on the effect of the 2 per cent, straitjacket put on the hospital service. We have had this large scheme for spending between £700 million and £800 million by 1975, but Ministry circulars have informed the hospitals that their revenue estimates must not exceed 2 per cent. those of the previous year.
  In the first circular in 1960 it was made clear that the 2 per cent. applied in real terms to 1961–62 allocations, which included the cost of increments to staff on salary scales, though it is true that since then there has been some let-up in that respect. This was repeated in the second circular and again in the one issued on 14th September, 1962. Although the pay pause
  1514
  seems to have been relaxed for almost everyone, it has not been relaxed for the hospital services, with the result that the approach to hospital management is basically wrong because financial considerations come first and needs are made to fit in with those considerations. Is this done for administrative convenience because it is a handy form of commitment merely to give a figure of 2 per cent. whereas in fact in one area it shot Id be much more whilst in another area, the hospitals might be able to manage with less? Maintenance work has been deferred and deferred again, and there is now an accumulation which must be met if we are to succeed in returning to proper standards.
  Two-thirds of most hospital budgets deal with staff pay, which means that when budgets are confined within this rigid 2 per cent. straitjacket there is no room for manoeuvre, except of maintenance which thereby suffers. In spite of easement on pay increases which enables the hospitals to have a little more freedom, the Minister has failed to provide any alleviation in two categories. No addition was made in respect of extra leave given to the nursing staff, with the result that hospital committees have had to cut into their funds to meet this cost. No allowance has been given for extra staff needed as a result of the reduction in hours worked by those already employed by hospitals.
  There has been no mention of what is to happen about price increases if the 2 per cent. rate is to continue and we are still to have this Treasury approach to the Service. The Minister should instigate research into the cost index of hospitals and should check prices to find out whether a 2 per cent allowance can be fitted into sound business management. Heavy increases are being made in local authority rates. There are increases in the Metropolitan area water rates and large increases in the cost o: electricity. If these costs rise by more than 2 per cent. a hospital management committee will find itself having to try to cope with an impossible situation with deferred maintenance having to be put off again and again until events ally it is too expensive to be undertaken, or too late.
  I presume the £4½ million mentioned by the Parliamentary Secretary will deal

  1515
  with such matters as provision of furniture, fittings, surgical instruments and appliances and current building maintenance, but in terms of backlog and assessed need is this considered adequate, or is it to be said that a sum of £4½ million is available and the hospitals must try to fit their programmes into it? By seeking to put all the emphasis on the capital programme for new hospital building we believe that the Minister is leaving behind a legacy of maintenance work on existing buildings which will have to be cleared up by the next Labour Minister of Health. This is a failure to do what is considered to be normal in any well-managed household or business concern.
  I should like to draw the attention of the Minister to some of the problems which his policies have failed to tackle or even touch. The first is that of the 18 people who, during the time covered by this debate, will die from lung cancer. A total of 26,383 died last year, and 72 die every day from this disease. At a time of year when the Minister of Transport cannot get to the television screen too quickly to tell us about the 7,000 killed on the roads, which we all deplore, why cannot the Minister of Health be equally active about the three times bigger problem of the people who are dying of lung cancer? In Willesden 30 people died in 1950, according to the medical officer of health. In 1962 the number was 78. In our local hospital in 1958 there were 141 lung cancer patients. In 1962 the number was 169 and of all the cancers now treated in hospital in my constituency a quarter are lung cancer cases.
  The annual report of the medical officer of health for Middlesex shows that cancer and coronary disease were last year again the two largest causes of death in Middlesex, accounting for 40 per cent. of those who died. What steps is the Minister taking to meet this great problem? The right hon. Gentleman cannot even stand up to the Advertising Council which refuses to put up his posters designed to discourage young people from smoking.
  I received a letter only this week from a consultant physician of my local hospital in which he asked me if anything can be done to draw the attention
  1516
  of the House and the country to this great problem. He gives the example of Mr. X who died last week and says:
  "He smoked thirty cigarettes a day until shortly before he died. He had started smoking at the age of 14 and it is my belief that cigarette smoking was the cause of his death. He leaves a young wife and six children between the ages of 18 months and 9 years."
  I do not know how we can get these human facts home. We talk a lot of nonsense about having the strong will to put a cigarette down, or there is the kind of Boy Scout approach that it is manly not to smoke; we take an attitude and then defend it, instead of the Ministry dealing logically, scientifically and effectively with this problem.
  The Parliamentary Secretary raised the question of waiting lists at hospitals and the efforts made to deal with them. As he said, emergency cases are admitted quickly, but I should like to know from the Minister how soon he expects to receive the report, which has been mentioned several times in the House, on steps taken to reduce waiting lists and what effect the returns which he expects on 31st December will have on his action.
  I should also like to know what policy the Government are pursuing on the question of part-time and full-time consultants, which is fundamental to the problem raised by my hon. Friend the Member for Accrington (Mr. H. Hynd). Is the Minister's policy that there should be whole-time consultants, or are we to continue with the nine-elevenths arrangement? In view of the fact that the right hon. Gentleman is examining the Platt Report, I should like to know what he proposes to do about the bottleneck in the supply of consultants which is the main cause of delay in admission, and the fact that it pays a consultant not to have another in his specialty because he would share fees for the available private patients with him. It is no use giving us phrases about looking after the weak or earnestly considering the problem. The right hon. Gentleman should now be presenting a solid policy to the country.
  There are many other subjects which I should have liked to mention had there been time. There is the question of the health authority services and the place of welfare, and there is no time now to go into the Gillie Report. The

  1517
  Minister talks about the general practitioners being the keystone of the Service, but he has left this Service as the last to consider and even this last report is not issued as a Government report. Do the Government intend to consider the implications of a number of the Gillie recommendations, and will the House have an opportunity of debating the whole subject of general practice? In view of the seething unrest in the medical profession, will this matter be one of those things which somehow or other never sees the light of day?
  Tributes have been paid, as in the fine maiden speech of my hon. Friend the Member for Manchester, Openshaw (Mr. C. Morris), to the way in which the foundation of the Health Service was laid against a background of terrific opposition, and was laid so soundly that in spite of the attempts to nibble it away, and in spite of the philosophy put forward in a famous pamphlet in 1951 by the right hon. Member for Wolverhampton, South-West (Mr. Powell) and the right hon. Member for Enfield, West (Mr. Iain Macleod), the present editor of the Spectator, we have achieved, as the hon. Member for Putney has said, a marvellous Service. But that foundation should be the starting point which now gives us the opportunity to go further, not only in the three sectors, but to establish an occupational health service and to start a drive with new initiative to cure some of the modern killing diseases. So much could be done, for instance, about bronchitis, which causes 31 million lost working days each year. We are fed up with the promises of the Minister. Instead of promises for the future, let us have some policies today which will lead to positive results.
  7.0 p.m.
  Mr. Geoffrey Johnson Smith: I hope that the hon. Member for Willesden, West (Mr. Pavitt) will not mind if I do not follow him closely in his discussion of lung cancer and other matters. In the short time which I intend to take, I shall discuss the work of the general practitioner, but what I have in mind arises not so much out of what the hon. Gentleman said but out of what was said by my hon. Friend the Member for Stroud
  1518
  (Mr. Kershaw) in drawing attention to the future of the small hospital within his constituency and the cottage hospital generally.
  It may surprise my hon. Friend and other Members from rural constituencies that I, who represent a constituency within which many of the big teaching hospitals are situated, should express concern about the future of the smaller hospital. I do so because I take the view that the small hospital has a future inasmuch as it provides, or could be made to provide through the growing development of our health and welfare programme, a suitable place for the general practitioner to work, and, more than that, it can within the terms of the Hospital Plan and the Health and Welfare Plan for the next 10 or 15 years, have a tremendous part to play if its buildings are used for the provision of special services.
  Perhaps my hon. Friend the Member for Stroud and others like him who are worried about the possible closure of smaller hospitals do not fully realise that there may be a valid case for using these hospitals for a different purpose. In Other words, although a small hospital may not be closed, it may quite properly continue to exist though not in its present form. In this connection, I hope that my right hon. Friend will be able to give hon. Members on both sides the sort of assurances which I think we want about the future of this type of hospital.
  In paragraph 25 of the Blue Book, A Hospital Plan for England and Wales, after reference to the need for new district hospitals comprising 600 to 800 beds to be provided, it is said:
  "But many small hospitals will still be needed. Some will be retained as maternity units…Others will provide long-stay geriatric units Others again, where a local population is remote or inaccessible, or where isolated towns receive an exceptional seasonal influx of visitors, will continue to admit medical emergencies which do not require specialist facilities."
  One can see a use for such hospitals in those ways. The paragraph points out, also, that some of the small hospitals will be needed where patients can go as out-patients, the idea being that out-patient services will be provided there.
  What is suggested in that paragraph of the Hospital Plan does not indicate

  1519
  to me that the small hospital will necessarily continue in its present form, but it does indicate that, if the plan is to be properly developed as envisaged, those who fear that such hospitals will be closed and left empty or put to another use could have their fears put at rest if the Minister would emphasise the intention as outlined in that paragraph.
  I believe that an assurance from my right hon. Friend is necessary. Like other hon. Members, I do not have much time to look at television—
  Mr. Denis Howell: Because the hon. Member is on it.
  Mr. Johnson Smith: No, not because I am appearing on television, because I have no time for that, either. However, the other evening I did take a little time to look at Panorama. That evening, Panorama showed one of its special reports—a good sort of newspaper trick—about what is wrong with our hospital service. It took the example of a particular cottage hospital, quoting the views of various people who are very anxious about the possibility of its closure. An eminent member of the medical profession, whose name escapes me for the moment but who represented the views of general practitioners, said that he would be very disappointed if the hospital were closed, that its closure would be a crime for the neighbourhood, and so forth.
  Towards the end of the rather frightening story which was unfolded, we began to learn that the possibility of the hospital actually being closed was not likely to be discussed for about 10 years or so, and, moreover, it did appear in due course, though rather fleetingly, that these discussions would be without prejudice, and, in all probability, the hospital might be kept open.
  Nevertheless, that television broadcast was not an isolated example of the fears which people have. One has seen similar views expressed in the Press and elsewhere, and I believe that there is here a cause for considerable concern, not only in such places as the constituency of my hon. Friend the Member for Stroud but in many other parts of the country.
  1520
  I suggest, therefore, that it would be a most timely use of the opportunity of this debate if my right hon. Friend were to reassure people throughout the country that there need be no fear of wholesale closure of small hospitals and that they will continue within the pattern of the Hospital Plan to provide very useful medical services for their neighbourhoods. Not only that, the smaller hospitals can provide for the general practitioner the opportunities which many people feel are all too frequently denied to them.
  As I understand it, what is envisaged—here, I think, some people may, perhaps, be disappointed—is that such hospitals will not necessarily close but people may have to become accustomed to the idea that they will change in terms of their actual use. This is why I drew attention to paragraph 25 of the Hospital Plan which envisages that small hospitals could be turned into maternity units, long-stay geriatric units, and so on.
  Looking at the possibilities in the light of the welfare plan generally, not just the 10-year Hospital Plan, it seems to me that the function of the small hospital can be of very great importance in the development of the community services which are so vital within the scope of the National Health Service as a whole. Therefore, if it is decided to change the use of a particular small hospital, the decision, instead of being viewed in isolation, could be seen to be a progressive move for the benefit of general community care in the neighbourhood.
  That is all I have to say on that wider point. I turn now to two matters which arise more particularly in London. The first concerns the general practitioner. We have had the Gillie Report and other reports, articles have been written in the Press, and much has been said generally about the rôle of the general practitioner not only in relation to the opportunities he has or should have for access to hospital, but also in relation to the better facilities which all hon. Members are convinced that he needs if he is to carry out his duties more effectively and efficiently. One hears a good deal said about better conditions for group practice and better ancillary services.

  1521
  The sooner some of the ideas mooted in the Gillie Report and elsewhere are implemented, the happier I shall be, but one must admit that it may be some years before they are implemented on as wide a scale as one would wish. A question arises, therefore, with reference to the general practitioner in London. The London general practitioner receives the same emoluments as his colleague anywhere else. Whenever it has been suggested that there ought to be some sort of London weighting allowance to take account of the increased cost of rent and other matters connected with his circumstances in London—one knows how important these things are—the reply has always been, "No, that would not be fair to general practitioners elsewhere. The rural doctor may not have such a large list of patients as the London doctor, and he does not have quite the same opportunities as his big city colleague for taking on other jobs in hospitals, such as consultant posts."
  I suggest that this does not really hold good to quite the extent suggested. The complaint now among general practitioners in London is that they have extreme difficulty in getting the same access to hospitals as used to be open to them some years ago. There are not the requisite number of consultancies available and it is not as easy as it was in the past for them to augment their income to take account of the increased cost of practising in London. Therefore, I ask my right hon. Friend to comment on the suggestion that in the interim period, before we are able to implement the suggestions of the Gillie Report and others, further consideration should be given to the possibility of introducing the principle of London weighting for general practitioners in London.
  My second more local point, although it may have a wider interest, arises from another report which has not so far been quoted in the debate and which is one of the least known of the various reports concerning the medical services of this country. I refer to the recently published Report of the Committee of Inquiry into the Recruitment, Training and Promotion of Administrative and Clerical Staff in the Hospital Service—or, more succinctly, the Lycett Green Report.
  Many of us are concerned with the general overall efficiency of hospital
  1522
  management, and there have been a number of criticisms about its shortcomings. This Report makes a series of suggestions designed to improve the training and general standard of efficiency of the administrative side, the non-medical side, of the Health Service. So far as I know, it is held to be a good Report. I have not seen any criticism of its recommendations.
  Hon. Members on both sides of the House will know that one of the factors having a bearing on the standard of recruitment is the remuneration that a person can expect if he wishes to embark on a career of administration in the National Health Service.
  The Lycett Green Committee was not allowed to discuss this particular subject, because it was not within its terms of reference. I should, therefore, like to make a point concerning this aspect. Anyone who knows anything about hospital management must be convinced that one of the most onerous and responsible posts is that of group secretary of a hospital management committee. I remind hon. Members of the relevant grade definition in this Report:
  "A Group Secretary: the principal administrative officer, responsible for the administration of the group of hospitals and for the work of the Committee. This officer may be medical or lay, but, if medical, should not be engaged in clinical work."
  The group secretary's salary ranges from just over £1,000 to a maximum scale of just over £3,000. The minimum scale is £1,125 to £1,382 per annum. How can it be possible to get anyone of sufficient calibre and with sufficient qualifications to undertake a tithe of the responsibilities as set out in the Report if such salaries are to be paid? I again refer to London because it is the area that I know best, and the financial aspects of living in London are well known. It seems to me that, if we are to have this Report implemented and improve the efficiency of the overall administration in the Health Service and of the hospitals particularly, it is essential to increase the salary scale of people who carry out such onerous duties, because only in that way shall we be able to get people of sufficient calibre to come into the Service.
  Let me come to another point which affects this particular aspect at the other end of the scale. I come to the

  1523
  question of the remuneration of a secretary who comes within the ordinary clerical grade officers engaged in clerical and related duties which may include the handling of particular matters of minor importance not clearly within the scope of defined instructions, and so on.
  Such a person, at the age of 16, if he wishes to come into the service, would enjoy the princely salary of £278 rising to £445 at the age of 21. Many of the post-graduate teaching hospitals are trying to compete in this very important field for people in the clerical grades and I submit that this put an almost impossible burden upon them. It is extremely difficult to get people to engage in this sort of work when the salary cannot increase beyond £445 at 21, although there is a maximum scale which allows such people to enjoy a salary up to £696. I could go through the various grades, but I have chosen one at the top and one at the bottom which cry out for swift re-examination.
  I should like to wish my right hon. Friend well in his new post. I think that he has made a good start by his reaction to the pleas of the general practitioner and I feel that he is in a fortunate position because he follows in the footsteps of a man whom the British Medical Journal recognises as being one of the finest Ministers of Health that this country has ever had. I have a great appreciation for the tremendously valuable work carried out by my right hon. Friend the Member for Wolverhampton, South-West (Mr. Powell). After all he is the man who put his hand to this Hospital Plan, and to the Welfare Plan, both of which have his personal imprint. That is why I pay tribute to him.
  7.18 p.m.
  Mr. Charles Grey: I hope that the hon. Member for Holborn and St. Pancras, South (Mr. Johnson Smith) will forgive me if I do not take up his remarks, because, in the interests of brevity, I want to confine myself to one specific issue—the shortage of doctors.
  It was put to me some time ago that during the recent Indo-China dispute it was said that if Nehru had called in all his doctors from this country our hospital services would not have been
  1524
  able to carry on. That is the plight that this country is in. The blame for this position entirely rests with the Government. The Willink Report has been mentioned and my criticism of the Government is that while it was fair that they should have the Report they were far too long in discovering that a 10 per cent. cut in the number of medical students was a bad assessment. When we take into account the 10 per cent. cut in the number of medical students recommended by the Willink Committee we have to measure this alongside the fact that today we are so short of doctors that we have to rely upon 3,760 doctors from abroad to fill the vacancies.
  In addition to this, we have the Robbins Report, which estimates that by 1981 we shall require a further 3,000 medical students. Further, when the House realises that it takes about six years to train a doctor, it will understand the country's plight. This is a situation which demands immediate remedial action. Even if we start now to train doctors it will be six years before the first one qualifies. My hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) said that it would not be possible to get the first doctor inside 10 years. If we do nothing about this now, we can imagine what this country will be like by 1980.
  I have mentioned the Robbins Report and said that by 1981 we shall require an additional 3,000 medical students. It is said that six or seven new medical schools will be required to cater for this number of students. This information comes to me from a reliable source, although several figures have been mentioned. We hear from the Parliamentary Secretary that all that is proposed is one new medical school. It is shocking that we should be recommended to accept this. I am sure that the hon. Member has not read the Robbins Report.
  Mr. Braine: I am sure that the hon. Member would not wish to misquote me. I said that the University Grants Committee had been asked to advise my right hon. and learned Friend the Lord President of the Council, as the Minister responsible for university grants, what provision should be made, and it recommended that at least—and I emphasise "at least"—one new medical school

  1525
  should be planned and that, at the same time, the possibility of further expansion of existing medical schools should be examined. My right hon. and learned Friend has accepted that advice.
  Mr. Grey: That sounds a bit better, but the point is that we are to get only one new medical school. He could have put it to the University Grants Committee that one was not sufficient. I hope that he will consider this point.
  I am sure that the House will forgive me if I put the case for Durham, which I often do when I speak in the House. We must get the position in focus. Regions suffer in differing degrees, and it is because of that that I want to put the case for Durham. Durham University has lost its medical faculty, not because it has lowered its standard, but simply because the universities of Newcastle and Durham have been separated and the faculty has gone to Newcastle. I could stir up many emotions about this, but all I will say is that it is to be regretted that the Durham medical degree, which had become internationally famous, ceased to be awarded after1st August this year. I will cot enlarge on the sentimental side of this argument, because the factual side is even stronger.
  Not one, but at least half a dozen medical faculties are wanted. They should be properly spread throughout the country, and for this reason I want to put in a claim for Durham. One of my hon. Friends said that in Birmingham about 60 per cent. of the students are from overseas. The North-East is so badly off that 51 per cent. of the junior hospital staff are doctors from overseas. It is not without significance that the British Medical Association has stated that there are strong tendencies for young doctors to settle in areas near to the medical schools in which they were trained.
  No matter how good Newcastle is now—and it is good—or will be in future, it is absolutely impossible for it to produce all the doctors required in the North-East. The B.M.A. has also noted that there is great difficulty in filling positions in the industrial North. It recommended—and I hope that the Parliamentary Secretary will note this—that new medical schools should be silted in the industrial North. That is not a
  1526
  plea from me, but a statement of fact by the B.M.A.
  It is estimated that, by 1981, the population in the Northern region will have gone up from 2,875,000 to 3,300,000. I quote this because of a statement which appeared about a month ago in one of the medical publications—I believe it was the Lancet—which estimated that what was needed for setting up anew medical school was an administrative and geographical area of 1½ million people. On this basis, Durham qualifies for a new medical school, and I can find to better argument in favour of this proposition than the fact that there will be that increase in population by 1981. This is further proof of the fact that, with the best will in the world, Newcastle University cannot possibly provide all the doctors which the North-East needs.
  This argument for a new medical school for Durham is no emotional spasm, because it goes back as far as 1935, when a Royal Commission considered this future development of Durham University There was a committee in 1952 which considered the matter. The members of that committee included the Earl of Scarbrough and Sir Edward Collingwood. If the people who sat on the Royal Commission in 1935, or who served on the committee in 1952. had been able to look into a crystal ball and see the position as it is today, they could not have been more dogmatic in favour of Durham having a new medical school.
  I know that the hospitals come into this matter. We have been promised a 1,000-bed hospital. The sooner we get it the better, because we need it. However, surrounding the university are some hospitals which could work in a kind of network system. These hospitals could be adapted for such a purpose. I would much prefer the Government to announce that they are going ahead with the 1,000-bed hospital. But if we cannot have that, let us at least have the other thing which we need—the medical school; and. as I have said, we could use existing hospitals until the new one is built.
  Durham University itself is backing this proposal with the support of Durham County Council, Durham City Council, Durham Rural District Council, the local

  1527
  branch of the B.M.A. and many other organisations of people not only in Durham but throughout the country. Durham is a grand old cathedral city and the university is ideal for undergraduate medical education. It is in a picturesque setting. Behind it lie hundreds of years of fine scholarship. What more could one wish for a medical school? Durham would also be very suitable from the point of view of residence for students, because all the local authorities will back efforts to see that there is sufficient residential accommodation. I hope that the Minister will favourably consider this request, because if he does he will earn our gratitude.
  7.32 p.m.
  Mr. Daniel Awdry: I hope that the hon. Member for Durham (Mr. Grey) will forgive me if I do not follow his arguments about Durham. My knowledge of it is limited. I come from the South and that is a nice place, too.
  I have been present throughout the debate and am the third hon. Member to say something about cottage hospitals. I do not apologise for referring to them again, for this shows the depth of feeling that exists on this topic. I realise that my hon. Friend the Member for Stroud (Mr. Kershaw) has already made some of the points to which I want to refer, but I am glad to reinforce some of his arguments.
  I understand that the main concept of the Hospital Plan is to concentrate all facilities into these large, district general hospitals. This is bound to mean the elimination of a great many smaller hospitals and such a large-scale operation is bound to lead to a certain amount of amalgamation.
  But a large proportion of the threatened hospitals are staffed by general practitioners and are an integral part of general practice. They are not out of date or old-fashioned, and I wish to put in as strong a plea as I can for their salvation. I am thinking most particularly of the Bath clinical area, where I live, but the principle applies to many other rural areas as well.
  The Bath clinical area is one of the best in the country, because the large number of these hospitals in the area has raised the standard of work done
  1528
  by general practitioners and consultants. To close these excellent hospitals would be a retrograde step. There are four arguments, in my view unanswerable, in support of my case. Some were touched on by my hon. Friend the Member for Stroud.
  First, the smaller hospitals were started by public-spirited men and over the years have been sustained and maintained by the generosity of local people. Local feeling runs very strongly about them and if these hospitals are to be closed there will be a storm of protest.
  Secondly, my hon. Friend the Parliamentary Secretary said that there was a tendency to increase visiting facilities in hospitals. That is obviously good for patients. But what is the use of such facilities, if a hospital is to be moved 20 or 30 miles away from the place where many patients live? I suppose that it could be argued that relatives and friends could travel to see them, but that would involve expense just at the very time when the family finances are at the lowest ebb. I believe that hardship will be caused if people have to travel these distances.
  Thirdly, these hospitals give an excellent opportunity for discussion between general practitioners and consultants. New methods of treatment are discussed, anaesthetics are administered and there is opportunity for the general practitioner to keep up to date with operating theatre techniques. I am sure that all medical authorities will agree that we should encourage greater liaison between general practitioners and specialists. It will be extremely frustrating for the keen family doctor if, in future, all hospital patients are to be taken 20 or 30 miles away, where he will lose touch with them.
  Finally, only a very small number of patients are sent on to the general hospitals. The larger proportion merely need good nursing under their own doctor who, of course, knows far more about the background of the patient and his or her family than anyone else. He can thus give a very much better service than the specialist who has no personal knowledge of the family. The Annis Gillie Report says, in paragraph 172:
  "These particular hospitals play a great part in maintaining the high standard of general practice in the rural areas, and even if substitute facilities are provided for the

  1529
  general practitioners in the district hospitals distance may well preclude the rural general practitioner from using them."
  The Report follows this with the recommendation, on page 48, that
  "Many hospitals in rural areas staffed by general practitioners and visiting consultants should be retained."
  It would be a very great tragedy if these hospitals were extinguished.
  Mr. Dempsey: What type of medical cases are treated in these cottage hospitals?
  Mr. Awdry: A great variety. As stated in the recommendation, they are staffed for the day-to-day work by general practitioners and visited by consultants. Ordinary medical cases are dealt with by the ordinary family doctor and these include the simple types of operation. Specialist cases, of course, must go further away.
  We all tend to pay lip-service to general practice and, as the Gillie Report points out, 90 per cent. of all medical cases are treated by general practitioners. The fact is that the general practitioner deals with what is usual in medicine while the consultant deals with the unusual.
  Not long ago a survey was carried out by the College of General Practitioners. A large number of doctors were closely questioned about their attitudes to their profession. They answered a detailed questionnaire and about 80 of the replies were carefully analysed. The doctors questioned were mainly in their mid-30s or early 40s, were nearly all family men with children and all had been in practice for 15 to 20 years.
  Just over 25 per cent. were quite happy with their conditions of work. At the other end of the scale, nearly 25 per cent. said that they did not at present enjoy their work. If we look into the matter more closely we find that their dissatisfaction falls under three main headings.
  First, I sincerely believe that there is a need for a greater feeling of team spirit throughout the National Health Service. Some of these dispirited G.P.S feel that perhaps they do not matter because so much emphasis is given to consultants. I hope that my right hon. Friend will stress that it is the Government's policy that the family doctor service should be maintained as the back-
  1530
  bone of the whole of the medical health service.
  Secondly, I ask my right hon. Friend to see that greater access is granted to ordinary general practitioners to normal X-ray equipment and pathological services in hospitals. This comes out in the Annis Gillie Report, in paragraph 156, and the principle is accepted by the Minister. But it is not implemented in full. Not all general practitioners have access to X-ray departments, and in that way the local doctor loses contact with his patient and a great deal of time is wasted.
  Finally, there is the question of remuneration. I do not want to become involved in detail, but if the family doctor is to do his job properly we must remove from him worries about whether his family can enjoy a reasonable standard of life and whether he can have reasonable premises and equipment to carry oat his job.
  This was brought very forcibly home to me last week, when I was discussing a case with a local general practitioner. He had been called out in the middle of the night to sew an ear on a man after it had been bitten off by a horse. It was a nasty, difficult job, and it took an hour and a half in the middle of the night, and it had to be done well. He calculated that his remuneration for the operation, after deducting his expenses, was 2s. 10d.
  To maintain a competent body of family doctors, we must consider increasing their general level of remuneration, and do it soon.
  7.41 p.m.
  Mr. Maurice Edelman: The hon. Member for Chippenham (Mr. Awdry) began his speech with a plea for more beds, and to that extent I have to support him.
  I turn more specifically to the question of the maternity services, in connection with which two extremely valuable reports have recently been published. One is the General Perinatal Survey and the other in the Report of the Maternity Services Emergency Committee of the National Birthday Trust Fund, both of which deal with the appalling fact that today three children are born dead or die every single hour. This should engage the attention of the House very closely.

  1531
  It has been stated that the perinatal mortality rate in England and Wales is relatively substantially higher than in many other countries in Western Europe and certainly the United States. When the survey was made, the figure was established at 32·9 of every 1,000 live births. I believe that since then the figure has declined. The fact remains that it has to be compared with 26 in Sweden, 27·2 in Switzerland, 23·9 in Norway and 29·6 in the United States. Perhaps I may make reference to my constituency. Coventry is a city with a relatively high standard of living. Nevertheless, the perinatal mortality rate is at the high figure of 32·4.
  It is well known to many of us that infants are being born in what can only be described as Dickensian conditions—conditions in which there is no hot water, where asepsis is absent, and where the infant born under domiciliary conditions is born in a manner which makes it inevitable that we have this extremely high rate of mortality around and during the time of birth.
  It is true that the mortality of mothers in childbirth has substantially declined. That is due in great measure to the development of antibiotics and other drugs which counter infections and thereby make childbirth easier. Yet the fact remains that because children are being born in circumstances where midwives and doctors do not have access to equipment and other means by which the life of the child can be saved, we have the appalling situation which exists today.
  The recommendation of the Emergency Committee should be inscribed as the motto for the Ministry for the next ten years. The Committee's central recommendation was that:
  "sufficient beds should be made available in fully-staffed hospitals or wards to enable every mother whose age or health involves a risk to her child at birth to have delivery in a hospital where specialist care and equipment is available in case of need."
  That is not a very academic concept. It is a very relevant consideration, a consideration of equipment. The Survey and the Emergency Committee's Report have established that of the children who are born dead or die shortly after birth 30 per cent, die from asphyxia. My medical colleagues will no doubt confirm the statement in the Report that if adequate
  1532
  equipment and experience in the doctors or midwives were available for resuscitation the number of deaths in those circumstances could be substantially reduced.
  I asked the Minister a question to which he did not give me a satisfactory answer. He suggested that it was the Ministry's intention within the foreseeable future to provide a hospital bed for every mother who sought one. He stated that as a principle. That seemed to me to run counter to what was said on behalf of the Minister at the Maternal and Child Welfare Conference in 1963, that even the existing hospital building programme undertakes to provide hospital delivery for only 70 per cent. of the mothers of the 900,000 children who will be delivered in 1972. In other words, there will be a substantial shortfall in the availability of hospital accommodation for mothers without even taking into account the exceptional increase in the birth rate. The importance of all this to the mother is that only in a hospital can the specialist care be made available which is necessary in order to reduce the high perinatal mortality rate.
  We must all accept that there is a great shortage of obstetric consultants. A point which might have been brought out during the recent Commonwealth immigration debate is that but for the fact that there is a considerable number of Commonwealth consultants engaged in obstetrics today, the lack of consultants would be even greater than it is. But accepting the present situation, since 1955 the number of consultants has risen by only 1·84 per cent. although the number of births has risen by 10·9 per cent. Therefore, there is a very great problem.
  As we all know, the problem has been tackled by emergency measures. If my hon. Friends who represent Bradford had been present, I would have congratulated them on the way in which Bradford has tackled the problem by what is known as the Bradford scheme of short-term release from hospitals so that the mother, having had her child delivered in hospital, can return home for the remainder of her confinement. Here is a specific way in which the Ministry can help. There is a £6 confinement grant. If the mother goes into

  1533
  hospital under the short-term emergency scheme, she forfeits the £6. Many mothers who at home may lack domestic help and the attention which they would get in hospital are reluctant to go to hospital to obtain the advantage of specialised attention and equipment because they fear that they will be deprived of the grant. Therefore, I ask the Minister urgently to consider whether if a short-term release scheme is operated it would be possible for the Ministry to give at least a proportion of the grant to the mother so that when she is at home she can engage proper domestic help.
  I turn from that to the question of midwives. We are all agreed that the midwifery service is outstandingly good and that the midwife is the queen of the confinement period. Because of the circumstances in this country, it is the midwives who do the greater part of the work. The problem remains, however, that in 1962, of 78,000 midwives who were consulted, only 18,000 said that they intended to practise. This reveals a serious situation.
  One of the reasons why the midwives are reluctant to practise is simply because the status of the midwife has not been maintained at a level which is consistent with the important and valuable work which the midwives do. In the past, for example, the midwife had a bicycle. Surely, in the context of contemporary living, the midwife should be provided with a motor car, especially in view of the number of jobs which she has to do. There should be opportunities of promotion and advancement for the midwife. I hope that the Minister will consider the whole question of promotion inside the midwifery service.
  There should be a grade of midwife-matron to which the ordinary midwife can aspire, otherwise it seems to the midwife that, unlike the nurse, her prospects of personal advancement are blocked. The status of the midwife should be raised, and so also should her salary. Only in this way will it be possible to get large numbers of women to return to this honourable profession.
  The position today is that not enough money is being spent on the maternity services. There have been enormous advances in equipment to obtain the advantages of analgesia, there have been
  1534
  great advances in anaesthesia and modern portable equipment has been developed, yet it is true to say that these resources are not available to the midwife in the course of her domiciliary visits.
  The technique of training midwives, although greatly advanced, has been criticised by the Emergency Committee, not in any sense derogatory to the mid wives themselves, but simply because there are modern techniques which could be taught to midwives but which are not being taught. There is the question of episiotomy, something which every midwife is capable of learning, studying and practising. In these specific ways it could, and should, be possible to reduce the perimortality rate of infants.
  It has been asked how the money which is necessary for these purposes is to be made available. I am sorry that the hon. Member for Putney (Sir H. Linstead) is not present. I listened to him with great regret when he was defending the making of prescription charges. He said that they were necessary to make money available for other purposes. With his close knowledge of the pharmaceutical industry, the hon. Member might well have applied his attention to reducing the price of drugs. Here, surely, is a direction in which a great deal can be done.
  In 1949, when the late Aneurin Bevan introduced this splendid National Health Service, the cost of prescriptions issued under the National Health Service was £30 million. In 1962 it was £83 million, and this despite the imposition of prescription charges. In other words, the Minister who introduced prescription charges, instead of attacking the drug companies and their methods of high pressure sales, chose to attack the patient, the poorest, those who could least afford the burden.
  If there are any improvements today in the National Health Service, if there is expenditure which is being attributed to worth-while purposes which, I am sure, the Joint Parliamentary Secretary has in mind, the fact is that the people who pay for it are not the drug companies, who could pay for it, but the poorest patients, who certainly cannot afford it. Here is something which could be tackled. It is true that some Ministers of Health, of whom we have

  1535
  had several, have made various gestures of shaking their fists under the noses of the drug companies, but all that has been disclosed about the proceedings of the drug companies has come from independent sources.
  For example, that excellent journal Which?, the journal of the Consumers Association, which recently investigated the price of aspirin tablets, showed that prices of identical forms of aspirin ranged from 4d. to Is. 10£d. for twenty-five. In other words, it is certain that for several years—in fact, ever since the dramatic rise in the cost of drugs—the drug companies have been treating the National Health Service as a cow to be milked and exhausted. They have done so with high profits which in America have been challenged.
  It is not without significance that the companies which today dominate the British drug industry are American companies who were tackled by the Kefauver Committee. I wish that the proceedings of that Committee had had wider distribution in this country. The hon. Member for Putney called for a commission of inquiry into various aspects of the Service. I wish he had added that it would be wholesome and advantageous if there were the equivalent of a Kefauver Committee in this country to look specifically into the question of the exaggerated profits of the drug companies.
  These are something about which, I know, the new Minister of Health is concerned, but in an extraordinary way the drug companies seem to have preserved a mystique around their operations which not even Ministries have been able to penetrate. Translated into British terms, what is required is a Royal Commission to call evidence and act in the way in which the Kefauver Committee acted, asking the companies to produce their accounts and calling their scientists, researchers and businessmen for questioning to get at the truth.
  The companies talk always about how much they spend on research and about how they must make these large profits to be able to engage in the necessary scientific research in the interests of the nation. When, however, we look at that research, we find that it is largely made up of promotional research. We have
  1536
  seen some of the advertisements even in reputable papers, which look like new aspects of "pop" culture. Those advertisements are infinitely more commercial than scientific. They have gone in for the kind of promotional development which in America is called molecular manipulation and sometimes, here, the creation of "me too" drugs. All this is merely to try to create attractive packages with which they can incite the general public, and in many cases the National Health Service, to buy their products.
  It has been established that 60 per cent. of National Health prescriptions for branded items are for drugs for which a comparable generic equivalent could be produced at a fraction of the cost. What is the Minister doing about this? I suggest that he should do something about it. I believe that he could cut the cost of the drugs to the National Health Service by 30 per cent. without the nation suffering. If he were to cut the cost of drugs to the National Health Service by this 30 per cent., he could spend the money on improving the maternity services and would earn the gratitude of the nation.
  8.0 p.m.
  Miss Joan Vickers: I hope that hon. Members will forgive me for not having been here throughout the debate, but I had another important meeting and I did not think that I would be able to catch your eye, Mr. Speaker.
  I am glad to have had the opportunity to follow the hon. Member for Coventry, North (Mr. Edelman), who takes a great interest in this subject. I agree with most of what he said. I should like every mother to have her first and fourth child born in hospital, for those are the two critical births.
  Perhaps my hon. Friend the Parliamentary Secretary will convey to his right hon. Friend the Minister of Pensions what the hon. Member said about the grant of £6, because I believe that that is a Ministry of Pensions matter, although it is important.
  The provision of cars for midwives is a matter for local authorities. Many local authorities do provide cars, but this is a subject on which hon. Members should press their local authorities.

  1537
  I was interested in what the hon. Member said about prescription charges. The Motion speaks of policies which would improve
  "standards of service to the patient and permit the abolition of health service charges".
  I gather that these now amount to about £70 million. If we are to improve the standards, costs are bound to go up as salary and building costs increase. I hope that the hon. Lady the Member for Cannock (Miss Lee), whom I am very glad to see on the Front Bench, will be able to tell us how the Opposition propose to improve the Service and at the same time to do away with this sum of £70 million. I am particularly interested in that aspect of the subject, because I did not vote for the raising of the prescription charges. I abstained. Nevertheless, I should like to have it proved to me that the charges can be abolished while the Service is improved. Perhaps this can be done, but I have not yet heard any hon. Member prove how.
  The other day, when I was in Brussels on a Parliamentary delegation, I was in the Senate when a debate on health was taking place. Having listened to that debate and having visited and lived in many countries, I am sure that, with some exceptions which hon. Members have pointed out, in this country we have a Health Service of which we can be proud. It is the best all-round service in the world. There are many other services which specialise in one branch or another—New Zealand has always been particularly good about infant mortality and has the lowest rate in the world—but this country has the finest all-round service.
  I was a member of the London County Council for nine years and a member of its Hospitals Committee. I was not on the council in 1930, when the hospitals were taken over by the council, but even in 1937 they were in a fairly parlous state. In 1930 some patients in the chronic wards were sleeping on palliasses, and I expect that the hon. Member for St. Pancras, North (Mr. K. Robinson) will have seen that.
  Mr. K. Robinson indicated assent.
  Miss Vickers: The terrific change from 1930 to 1963 has been astonishing, especially as it has taken place all over the country.
  1538
  I have listened with interest to what has been said, especially by my hon. Friend the Member for Chippenham (Mr. Awdry), about general practitioners. I agree that the general practitioner is the backbone of our present Service, but how does the fare in this Service? He is at everybody's beck and call. He does not have limited hours of work and he can never be certain when he will be off duty. We will have to consider the general practitioner service and put it on a rather different basis. I suggest that he is given a salary on the lines of that given in the R.A.M.C. and is no longer paid on the per capita basis which is unfair.
  The per capita basis is unfair on the conscientious man and on the doctor in the rural area who cannot get many people on his books. But it has another bad effect. If the doctor wishes to keep up his income, he must accept as patients all those who come to him and it is very difficult for' him to refuse them when they ask for a chit to go into hospital, or a letter for this or that.
  I should like doctors to be given a salary which would be reviewed and on which there would be increments for a number of years, and for the doctor to receive special remuneration if he specialises. For instance, if he specialises in gynaecology, or heart diseases, or ear, nose and throat, or eyes, he should receive a special salary. This would build up the faith of the patients in the doctors themselves. I was very interested in what was said about group practice. I believe that the grouping of doctors is essential, and if we could create surgeries of doctors with special qualifications, individual patients might then not think it necessary to go to hospital. This would considerably reduce the hospital waiting lists. One of the present difficulties is that people really in need of hospital treatment are kept waiting by those who could get the same sort of treatment from their general practitioner, but at the moment the general practitioner is liable to fall foul of his patient if he does not give him a note to go to hospital if the patient demands it.
  The general practitioner is in a lower grade than the consultant in terms of services provided. Invariably he has to do his own secretarial work because

  1539
  he cannot afford to pay a secretary and he has to take his own telephone messages, and in many cases the wives of general practitioners are unpaid secretaries. I was discussing this with some general practitioners the other day and they told me that their general expectation of life was no more than about 55 years. That is something to be drawn to the attention of my right hon. Friend.
  The service of care in the community is building up well. The more we can increase it, the better it will be for relieving the pressure on beds and for the general health of the nation. I was glad to see that the number of home nurses has increased by 20 per cent. since 1951 and that home helps assisted in more than 341,000 cases in 1962. This is a splendid record. The difficulty arises with the mental health services.
  The Mental Health Act, 1959, one of the finest Acts to go on the Statute Book for a long time, has meant that far more help is needed in the community. I was rather disturbed to read that more patients than ever before are being admitted into mental health hospitals. In 1962, 12,907 more mental patients were admitted and the average bed-occupancy in my own area has risen from 95 to 96 per cent.
  Mr. Braine: My hon. Friend is quite correct in what she says about this trend, but it is offset by shortening the stay in hospital.
  Miss Vickers: But bed occupancy is still very high. I am worried about the number of confused old people going into mental hospitals and taking the room of people who are really mentally sick and who, as my hon. Friend has said, go in for a short time.
  We have far too many of the elderly confused in these hospitals. Many schemes have been put forward recently for the care of these people. One was that there should be many smaller homes, with about a dozen people in them. I do not think that that would be economically sound, and I do not see how we could staff such homes. I suggest that there should be more special wards in general hospitals to deal with these people, because this would give nurses the opportunity of doing a different type of nursing throughout their careers.
  1540
  When I was a member of the London County Council, I was told that if one could nurse an old and chronic sick person, one could nurse anybody, because these old people were the most difficult and the most trying to nurse. I hope that my right hon. Friend will consider the proposal which has been put forward instead of letting these old people go to a mental hospital where the nurses and doctors specialise in mental diseases and not in the treatment of the chronic mentally confused.
  Turning next to care in the community and the idea of more people living out, what is happening about the training of social workers? Unfortunately we never had a discussion on the Young-husband Report, but in that Report it was pointed out that many of our people were aged, and that we were extremely short of the type of worker needed for care in the community. I understand that two-year full-time courses are now being run in Bristol, Coventry, Leeds and Manchester, and that in Birmingham, Liverpool and London similar courses are being started. The National Institute of Social Work Training runs a one-year course, and I had the pleasure of going there and seeing it in action.
  The results of these courses will be of great benefit, but I hope that my right hon. Friend will carry out a survey to discover the number of social workers that we shall need to implement care in the community. At the moment we have no idea of the number required, and I think that far too few areas are thinking about training these people. I have recently taken this matter up with the local authority in Plymouth. The authority is not yet able to implement the scheme, but it hopes to do so in the spring. How many local authorities are thinking about training social workers who are so urgently needed for this work?
  I have spoken about the old, and I now propose to deal with the other extreme, nursery nurses and children. What worries me is that in certain areas children, when they first go to primary schools, are hardly able to talk, and are not always house trained. They have a difficult time starting in school. I was glad to see that the number of nursery nurses is increasing, but I think that it is necessary to have even more nursery

  1541
  schools for these children, particularly the mentally and physically handicapped.
  Far too many parents have the greatest difficulty in dealing with handicapped children. What can a mother do with a five-year old handicapped child, especially if he is autistic? There is often nowhere that she can send him. I know that the provision of more nursery schools will prove expensive, but I think that the results will be worth while in the end, because we now know that many of these mentally handicapped children can be helped to get on in life.
  I am glad to know that my right hon. Friend is to have an annual meeting of the voluntary organisations, including, of course, the Red Cross, and the League of Hospital Friends, to whom we all owe a tremendous debt of gratitude. When we started the hospitals under the State scheme, many of these voluntary organisations had house committees which worked in the hospitals, but I do not think that anybody visualised the tremendous voluntary spirit in this country which created these innumerable voluntary organisations which are doing so much good by helping hospital staff, not only by doing the actual nursing, but by providing entertainment for the staff.
  We also owe a debt of gratitude to the National Old People's Welfare and the Women's Voluntary Service. I hope that my right hon. Friend will encourage all the voluntary organisations to continue with their pioneering work, because they can do one thing which a Government Department finds it difficult to do. They can put into practice some ideas which may be beneficial later on.
  Most of the child welfare clinics were started by voluntary organisations. They were partly taken over by local authorities, but they kept their voluntary status if they contributed one-eighth of the cost before being taken over in the State scheme. I think that voluntary organisations can still be encouraged to play their part in pioneer work which can be extremely beneficial for the future.
  I congratulate my right hon. Friend, and wish him luck in his new job. He had a sympathetic outlook when dealing with Income Tax cases. He gave me very favourable answers when I raised cases with him, and anyone who can do that when dealing with Income Tax
  1542
  must have a very agile mind indeed. I hope, therefore, that the Service will benefit as a result of my right hon. Friend's appointment.
  Mr. Barber: If, next year, my hon. Friend would like me to help her once again to fill in her Income Tax return, I shall do so willingly.
  Miss Vickers: It was not my Income Tax return; it was my constituents' returns.
  8.17 p.m.
  Mrs. Judith Hart: My hon. Friend the Member for Coventry, North (Mr. Edelman) raised a point on the perinatal survey on which I want to concentrate my remarks. As the hon. Member for Plymouth, Devonport (Miss Vickers) can probably imagine, I should like to take the time to follow her on what she said about social workers—because she knows that I share her interest in that question—and the possibility of salaried service for general practitioners. I believe that in the Health Service we are bound to move towards a salaried service. Many advantages will accrue from it. Much of what the hon. Lady said has my support, so the Minister can regard it as having been said by me, as it were, in shorthand.
  I turn now to the perinatal survey, because there are one or two points which have not been mentioned. The question to which I direct my attention is the simple one—which babies are dying? Many of my hon. Friends will remember the remarkable work of Professor Titmus and his book, Birth, Poverty, and Wealth, which he published before the war. In that book he showed that the chances of staying alive, the chances of being alive at birth, and the chances of being healthy, varied between one social class and another, and between one income group and another.
  At the end of the war, particularly when the Health Service was introduced, we thought that that book was a thing of the past. We thought that it was something we could leave behind us because the nation would go forward to good health, and to equal chances of survival. But what do we find in this survey? I do not propose to quote the figures, because they have been quoted often enough. If we consider the figures for 1911, 1921, 1931, 1950. and

  1543
  the figures of our own time, what do we find?
  I quote one remark from the survey. Talking of the relationship between one social class and another in our community, it says:
  "The results of this Survey suggest…that the gap may be increasing rather than narrowing between social classes."
  It seems to me that of all the indictments by which one can judge the Government during the last 12 years this is perhaps the most devastating. At the end of this period of 11 or 12 years we can say that the chances of babies surviving are differentiated more by the factor of social class than was the case when they came into power.
  That is a political point, and it is one which my hon. Friends must hold on to and not let go of, because it is the kind of thing that matters when one judges what kind of society we are living in. I cannot think that a good society would permit the number of babies that this society has done to die at, or shortly after, birth.
  Let us look at the way in which this survey establishes the simple fact that the gap is widening instead of narrowing. There is no doubt about the adequacy of the survey, or about the depth with which the statistics were analysed. What was done was to take all the factors which are likely to cause perinatal mortality. There is the factor of whether the mother is having her first, second, third, fourth, or subsequent baby; the factor of her home circumstances; the factor of her previous medical history, and the factor, among many others, of social class—whether she happens to be the wife of an accountant or lawyer, or the wife of a builder's labourer or docker, or farm worker This is the kind of difference that is taken into account.
  Excluding all the other factors—whether it is the first or fourth baby, and the rest—if we take the single factor of social class the survey shows that there is four times as much danger to the baby born in the lowest income groups in our society than in the highest. That is the scale of difference. What emerges from the analysis is the question of what we ought to be doing to decrease rather than widen the gap.
  1544
  What needs to be done in our maternity services so that the child of a farm worker or a builder's labourer has as good a chance of survival as the child of a lawyer or of the doctor himself?
  The two problems that come up are, first, the inadequacy of the number of beds, and, secondly, which people ought to have the use of the available beds? There are tremendous regional variations in this respect. It has already been mentioned that Scotland has a much higher rate of perinatal mortality than does England and Wales. It may be that Scotland has more people who earn less than is the case in England and Wales. Scotland certainly has more people living in bad housing conditions, and therefore a less fair proportion of the number of maternity beds, taking into account the fact that it has to provide beds on a scale suitable for the larger number of mothers who desperately need them.
  But it is not just a question of more beds, and how to select the people who are to have the beds. I wish that my hon. Friend the Member for Coventry, North was still here, because he concentrated on the single factor of home circumstances. The survey shows that to limit perinatal deaths it is necessary to concentrate much more on the single factor of social class and the income group of the mother than upon the home circumstances. In other words, a mother's chances of having her baby stay alive in its first weeks after birth are likely to be affected more by her own background—the question of who her father was, how she was brought up, and at what kind of income level she has lived during her life—than by her home circumstances.
  The high-risk people ought to be considered much more on a social class basis. This means that a whole new way of thinking must be done in our maternity hospitals about the basis upon which cases are selected when there is a shortage of beds. We find that with the high-risk mothers who are having, for example, their fifth or later baby—this is the group which has a very high perinatal mortality rate—only 29 per cent. are booked for hospital delivery. The same thing happens in the case of people known to have a high degree of risk involved in having

  1545
  a baby, and who are not the people who tend to ask to go to hospital, although some may have to be brought in as maternity cases during the course of confinement. We find that 60 per cent. of those having their fifth or later babies were delivered at home.
  One question which will prove to be an issue between my hon. Friends—although perhaps I should speak here only for myself—and the Minister came when the Parliamentary Secretary answered a point made this afternoon about the extent to which the Government need to provide more maternity beds, and the extent to which they are already provided. Here, what again comes out very clearly from the perinatal survey is that if we are concerned to reduce to the lowest possible number the perinatal deaths we must take account, in providing hospital beds, of those hospitals which have consultant hospital services available to them, and not merely general practitioner unit beds.
  This is where the difference will come. I quoted a figure this afternoon, and I have the survey with me, so that I can clarify the point which is at issue between us. The survey says, of the population study, of women having babies, that hospital births were 49·1 per cent., homebirths were 36·1 per cent.; those born in a general practitioner unit were 12·4 per cent., and the rest—born in private nursing homes, or born on the way to hospital, and so on—were 2·4 per cent. The fact that barely half the mothers were confined in hospital is of great importance. The general impression was that the figure was 65 to 70 per cent. We remember the Cranbrook and Montgomery recommendations in relation to Scotland. This false impression of security arises from the reports of the Ministry of Health, which have always included general practitioner beds in the hospital category.
  The perinatal survey says that this is not good enough. It says that consultant hospital facilities are necessary for pre natal care and for delivery, and in most cases continuing supervision is necessary in order to reduce the number of perinatal deaths to the extent to which it is believed they could be reduced, with adequate hospital care.
  1546
  This is why there is such an element of condemnation in what I am saying. In this case things can be done and they are not being done. Beds could be provided which have not been provided, and which clearly will not yet be provided, so that avoidable perinatal deaths and deaths of young babies will continue. The Government are not doing the right things to prevent them. It is as clear as that. The conclusion of the survey is that consultant hospital facilities should be available for at least 70 to 80 per cent. of mothers. Perhaps I might illustrate by reference to what could be done. My hon. Friend the Member for Kilmarnock (Mr. Ross) knows of the wonderful record of Aberdeen, where Professor Bury has established that over 90 per cent. of births take place in hospitals where there is a consultant service available and all the excellence of the ante-natal care which is provided in a city where this matter has been taken seriously and where, for many years, the professor has been pushing for the money to do what he thought was necessary.
  On the difference between consultant hospital beds and general practitioner beds let me again quote from the Report:
  "…p;such units"—
  that is, this general practitioner units—
  "must be regarded as having collective domiciliary facilities with improved nursing and domestic services rather than as obstetric hospitals."
  If I may make a constituency point, I have been told that, after a great deal of pressure, a hospital which serves the new town of East Kilbride in my constituency is to have a new general practitioner maternity unit and not the kind of unit with consultant medical services which is what is needed in a new town where large families are being born; where the parents have a background of Glasgow poverty and where there will be a high proportion of mothers in the highest risk groups when having their fourth or subsequent child. I should like a consultant medical hospital unit rather than a general practitioner unit and I hope that the Under-Secretary of State for Scotland will consider the whole of the maternity programme for Scotland, bearing in mind the points which emerge from this survey.

  1547
  There is a further point relating to the question of antenatal care. A surprising number of mothers did not avail themselves of the existing antenatal facilities; or rather, some of them did, but some of them, reading between the lines, seemed to have suffered from the fact that the antenatal care which they received was administered by the midwife and the general practitioner, so that the mothers did not get the proper tests—the haemoglobin and Rhesus factor and blood pressure tests which they should have received—at the proper time. Apparently where it was a case of a combination of general practitioner and midwife only 12 per cent. to13 per cent. of the mothers had the Rhesus factor test, which had a profound implication on the chances of the survival of the baby.
  Here, we must think of the need to integrate antenatal care much more, and make sure that the mother is attended by one person or receives the treatment at one place, and that it is not divided between the hospital, the general practitioner and the midwife. Emphasis should be placed on the need to educate mothers to use the existing antenatal facilities adequately. We have tended to assume that mothers have learned about these things. But it is necessary to go back and concentrate on that matter again.
  Linked with all this is the question of how to start the kind of service which is essential. My hon. Friend the Member for Coventry, North referred to midwives and home helps. Some years ago one of the first posts in sociology which I held involved working for two-and-a-half years for the Ministry of Health, doing social research for a working party looking into the recruitment and training of midwives. I remember the number of investigations which we made. One investigation, I think that it was the first of its kind—it was a very small investigation—established that the chances of examination success, or success in their career for middle-aged women who returned to nursing or midwifery after having their own families was as great, or greater, than among younger women.
  We paved the way to encouraging these people to take up their careers
  1548
  again after refresher or training courses. We shall not solve the problem caused by the shortage of midwives unless we bring back into the service those who are registered but are not practising continually. They may be ready to return to practice if encouraged by the provision of refresher courses and training facilities and adequate salaries. We can solve none of those problems unless we pay reasonable and adequate salaries.
  I emphasise a point which was made by my hon. Friend the Member for St. Pancras, North. When a student nurse has taken her nursing qualification and wants to go on to become a qualified midwife, she has to go back to student pay. This is ridiculous. Here is a simple decision which the Minister could make and announce to us tonight, which would encourage more people to be trained as midwives. The Minister should look carefully at this. It is tough on hospital midwives to have difficult jobs of actual deliveres and so on in hospital without, as it were, any of the rewards of following up a case and maintaining contact with the mothers when they go out of hospital, particularly when they leave after such a short stay in hospital. Are we sure that it is right to maintain this sharp separation? Would it not be better from the point of view of recruiting more midwives and making the work more satisfactory if we integrated these services.
  If we turn mothers out of hospital after 48 hours because of the shortage of hospital beds and make it necessary for many mothers to have their babies at home when they ought to have them in hospital, we must solve the home help problem. The hon. Lady the Member for Devonport gave the total number of cases in which home helps had been working during the year, but as against every case in which a home help was called in there were a dozen cases where a home help could not be obtained. That was partly because there were not enough women prepared to work the hours required in this service, or at the salary which is offered.
  The National Birthday Trust, in its report, suggest that maternity aids could enlarge the service and help in recruitment to it. Maternity aids could

  1549
  act as a group to supplement the work of midwives to help the mother when she goes home with her baby and perhaps already has three or four children in the family at home.
  Mr. Lubbock: Would the hon. Lady agree that so long as the present set-up lasts there is no incentive for a local authority to do this, because if a mother goes into hospital to have her baby she is outside the local authority's provision of home helps?
  Mrs. Hart: A burden is placed on the local authority to solve the problems which the Government are not prepared to meet.
  As other hon. Members wish to speak in the debate, I have made by points as briefly as possible. It is a condemnation of the Government when things can be said which are obliquely said in this perinatal survey. I hope that the nation will realise that if it wants the National Health Service to be a reality and to bring health within the reach of all people, whatever their background, we have to leave behind many of the memories of the last 12 years and start a new era.
  8.38 p.m.
  Mr. Jasper More: The hon. Lady for Lanark (Mrs. Hart) has spoken very eloquently and has covered a large number of facets of the National Health Service. She touched on two matters which are of particular interest to me, the part which local authorities are to play in the National Health Service in the years to come and the disparities between the regions which administer our hospitals.
  I should like to deal with those two topics after I have dealt with what I am afraid the House has heard much about in this debate, the cottage hospitals. I also represent a widespread constituency. All the arguments advanced by my hon. Friend the Member for Stroud (Mr. Kershaw) and my hon. Friend the Member for Chippenham (Mr. Awdry) are realities in a widespread constituency such as Ludlow. Involved in this problem is the question of visiting, the question of local generosity, as many of these hospitals were started by charitable private individuals, the focus they provide for discussions between general practitioners
  1550
  and specialists and the facilities they provide for local patients who need only good nursing under the supervision of doctors who know them. These cottage hospitals serve a need for patients which cannot be replaced by a large district hospital 20or 30 miles away. More important is the effect that the abolition of these small hospitals is bound to have on G.P.S, many of whom in my constituency have spoken to me about the concern they feel at the prospect of these hospitals being closed. I am sure that that concern is only too well founded.
  The magnitude of the problem in my constituency can be realised when I say that of our nine cottage hospitals, five will go and one of the remaining four is to be replaced. What has impressed me in the discussions is that this situation causes one to wonder whether the organisation of our hospital service is sound. Is it not time to take a look at the whole organisation of hospital management as we have known it in this country over the years? Hon. Members who have followed recent developments must realise the fundamental improvements there will be in the years to come. These improvements will, naturally, be much greater than those we have seen in years gone by, and if they are to be used to the full there must be effective co-operation between hospital managements and local authorities.
  I serve on a local authority and have served on hospital management committees, so I can claim to have seen the problem from both sides. We cannot always be proud of the things that have happened in the past when considering the co-operation that exists between the two sides. Two examples have come to my knowledge in the last six years. The first is the difficulty of getting building done where it is a combined hospital effort, as must happen in country districts, between hospital management committees and local authorities. I know of a case where construction had to be deferred for two years because the two authorities could not agree.
  The second, and even more important point, is the question of representation on local management committees. In my constituency one of the members of our local management committee was

  1551
  the chairman of the public health committee of the county council. Suddenly, for no reason, he was dismissed from the hospital management committee. That was not a courteous thing on the part of the hospital authorities vis-à-vis. the county council, and it is unfortunate that such things can and do happen.
  I am not a critic of hospital management committees in general, but we are all conscious of the things we see and hear—the long waiting lists, inadequacies of the organisation, unnecessary difficulties and journeys which patients and visitors must endure, and so on. Has the time not come to take a look at the whole question of management committees and regional hospital boards to decide whether improvements need making?
  There is a great contrast between the ways in which these boards and committees are constituted and the ways in which, for example, our local authorities are constituted. The most obvious point to appreciate is that we have no area representatives on the hospital committees and boards. That can be of great importance, as in the present case when the question of whether or not a hospital should be closed arises. Who is to speak? There is no one whose job it is to say, "I represent the district in which this hospital is."
  What happens in my area is that representatives of the regional board make a point of meeting, rather at random, representatives of local authorities if they wish to make a row, or with representatives of the local doctors or local medical committees if they make a row. This discussion takes place, perhaps, once a week with one and perhaps a month later with someone else. I cannot see any co-ordination here. It suddenly occurs to someone to write to the Member of Parliament, who then comes in as well, but the whole thing is haphazard and derives from the fact that there is no specific area representation on hospital regional boards and management committees.
  The hon. Lady the Member for Lanark has referred to disparity between the regions, and I should like my right hon. Friend to consider the elementary question of size. Is there or is there not
  1552
  an optimum size for a hospital regional board? This is very noticeable in my own case. I live within the area of the Birmingham Regional Board, but our population is more than twice as large as that of the Oxford Hospital Regional Board next door. Should we not consider whether there is a right and a wrong size?
  Then there is the important matter of delegation of functions. In very large administrations, such as the hospitals have, a matter of importance must be at what level, and by whom, decisions are to be taken, and at what level there is to be financial authority. We have the situation now that for individual hospitals the decisions are taken, and the financial authority rests, at regional level. Does not my right hon. Friend think that the time has come for more delegation of function, at any rate of hospital management committees, and some delegation of financial authority?
  I subscribe wholeheartedly to what has been said of the wonderful voluntary help the hospitals have, in particular the help they get from those who form themselves into voluntary committees, but I should like my right hon. Friend to take this further, and consider whether there should not be, compulsorily in every hospital a house committee which is, at any rate in part, representative of the local management committee; and whether that house committee should not have some degree of responsibility and financial control.
  A really important question for the future is: ought we not to look at boundaries? If local authorities are to play this important part, as they must, is there not a case for saying that boundaries should be so readjusted that, as far as possible, the local authority area corresponds with the area of the hospital with which it has to work? It may be an extreme case, but in my constituency, although we are within the Birmingham regional area, we are divided between no fewer than three hospital management committees—although we are all in the same county. I think that serious consideration should be given to whether local authority boundaries should not, to some extent, be taken as a model for hospital boundaries.

  1553
  As other hon. Members have done, I congratulate my right hon. Friend on his appointment. All of us—certainly, on this side—had the very highest respect for his predecessor. I wish my right hon. Friend well while he occupies this important office, and I am sure that he will find no lack of problems to occupy his attention.
  8.50 p.m.
  Mr. E. L. Mallalieu: This has been a most interesting debate, particularly for me because of the degree to which it has shown that hon. Members on both sides of the House recognise that the National Health Service, whatever particular criticisms we may have of it, is one of the finest things that have been introduced into the country for many years. However good the institution, there are bound to be faults in it; there are bound to be human failures.
  I am grateful to the hon. Member for Ludlow (Mr. More) for having again stressed the absurdity of closing down small hospitals at this time. Surely the case now is for improving them rather than shutting them down. There might be admirable financial reasons for shutting them down, but where, by their services, they have earned the respect of the neighbourhood in which they are situated, these hospitals should not be closed down wantonly merely on financial grounds.
  During the few minutes at my disposal I want to refer to a matter which has been touched upon by every hon. Member, and that is the position of the general practitioner in this Service and his status relative to that of the consultant. At present, many people say that the general practitioner is the linchpin of the Service, but is that the regard in which he is held by those who are now responsible for the Service? I am not at all sure that it is.
  I believe that the way in which the specialist has been upgraded compared with the general practitioner is the reason for one of the greatest malaises in the Service. There have, of course, been tremendous changes in the character of the specialist, and I do not want it to be thought for a moment that in the criticism I have of certain specialists, though, thank goodness a small minority,
  1554
  I am condemning all specialists. I am not doing anything of the sort. But there have been rather too many instances of consultants under the Health Service treating their patients as soulless clots who are incapable of understanding what the specialist might tell them, if he were so minded to tell them anything at all.
  There has been this tendency to regard them as clots and not to explain their condition and the treatment necessary. In some instances which I could mention there have even been cases of no reports being made to the general practitioner about the condition of the patient. This is an utterly outrageous state of affairs. I will not even say from what part of the country it comes, but I know of one case where the general practitioner was afraid to complain when he had not received a report about his patient from the consultant, because, as he said, "I might need this man's services for my family some time." What a lamentable state of affairs that shows. It is merely because some of these consultants have been so up-graded compared with the general practitioner that they have just not been able to carry their corn.
  Is there any logical reason why a consultant should be paid more than a general practitioner? I do not think that he is a cleverer man. He is a man who has more knowledge of a particular subject and not, in general, more knowledge than the general practitioner. His knowledge is more channelled, and that is all there is to it.
  Mr. More: Is there not something to be said in doctoring for "knowing your patient"?
  Mr. Mallalieu: It is very important to "know your patient", and that is where the general practitioner comes in.
  At the moment, I am pointing out that it is, so far as one can see, accepted almost universally that for some reason or other the consultant, the specialist—call him what one likes—is a man of greater capacity "upstairs" than the general practitioner. This is not necessarily so at all, although the difference in remuneration is colossal.
  Of course, the general practitioner is the kingpin of the Service. It is he

  1555
  who, as the hon. Gentleman says, knows, or should know, the patient, his family background and all the things which concern him and which are of such vital interest to the medical man who is trying to decide what treatment to prescribe. It is the general practitioner who has to fit the report of the consultant into the general picture. There may be several consultants involved and the general practitioner has to fit all their reports into the general picture. In fact, the general practitioner is the commander-in-chief in the operation of making the patient well. It is quite wrong, in these circumstances, that the general practitioner should be regarded, to judge by his earnings compared with those of the consultant, as the scum of the service.
  If he has a full list, the general practitioner may have a gross income of about £2,750, but out of that he has to pay for his professional consulting rooms, for his secretary, for his car, and for his locum when he takes a holiday, if he can afford one. The net result is that his earnings are by no means princely. The specialist, on the other hand—I do not say that he is not worth it—earns far more.
  The point I urge upon the Minister is that there should be a reappraisal of the general practitioner's part in the Service. Is not the general practitioner worth more at present than he is given? Is the Minister satisfied with the intake of general practitioners into the Service? Has not recruitment something to do with the level of remuneration? If the Minister would consider these things, he could do immense good for the future of the Service.
  Whatever the institution, of course, there will inevitably be human failures in it. There were human failures in the Garden of Eden, according to one view of what happened there—although, on another view, perhaps, it was rather a good thing. In the National Health Service in the future, no doubt, there will be human failures as there are now. Nevertheless, it seems to me that one way in which the Minister could make his mark upon the Service and give it a more fruitful future would be to reappraise the position in it of the general practitioner. In my submission, the time has now come to upgrade the general practitioner.
  8.58 p.m.
  Miss Jennie Lee: During the course of this wide-ranging debate, more than enough has been said to justify the Motion of censure which we have put down.
  Straightaway, I pay my compliment to the hon. Member for Manchester, Openshaw (Mr. C. Morris) who, in a most sensitive and distinguished maiden speech, emphasised a point which, I believe, all of us on this side of the House would regard as one of the central themes to which attention should be called. He told us, for instance, that, although the average infant mortality rate is two per 100 for the country as a whole, in Openshaw it is three per 100.
  Later in the debate, my hon. Friend the Member for Lanark (Mrs. Hart) returned to the same point, the essence of it being that, after twelve years of Conservative Government, a Government who have had full powers and full opportunity, the maldistribution of wealth in this country is in some respect worse than it was before, and this maldistribution is reflected in the health of the people and their relative chances of health or even of survival in infancy. There have been moments when hon. Members opposite have been speaking that have led me to ask myself who has been governing this country in the last 12 years. I hope that when the Minister replies he will address himself to the record of his party in those 12 years—not tell us about the future, because he will not be there in the future.
  I should like to compliment him personally, but I would be more inclined, at the moment, to sympathise with him, because I think that the Sunday Times, which is not one of our Socialist journals, was quite right when it headlined the fact that he had inherited an awful mess from his predecessor. He has inherited a crisis in a great number of different fields. As I say, I am inclined to ask who has been governing this country.
  Hon. Members opposite have been talking about the plight of the family doctor, the bad food in hospitals, shortcomings of many kinds. Before we go on to deal with specific sins, either of omission or commission, it is well for us to understand, and for the people of this country to understand, how it comes about that hon. Members opposite can

  1557
  stand for such a mass of contradictory evidence and contradictory apologies.
  My hon. Friend the Member for St. Pancras, North (Mr. K. Robinson), in opening the debate from this side of the House quoted from One Nation, produced in 1950, and I think that most of us know it almost by heart. We have also had quotations from the Social Services: Needs and Means, 1952, with which two right hon. Members opposite have been closely associated. It may be said that there has been a change of heart, that the Conservatives are now "with it" and that they have come up to date. In fact, the most recent writings of young Conservatives express the same basic attitude towards social questions in general and the Health Service in particular as was expressed 10, 11 or 12 years ago.
  What is the essence of the Conservative position? The right hon. Member for Wolverhampton, South-West (Mr. Powell) in his book twelve years ago stated quite boldly that redistribution of income in this country had already gone too far; that the gap between rich and poor had been narrowed too much. Again and again we have heard the plea in those earlier books that a means test should be applied, that no one should receive any benefit from the Health Service unless he was not able from private resources to look after himself. I do not think that hon. Members opposite would contradict that this was the philosophy put forward. What have the young Conservatives got to say?
  A fascinating book was published in 1961 called Principles in Practice, produced by the Conservative Bow Group. Mr. Geoffrey Howe was particularly responsible for it. They certainly have had time to put their principles in practice. Part of the advice given in this book is that the public should insure in private companies and opt out of the Health Service. In order to encourage them to do so, it is proposed in this book that those who opt out of the Health Service should have their tax liability reduced by an amount equivalent to the average cost per head of the service.
  I am not saying that the Minister has reached that point yet and I should be delighted if he would repudiate both the theory and practice of his pre-
  1558
  decessors. We have had about as many different Ministers of Health as Ministers of Defence, but every Minister of Health, however good his personal intentions may have been to begin with, has had to carry out Conservative policy. It is clear, both from theory and practice, that hon. Members opposite do not understand the meaning of a comprehensive Health Service.
  The Government have even failed to give us even an adequate medical service. There is a difference between the two concepts, that is a comprehensive health service and a mere medical service. We are, after twelve years of Conservative rule, asking hon. Members opposite whether they think that they have brought this country to that level of economic well being when we can exempt at least the sick from financial worries when they are sick. We shall have the answer when hon. Members opposite go into the Lobby tonight.
  What is the verdict of those on the benches opposite on Tory rule? Will they say to us that this country had such faith in its people and such vision two or three years after the most destructive war in history that it could say that from our combined resources the strong would look after the weak and that, whatever we had to go without, we would try to provide complete medical care for everyone, beginning with the mother before her child was born? What have hon. Members opposite done to this proud record? They should be providing not just a medical service but health service. Today, we should have been discussing preventive medicine. We should have been discussing health, not disease.
  Even the party opposite should know that some of the main causes of illness today are tension, strain, nervous exhaustion and worry. Can any of us think of anything more liable to maximise strain and nervous exhaustion than for a family, at the very moment that it has to cope with sickness and needs additional income in the home, to be told by the great Conservative Party, "We have had our ups and downs in the last ten or eleven years". It has been rather like the case of the Grand Old Duke of York: we have gone up and then come down again. There have been times when we have been able to come to the rescue of Surtax payers."

  1559
  Every time that there has been an economic crisis, it has been seized upon by the Government as an opportunity to put taxes on the sick and to transfer the burden, so far as it lay in their power, from the Chancellor of the Exchequer to the employer and the employee. This is Conservative philosophy.
  Hon. Members opposite are not fit to be in charge of this Service. They do not understand it. If, once again, they were entrusted with power, they would be no better in the future than they have been in the past. They would simply try to take one step further towards their ugly, vulgar philosophy of asking the rich to look after themselves and leaving the insured worker, whether industrial or professional, to pay for his services as much as possible from his insurance and his taxation. For those not rich enough to sign a cheque for their child's schooling, for illnesses or for hospital services, if they were not covered by insurance, back they would go to the spirit of the old poor law and then to National Assistance, with a rigid means test making them feel that it is a crime to be poor.
  I could spend the limited time at my disposal in taking each of the health charges one by one—spectacles, teeth prescriptions and the rest—but I consider it more important that we should be completely clear about why hon. Members opposite behave as they do. They belong to what I can only describe as a social handicapped group. Therefore, they must not expect me to be indignant with them or shocked by them. I would rather try to understand them.
  Our medical services are not quite adequate to deal with the physically handicapped and with the mentally handicapped, but I hope that one day we will be able to deal even with the socially handicapped. By "socially handicapped" I mean having many of our Conservative leaders conditioned by birth to segregation. It was not for them in their school years to make friends with the little lad who did not have the right kind of accent. They had to be careful about all their social contacts. I do not blame them. Hon. Members opposite belong to a socially handi-
  1560
  capped class who, from their earliest days, have been conditioned to think in terms of the masses and the classes, in terms of "them" and "us", because I do not for one moment believe that they would ever allow their own children or their parents, or anyone who was close to them or one of them, to be treated in the way in which they expose hundreds of thousands of other children and parents to be treated.
  There is something extremely brash and vulgar about the philosophy of "I'm all right, Jack", but there is something utterly contemptible in the philosophy, "My child's all right, Jack". For the love of one child should come the love of all children. Therefore, I am serious in speaking about enabling hon. Members opposite to understand themselves better. I am talking in all seriousness when I say that there are ranges of knowledge and experience which they simply do not share.
  Hon. Members opposite want the type of society in which the rich look after themselves. They have increased the insured workers poll tax. They have increased the tax on the insured worker three or four times since they came to office, so that the maximum amount should be added to the burden of the employer and the employee, which, incidentally, is a burden upon industry and upon the products that we sell. Thus we have the three categories. The rich look after themselves. The insured worker, industrial or professional, pays through insurance. The third category goes for National Assistance, and National Assistance is made as rigid as possible.
  Do not hon. Members opposite realise what a close link there is between welfare and industrial production? Let them imagine a typical working-class family with the man working overtime so that he has a little extra to spend in addition to rent and food and can go out and be a man among men, standing treat to himself and his friend. Visiting his mother and father, he would enjoy saying to the old man, "Here is 10s. Go out and enjoy yourself". But if he finds when he stands treat to his parents that his father has to use the 10s. to pay for a prescription for cough mixture or his mother has to use it to buy tablets for her rheumatic pains.

  1561
  what do hon. Members opposite think the typical industrial worker feels?
  In other words, it is very important to realise that our social services are part of the standard of living of the country. When one transfers charges to the industrial worker through his insurance payments and when his parents have to use their savings to pay for prescriptions, one is depressing his standard of life. If hon. Members opposite want that, the young man's reply will be, "Right. If I am not going to have my standard of life sustained by civilised social services, then I want more money." Hon. Members opposite have not the slightest chance of carrying forward the country's economy on a buoyant basis with peaceful co-operation in industry.
  Among the many letters sent to me is one from a retired couple. The writer says:
  "I have money invested in Defence Bonds and local government stock that give me an income of £52 10s. a year. Because of this I am barred from assistance and have to pay for four different medicines, milk and a diet out of a health benefit of £5 9s. for myself and wife. Perhaps I should not have said 'a diet', because if you subtract £2 6s. 96. rent you can see my situation."
  Because of his life's savings, this retired worker is placed just a little above the bare retirement pension.
  What hon. Members are saying is "Let us all end up on National Aissistance". Why should anyone trouble to set aside Is., £1, or £100? It seems a lot of money to poor folk. It may be that a worker may save between £1,000 and £2,000, but the investment income from it may be such that he will find that he has to pay for the prescriptions which he gets from the doctor.
  The Conservative Party was the party which was supposed to believe in saying, dignity and independence. But this is why I call hon. Members opposite a socially handicapped class. They think it is quite all right for poor people to come appealing for National Assistance. Consequently, whether we are dealing with the general situation of our hospitals or these disgraceful charges for prescriptions and services, hon. Members opposite are not fit to administer the scheme.
  I go further and say that when the right hon. Gentleman's predecessors had to deal with sick people, old people and
  1562
  crippled people they were very brave indeed. They got their own way. But when they were dealing with some of the highway robbers exacting quite indefensible profits in the drug industry they were beaten They met more than their match.
  No Conservative Minister will really deal with the profiteering at the expense of the sick and the National Health Service and the community because it is alien to his philosophy to do so. There is no point in attacking the pharmaceutical industry for these vast profits and still leaving it to do the research. Many of these firms are sulking. They say, "If you are going to encourage the family doctor not to use our products, we shall not do your research for you." Right hon. and hon. Members opposite cannot do it both ways. There is no answer to the problem unless we are prepared to have competitive public ownership in the drug industry.
  The Government must do proper costing and their own research to know what is happening. The other day I looked again at the Cohen Report of 1951. It set out clearly what had already been begun by the Labour Government and what could have been done by the Conservatives. I remember the joy it gave to many of us on this side of the House when we started investigating the profiteering that was going on, not just in medicine but in all kinds of equipment needed for patients and hospitals. I recall the case of the hearing aids brought down in price to one-tenth of what they had cost before.
  It is nonsense to expect right hon. and hon. Members opposite to do anything about profiteering in any sector of the National Health Service, but I can promise them that in the near future, when what have now become the caretaker Government have got the verdict of the country, we shall be concerned not only to spend money on the National Health Service but also to save money in it. The pharmaceutical industry cannot be tackled, its high profits cannot be tackled, unless we are willing to go into this ourselves, change the costs and do a great deal more of our own research than the Government are doing at present.
  I come now to an aspect that right hon. and hon. Members opposite have not touched—preventive medicine. The

  1563
  other day I was talking to the distinguished head of a dental institute. He was listing the diseases that are the result of dental neglect. The Government have managed in twelve years to begin and complete four hospitals. They have managed to begin and complete one dental institute. I hope that the right hon. Gentleman will contradict me at once if I should be misleading the House in any way in saying that.
  When the right hon. Gentleman comes to reply, I would like him to tell us what he has done about preventive medicine. But I can tell him now. He has made it more difficult for children to get their orange juice and cod liver oil. He has made it more difficult for expectant mothers to get their vitamin pills. By the charges on prescriptions he has added money worries to the anxieties of every home where there is sickness.
  I can think of nothing that has been done by the Government that can be genuinely called preventive care. I listened carefully when the phrase was used by the Joint Parliamentary Secretary, but he had nothing to say. He talked about the importance of the local authorities and, of course, the Government have managed to transfer from hospital care to the local authority care many of the mentally sick. They have managed in that way to make a bad hospital situation seem a little better than would otherwise have been the case.
  But I wish that the Minister would tell me what he thinks he is doing for preventive medicine when he has these charges on the most vital disease-resisting foods and when he takes them from mothers and children, the most vulnerable in the community, and when he is harassing the health as well as the physique of many old people who are just above the National Assistance level. Far from being preventive medicine, this is exactly the opposite, but I do not see any hope of hon. Members opposite doing anything else.
  A short time ago, I asked a child what a gentleman was. He was a very young boy, but, quick as a flash, he said, "Gentle and a man". He did not say someone who was very rich; he did not say someone who had 1,000 acres or 100,000 acres; he did not say someone who talked with a special
  1564
  quaint accent; none of those categories; he said, "Gentle and a man".
  It is only someone who is both gentle and strong who is fit to be Minister of Health in this country. Gentleness alone is not enough, not when dealing with some of the tougher hon. Members opposite; gentleness is not enough when dealing with some of the great vested interests outside the House. It will take someone who is really tough and who really believes in what he is doing.
  But, at the same time, it needs someone who is prepared to regard all the people of this country as his friends, all the children, all the old and all the young. This National Health Service was hard won. We fought hard to have it. Hon. Members opposite fought hard to prevent us from having it. All that has happened in these succeeding twelve years has proved that it cannot be left to their narrow, unloving, insensitive prejudices.
  9.28 p.m.
  The Minister of Health (Mr. Anthony Barber): I hope that the hon. Lady the Member for Cannock (Miss Lee) will not think me offensive when I start by saying that, whatever views hon. Members may have about the policy underlying her speech, the whole House will recognise the honour being done to her by inviting her to wind up the debate for the Opposition. It is with complete sincerity that I say that it is all the more fitting because of the great contribution to the National Health Service which was made by Aneurin Bevan. I shall have something to say about her remarks in a few moments.
  However, first, I should like to refer to the speech of the hon. Member for Manchester, Openshaw (Mr. C. Morris). His speech could truly be said to have been all a maiden speech should be. He spoke modestly and wittily and he was more or less uncontroversial, although I must say that he seemed to get away with one or two rather telling points. He was particularly concerned about infant mortality, to which I shall refer later, saying now only that he was quite right to stress the importance of effective education of expectant mothers. I join in the congratulations given to the hon. Member by the hon. Member for Cannock, and would say that those of us who were fortunate enough to hear

  1565
  the hon. Member look forward to doing so again.
  It is less than two months since the Prime Minister invited me to become Minister of Health, and I hope, therefore, that the House will allow me one or two words by way of introduction, and a reference to two people in particular. In all I am doing, and in all that I seek to do, I am conscious that I have the advantage of being able to build on the sure foundations which were laid by my predecessor the right hon. Member for Wolverhampton, South-West (Mr. Powell). Whatever right hon. and hon. Gentlemen opposite may think, those who work in the Health Service, and those who benefit from it, have cause to be grateful to my right hon. Friend.
  Then there is the hon. Member for St. Pancras, North (Mr. K. Robinson). I think that it would be ungenerous of me not to admit in public what I have said in private, that I am delighted that it is the hon. Gentleman with whom I have to deal. Although he may from time to time make the mistake of equating good medicine with bad Socialism, he has an intimate first-hand knowledge of the Health Service, and I know that he wishes only to improve it.
  Total expenditure on the health and welfare services this year will amount to more than £1,000 million. Part of the service is administered centrally, and part locally, but one thing that is clear is that if the great range of services is to be used to the best advantage those services must be considered as a whole, in fact, as one integrated service, the overriding purpose of which is to make the most effective provision for those in need. Looked at in that sense, there is no other undertaking in the country which is at once so large and so complex, and that was certainly evident from the remarks of my hon. Friend the Member for Ludlow (Mr. More).
  The difficulties with which any Minister of Health is faced are not simply difficulties of magnitude. There is the added complication that medical science is advancing at a pace which makes it impossible to lay down rigid criteria for the years ahead. It is not simply a question of finance. What was appropriate 10 years ago, or even one year ago, may well be out of date today.
  1566
  I mention by way of example only two changes. In 1949, there were 20,000 deaths from tuberculosis, and the 32,000 beds allocated for its treatment were so inadequate that even in those days arrangements had to be made for patients to be treated in Switzerland. By 1962, the number of deaths had dropped to 3,000, and only two-thirds of the 18,000 beds available were filled. In 1950, if capital had been available—and I think that the hon. Lady will agree with this—we might well have embarked on a major programme of building T.B. hospitals, which, 10 years later, would, have turned out to be white elephants. The decline in infectious diseases has had a similar effect. The 20,500 beds allocated in 1950 had fallen to 6,600 in 1962, and only half of those were filled. Unfortunately, the hospitals for Doth T.B. and infectious diseases were specially constructed and so located as to be of limited use elsewhere.
  I mention those examples to show how difficult it is to plan for any number of years ahead, and I think the lesson is that hospital accommodation has to be so designed that it can be modified quickly and cheaply, and that room must be left for expansion of those departments where the change is most likely.
  No arm of the National Health Service can be said to be pre-eminent but before I came to the Ministry of Health I had always taken the view that the Health Service revolved round the general practitioner, the family doctor. What I have seen during the past few weeks has served only to confirm that view.
  Several hon. Members have referred to the position of the family doctors—the hon. Member for St. Pancras, North and my hon. Friend the Member for Plymouth, Devonport (Miss Vickers), the hon. Member for Stroud (Mr. Kershaw), and the hon. Member for Holborn and St. Pancras, South(Mr. G. Johnson Smith) among them. It is true to say that the supreme duty of the National Health Service is to serve the patient and the individual family. But if the public is to be well served it seems to me that it is essential that the profession should be in good heart.

  1567
  Hon. Members will have read the Gillie Report. I agree with the hon. Member for St. Pancras, North that it it a remarkable document. I have rarely considered a report which is at once so concise and so very readable. The Report draws an inspiring picture of what general practice can become, and it is based on what the best doctors are doing today. I can see no reason why this picture should not become the reality throughout general practice, provided that the profession and the Government work in partnership. There are some things which only the Government can do; there are others which only the profession can do. But each can help the other.
  Hon. Members know that the pay system of general practitioners is a fairly complex one, and I shall not go into any detail about it this evening. The purpose of the pool system is to provide doctors with a sum of money out of which they can meet their practice expenses and be left with a fair level of net pay. It is sometimes forgotten that the Government pay into the pool every penny of practice expenses which doctors incur and which is accepted in their Income Tax returns. This is not always understood, but it is the case. For 1961–62, the sum came to about £31½ million.
  The other element in the pool, amounting to about £53¾ million in 1961–62, represents the net pay which the Review Body says that the average doctor should receive for his public work. This is the element which was increased by 14 percent. last April. All this money—the practice expenses and the net pay—is distributed to general practitioners, mainly in the form of capitation fees.
  This distribution system is not dictated by the Government; it is agreed with the profession. As hon. Members will have read in the Press, the profession is soon to present a case for increased net pay. The profession is not ready to send it to me, and when it does, I shall doubtless seek the advice of the Review Body, so I will say no more about it now. But on the distribution of practice expenses, to which the hon. Member for St. Pancras, North again referred today, I believe that we can make some progress. I certainly hope so.
  1568
  The present system has some very odd results. Again, I shall not go into detail, but the fact is that two doctors with widely differing expenses may be reimbursed to precisely the same extent. One gets more than his actual expenses, and the other less. If a doctor increases his practice expenses, the Government find the extra money, but it does not go to that doctor; it is distributed over the whole profession. In a sense, one can say that this is a useful deterrent against individual extravagance. Unfortunately, it also provides a disincentive to the doctor who wants to increase his expenses in order to improve his standards.
  We have, therefore, asked the profession to consider ways of channelling the money more equitably, and I hope that it will agree. We shall also be discussing the question of capital expenditure. But we do the profession an injustice if we think of it as concerned merely with its own status and pay. Some doctors may sometimes give that impression, but, generally speaking, it is unfair. Doctors want to practise good medicine, and my task is to help them to do just that.
  I have no power—I do not want any power—to compel doctors to adopt an appointments system or to make more use of health visitors and to do all the other things that are recommended in the Gillie Report. That is not for me. Doctors value their individual freedom to run their practices as they wish. But although further progress is, to a considerable extent, in the hands of the doctors themselves, I want, on this the first occasion when I have the opportunity of speaking to the House on health matters, to make my attitude clear. It is to do everything that I reasonably can to help, because after all the overriding objective of us all is to secure the highest standard of medical care which general practice can give.
  Dr. J. Dickson Mabon: Would the right hon. Gentleman be kind enough to consider the question of deductions from the central pool, which is a great irritant? The harder that doctors work in relation to matters outside general practice the less there is from the general pool. The 14 per cent. award has become a 6 per cent. rise to general practitioners.
  Mr. Barber: If the hon. Gentleman will look at the Official Report of what I have said about the 14 per cent. I think that he will agree that I have stated it correctly. The other point had not escaped me.
  A good deal has been said in the debate, by the hon. Member for Durham (Mr. Grey) and other hon. Members, about the shortage of doctors. I agree with the hon. Member for St. Pancras, North that there is a shortage. But to listen to hon. Gentlemen opposite, one would think that nothing was being done about it. Certainly, hon. Members who have referred today to the shortage of doctors seem to have taken no account whatever of the figures given by my hon. Friend the Parliamentary Secretary, when he opened the debate.
  The fact is that despite the advice in the Willink Report that the annual intake in British medical schools from 1961 onwards should be reduced to about 1,760, in fact, in 1961–62 it was increased to 1,896. The next year it was increased again to 2,047. The October entry this year rose still further to 2,153. The number of family doctors in practice has increased by 3,500 during the past 12 years. Then there was the announcement made by my hon. Friend this afternoon concerning at least one new medical school.
  Mr. K. Robinson: Is the right hon. Gentleman aware that he has made history, that he is in fact the first Conservative Minister of Health to admit that there is a shortage of doctors?
  Mr. Barber: The hon. Gentleman has already referred to the fact that I have admitted this in an interview which I gave only the other week. It seems to me obvious, in present circumstances, that there is this shortage. If there had not been a shortage of doctors in the past, my predecessors would not have arranged for the intake of medical schools to go up at the rate that it has gone up. I certainly should not seek to minimise the shortage of doctors. But it would be a travesty of the facts to pretend that the Government have not made good progress over these years. The real trouble with hon. Gentlemen opposite is that they proceed from fabricated facts to foregone conclusions. Fortunately, the British public is more
  1570
  intelligent than some hon. Members opposite seem to realise.
  A good deal has been said about nurses, and the first point which the House should be in no doubt is that there is no shortage of recruits. I ask hon. Members to remember that the pay of nursing staffs was increased by 7½per cent. last year and again by an average of 6½ per cent. this year, and within the last fortnight it has been agreed that over a period there will be a reduction in hours.
  One fact which has struck me as somewhat strange is that there is no general yardstick for measuring staffing needs. The needs are determined locally and in different ways. What we must do, and, indeed, are doing, is to try to find a better method of assessing individual hospitals nurse staffing needs. I have already said that there is no general shortage of recruits. The truth is that, for one reason or another—the most obvious being marriage—a good many women leave the profession, although we should not forget that the number of qualified nurses still practising today is an all-time record. That certainly does not bear out the assertion of the hon. Member for St. Pancras, North that they are disheartened.
  My hon Friend the Member for Stroud, who referred to part-time nurses, may like to know one striking fact. During the past 12 years the number of part-time qualified nurses in the hospital service has almost doubled. I am quite sire from all I have seen so far that much more can be done in some hospitals to make the best use of nursing staff and to relieve them of non-nursing duties.
  I have been getting round the hospitals during the past few weeks and I mention a few possibilities: the rearrangement of duty rosters to enable more part-time staff to be used, the introduction sometimes of five-day wards to enable waiting lists for minor operations to be dealt with more quickly—these can be staffed largely by part-time staff—the greater use of nursing auxiliaries and ward orderlies and the grouping together of patients according to nursing needs. My right hon. Friend's Hospital Plan will help by providing more facilities in out-patients' departments so that patients can undergo investigations and treatment

  1571
  there rather than being admitted to the wards.
  I turn, in the limited time available, to maternity services, to which so many hon. Members have referred, particularly my hon. Friend the Member for Plymouth, Devonport (Miss Vickers) and the hon. Member for Lanark (Mrs. Hart). The first thing I want to do is to express my gratitude to the National Birthday Trust Fund for having set up a body of such distinguished practitioners to consider the problem of the maternity services. There are two important points about the report on perinatal mortality which should be recognised, although they do not diminish at all either my concern about the shortage of beds and the shortage of midwives, or my recognition of the great importance of the Report.
  The hon. Member for St. Pancras, North said that according to the survey perhaps 100 deaths a week or more could be prevented. The Report itself fairly points out that it is impossible to assess what proportion of deaths recorded could have been prevented. The second point is that all the data in the Report on perinatal mortality relates to a period more than five years ago, early in 1958. This is important because since then a considerable amount of work has been done. I have the figures for perinatal mortality, both for stillbirths and live births, but I shall not weary the House with them because I have a great deal more to say.
  Mrs. Hart rose—
  Mr. Barber: I have not very much time and if the hon. Lady will allow me to continue I shall not give way.
  The House will agree that great credit is due to the devoted men and women in the maternity service who have been responsible for the improvement since 1958.
  Mrs. Hart: May I ask one brief question? Would the right hon. Gentleman agree that it is a reasonable assumption that the perinatal rate achieved in the highest social class could have been achieved in the lower classes if proper maternity provision were made?
  Mr. Barber: I hope that we shall increase the average rate across the
  1572
  whole country. I was about to say that it is obvious that we must try to do much better. To anyone like myself, with two healthy children, even one solitary family tragedy, especially when one has seen it close at hand, is a distressing reminder of the extreme urgency of this problem.
  One of the principal reasons for the present difficulty is that the birthrate has risen more steeply than any of the experts could have foreseen. The remarks of the hon. Member for St. Pancras, North were, to say the least, a little ungenerous to my right hon. Friend the Member for Wolverhampton, South-West. The action required is twofold, more midwives and more maternity beds. In the need for more midwives we start from the position that in the hospital service the number of full-time midwives has gone up by 19 per cent. since 1958 when the report was made and in the same period the number of part-time mid wives has gone up by 51 per cent. The number of pupil midwives has also increased. But this is still not enough. The answer lies largely in improving the working conditions of midwives and, in some cases, in delegating work to other staff and, in other cases, in the better organisation of midwifery departments. I heard the other day, for example, of one hospital which is encouraging the return of part-time staff by providing a nursery for children of the staff.
  Then there is the domiciliary service. The numbers here have been increasing, but some areas still need more. There is no shortage of qualified midwives. The task is to persuade them to return to practice and many local authorities provide houses and cars. The hon. Member for Coventry, North (Mr. Edelman) mentioned that many midwives were still riding bicycles. My own wife thinks that every midwife should be given an E-type Jaguar. Many local authorities have introduced rot as for night duty and many are employing more part-time staff for post-natal care.
  This is the right sort of approach, but the other need to enable us to cope with the unforeseen rise in the birthrate is more maternity beds. I accept without qualification the opening words in the summary of recommendations of

  1573
  the Committee's Report, which are to the effect that the Committee considered that sufficient maternity beds should be available in fully staffed maternity hospitals or wards to enable every mother whose age or health involves a risk to her child to have her baby delivered in hospital.
  The original Hospital Plan, introduced by my right hon. Friend, provided for a net addition over the next 12 years of 6,500 new maternity beds. Since then it has been revised, and, as hon. Members know, provision has been made for a further increase. I am asking regional hospital boards to bring forward as far as possible the starting dates for the construction of new maternity units or extensions to existing units. In those areas where the need is most pressing I want them also to consider bringing to maternity use every bit of other ward accommodation. And the closing of some maternity units due for eventual replacement can be deferred.
  My Chief Medical Officer is arranging to hold a conference of representatives of all the main professional bodies concerned with maternity services. The Chief Nursing Officer is also arranging a meeting of maternity matrons and superintendents of maternity units. The hon. Member for St. Pancras, North said he thought that a State-registered nurse, when taking a midwifery course, reverted to the pay of a student nurse. A State-registered nurse who takes a midwifery course, which lasts for about 12 months, gets the rate of pay of a pupil midwife, that is true, but the hon. Member will be pleased to know that three weeks ago arrangements were made which will enable a hospital which has a nurse who is willing to train and subsequently to return to practise as a midwife to make up to her the difference between her pay as a pupil midwife and her pay in her previous nursing post.
  There was much more I wanted to say about all we are doing in industrial building and in other respects. I had also hoped that I would have had time to say something about the points raised by my hon. Friend the Member for Putney (Sir H. Linstead) concerning the pharmaceutical service. I listened not only with interest, but with some
  1574
  concern, to what my hon. Friend had to tell me. I can assure him that I am well aware of the essential part played by the service. My hon. Friend asked about new legislation. The intention certainly is that it should deal with medicines and not just with poisons.
  As to the closing of small hospitals—and this subject has been referred to by many hon. Members—I know that some people are still concerned about this matter and I would, therefore, like to give four assurances. First, the Hospital Plan does not represent final decisions on the future of the individual hospitals named in it. Secondly, no hospital will be closed unless and until there is alternative provision for the services which are needed. Thirdly, as long as I am Minister of Health no hospital will be closed without my personal consideration and approval. Fourthly, even where a small hospital is no longer required for its present use we shall consider the possibility of using it for some different function.
  The Opposition Motion says that the Government are not securing "improved standards of service", and the hon. Lady the Member for Cannock—and, indeed, the hon. Member for St. Pancras, North—referred to the record of Conservative Government; for the last 12 years. The hon. Lady asked me to deal with that record, but perhaps I might put a few questions. Is it not an improvement that during the past 12 years there has been an increase of 34 per cent. in the number of in-patient courses of treatment in our hospitals? Is it not an improvement that some 400 new operating theatres have been provided since 1948—most of them since 1951—and that 157 more are now under construction?
  Is it not an improvement to spend £52 million on hospital building, as we are doing this year, rather than £11 million in 1951—the year in which the Labour Government unnecessarily cut the social services? I am quoting from the present Leader of the Opposition, who said that an "integral part" of the Budget proposals of his right hon. Friend the Socialist Chancellor
  "…involves the first cutting-in to our social services…I cannot believe it to be necessary."—[Official Report, 24th April, 1951; Vol. 487, c. 229.]

  1575
  Yet the Opposition have the nerve to table a Motion regretting this Government's failure to secure improved standards.
  Of course, there remains an immense amount to do in practically every field, but the terms of the Opposition Motion bear no resemblance to the truth. Is it not an improvement that since we came into office, while the total population has increased by less than 7 per cent. the number of nursing and midwifery staff in the hospital service has increased by 30 per cent., and the number of family doctors by 18 per cent.?
  The very last Budget of the Labour Government provided for what the Socialist Chancellor was pleased to call "A slight increase in expenditure on health." That was a mere £7 million above the previous year. Since the present Government has been in office, the current annual expenditure on health and welfare has increased by more than £500 million.
  What is the only positive proposal in the Opposition Motion? It is to abolish the health charges. One would think that the idea of such charges had nothing to do with the Labour Party. Nobody would believe that it was a Labour Government which first imposed charges for false teeth and spectacles. Nobody would believe that, together with some 250 other hon. Members, there went tripping into the Lobby in support of those charges, not only the hon. Member for St. Pancras, North, but the
  right hon. Gentleman the Leader of the Opposition.
  The idea now is to abolish the charges at a cost of £50 million. Let the House realise what that would mean. It would mean that expenditure on the Health Service would have to be cut by that amount, or that there would be the same amount less for some other public service which no member of the Opposition has been frank enough to specify, or that taxation would be increased to the same amount. The reason we are not told which choice a Socialist Government would make is that it would tarnish one of the Labour Party's brightest electoral gimmicks, but I have absolutely no doubt that the people of Britain would infinitely prefer to keep these Health Service charges rather than to slow down the development of the Service, which was admitted by the last Labour Minister of Health.
  We on these benches have good reason to be proud of what has been achieved, and we do not mean to be diverted from our task of further expanding and improving the Health Service either by the magnitude of the plans which my predecessors have set in train or by the nebulous promises of the party opposite which, on past performance, it has no hope of fulfilling.
  Question put. That the words proposed to be left out stand part of the Question: —
  The House divided: Ayes 170, Noes 249.

  Division No. 7.]

  AYES

  [10.0 p.m.

  Albu, Austen

  Darling, George

  Grimond, Rt. Hon. J.

  Allaun, Frank (Salford, E.)

  Davies, G. Elfed (Rhondda, E.)

  Gunter, Ray

  Allen, Scholefield (Crewe)

  Davies, Harold (Leek)

  Hamilton, William (West Fife)

  Bacon, Miss Alice

  Delargy, Hugh

  Hannan, William

  Barnett, Guy

  Dempsey, James

  Harper, Joseph

  Beaney, Alan

  Dodds, Norman

  Hart, Mrs. Judith

  Bellenger, Rt. Hon. F.J.

  Doig, Peter

  Hayman, F. H.

  Bence, Cyril

  Donnelly, Desmond

  Henderson, Rt. Hn. Arthur(Rwly Regis)

  Benn, Anthony Wedgwood

  Driberg, Tom

  Herbison, Miss Margaret

  Bennett, J. (Glasgow, Bridgeton)

  Duffy, A. E. P. (Colne Valley)

  Hewitson, Capt. M.

  Benson, Sir George

  Ede, Rt. Hon. C.

  Hllton, A. V.

  Blackburn, F.

  Edelman, Maurice

  Holman, Percy

  Bottomley, Rt. Hon. A. G.

  Edwards, Robert (Bilston)

  Holt, Arthur

  Bowden, Rt. Hn. H.W. (Leics, S.W.)

  Edwards, Walter (Stepney)

  Hooson, H. E.

  Boyden, James

  Evans, Albert

  Houghton, Douglas

  Bray, Dr. Jeremy

  Fernyhough, E.

  Howell, Denis (Small Heath)

  Brockway, A. Fenner

  Fitch, Alan

  Howie, W. (Luton)

  Butler, Herbert (Hackney, C.)

  Fletcher, Eric

  Hughes, Emrys (S. Ayrshire)

  Carmichael, Neil

  Forman, J. C.

  Hughes, Hector (Aberdeen, N.)

  Chapman, Donald

  Fraser, Thomas (Hamilton)

  Hunter, A. E.

  Cliffe, Michael

  George, Lady MeganLloyd(Crmrthn)

  Hynd, H. (Accrington)

  Collick, Percy

  Ginsburg, David

  Hynd, John (Attercliffe)

  Corbet, Mrs. Freda

  Gooch, E. G.

  Irvine, A. J. (Edge Hill)

  Cronin, John

  Gordon Walker, Rt. Hon. P. C.

  Irving, Sydney (Dartford)

  Crosland, Anthony

  Grey, Charles

  Jay, Rt. Hon. Douglas

  Dalyell, Tam

  Griffiths, Rt. Hon, James (Llanelly)

  Jenkins, Roy (Stechford)

  Johnson, Carol (Lewisham, S.)

  O'Malley, B. K.

  Skeffington, Arthur

  Jones, Dan (Burnley)

  Oram, A. E.

  Small, William

  Kelley, Richard

  Owen, Will

  Smith, Ellis (Stoke, S.)

  King, Dr. Horace

  Padley, W. E.

  Snow, Julian

  Lawson, George

  Paget, B. T.

  Sorensen, R. W.

  Ledger, Ron

  Pannell, Charles (Leeds, W.)

  Steele, Thomas

  Lee, Frederick (Newton)

  Pargiter, G. A.

  Stewart, Michael (Fulham)

  Lee, Miss Jennie (Cannock)

  Parkin, B. T.

  Stonehouse, John

  Lever, L. M. (Ardwick)

  Pavitt, Laurence

  Stross, Dr. Barnett(Stoke-on-Trent,C.)

  Lewis, Arthur (West Ham, N.)

  Peart, Frederick

  Swingler, Stephen

  Lipton, Marcus

  Prentice, R. E.

  Taverne, D.

  Loughlin, Charles

  Price, J. T. (Westhoughton)

  Thomas, Iorwerth (Rhondda, W.)

  Lubbock, Eric

  Probert, Arthur

  Thorpe, Jeremy

  Mabon, Dr. J. Dickson

  Pursey, Cmdr. Harry

  Tomney, Frank

  McBride, N.

  Randall, Harry

  Wainwright, Edwin

  MacColl, James

  Rankin, John

  Warbey, William

  Mackie, John (Enfield, East)

  Rees, Merlyn (Leeds, S.)

  Weitzman, David

  MacPherson, Malcolm (Stirling)

  Reid, William

  Wells, William (Walsall, N.)

  Mallalieu, E. L. (Brigg)

  Reynolds, G. W.

  Whitlock, William

  Mallalieu, J. P. W.(Huddersfield, E.)

  Rhodes, H.

  Wigg, George

  Manuel, Archie

  Robertson, John (Paisley)

  Wilkins, W. A.

  Marsh, Richard

  Robinson, Kenneth (St. Pancras, N.)

  Willey, Frederick

  Mendelson, J. J.

  Rodgers, W. T. (Stockton)

  Williams, D. J. (Neath)

  Millan, Bruce

  Rogers, G. H. R. (Kensington, N.)

  Williams, W. T. (Warrington)

  Mitchison, G. R.

  Ross, William

  Willis, E. G. (Edinburgh, E.)

  Monslow, Walter

  Royle, Charles (Salford, West)

  Wilson, Rt. Hon. Harold (Huyton)

  Moody, A. S.

  Shinwell, Rt. Hon. E.

  Wyatt, Woodrow

  Morris, Charles (Openshaw)

  Short, Edward

  Yates, Victor (Ladywood)

  Morris, John

  Silkin, John

  Zilliacus, K.

  Moyle, Arthur

  Silverman, Julius (Aston)

  Mulley, Frederick

  Silverman, Sydney (Nelson)

  TELLERS FOR THE AYES:

  Mr. Redhead and Mr. McCann.

  NOES

  Agnew, Sir Peter

  Critchley, Julian

  Hollingworth, John

  Aitken, Sir William

  Crowder, F. P.

  Hope, Rt. Hon. Lord John

  Allan, Robert (Paddington, S.)

  Cunningham, Sir Knox

  Hopkins, Alan

  Allason, James

  Curran, Charles

  Hornby, R. P.

  Amery, Rt. Hon. Julian

  d'Avigdor-Goldsmid, Sir Henry

  Hornsby-Smith, Rt. Hon. Dame P.

  Anderson, D. C.

  Deedes, Rt. Hon. W. F.

  Howard, Hon. G. R. (St. Ives)

  Atkins, Humphrey

  Doughty, Charles

  Howard, John (Southampton, Test)

  Awdry, Daniel (Chippenham)

  Drayson, G. B.

  Hughes Hallett, Vice-Admiral John

  Barber, Rt. Hon. Anthony

  du Cann, Edward

  Hughes-Young, Michael

  Barter, John

  Duncan, Sir James

  Hulbert, Sir Norman

  Batsford, Brian

  Elliot, Capt. Walter (Carshalton)

  Hurd, Sir Anthony

  Beamish, Col. Sir Tufton

  Elliott, R.W.(Newc'tle-upon-Tyne,N.)

  Hutchison, Michael Clark

  Bell, Ronald

  Emmet, Hon. Mrs. Evelyn

  Iremonger, T. L.

  Bennett, Dr. Reginald (Gos & Fhm)

  Errington, Sir Eric

  Jackson, John

  Berkeley, Humphry

  Erroll, Rt. Hon. F. J.

  James, David

  Bidgood, John C.

  Farey-Jones, F. W.

  Johnson, Dr. Donald (Carlisle)

  Biffen, John

  Fell, Anthony

  Johnson, Eric (Blackley)

  Biggs-Davison, John

  Foster, John

  Johnson Smith, Geoffrey

  Bingham, R. M.

  Fraser,Rt.Hn Hugh(Stafford&Stone)

  Jones, Arthur (Northants, S.)

  Bishop, F. P.

  Fraser, Ian (Plymouth, Sutton)

  Jones, Rt. Hn. Aubrey (Hall Green)

  Black, Sir Cyril

  Galbraith, Hon. T. G. D.

  Kaberry, Sir Donald

  Bossom, Hon. Clive

  Gammans, Lady

  Kerans, Cdr. J. S.

  Bourne-Arton, A.

  Gardner, Edward

  Kerr, Sir Hamilton

  Box, Donald

  Gibson-Watt, David

  Kershaw, Anthony

  Boyd-Carpenter, Rt. Hon. John

  Gilmour, Ian (Norfolk, Central)

  Kimball, Marcus

  Boyle, Rt. Hon. Sir Edward

  Glyn, Sir Richard (Dorset, N.)

  Kirk, Peter

  Brains, Bernard

  Goodhew, Victor

  Lagden, Godfrey

  Brewis, John

  Gough, Frederick

  Langford-Holt, Sir John

  Brooke, Rt. Hon. Henry

  Green, Alan

  Leather, Sir Edwin

  Brown, Alan (Tottenham)

  Gresham Cooke, R.

  Leavey, J. A.

  Browne, Percy (Torrington)

  Grosvenor, Lord Robert

  Legge-Bourke, Sir Harry

  Bryan, Paul

  Gurden, Harold

  Linstead, Sir Hugh

  Buck, Antony

  Hall, John (Wycombe)

  Litchfield, Capt. John

  Bullard, Denys

  Hamilton, Michael (Wellingborough)

  Lloyd,Rt. Hn. Geoffrey (Sut'nC'dfield)

  Bullus, Wing Commander Eric

  Harris, Frederic (Croydon, N.W.)

  Lloyd, Rt. Hon. Selwyn (Wirral)

  Carr, Compton (Barons Court)

  Harris, Reader (Heston)

  Longden Gilbert

  Carr, Rt. Hon. Robert

  Harrison, Brian (Maldon)

  Loveys, Walter H.

  Channon, H. P. G.

  Harvey, Sir Arthur vere(Macclesf'd)

  Lucas, Sir Jocelyn

  Chataway, Christopher

  Harvey, John (Walthamstow, E.)

  Lucas-Tooth, Sir Hugh

  Clark, Henry (Antrim, N.)

  Harvie Anderson, Miss

  McAdden, Sir Stephen

  Clark, William (Nottingham, S.)

  Hastings, Stephen

  MacArthur, Ian

  Cleaver, Leonard

  Hay, John

  McLaren, Martin

  Cole, Norman

  Heald, Rt. Hon. Sir Lionel

  Maclean, Sir Fitzroy (Bute & N. Ayrs)

  Cooke, Robert

  Henderson, John (Cathcart)

  Macleod, Rt. Hn. Iain (Enfield, W.)

  Cooper, A. E.

  Hill, J. E. B. (S. Norfolk)

  McMaster, Stanley R.

  Cordeaux, Lt.-Col. J. K.

  Hirst, Geoffrey

  Macmillan, Maurice (Halifax)

  Corfield, F. V.

  Hobson, Rt. Hon. Sir John

  Maddan, Martin

  Contain, A. P.

  Hogg, Rt. Hon. Quintin

  Maitland, Sir John

  Craddock, Sir Beresford (Spelthorne)

  Holland, Philip

  Markham, Major Sir Frank

  1578

  1579

  Martowe, Anthony

  Redmayne, Rt. Hon. Martin

  Temple, John M.

  Marten, Neil

  Rees, Hugh (Swansea, W.)

  Thatcher, Mrs. Margaret

  Matthews, Gordon (Meriden)

  Rees-Davies, W. R. (Isle of Thanet)

  Thomas, Peter (Conway)

  Mawby, Ray

  Renton, Rt. Hon. David

  Thompson, Sir Richard (Croydon, S.)

  Maxwell-Hyslop, R. J.

  Ridley, Hon. Nicholas

  Thornycroft, Rt. Hon. Peter

  Maydon, Lt.-Cmdr. S. L. C.

  Ridsdale, Julian

  Thornton-Kemsley, Sir Colin

  Miscampbell, Norman

  Rippon, Rt. Hon. Geoffrey

  Touche, Rt. Hon. Sir Gordon

  Montgomery, Fergus

  Roberts, Sir Peter (Heeley)

  Turner, Colin

  Neave, Airey

  Robson Brown, Sir William

  Turton, Rt. Hon. R. H.

  Nicholson, Sir Godfrey

  Rodgers, John (Sevenoaks)

  Tweedsmuir, Lady

  Noble, Rt. Hon. Michael

  Roots, William

  van Straubenzee W. R.

  Nugent, Rt. Hon. Sir Richard

  Ropner, Col. Sir Leonard

  Vane, W. M. F.

  Orr, Capt. L. P. S.

  Royle, Anthony (Richmond, Surrey)

  Vaughan-Morgan, Rt. Hon. Sir John

  Orr-Ewing, Sir Charles

  Russell, Ronald

  Vickers, Miss Joan

  Osborne, Sir Cyril (Louth)

  Scott-Hopkins, James

  Vosper, Rt. Hon. Dennis

  Page, Graham (Crosby)

  Sharples, Richard

  Walder, David

  Page, John (Harrow, West)

  Shaw, M.

  Walker-Smith, Rt. Hon. Sir Derek

  Pannell, Norman (Kirkdale)

  Shepherd, William

  Wall, Patrick

  Partridge, E.

  Skeet, T. H. H.

  Ward, Dame Irene

  Pearson, Frank (Clitheroe)

  Smith, Dudley (Br'ntf'd & Chiswick)

  Watkinson, Rt. Hon. Harold

  Peel, John

  Smyth, Rt. Hon. Brig. Sir John

  Wells, John (Maidstone)

  Percival, Ian

  Speir, Rupert

  Whitelaw, William

  Peyton, John

  Stainton, Keith

  Williams, Dudley (Exeter)

  Pickthorn, Sir Kenneth

  Stanley, Hon. Richard

  Williams, Paul (Sunderland, S.)

  Pike, Miss Mervyn

  Stevens, Geoffrey

  Wilson, Geoffrey (Truro)

  Pitman, Sir James

  Steward, Harold (Stockport, S.)

  Wise, A. R.

  Pitt, Dame Edith

  Stodart, J. A.

  Wolrige-Gordon, Patrick

  Pott, Percivall

  Studholme, Sir Henry

  Wood, Rt. Hon. Richard

  Pounder, Rafton

  Summers, Sir Spencer

  Woodhouse, C. M.

  Powell, Rt. Hon. J. Enoch

  Talbot, John E.

  Woodnutt, Mark

  Price, David (Eastleigh)

  Tapsell, Peter

  Woollam, John

  Prior, J. M. L.

  Taylor, Sir Charles (Eastbourne)

  Worsley, Marcus

  Prior-Palmer, Brig. Sir Otho

  Taylor, Frank (M'ch'st'r, Moss Side)

  Pym, Francis

  Taylor, Sir William (Bradford, N.)

  TELLERS FOR THE NOES:

  Quennell, Miss J. M.

  Teeling, Sir William

  Mr.Chichester-Clark and Mr. Finlay.

  Proposed words there added.
  Main Question, as amended, put and agreed to.
  Resolved,
  That this House welcomes both the considerable expansion of the National Health Service which has taken place in recent years and the further improvements which will be brought about by the policies of Her Majesty's Government.

  BUSINESS OF THE HOUSE
  Ordered,
  That the Proceedings of the Committee of Ways and Means may be entered upon and proceeded with at this day's Sitting at any hour, though opposed.—[Mr. Hughes-Young.]

  WAYS AND MEANS
  Considered in Committee.
  [Sir Robert Grimston in the Chair]
  Resolved,
  That towards making good the Supply granted to Her Majesty for the service of the year ending on the 31st day of March, 1964, the sum of £40,084,000 be granted out of the Consolidated Fund of the United Kingdom.—[Mr. Green.]
  Resolution to be reported.
  Report to be received Tomorrow; Committee to sit again Tomorrow.

  RATING (INTERIM RELIEF) [MONEY]
  Resolution reported,
  That, for the purposes of any Act of the present Session to make provision with respect to England and Wales for grants to rating authorities, it is expedient to authorise the payment out of moneys provided by Parliament—

  (a) of any expenses of the Minister of Housing and Local Government incurred—

  (i) in making to rating authorities in the case of whom, in the year 1964–65 or any subsequent year, the number of persons over the age of sixty-five estimated to be included in the population of the authority's area exceeds one-tenth of the estimated total of that population a grant in respect of that year at a rate of five pounds per head of the excess;

  (ii) in making to rating authorities who have afforded relief for any year in accordance with the said Act to the residential occupiers of dwellings a grant equal to half the aggregate amount of that relief plus one-sixth of the amount, if any, by which that aggregate amounts exceeds three per cent. of the gross rate income of the authority's area for that year within the meaning of the Rate-product Rules 1959 or the Rate-product (County Boroughs) Rules 1959;

  (b) of any increase attributable to the said Act in the sums payable out of moneys so provided under any other Act.

  Resolution agreed to.

  RATING AND VALUATION
  10.14 p.m.
  Mr. James MacColl: I beg to move,
  That an humble Address be presented to Her Majesty, praying that the Rating (Charitable Institutions) Order 1963 (S.I., 1963, No. 1361), dated 1st August 1963, a copy of which was laid before this House on 9th August, in the last Session of Parliament, be annulled.
  One of the main disadvantages of the negative Resolution procedure as applied to Statutory Instruments is that it is not possible to get a clear explanation of what a Statutory Instrument is about before one starts discussing it. I confess that there is a good deal about this Statutory Instrument which I find uncertain and rather obscure and on which I should like to have information. I can only try to give what seems to me to be the broad effect of it.
  In the 1961 Act there is a provision that all charities should have a mandatory rating relief of 50 per cent. In the First Schedule of the Act there is a provision that certain institutions, mainly universities, should be exempt from that exemption. In other words, they have to pay the full amount of rates.
  I understand that this Statutory Instrument does two things. First, it adds certain institutions to the Schedule and makes them liable to pay full rates, whatever they may be. It also takes certain colleges out of the Schedule. Most of the bodies which are to be brought into the Schedule are new universities, all in varying degrees of development, except Keele, which appears under another name, namely, the University College of North Staffordshire, in the third paragraph of the Schedule. Just to make things easy for the layman, it has had its name changed in the Order, but that does not make any difference to the position. The other universities concerned are East Anglia, Essex, Kent at Canterbury, Lancaster, Newcastle-upon-Tyne, Sussex, Warwick and York.
  This is an extremely interesting Order because it marks the beginning of what I suppose will be a very considerable rating or derating operation. As more and more universities come into existence as the Robbins Report is
  1582
  carried out, more universities will be coming into rating, and, therefore, we will have more Orders adding them to the Schedule.
  I think that it should be made clear what the discussion is about. It is not about whether places of higher education should pay rates, but about who should pay the rates. In other words, the question is whether these places should be derated so that the burden falls on the local authority—because, broadly, that is the effect of derating—or whether they should be rated and the rates paid, not by the institution, but by somebody else who will find the money for the institution. That is the first point about which I want to ask the Minister.
  During the Second Reading of the Rating and Valuation Bill, the Home Secretary, in talking about the Schedule, said:
  "Let me hasten to make it clear that the universities will in no way suffer thereby. My right hon. Friend the Chancellor of the Exchequer is ready to give assurance that any additional rates failing on them as a result will be taken into account in determining the amount of recurrent grants to be paid to them from the Exchequer. It is simply a question whether the money will come from the taxpayers or from the other ratepayers."—[OFFICIAL REPORT, 30th November, 1960; Vol. 631, c. 402.]
  That is fairly clear, and I suppose that it has been carried out. However, it does not deal with one serious aspect of this, namely, upon what basis of assessment universities are rated. It may be that, although on paper the full value is being paid, if the method of assessment produces a low result, the other ratepayers suffer.
  What is happening in the case of new universities? It is one thing to say that if there is a difference in the valuation on the University of Leeds or of Sheffield, the difference that will be paid by the Exchequer is a fairly clear sum. In almost every case mentioned in the Statutory Instrument, however, these universities ire green fields and at some stage came, or will come, into development.
  Could we be told at what stage these Orders will be made? At what stage does a university ripen sufficiently for it to be brought into rating and into the Schedule? Can we be sure from the

  1583
  Minister that the difference between the rateable value of a green field—which has normally, I suppose, in many cases been rated as agricultural and may well be zero—and the full rateable value as it is developed into a flourishing university will be met by the Exchequer? Will it be met immediately, or will there be a time lag before these payments are made? What is the machinery for beginning to pay the rates on the universities?
  That is all I have to ask in the case of the universities which are being brought into rating. The only other thing which I want to ask comes later concerning those which are being taken out of rating. We have been given a cryptic statement, which, again, is one of those triple negatives, because things are put back into the Schedule and then taken out again.
  I understand that the university of London will not now cover Goldsmiths' College. In other words, full mandatory derating will occur in the case of that College.
  The Minister of Housing and Local Government and Minister for Welsh Affairs (Sir Keith Joseph): The hon. Member is being so correct in his analysis that I should like to put right the one mistake which he is making. It is not full mandatory derating, but 50 per cent. mandatory derating. I should ask him to read that back throughout his speech where he has referred to full derating.
  Mr. MacColl: I meant the full amount as provided for in the principal Act.
  It will be interesting to know why, particularly, Goldsmiths' College has been singled out for this treatment. Is it something that has changed about the constitution of the college since 1961, or is it something that has always existed in the college but has only just been discovered? It should be regarded with a good deal of care, because the effect of taking Goldsmiths' College out of the Schedule and making it subject to derating for the 50 per cent. is bound to have an effect on the rateable value of the area in which the college is situated.
  I must declare an interest. At one remote time in my career, I was a member of the delegacy of Goldsmiths' College and I think I am right in saying that it is in the County of London, although I am not certain which borough it is in.
  Mr. Michael Stewart: Deptford.
  Mr. MacColl: I thought that it was south of the river. What will be the effect on the rateable value in the County of London in general, and of Deptford in particular, of allowing Goldsmiths' College to be derated.
  When the original Bill was being passed, there was a good deal of discussion about the effects of the derating of these colleges. One of the arguments that was used was that there was no need to worry very much about this, because most of the places which had educational institutions got rate deficiency grants. Therefore, if one takes a college and reduces the rates to be paid on it, the only main effect of it is that it is picked up by the rate deficiency grant and there is virtually no trouble as a result.
  I should like to know in the case of each of these institutions—Goldsmiths' College is one, and then there is a series of theological departments or colleges and also the Lister Institute of Preventive Medicine—whether they are in rating areas in which rate deficiency grant is paid or whether they are not.
  There is a good deal of distress among local authorities about the effect and impact on their areas where colleges are subject to a very substantial amount of derating so that the product of a 1d. rate is very substantially reduced and they do not get any rate deficiency grant and so the whole burden must fall on the authority. There is no precept by which they can spread the effect. In the case of Goldsmiths' College there is a precept and an equalisation grant within the county, and, therefore, it may well be that the effects of derating in this case will be spread over a comparatively large area.
  What is the position with the other institutions? Are they in areas where there is no means of spreading the burden and it must fall on one authority, or are they in areas where there is a reasonable chance of spreading it?
  Also, what is the method—this is a technical question—of assessing the rateable value of these colleges? Is the principle followed that which was laid down by the Lands Tribunal, or, more correctly, by the Court of Appeal which to some extent followed the Lands

  1585
  Tribunal in the case of Magdalen College, Oxford, and the other colleges which were subject to appeal on their method of assessment?
  I believe that that is the leading case in this field. Here I walk on very treacherous ground, and I may have got it all wrong. I think that, put simply, the position is that in the case of those colleges it was decided to follow what is called the contractor's method of assessment. There are two steps in that method. First, one determines a capital value for the whole educational plant, if I may use an Americanism—the network of buildings; residences, laboratories and the rest—and then one finds a rate of interest from which one calculates the notional or hypothetical rent. On the rate of interest depends one's ultimate rateable value.
  I could refresh the memory of the House about the Magdalen College case by reading an extract from the judgment of the Master of the Rolls, but perhaps I need not waste time. What was said was that the normal commercial interest rate which is used for calculating the value of a commercial undertaking which is being assessed by the contractor's method is 5 per cent. Because the buildings in Oxford were financed partly by charitable, benevolent and endowment gifts, the rate of interest was halved—to 2½ per cent.
  One of the things which brings startling light to the layman is that in the Shrewsbury School case, decided just previously, the rate of interest was calculated at 3½ per cent. Far be it from any layman to understand why the wise, good and just men who decide these matters assessed the rate of interest for Shrewsbury School as greater than that for Magdalen College. I would not know. But I should like to know whether the rate of interest is 2½ per cent., or whether it will be something greater. If this doctrine is being accepted that the commercial rate of interest is to be reduced by half or by some other reduction factor because the institution concerned is a charity and financed largely by a benevolency, by endowments and so on, then it seems to me that these educational institutions are getting double relief.
  They are getting relief, first, because it is said, "If this were a commercial
  1586
  concern we would capitalise the rate of interest at 5 per cent. Because it is an endowment we are making it 2½" Therefore, the gross value is being cut by half as compared with a full commercial building. One is, therefore, bringing into one's calculations at that early stage a factor of reduction for purposes of a charity and for the purpose of recognising the source of the fund.
  If that applies to Goldsmiths' College, it seems to me that there is a strong case for saying that there should not be a double relief by taking it out of the Schedule and by giving it the 50 per cent. mandatory relief. I am not saying that Goldsmiths' College should pay the full amount of these rates, but I am saying that it is wrong for this burden to kill doubly in this way on the rating authority. The college should not be subject to derating virtually by the fact that its character is taken into account in calculating the assessments and also by being given this mandatory relief of 50 per cent. That is unfair, a kind of double scissors movement.
  If what I say about Goldsmiths' College and the other theological colleges is correct, why does the Minister want to take them out of the Schedule? The fairest thing would be to leave them in the Schedule instead of letting them be a burden on the rating authority.
  I should like to see these matters cleared up because we are at the beginning of what I believe will be a very long series of these Orders, some putting things in and others taking things out. Therefore, my hon. Friends and I thought that it only right that the implications of this Order should be fully appreciated and discussed.
  10.35 p.m.
  Mr. G. W. Reynolds: My hon. Friend the Member for Widnes (Mr. MacColl) has drawn attention to the institutions which are being newly added to the Schedule by this Order, and, as my hon. Friend has suggested, there are others which will be coming along no doubt in the future, and they are in the same position, as many at present in the Schedule, namely, to charitable trusts, which, if they were not included in the Schedule, would get mandatory relief. No doubt they will also have the nerve to apply for discretionary

  1587
  relief, although I think that they might get short shrift from local authorities if they did. Still, no doubt, they will try to get it.
  The main reason for their being in the Schedule is that they are financed through public funds. They will in due course provide a large chunk of rateable value in the areas in which they are, and as a large part of their costs are provided for by public funds, and as they are not real charities in the normally accepted sense of the word, they should, therefore, bear their full share of rates. I think that this is right and proper. Having at last got a proper standard valuation for all hereditaments right over the country, we are now in the position, by the 1961 Act and by a Bill which is now before the House, of mucking the whole lot about again. Tonight, we are dealing with those being put in the Schedule here.
  What I should like to know is why these properties are being put into the Schedule and some others which receive grants from public funds are being left out. These colleges are being put into the Schedule, but it is a prerequisite of being accepted by the University Grants Committee that they are scheduled as universities. They manage to obtain from local sources, industrial or commercial or otherwise, a certain amount of endowment to bear part of their costs, but, nevertheless, the major part of their costs is met from public funds. There are other institutions whose entire costs are met from public funds, where there is virtually no private money involved at all, and yet they, because they happen to be registered charities, are entitled to 50 per cent. reduction in their rates.
  I refer particularly to12—I believe that it is still 12—colleges of advanced technology, in their present form created since the 1961 Bill went through the House and became an Act. In 1961, those institutions had recently been recognised, though they were at that time entirely under the control of local education authorities, with boards of governors appointed by the local education authorities and they were registered for rating purposes in exactly the same way as any technical school or any other school which came under the local education authorities. Therefore, they
  1588
  were not put into the Schedule to the Act at that time; it was not necessary at all; but since the Act was passed the status of these colleges has completely changed.
  They are now taken right outside the local government field. They are now governed by charitable trusts. They receive 100 per cent. of their income direct from the Ministry of Education. In due course, if the recommendations of the Robbins Report are accepted, as, we are told, in general they are, by the Government, these colleges will become universities, and then presumably they will come—
  Mr. Deputy-Speaker (Sir Robert Grimston): I am sorry to interrupt the hon. Member, but I think that he is getting a little far from this Order. He may, if he wants, give a little background explanation, but I cannot relate to the Order what he is now saying. Perhaps he will help me.
  Mr. Reynolds: I will do my utmost, Mr. Deputy-Speaker, to keep within your Ruling.
  The point I am trying to make is that these colleges which are being added to the Schedule are partly, not entirely, financed by public funds. I am in favour of adding them to the Schedule. I understand the Minister is looking at certain other establishments, colleges of advanced technology and others, and what I am attacking is his dilatoriness in the matter, because I am disappointed because the Order is not designed to cover all the matters which I think it ought to cover.
  In my view, various educational institutions, particular colleges of advanced technology, ought to be included in it. We have 12 authorities losing at present, because of the present position, several thousands of pounds each by way of rate income. The beneficiary is the Minister of Education. The losers are the local ratepayers. I ask the right hon. Gentleman for an undertaking that the wider aspects of this are being looked into and that the C.A.T.s will be included in the near future.
  10.40 p.m.
  The Minister of Housing and Local Government and Minister for Welsh Affairs (Sir Keith Joseph): I congratulate

  1589
  the hon. Member for Widnes (Mr. MacColl) on his largely accurate homework. He has correctly described the contents of the Order and has related it correctly to the 1961 Act. To put it neatly again, charities were, under that Act, entitled to 50 per cent. mandatory relief, plus any additional discretionary relief at the discretion of the local rating authority. Institutions listed in the First Schedule were excluded from that mandatory relief because they were supported by the University Grants Committee—that is, by public funds channelled from the Treasury through the Committee.
  It was then explained by my right hon. Friend the present Home Secretary that the Schedule would need alteration from time to time as new institutions supported by the U.G.C. came into existence and he warned that it would need reviewing also in case any of the institutions included at first did not, on closer inspection, qualify in the way I have described.
  The Order adds a number of new university institutions to those that are, by the Schedule, excluded from the 50 per cent. mandatory relief and, at the same time, correots two or three anomalies that had crept in. To get into detail at this stage, let me try to answer the questions of the hon. Member.
  It was necessary after the Act was passed to go into closer examination of the relationship between several colleges and institutions of London University. As a result, Goldsmiths' College, which was, at that time, thought to be just a part of the University, supported by the U.G.C, has been found to receive no direct grant from the U.G.C. and consequently has been removed from the Schedule. It will, therefore, under this Order, remain entitled to 50 per cent. mandatory relief. The college happens to be in Deptford, which receives a rate deficiency grant, so to that extent there will be no extra hardship on the local ratepayers.
  The three theological colleges referred to in paragraph 2,c of the Order were similarly found not to be in direct receipt of U.G.C. money and are, therefore, removed from exclusion and return to eligibility for 50 per cent. mandatory relief. I cannot, I regret, give the hon. Member a full answer about the rate deficiency grant status of those areas in which these colleges are situated. All
  1590
  I can say now is that they do not receive direct U.G.C. support and will get rate relief. They will thus be like a number of other charities whose mandatory rate relief does impose, to some extent, an extra burden on the local ratepayers, though limited to some extent by the rate deficiency grant. This is something that the House expected at the time when mandatory rate relief was put into the Act.
  The hon. Member for Islington, North (Mr. Reynolds) asked about the colleges of advanced technology. They have not been included because they did not have the same financial relationship to the Exchequer us did the universities when the Order was drafted. Nor do they today. But, as he said, the Government have accepted the Robbins Committee recommendation that these institutions should have university status, and action to give effect to that decision is in hand, together with a full review of the finances of higher education.
  I am in a position to assure the House that as the colleges of advanced technology achieve university status they will be put on the same financial basis as all other university institutions, although, of course, the financial framework itself may be changed as the result of the review now going forward. Orders will be laid before the House as necessary when their position is clear.
  The hon. Member for Widnes raised the interesting question of the timing of rateable obligations falling on a green field as it was developed into a university. This is very much the business of my right hon. Friend the Chancellor of the Exchequer, advised by the U.G.C., but I understand that, as buildings are put up, so my right hon. Friend ensures that the recurrent grants include the necessary provision in the case of new universities to cover the rating obligation which falls upon them.
  The hon. Member also asked me about the valuation of university buildings. He quite rightly explained to the House that these institutions are dealt with by the contractor's test and that the Lands Tribunal had validated a 2½ per cent. interest rate in the case of Magdalen College. He was also right to say that a recent case had shown that a 3½ per cent. interest rate was used. I can tell the House that

  1591
  in the recent valuation the Inland Revenue used the 3½ per cent. basis for university buildings.
  The only quarrel I had with the hon. Member's presentation of his series of questions was when he spoke of the double relief which universities got by being given a 2½ per cent. interest rate, as he thought they were. The whole object of the contractor's test, the contractor's method, is to arrive at an acceptable basis of valuation. We have to assume that what the Inland Revenue uses and what is validated by the courts is the way of arriving at the correct valuation.
  I do not think that it is open to us to say that because the Inland Revenue uses a lower rate of interest for university buildings than it may for commercial buildings, this is, as it were, therefore a method of relieving universities. It is a method of arriving at what is thought to be the correct valuation of universities. However, as the hon. Member has asked me, I am glad to be able to assure him that in the recent valuation the 3½ per cent. basis was used.
  I think that I have answered all the questions. If more are asked, I shall try my best to answer them, but I hope that hon. Members will be satisfied that this Order is sensible and should not be invalidated.
  Mr. M. Stewart: The right hon. Gentleman said that we must regard the valuation on the contractor's basis as the correct way of valuing universities. Even if that is so, does it not create a considerable difficulty for a local authority which has a great deal of this property in its area when it finds that there is this lower method of valuation and that the institutions are entitled to full mandatory relief, if it is also an authority, as is the City of Oxford, which does not qualify for rate deficiency grant? That creates a peculiar situation.
  When one adds all those things together, one must regard that as an anomalous situation. Each effect which has caused that can be justified by itself, but when they are all added up there is an anomaly which hits the local authority very hard. Since the right hon. Gentleman is the Minister whose job it is to look after local authorities, when he is introducing an
  1592
  instrument of this sort is there no way in which he can cure an anomaly of that kind to the benefit of, Oxford in this instance, but also of any other authority which may find itself in that position?
  Sir K. Joseph: I fear not. The situation in Oxford flows from a series of ingredients each of which is individually justified. Although the hon. Member is right in his description of the ingredients, I question whether he is correct in saying that the effect is so serious—I forget his words, but he used some strong adjectives about the effect.
  I think the hon. Gentleman would like to know that the effect is the equivalent of a 2¼d. rate. No one in my position could possibly be indifferent even to a ½d. rate, or a ¼d. rate, because I know what strong feelings can be aroused, but the fact is that at Oxford the combined effect of these ingredients amounts to the equivalent of a 2¼d. rate. That combination, which is considerably less than in many other cities, has been caused by revaluation, whereas in Oxford, as it happens, the effect of revaluation has in itself left the domestic ratepayers unscathed. The rise in the rates of the domestic ratepayers in Oxford has been brought about entirely by the increased rate call from the local authority.
  Mr. MacColl: I understand that the share of rateable expenditure borne by the Oxford colleges has fallen from 6½ per cent. to 2½ per cent. What I wanted to draw to the attention of the right hon. Gentleman was the passage in Lord Ever-shed's judgment where he quoted from the Lands Tribunal. He said:
  "The money for the erection and improvement of university buildings and colleges is generally provided by benefaction, and for these reasons we consider that a commercial rate of interest is not appropriate. We would apply 2½ per cent. as being half of what we were told in evidence was the normal percentage used for commercial properties…"
  Without probing too deeply into what went on in the Tribunal's mind, I should have thought that that was a rough and ready way of saying that these bodies are not commercial, that they are not getting a profit from private sources, that they are living on benefactions, and therefore the method of assessment will be reduced. That is why I said that there was a double measurement of charitable objects, and why it was reduced from 5 per cent. to 2½ per cent. Secondly, it was the reason

  1593
  for giving them 50 per cent. under the Act.
  Will the 3½ per cent. measure be applied retrospectively to the Oxford colleges, or will it be applied only to other institutions which come into the valuation later?
  Sir K. Joseph: I understand that this is retrospective, and that it was used as the valuation basis this time, but if I am wrong I shall write to the hon. Gentleman about it.
  I may have given a wrong impression when answering the hon. Member for Fulham. The 2¼d. in Oxford is the amount attributable only to the 50 per cent. obligatory derating.
  Mr. MacColl: I appreciate the help which the right hon. Gentleman has given the House on this very difficult subject, and I beg to ask leave to withdraw the Motion.
  Motion, by leave, withdrawn,

  RAILWAY LINES, BUCKINGHAMSHIRE AREA (CLOSURE)
  Motion made, and Question proposed, That this House do now adjourn.—[Mr. Chichester-Clark.]
  10.53 p.m.
  Major Sir Frank Markham: I rise to protest against the proposed closure of four railway lines and several stations in my constituency and in adjacent areas. The lines in question are the Bletchley—Buckingham line; the Wolverton—Newport Pagnall line; the Oxford—Bletchley—Cambridge line; and the Bedford—Northampton line. Over and above those, it is proposed to close the stations of Castlethorpe and Roade.
  In this protest I have the support of nearly every Member for the four counties of Oxfordshire, Buckinghamshire, Bedfordshire and Cambridgeshire, and the support of nearly every local authority through which any of those railway lines pass. Indeed, the transport users' consultative committees must be snowed under with protests from these areas. In addition to those I have the support of my hon. Friend the Member for Northants, South (Mr. Arthur Jones) and also of the N.U.R. group in this House.
  1594
  This represents a formidable body of opinion and it is a great regret to me that the Minister has already refused to meet a deputation from the area, centred on Bletchley, known as the Steering Committee and which consists of representatives of all political parties and of the leading local authorities. The Minister has replied saying that the usual channels must be adhered to, that cases of hardship will be considered by the T.U.C.C. and that anything else he will himself consider at postal distance.
  It is in the vast range of subjects that cannot be considered by the T.U.C.C. that we feel that grave mistakes can occur unless the Ministry is fully informed of what is in the minds not only of those of us who are directly concerned but of many others, including the leaders of the British Railways Board.
  The area about which I am speaking is one of the fastest developing parts of the country. In Buckinghamshire alone there has been a 28 per cent. increase in population during the last 10 years. In Bedfordshire, there has been a 30 per cent. increase in that period. No other part of the country can show a similar rate of expansion. Added to all this is the fact that if one considers the area which is usually known as the Home Counties around London, one finds it estimated that there will be an increase of another 1½ million people within the next five to six years.
  If the railways cannot make good in a developing area like this, it is obvious that they cannot make good anywhere. The electrification of the main line London-Birmingham is going ahead and this, we hope, will do something towards improving the services provided by the railways. This, however, is only part of the story, for the other points concern finance, railwaymen's transport and jobs, stewardship, costs of alternative services, and so on. And none of these can be considered by the T.U.C.Cs.
  The Minister has laid it down in legislation that the T.U.C.C. may consider only oases of travelling hardship. Thus local protesters can be heard only on this one subject of travelling hardship. Any protests on any other subjects made either by individual objectors or local authorities must be made in writing to the Minister of Transport,

  1595
  who is already a prejudiced person, as it were, because he is carrying out the legislation that he has introduced by means of an organisation, and individuals which he has created or appointed, and often clashing with other policies which he has enunciated as the principal roads Minister in this country.
  This shows that in these broad spheres of finance, transport, stewardship, costs of alternative services and many others we can appeal only to the Minister in writing. We are never allowed to see the replies given by the British Railways Board or another Ministry, and from the moment the Minister receives our letters of protest we are entirely excluded from any further investigation. This is wrong, unjust and does not even give the appearance of justice.
  British Railways give us certain figures, but not the lot. We are told some of the costs, but not all of the takings. Not only the N.U.R., but, I believe, other bodies would like to have an opportunity to challenge the figures. These organisations say that the figures do not contain the accretion of the parcels services, advertisements and vendors. They also say that the railways have not included in the costs the future costs of caretaking of disused stations. There is also the cost, possibly, of subsidising the buses.
  Let me refer to the railwaymen again, because theirs is one of the key protests that ought to be considered. Articles 51, 52 and 53 of the Handbook of the Transport Users' Consultative Committees state that if the railwaymen have a protest they can put their protests through the hierarchical channels of the trade unions. Their protests never get up through those channels. They are dead-ended at somewhere like branch level. Railwaymen both at Bletchley and at Wolverton have protested—and I believe them—that their protests got to the local consultative committee, and not a step further.
  Many of these railwaymen are not only indignant, perhaps, at losing their jobs, but are more public spirited and are indignant at a good service being closed down, and indignant because there is no channel through which they can make constructive proposals for improving
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  traffics on the railways. These are grave charges against the present system by which these railway closure inquiries are conducted.
  Let me give another example of what this will mean to the railwaymen at the Wolverton works and at Castlethorpe and on the line between Newport Pagnell and Bletchley, which it is proposed to close down. Travelling daily from Newport Pagnell to Wolverton there are between 275 and 300 railwaymen. If this line is closed nobody cares "a tuppenny hoot" how these men will get to work in future. British Railways have said that it is not any business of theirs to provide transport for them. The transport users' consultative committee may say to the Minister that there may be hardship here, but it is not the committee's business to make constructive proposals to the Minister as to how that hardship can be dealt with.
  If this hardship is to be met at all. they will have to organise about 10 buses, leaving at practically the same time from Newport Pagnell to Wolverton, and vice versa, to take not only the railwaymen themselves, but the school children. The Railways Board says that it is not its business how the children get to school, but that that is the sole responsibility of the local education authority. In short, the railway divests itself of its necessary public service and leaves the wounds to others to heal.
  One of the most shocking things about the present system is that in a case like the Wolverton works it is not incumbent on the railways themselves to provide some alternative transport arrangements for their own workers who have been travelling by train hitherto.
  Another thing that the railwaymen feel very keenly about is that some services are already so badly run that, for example, on the Bletchley-Bedford line, which it is proposed to close, passengers have to stand in two trains, in particular—the 9.5 a.m. from Bletchley to Bedford and the return train at 4.10 p.m. from Bedford to Bletchley. When a train is so crowded that passengers have to stand, there cannot be any good reason for closing the line; there is every reason why that railway service should be improved, and passengers given the comfort they used to get before the railways were nationalised.

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  That is the kind of thing that the railwaymen themselves would have liked to put before the T.U.C.C., but they were short-circuited in the channels of the trade union movement. We have the assurance by the Minister that he will consider anything that comes up before him, how can he make sure railway complaints will come to him? The Minister says, and has said many times, that when he gets these protests in writing he will consult other Ministries. Obviously, one of the first things is the provision of alternative road transport to replace the railways.
  The Minister must, therefore, consult the Minister responsible for road transport, but he is himself the Minister responsible for road transport so that he is appealing from himself to himself. That is why I say that he is prejudiced on the question of further road programmes to replace the damage that will be done generally by removing these railways services.
  The Minister of Transport can also approach the Minister of Housing. In all the cases I have mentioned the Minister of Housing must say, and I think that he will say to the Minister of Transport, "If you ask me about development in this area, all I can say as Minister of Housing is that we should wait for the south-east regional review." The South-East, as we know, is to be developed. London's expansion or relief will become more and more distant from London and new towns, like Bletchley, will be focal centres of new development, and it is here where this cross country line from Oxford to Cambridge centres at the moment. Will the Parliamentary Secretary give an assurance to the House that if such an answer is received from the Minister of Housing his right hon. Friend the Minister of Transport will postpone closures until the south-east regional review has been considered by the House?
  Secondly, I should like to see all closures stopped until a better system of investigation has been worked out. It is evident throughout the country that the present system is received with considerable scepticism. The consultative committees have been looked upon as rubber stamps of British Railways. I know that this is not entirely true but
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  that is the impression. I urge that the Minister should establish a new system of investigation which would give the impression of being much more just than does the present one. I beg of him also to suspend judgment on these four lines and the stations until the review of the South-East is available and we cars see what the future holds for this rapidly developing part of England.
  11.7 p.m.
  The Parliamentary Secretary to the Ministry of Transport (Mr. T. G. D. Galbraith): I am grateful to my hon. and gallant Friend the Member for Buckingham (Sir F. Markham) for the lucid way in which he has made his case tonight. I am glad also to have this opportunity of dealing with such an important subject. My hon. and gallant Friend has certainly been most assiduous in his efforts to make representations about the proposed closures in his constituency. I do not want him to think from anything I say that I am not sympathetic to him in the situation he has described where the population in his constituency is increasing at the same time is there are these proposals to reduce the number of railways. But the picture which he has painted is not, of course, the whole story.
  I should like to set it in its context, but, obviously, I cannot comment at this stage on the merits or demerits of the proposed closures he has mentioned, nor can I enter into discussion on the relevance or otherwise of various facts to which he has referred, such as passengers standing in certain of the trains in his constituency. On the other hand, I have noted what he has said and will report them most carefully to my right hon. Friend. The reason why I cannot comment fully on these matters of detail is that the future of these stations is, as it were, sub judice, and I am sure that my hon. and gallant Friend will realise that for that reason I cannot be very specific in what I have to say.
  This difficulty, which arises in all closure castes, as I am sure the House will realise, was dealt with by my right hon. Friend in a somewhat similar Adjournment debate in May. To save time and to avoid repetition of what my right hon. Friend said then, it might

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  be helpful if I sent my hon. and gallant Friend, as I shall do, a copy of that debate. There ate, however, certain points which I can answer, but before dealing with them I think that it would be helpful if I were to explain how proposals are made by the Board, how representations are considered, and how decisions are reached, because my hon. and gallant Friend seemed to have doubts about fairness, particularly with regard to how decisions are reached. I hope that I shall be able to convince him that he should not be as doubtful as he now seems to be.
  The first and most important thing to get clear is that the responsibility for deciding whether or not to propose a closure is a matter for the railway management. Often, hon. Members come to me and say, "Why are you proposing to close this line?", when what they mean is, "Why is Dr. Beeching proposing to close the line?". Why Dr. Beeching should be doing it is, of course, a question which the Minister cannot answer. After all, he does not run the railways; that is the Board's duty, and the Board has, to quote the words of the 1962 Act, to do it with "due regard" to efficiency, economy and safety of operation.
  It was in fulfilment of this duty that, last March, in its Report, the Board gave in outline plans for closing about 330 passenger services involving over 2,000 stations. This was a general proposal, but when it comes to any particular line or station the Board must give formal notice, and this allows users seven weeks in which to object, and, if they do object, then the proposal cannot be effected without the Minister's consent. This is an important restriction on the railway management's discretion which was introduced in the 1962 Act, which my hon. and gallant Friend seemed to be complaining about, because it brings in both the T.U.C.C. and the Minister.
  The new procedure thus gives full opportunity to discuss what really matters to passengers, that is: will there be hardship, and are the alternatives satisfactory? This is the only thing that a passenger is really concerned with—how to get from one place to another if the railway line is closed. The financial matters to which my hon. and gallant Friend referred and other wider planning considerations are
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  utterly irrelevant to the passenger. He is concerned only with movement, not with costs, and that is why there is no wide-ranging discussion at the T.U.C.Cs. and why there is no cross-examination of financial figures, since whether the railways lose £5 or £500,000 does not really affect the hardship issue.
  My hon. and gallant Friend may well ask, "If that is so, why should these figures of finance be mentioned at all, when they are clearly irrelevant to hardship?" The answer is that the T.U.C.Cs. asked the Railways Board to provide them because they find it helpful to have some idea of the sum involved as general background, particularly when they are considering possible alternatives.
  Although the provision of these figures is essentially a matter between the Railways Board and the T.U.C.Cs., in view of the public interest which has been shown in them, to which my hon. and gallant Friend referred tonight, my right hon. Friend, on the recommendation of the president of the Institute of Chartered Accountants, got Sir William Carrington to carry out an investigation, and his report, which is in the Library, shows that the figures are both appropriate for the consultative committees' purposes and are compiled on bases which are sound in principle.
  What it amounts to is that the consultative committee's job is to report to the Minister on hardship. The committee does not—I cannot stress this too strongly—decide or even recommend whether a closure should take place. It is concerned only with deciding what hardship will be caused by the closure, if it takes place, and with proposals for alleviating that hardship.
  I recognise that my hon. and gallant Friend has in his constituency a particular problem raised by the large number of railway employees who reside there. He has referred to various aspects of the problem. But I think that this is an internal matter for the railways. My right hon. Friend must be at pains not to interfere with the machinery which already exists in the industry for consultation between management and the elected representatives of the staff.
  As my hon. and gallant Friend probably knows, before a closure proposal is published, the Railways Board consults these elected representatives at both

  1601
  regional and local levels, and the object of the consultation is not only to inform the staff representatives of the Board's intentions and their implications for the staff, but also to invite their comments—the very point which my hon. and gallant Friend made.
  This is the established machinery, and it allows full opportunity for the staff to state their views. But if, as my hon. and gallant Friend has suggested, the machinery has got bogged down and if it is not working properly, this is a matter between the unions and Dr. Beeching, and I have no doubt that Dr. Beeching will pay attention to what my hon. and gallant Friend has said. To make absolutely sure that he does, I shall send a copy of this debate in Hansard to the Railways Board. This is essentially a question of management, and, therefore, not for the Minister. I am sure that my hon. and gallant Friend, with all his wide experience in these matters, will realise that this is so.
  To return to the procedure, having then received the report from the T.U.C.C. on hardship, the Minister must decide whether to give his consent to the closure or not. It is at this stage that other considerations come in. Dr. Beeching's object is to shape and operate the railways so as to make them pay. The job of the T.U.C.C. is to consider hardship to the passengers and ways of alleviating it. But the Minister's job is to take a much wider view, because it might well be that though a line was losing money and though there was no hardship caused to the passengers if it was closed, it would still be wrong to close the line, or at least to dispose of it, because of possible future industrial development or because of defence considerations or because of the growth of housing and population, such as my hon. and gallant Friend referred to, or, indeed, the pattern of road traffic.
  This brings me on to one of the most important points raised by my hon. and gallant Friend, when he asked about the deputation which his local authorities wish to bring to see my right hon. Friend. This raises a matter of some difficulty which I shall try to explain to him, and I hope he will understand.
  First, the Minister is in something like a quasi-judicial position on these cases. He has to reach his decision in the light
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  of all the facts. For that reason it would be improper for him to discuss cases with any of the parties. He must hold himself aloof from all interested parties, railways and local authorities alike, so that he is quite impartial and is not prejudiced at all. I was rather sorry that my hon. and gallant Friend used that word, because my right hon. Friend goes out of his way to be impartial.
  Sir F. Markham rose—
  Mr. Galbraith: I hope that my hon. and gallant Friend will not interrupt me, because I should like to try to finish and I have not very much time.
  Clearly, therefore, my right hon. Friend could not receive deputations for the purpose of examining the issues involved.
  There is the further point that if my right hon. Friend saw one local authority he could hardly refuse to see another, and with over 2,000 stations involved, seeing all the interested local authorities would create a physically impossible task even for anybody as vigorous and hard working as my right hon. Friend.
  Finally—this is most important—from the practical point of view there is everything to be said for local authorities putting their representations in writing. Not only does this help us to be sure that we have all the details but it enables my right hon. Friend to consult his colleagues, where this is necessary, easily and speedily.
  I hope, therefore, that my hon. and gallant Friend will stress to the Bletchley Council that my right hon. Friend is most anxious to receive any representations which it wishes to make and that there will, indeed, be considerable advantage both to him and to it if it puts anything that it has to say about matters other than hardship to him in writing. I can assure my ton. Friend that in this way all the council's points will be most carefully examined.
  The effect of all these arrangements is that when the report of the T.U.C.C. reaches the Minister he has also before him the representations of local authorities and the views of other Government Departments concerned, as well as the original information on which the board has based its proposals. All this evidence is then examined by a working party

  1603
  of Government officials representing the departments whose responsibilities are affected. The working party goes into every aspect in great detail.
  The next stage is examination by myself. Finally, the proposal goes to the Minister, and I can assure the House that he considers every case most carefully. Thus, at each stage assessments are made, not just about hardship to users, but also taking into account the views of the departments concerned and the arguments against closure put forward by local authorities and other bodies. It is, in fact, a very thorough and painstaking process. My hon. and gallant Friend has said that there is no appeal from this examination by the Minister. Yet how could there be any appeal? To whom could an appeal be made? What the Minister does is to assess the relative importance of various factors, and in the final analysis this is a Government decision. It is not possible to transfer the responsibility to anybody else.
  But I would like to make one thing quite clear to my hon. and gallant Friend and to the whole House. That is, that once a proposal is made it is not a foregone conclusion that the railway is going to be closed. The Government are very far from being a rubber stamp, as my hon. and gallant Friend seemed to suggest. Out of the cases which were decided this year, to give only two examples, one in a country district, the Alston line, in Northumberland, and another in a conurbation, the Sander-stead line, in Surrey, have not been closed because the Minister thought it would not be justified, taking all the issues into account. My right hon. Friend has also insisted on the continuance of the rail service over part of the Great Central line.
  In the cases where closure is allowed, the Minister attaches conditions where-ever necessary to ensure that adequate alternative services are available to the travelling public. In all this we must remember the need to balance the
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  various conflicting interests. The railways are losing vast sums of money—£150 million per annum—which is so often forgotten. That is why Dr. Beeching is making his proposals.
  Then the interests of the passengers must not be forgotten, and here the T.U.C.C. reports on hardship and on alternatives. Finally, there is the wider aspect which is something which the Government have to decide for themselves. Nobody can do it for them, and that is why there cannot be an appeal. I think that this procedure is as fair as possible and ensures that justice is done.
  I assure my hon. and gallant Friend again that the points he has raised will be reported to the Minister. I shall do it myself and I shall undertake to discuss any fresh points that he may wish to raise with me, although, of course, I shall not be able to comment upon them.
  My last words are to repeat what my right hon. Friend has said many times, that however strong the financial and other arguments may be my right hon. Friend will see that, where necessary, adequte means of alternative transport are available before a railway passenger closure takes place. That is the important thing from the point of view of my hon. and gallant Friend's constituents, and I can assure him that it is very much in our minds all the time we study these complicated and perplexing problems.
  Sir F. Markham:If I may be allowed one minute more, may I thank my hon. Friend for a very thorough survey of the points that I raised with him and also thank him for the thoroughness of his answer. There is only one thing that he has left out; he has not invited me to meet him again if I still feel dissatisfied.
  Mr. Galbraith: I am delighted to give that assurance to my hon. and gallant Friend.
  Question put and agreed to.
  Adjourned accordingly at twenty-three minutes past Eleven o'clock.