HC Deb 08 May 1963 vol 677 cc439-559

3.46 p.m.

Mr. Kenneth Robinson (St. Pancras, North)

The British nation is fitter and longer-lived today than ever before. Britain's health record and her medical services are the envy of many nations and may well become their model. Our Health Service has been described by an American social historian, Professor Almont Lindsey, as 'magnificent in scope and almost breath-taking in its implications'. Those sentences which remain broadly true even today, are not mine. They are taken from the first and the last pages of a pamphlet "Design for the Nation's Health", just published by the Conservative Central Office. It is a little odd how Conservative love for the National Health Service grows with the approach of a General Election, and just in case anyone may be mislead by any attempted takeover bid for the Service perhaps I had better start by reminding the Committee and the country, once again, that this great Service would never have been born if the party opposite, which voted against the Second and Third Readings of the National Health Service Bill, had had its way.

I should like to add a quotation of my own from the same American professor and the same admirable book which was quoted by the Conservative Central Office pamphlet, which is, incidentally, called, "Socialised Medicine". On page 100, Professor Lindsey writes: Until the Conservatives came into power in the fall of 1951, the cost of the Health Service was an issue that that party did not fail to exploit in its attack upon the Labour Government. The main structure of the Service was so soundly designed and built by Aneurin Bevan that it has stood up remarkably well to the strains and stresses of twelve years of government by the party opposite, but the Service has certainly not expanded and developed in the way that we all looked forward to at the start of what was then a great experiment. Indeed, far from advancing, in some respects we have been going steadily backwards and in the place of expansion we have had contraction. I want to come back to this in a moment.

I am sure that hon. Members on both sides of the Committee must have been entertained by an article which appeared last Sunday in the Sunday Times, entitled "Enoch's Week-end". It purported to be a kind of fly-on-the-wall report of that now famous Chequers meeting of 10 days ago, and if one is to believe this article, in the course of a generally dazzling display of intellectual virtuosity by Her Majesty's Ministers, one star shone out far brighter than the rest, and that was the right hon. Gentleman the Minister of Health.

I was reminded of the famous description of the boat race by the Victorian novelist Ouida, who wrote that All rowed fast, but none rowed so fast as stroke". I am sure that the right hon. Gentleman handled his stroke oar with great dexterity on that occasion. I am equally sure that some of his colleagues found great difficulty in keeping up with him in his break-neck excursion into the Britain 'seventies, but I beg the right hon. Gentleman to take his eyes off the far political horizon for a few moments and to take a closer look at what is happening today in the early 'sixties, to the hospital services, for which he has a rather more direct responsibility. The right hon. Gentleman has subjected the hospitals to a painful and quite deliberate financial squeeze which has had the effect of weakening the service and forcing it in many respects to contract.

This may all sound very paradoxical, at any rate to those hon. Gentlemen who have been dazzled by the ten-year Hospital Plan and the large sums of capital moneys which are scheduled to be spent an hospital building over the next fifteen years. Though we have criticised that plan in detail, I think the right hon. Gentleman will agree that we welcomed it in principle, even if we noticed that there was no firm commitment to anything anywhere. Nevertheless, we all recognised that at long last money was more freely available for capital development of the hospitals, and that this came after a long period of capital starvation when the hospital service could do little more than make do and mend.

During the last six to nine months we have become aware of the price, of at any rate part of the price, that we have to pay for these major developments in hospital building, because capital starvation has now been replaced by a maintenance squeeze. This all goes back to the right hon. Gentleman's Lloyd Roberts lecture in the autumn of 1961, when he expressed the view that a figure of 2½ per cent. in real terms was about the right figure for the annual growth of the National Health Service.

In Question and Answer in the House later, he made it clear that this was not so much his own figure as that of the right hon. and learned Member for Wirral (Mr. Selwyn Lloyd), who was then Chancellor of the Exchequer and who quoted this figure in his economic crisis statement of July, 1961. But the Minister of Health added his own refinement to this 21 per cent. and said that he thought 2 per cent. was enough for the hospital service.

I freely admit that at the time the right hon. Gentleman's remarks created no very great stir. They were not so much a bombshell as a time bomb, and this weapon went on ticking away merrily. Few people in the hospital service paid very much attention to it until it exploded in their faces about a year ago, because when the regional hospital boards came to examine their 1962–63 allocations, most of them found to their dismay that they had not got even 2 per cent. I think that out of 15 regional hospital boards 10 received markedly less than 2 per cent. The range was from just over ½ per cent. to just over 2½ per cent.

What does this figure mean to a hospital authority trying to run a group of hospitals or a region? It may not sound disastrous, but that is precisely what it is, because even a figure of 2 per cent., let alone one of 1½ or 1 per cent., for expansion, means one thing only, and that is a contraction of hospital services. I should like to explain this to the House, because it is not altogether a simple matter.

One must first ask oneself what this increase, which amounts to 3d., 4d. or 5d. in the £, has to do. First, it has to cover any increase in staff, though not of course, any increase in wages or salaries. I recognise that this is met by Supplementary Estimates as a separate operation, but any numerical increase in staff must be covered by this increase. It must cover any price increases in the course of the year, and last year there were many such price increases, particularly in food. I think that the Committee will recall that the price of potatoes, which are consumed in large quantities in our hospitals, rose to an all-time high. The increase also has to finance the maintenance costs of any new development in the hospital service, but above all this there is another and still more important factor.

The techniques of medicine are inevitably becoming more complex and more expensive all the time. This is an irresistible process, and is not unique to the hospital service. It is common to every scientific or technological field. In the hospitals, this increase in complexity and costs results, and I think is wholly justified, in more intensive and effective medical care of the patients. This is not easy to measure in monetary terms, but the amount of this increase, going on remorselessly year after year, is a good deal more than 2 per cent. One medical journal suggests a figure of 5 per cent. per annum for this aspect alone. All this can only mean that a hospital which is squeezed down to a 2 per cent. figure of increase must contract, and that to some extent the service it can give to its patients must deteriorate.

But this is not the whole story, because 1962 showed a sudden and marked improvement in the nurse recruitment situation. One cannot be sure what this was due to. It may have been due, to some extent, to rising unemployment, to fewer opportunities in fields in competition with the Health Service—light industry and that kind of thing—and possibly to some extent to the much publicised and ultimately successful fight of the nurses for more pay and a better standard of living. Anyway the situation improved.

Up to that time nearly every non-teaching hospital in the country had been suffering from a shortage of trained nurses and of suitable student nurses. The shortage was acute, and, indeed, endemic, but where hospitals had been able to recruit additional nurses the money had in the past been found somehow. Regional boards usually had some small reserve tucked away which they would make available to any hospital authority which managed to increase its establishment of nurses. Suddenly, about a year ago, the recruiting situation changed. More girls, and young men, too, became available. Some hospitals recruited more nurses, and immediately found themselves, often less than half way through the financial year, with a financial crisis because, owing to the squeeze, there were no reserves to meet this additional expenditure. Worse than that, other hospitals—the right hon. Gentleman might think that they were the more prudent ones—had no option but to turn away potential nurses. In fact, they were turned away in their hundreds and thousands and were lost to the nursing profession for ever. It is no less than a tragedy, and it is one for which we shall probably be paying many years hence.

What did the hospitals do, faced with this situation? Any hospital authority is reluctant in the extreme to cut down in any way the service which it gives the patient, but many of them had to close down wards for lack of nurses. In many more—indeed, in most—recruitment of nurses stopped absolutely. More than one regional hospital board actually instructed its hospital management com- mittees not to recruit any more nurses. Some hospitals were even unable to replace the nursing staff which had left for one reason or another. In one hospital that I know of the preliminary nurses training school had to cut down its intake of student nurses by 50 per cent. All this had an appalling effect on the morale in the hospital service.

Here again, this is not the end of the story. What else did the hospitals have to do to tighten their belts? Some made economies in food. We heard stories of butter being replaced by margarine. Some stopped overtime, and some dismissed staff. But most were forced to do the one thing that does not immediately affect the patient, namely, to defer building maintenance work and to postpone repairs, redecorations, and renewals of equipment of all kinds, including medical equipment.

The net effect of the right hon. Gentleman's economy drive on the hospitals was to force them into an utterly false economy, because maintenance and repairs must be done in the end. The equipment must be renewed, and it is bound to cost more when it is done. I have been talking about 1961–62, but exactly the same situation was repeated this year. No more money was allowed for maintenance; the same proportionate increase was granted by the Ministry, and the same work must be deferred for another twelve months, and will still be more costly to carry out when it can be deferred no longer.

Hospital management committees appreciate the sheer stupidity of this policy, even if the right hon. Gentleman does not. I do not know whether he is aware of the fact, but he is breaking the hearts of the members and officers of hospital authorities who are dedicated to improving the Service in any way they can. The situation was summed up in an editorial in the Lancet on 6th April this year, which said: hospitals can introduce improvements … only at the price of deliberate economies in existing services; and hospital authorities insist that, having saved as much as they can—for instance, on the hotel side, or by postponing redecoration, or even by abstaining from buying necessary medical equipment—they can save no more. In the drive to improve the service they have been brought to a halt: without extra aid the next move will be downhill. There is no sign that extra aid is coming from this Government, and in my view the move downhill has already begun.

I want to know why the right hon. Gentleman imposed these cuts—because they are cuts. Certainly, one can see nothing in the current economic situation to justify this. When, last July, the right hon. Gentleman was elevated to the Cabinet, nearly everybody in the National Health Service was delighted. Everybody felt, somehow, that this raised the status of the service, and that the Minister would he able to fight all the harder for the service and get more money for it. All I can say is that, in the event, they have been bitterly disappointed at the result.

Before I turn to my other main topic, I want to say a few words about the doctors' pay award. I thank the right hon. Gentleman for his courtesy in letting me have some statistics—making a special effort to do so—which might be useful in this afternoon's debate. There are some extraordinary features about this pay award. It stems from the original appointment of the Royal Commission on Medical and Dental Remuneration—which recommended the award of a 22 per cent. increase in medical salaries in February, 1960, although the House will recall that part of that 22 per cent. had already been paid in the form of interim awards before 1960.

The Royal Commission recommended the setting up of a review body, which was to be independent of the Minister of Health, of the Government and of the professions—a body which would be charged with the duty periodically of reviewing the level of medical and dental incomes, and a body to which the professions could from time to time make their submissions. There was some delay, but the review body was in due course set up—not by the Minister of Health but by the Prime Minister, presumably because the Royal Commission had been set up by the Prime Minister, and the review body derived from that Royal Commission. A prominent banker was chosen as chairman of the review body.

But, with that unerring instinct that characterises all the Prime Minister's appointments, and presumably to emphasise the impartiality of the review body, the Prima Minister selected as chairman the one bunker in Britain who just happened to be an honorary Fellow of the Royal College of Surgeons. At least, I hope that I am right in assuming that Lord Kindersley was not made an honorary F.R.C.S. subsequently, as a reward for his services to the medical profession. The form in which these recommendations are made is an extremely odd one. It comprises a long, chatty letter from the chairman to the Prime Minister, which begins, "Dear Prime Minister", and ends, "Yours sincerely, Kindersley". It is the Prime Minister who accepts or rejects the review body's recommendations.

When the body reported, I asked the Prime Minister, at Question Time, whether he knew of any other wage-negotiating body which reported its recommendations directly to him. The Prime Minister did not know of any—and, indeed, he did not seem to know why this one did. Does not the Minister of Health find this position slightly humiliating? Is it not time that this body was told that in future it should report to him? He is clearly responsible for the level of medical remuneration. I hope that ha will put this matter right.

In the event, the doctors were awarded another 14 per cent. This means that they have had very nearly a 40 per cent. increase in about six years, which is more than most groups of workers in the community have had—certainly more than most groups within the National Health Service. The latest award, affecting over 50,000 doctors, will cost the taxpayers about £16 million more per year. The review body explained, however, that it was really an award for the next three years. If that is so, it is equivalent to very nearly 7 per cent. cumulative for each of the next three years. When I put this point to the Prime Minister he said that he did not accept my arithmetic. If the Minister of Health challenges my arithmetic, I hope that he will correct me when he replies. I think that he will find that it is just about 7 per cent. per annum for She next three years.

Without in any way wishing to criticise the award, I have two things to say about it. First, the review body's terms of reference are, broadly, to keep medical remuneration in line with other professional incomes and, presumably, with the cost of living. In practice, how can the review body foretell what will be the level of other professional incomes in 1966, or what will be the cost of living then? Does it add clairvoyance to the other distinguished qualities which it brings to its work? Secondly, the figure of 7 per cent. goes a good way beyond any guiding light that has so far illumined the Government's incomes policy, if we may dignify it with that name. The 14 per cent. is still further removed.

I should like to ask one question of the right hon. Gentleman, and I hope that he will answer it. Why was this salary award not referred to N.I.C.? Is not that precisely the kind of thing that the National Incomes Commission was set up to consider? Is there any class distinction here? Are professional earnings exempt from N.I.C.'s baleful glare?

The Minister of Health (Mr. Enoch Powell)

Before the hon. Gentleman mentions 7 per cent. again, could he do the arithmetic a little more fully?

Mr. Robinson

It is perfectly simple. If the right hon. Gentleman starts at the figure of 100 and adds 7 per cent. on for each of three years. he will find that the result comes to just on 14 per cent. In other words, with 7 per cent. per year for three years, the doctors would have had, after three years, the same income as they will have with 14 per cent. increase straight away.

Mr. Powell

Will the hon. Gentleman do it again?

Mr. Robinson

I am not going on doing it. If the right hon. Gentleman has not time to do the arithmetic, he can get his right hon. Friend the Secretary of State for Scotland to do it between now and the winding up of the debate.

I want to ask the Minister one more thing about the doctors' award. Will he take this opportunity, the occasion of this very substantial increase, to discuss with the profession the present quite ludicrous method of reimbursing practice expenses? This is, as he must know, a system which, far from encouraging better standards in general practice, actually penalises those doctors who adopt better standards, and I would hope that he could have some talks with the profession about this.

Before I leave this topic, I want to say one word about this whole method of salary negotiations. Whatever the merits or demerits of the system, it has obviously done pretty well by the doctors. But why are the doctors and the dentists the only categories of National Health Service staff entitled to opt out of the Whitley system? I do not know of any group of Health Service workers who are at all satisfied with the Whitley negotiating machinery as it is at present functioning.

Why cannot, at least, the other professional workers have their own review body, or the same one for that matter? If it is right for doctors, why is it wrong for physiotherapists or radiographers, or P.S.W.s? Why not a review body for nurses, who, after all, have just received an arbitration award which leaves some student nurses worse off than they were before? Why not a review body for clinical psychologists, who have been awarded this morning by the Industrial Court not 14 per cent., but 4 per cent. increase?

I come to my last main topic, which is the control and safety of drugs. This is, of course, a subject which was thrust to the fore both in this House and in the public Press a year ago as a result of the thalidomide tragedy. The House and the public suddenly woke up to the fact that any drug manufacturer could market any product however inadequately tested, however dangerous, without having to satisfy any independent body as to its efficacy or its safety, and the public was almost uniquely unprotected in this respect.

Inevitably, comparisons were drawn with the United States of America, not, I think, a country noted for excessive State interference with private enterprise, but, nevertheless, a country where every new drug has to pass through a fine sieve of the Food and Drugs Administration, which is a Government agency, and one which incidentally, as the House will recall, managed to prevent the distribution of thalidomide in the United States. As soon as the facts became known about thalidomide, the United States Congress established even tighter control, so that no drug can now be marketed in the United States without the specific approval of the right hon. Gentleman's opposite number, the Secretary for Health, Education and Welfare. When we discussed this, the right hon. Gentleman seemed to adopt a rather negative attitude. It was only under some pressure from these benches and from the medical and pharmaceutical professions that he agreed last July to refer the problem to his standing medical advisory committee. We told him then that in our view the control of new drugs should be carried out by a statutory body responsible to him. This sub-committee, under Lord Cohen, has now reported. It has analysed the problem quite admirably, in my view, and also stated the difficulties that there are, but it has produced a solution which I can only describe as utterly unsatisfactory and disappointing.

It has produced a Report which, in places, is quite contradictory, or so it seems to me. Lord Cohen and the majority of his committee recommended in somewhat muted tones the setting up of an expert body to which drug manufacturers may, but will not be required by law, to submit new drugs for assessment of toxicity tests and approval of clinical trials. it is a little difficult to discover from the Report whether the Cohen Committee really believes that control of this kind is necessary or whether it is making its recommendation as a kind of sop to public and professional anxiety. The main point about this solution is that a voluntary scheme such as the committee suggests involves no legislation and can have no real sanctions of any kind.

Although the Cohen Committee apparently sees virtue in voluntary control, it says, in paragraph 7 of the Report: These arrangements themselves would obviously be more effective with legislative sanction than without and we are satisfied that legislation on the whole subject is urgently required. I think that few of us would contradict that. The basic poisons legislation on which we are working derives, I think, from the mid-Victorian era and is quite unsuitable to deal with the problem of modern drugs and medicine. We have had a number of patching up operations, such as the Penicillin Act, the Therapeutic Substances Act, but they are a very limited application, very much legislation ad hoc. The responsibility in this whole field is divided between the right hon. Gentleman and the Home Secretary on fairly arbitrary lines.

This same paragraph goes on a little later to say: We recognise, however, that legislation would probably involve a comprehensive review of the whole field and that this is a major undertaking. I think that this is misleading, if not disingenuous. Surely the Cohen Committee knew that just such a comprehensive review of this legislation had already taken place; that it had been undertaken by an inter-departmental working party which had reported to the right hon. Gentleman last July.

Was the Cohen Committee not told this? If it was not, why not? Surely this was relevant to its inquiry. I only discovered this fact from a Written Answer, which I got from the right hon. Gentleman last week, when I asked when the Report was to be published. I was told that this was a study by officials which was not for publication. Why not? What is there to hide? Why have we not yet had any action on this?

If the right hon. Gentleman took his responsibilities seriously and really regarded this as an urgent problem, we could have had a Bill in draft by now and it could have been ready for the next Queen's Speech, that is if we are to have another Queen's Speech from this Government, which I profoundly hope we are not. We do not consider that the Cohen Committee recommendations meet the situation at all, but fortunately it is not a unanimous Report. A very much more satisfactory solution is contained in the minority Report, which very faithfully reflects our thinking on this side of the Committee.

The minority Report was signed by the only two pharmacists on the Cohen Committee, one of whom is the Minister's hon. Friend the Member for Putney (Sir H. Linstead). Those who have signed the minority Report saw no virtue, as we see no virtue, in a voluntarily controlled body, even as a temporary expedient. They list criticisms of the majority recommendations in a quite devastating way. There are three major deficiencies. First, there is no certainty that the whole pharmaceutical industry will co-operate in a voluntary scheme; secondly, the sanctions will be few and weak; and, thirdly, a voluntary scheme may give the appearance of safety without the reality.

This note of dissent goes on to say that there is no country comparable with Britain which has not found it necessary to control drugs by Statute. It lists eight features, which I will not rehearse now because they are well set out in the Report, essential to effective control and inevitably absent from any voluntary scheme. Finally, they, too, press for a comprehensive single Statute bringing the whole field of drugs and medicine under the control of the Minister of Health, which is where it should lie, and that this be done as a matter of urgency.

We on this side of the Committee support this minority Report very strongly. Whatever steps the right hon. Gentleman may have taken already to set up a voluntary committee, I cannot believe that a Labour Government and a Labour Minister of Health would be satisfied with anything less than statutory safeguards as set out in the minority Report. Indeed, I am a little surprised at the rapidity with which the right hon. Gentleman accepted the whole idea of a voluntary scheme and acted upon it, because he has already appointed the chairman and chairmen of three subcommittees. It leads one to think that the right hon. Gentleman received the recommendation for which he had hoped.

Admittedly, a statutory duty places an additional burden on the Minister of Health, but I submit that this is a burden which a Minister charged with the duty of protecting the health of the people should be prepared to shoulder. We believe that a Minister who prefers to shelter behind an optional scheme and a semi-independent body with no teeth is in dereliction of that duty.

If the right hon. Gentleman had waited a little longer—and we have waited nine months already—to hear the views of the House of Commons, the pharmaceutical profession, and, I believe, the medical profession, he would have found very powerful support for the minority views in the Report. The Pharmaceutical Society felt so strongly about it that it held a Press conference to protest. More than one leading manufacturer has supported the idea of statutory control, and I should be surprised indeed if the medical profession would not prefer statutory to voluntary control.

Most important of all, I do not believe that the public will be reassured by any halfway house such as the right hon. Gentleman proposes. The right hon. Gentleman may say that this is only a temporary expedient. We know only too well how temporary expedients are apt to become permanent solutions. I hope profoundly that the right hon. Gentleman will think again about this before proceeding any further.

These general debates that we have on the National Health Service are so regrettably infrequent that one must exclude far more than one has time to discuss. It is possible to concentrate only on two or three topics. I have not said anything about the ten-year plan for the health and welfare services of local authorities. I have left this out deliberately because I believe, and I think that the right hon. Gentleman agrees with me, that this is a matter which should be discussed in a whole day's debate for which the Government should provide time. I have many serious reservations about the plan, and I would certainly welcome a debate on it.

I have not referred to the dental services, which are seriously inadequate, because I understand that we may have a debate on the admirable report of the Estimates Committee on Dental Services before the end of this Session. I have not been able to refer to the general medical services, to the need to associate general practitioners more closely with the hospital services and to the serious shortage of doctors in all branches and at all levels, and I have not mentioned the mental health services. I have said nothing about the system for the control of drug prices, which is improving but is far from satisfactory yet. Perhaps other hon. Members will fill these gaps.

There is much that is wrong with the National Health Service today. The Lancet recently ended an editorial by asking: is the hospital service to be allowed to slide into the second-rate, and if so, why? Fortunately for the many thousands who work in and for the Health Service, one thing will prevent that and that is the Labour victory at the General Election which is not very far away.

4.26 p.m.

The Minister of Health (Mr. Enoch Powell)

The hon. Member for St. Pancras, North (Mr. K. Robinson) admitted quite candidly in his concluding sentences that in opening this debate upon the National Health Service he had not been able to make more than a passing reference to one of the greatest developments in this whole field—the hospital plan—and none at all to another, the development of the services of community care outside the hospitals.

I recognise the limitations which time placed upon him, as it places upon all of us, though I cannot feel that the hon. Member's selection was entirely unmotivated. I am sure that he will not be surprised if I seek in some respects to fill out the picture.

Nevertheless, I should like to devote the greater part of my speech to the topics which the hon. Member chose, and I should like to start with the Committee on the Safety of Drugs which the Government have just announced their intention to appoint and towards which my right hon. Friend the Secretary of State for Scotland and I have taken the initial steps.

I must begin here by expressing our gratitude to Lord Cohen and the whole of his Committee for the work which they did upon this and for the advice which they tendered; to Sir Derrick Dunlop and his three colleagues, who will be the chairmen of the respective subcommittees, for undertaking what is an extremely responsible and difficult task under any arrangement or circumstances; and to the medical profession and the pharmaceutical industry for having so readily indicated that they will co-operate in making these arrangements effective—for effective they can be.

I wish to remove any notion that this is a safety control lacking in teeth and incapable of giving effective service. I should like to show this by looking at the three separate functions which the Committee on the Safety of Drugs will have to discharge. Taking, first, the third of these, the arrangement for collecting and evaluating data on the assessment of drugs in use, there can be no question of a statutory basis or statutory sanction being relevant here. This will depend upon the co-operation of a very large number of people, which, in any case, will be voluntarily given and cannot be enforced. and upon the arrangements which the Committee will organise. Therefore, I think that we can place that function on one side.

The first of the functions, in order, is to advise on the adequacy of toxicity tests before drugs are submitted to clinical trial. Here, the effective control lies in the hands of the consultant who is to carry out the clinical trial, and I cannot conceive that a consultant would either go against the advice of a Committee as influential and as authoritative as this, or that he would lightly proceed to the trial of a drug which this Committee had not cleared.

I must say at this point that I can see very great difficulties in applying statutory prohibition to the prescription of a drug by an individual doctor in his professional responsibility to an individual patient. I say that generally as well as specifically in relation to clinical trials. But I cannot conceive that in practice the advice of this Committee would be overridden by consultants or that clinical trials would be carried out upon drugs to which they had not given clearance.

There remains the function of advising on the adequacy of clinical trials before a drug is brought into general use. Nearly all new drugs, in the sense in which we are using the term, are presented as ethicals. That is to say, they are only available when they are prescribed for a patient by his doctor. Here again, it is virtually inconceivable that a doctor would deliberately prescribe to a patient, without the strangest reasons for which he would take personal responsibility, a new drug which had either not been cleared by this Committee or upon which this Committee had rendered an adverse report. It is really almost impossible to conceive that that would happen in practice.

Therefore, we are left only with the extremely improbable and unusual case where a new drug, a new medicinal substance, would be first brought into use as a non-ethical in sale across the counter. It is very difficult to think that this could, in fact, occur at all. But did this occur, then arrangements will be made for all drugs which are marketed—and this will include such a drug as I have posed—to come immediately to the notice of the Committee. After all, a drug cannot be marketed unless it is brought very widely to the attention both of the profession and of the public. If there were any question of the Committee not being satisfied, then in the brief interim between their receiving knowledge of this drug and reporting upon it, I have no doubt that the cooperation of the pharmaceutical profession would be available to ensure that the drug so in suspense was not offered for sale to the public.

In practical reality, therefore, these arrangements are armed with very effective teeth. It will neither pay a manufacturer if he so desired, nor will it be practicable for a manufacturer, to market a new drug either without clearance by this Committee or contrary to the recommendations of the Committee. I must say that whatever may be the legislative form that eventually it may be desirable to give to this control, as, indeed, it is certainly desirable that there should be a legislative reform of our law relating to drugs generally, I am sure that those provisions will be sounder, more practicable and better based as a result of the working the arrangements which are now being set up upon a voluntary basis. Therefore, from these arrangements, effective in themselves, armed in themselves with effective sanctions, we shall draw valuable experience which will help the House at a later stage to decide upon legislation.

I do not want to pass from this subject, however, without saying very emphatically that when we use the word "safety" in this context we should not be understood to mean absolute safety. Safety in this field is relative, whatever be the arrangements, whatever be the law. It is relative, as the Committee made clear, to the illness. It is relative in the sense that there is no system that can be devised which will make doctors or scientists aware of what medicine and science have not yet suspected.

In the case of thalidomide it is possible to say in retrospect that even if the proposed arrangements had been in force some years ago, be it on a statutory or on a non-statutory basis, it is unlikely that they would have averted the thalidomide disaster, and that proposition is supported by the fact that thalidomide was marketed in many countries which have statutory control of drugs, and that in no country which had such a control were the grounds on which this drug was withdrawn brought to notice by that machinery.

Lord Balniel (Hertford)

In these proposals would there be any legal redress for a person harmed by a medicine against this voluntary body, or are we clear that the legal redress is solely against the pharmaceutical company or the doctor concerned? Am I right in believing that responsibility for marketing these products rests solely in the hands of the pharmaceutical company?

Mr. Powell

I would hesitate to give a legal ruling on where liability in certain circumstances might lie, but the advice tendered by this Committee will be made available to those whom it concerns to act upon it, by my right hon. Friend the Secretary of State and by myself. But given that fact, I cannot see that these arrangements can alter the present legal situation as regards liability.

Dr. J. Dickson Mabon (Greenock)

Reverting to the right hon. Gentleman's comment about control, can he name one country which has a comparable system to the one which he is proposing here where this is true of thalidomide?

Mr. Powell

Yes, I am advised that in Canada, Norway, Sweden and Denmark, countries with comprehensive drug control legislation, thalidomide was placed on the market.

Dr. Mabon

Comparable to the system which the Minister is proposing?

Mr. Powell

Comprehensive control of the marketing of drugs.

The second major topic in the hon. Gentleman's speech was an elaborate attempt to show that there had been in recent years—and these were his words—a contraction in the hospital service. It is to the refutation of this paradox that I now turn. I should like to begin by describing briefly the system under which the allocations for current expenditure are made to hospital authorities. The object which underlies these arrangements is that there should be each year a definite additional amount of real spending power available to the hospital service, and that the approximate amount should be foreseen well in advance so that draft budgets can be prepared by hospital authorities two or three years ahead.

This system of forward looks, as we have got into the way of calling it, which I would hope before long to be able to extend to four and five years ahead, has given hospital authorities the opportunity of planning their expenditure, of a rational control of their expenditure in a way that they could not do on a purely annual basis of allocations. They are able to draw up their budgets and make their plans with much greater assurance of the resources which they will command.

To ensure that the hospital service has annually this additional spending power at its disposal, the allocations take full account of all the rises in costs which have taken place during the preceding twelve months. The whole of those rises in costs is made good in the Estimates for the following year, before the growth percentage is superimposed on top of that; and during the financial year Supplementary Estimates are made to cover all increases in cost, except certain price increases which in total represent only a tiny fraction of the whole expenditure and which, as a matter of fact, during the last financial year, were less than they had been during the previous one.

It is important to notice that while, for this small element of additional expenditure, additional allocations are not made, the hospital authorities have at their disposal the underspending on other items of their budgets which inevitably occurs in any circumstances and which, in the past, has often given rise to something frequently discussed in Committees of this House: the unplanned spending of the last few months or weeks of the year. In addition to that there is—and this must never be forgotten when percentage figures such as 2 and 2½ are talked about—the fact that there accrues to the additional real expansion of the service everything which the hospital authorities achieve by way of economies and increases in efficiency by organisation or otherwise. This, though it cannot be quantified, is almost certainly more important in total than what I might call the visible additional spending power which is allocated.

By all these means the hospital service is assured of the means that year by year it will be able to expand the real services it provides to the patient. I propose to illustrate how this has happened by the experience of the last twelve months. I will not go back and institute comparisons between the staffing of the service now and that of five or ten years ago. I will limit myself to the changes which have taken place in a short, recent period.

The hon. Member for St. Pancras, North made some assumptions and predictions about the future course of staffing in the hospital service. I must warn him that it is very unwise now to do this, because he has been so badly wrong in the past. Consider doctors. In a debate just over a year ago the hon. Member said that there was a …serious shortage of doctors throughout the hospital service … This shortage is growing and … will soon become critical."—[OFFICIAL REPORT, 27th March, 1962; Vol. 656, c. 1081.] As a matter of fact, in 1962 as compared with 1961—the year in which the shortage was "growing" and was soon to "become critical"—senior medical staffs in hospitals increased by 2½ per cent. and junior staffs by 6 per cent.

And in case anyone should say that this is attributable to the large numbers of doctors from overseas who come to add to their experience in our hospitals, who provide a useful and substantial reinforcement of the staffing of our hospitals and who are an advertisement to the world of British medicine and British hospitals, they constituted only a minority of this substantial increase. The increase in British-born doctors during the period was 455 and of non-British born only 289.

So medical staffing has seen a continuation of what has been happening throughout the history of the service. We have seen it continue in the last year, this increase in the size of professional staff. I will not trouble the House with a similar demonstration regarding all the other categories of staff, but I would like to indicate the order of increase that has been experienced in the last twelve months for which we have figures available in certain broad classes of staff. They are nursing: 4.7 per cent.; professional and technical, 3.8 per cent.; administrative and clerical 3.5 per cent.; and domestic and ancillary, 2.4 per cent.—all in whole-time equivalents. This is not the picture of a hospital service which is shrinking, or running down or in which the standard of staffing is falling.

The hon. Member for St. Pancras, North was very badly wrong about his predictions on nursing staffing a year ago. In a debate almost exactly a year ago the hon. Member said: … we are just not renewing even our present inadequate complement of trained nurses … this trend must have very seriously worsened during recent months".—[OFFICIAL REPORT, 14th May, 1962; Vol. 659, c. 938.] I warn the hon. Member about those words "must have"—because it did not. The reverse happened. In fact, at the very time the hon. Member was saying that, the staffing of nurses of every kind and class was rising to record figures. The total number of whole-time and part-time showed large increases and there was no category of nursing staff which, at the end of that statistical year, was not at the highest figure that had ever been achieved.

Mr. K. Robinso

n: To complete the picture, would the right hon. Gentleman remind the House that he stopped nurse recruitment because he thought that it had gone up too fast?

Mr. Powell

This demonstrates that with the allocations which the authorities had—the allocations of 2 per cent. in real terms, which continues the rate of real increase in spending power over recent years—the hospitals were able to recruit and continue to recruit every type of staff.

Mr. Denis Howell (Birmingham, Small Heath)

If the Minister served on a hospital management committee he would not talk that nonsense.

Mr. Powell

These figures derive from hospital management committees and reflect their experience.

When speaking about student nurses in that debate a year ago the hon. Member for St. Pancras, North said: It is becoming increasingly difficult to recruit student nurses."—[OFFICIAL REPORT, 27th March, 1962; Vol. 656. c. 1087.] In fact, the latest figures we have show that student and pupil nurses are at the highest figures which they have ever reached. This is not, therefore, a situation in which the service is starved of money and is running down its staff.

I would like at this point to make one exception to my general rule and look at a longer period of time, because I do not think that it is generally realised—and this is worth being publicly recognised—what a transformation there has been during the last ten or fifteen years in the nursing profession and the staffing of our hospitals. I will give just three figures which, I think, illustrate this point dramatically. Between 1949 and 1961 midwifery and nursing staffs in the Health Service increased by more than 21 per cent., compared with an increase of between 8 and 9 per cent. in the working population and less than 5 per cent. in the total population. These figures illustrate dramatically how the nursing staffing of our hospitals over these years has been transformed and how the nursing profession has—and there is no hon. Member who will not rejoice over this—drawn into its ranks an increasing proportion of the available part of the working population.

But we can test the proposition of the hon. Member for St. Pancras, North in another way. We can look at the volume of treatment which the hospital service has been able to give during the last twelve months. We can see whether that indicates "a contraction"—his word—in the hospital service. The volume of treatment given during the past year rose—[HON. MEMBERS: "Statistics."] I appreciate that these are statistics, but they are useful, interesting and important statistics.

For acute cases treated in hospitals there was an increase last year—that is, 1962—over the year before of 2 per cent. It was 3 per cent. in surgical cases. This represents, in one year, 50,000 additional patients relieved or helped by the service. There was a 4 per cent. increase in maternity cases, representing 24,000 additional births in hospital, and 4 per cent. in the volume of mental treatment.

These are increases in volume of treatment roughly matching the increase in staff and indicating that we are using the available resources in the service to better and better purpose. This is certainly not the picture of a service which is starved of money and unable to make advances. Whatever percentage figure one takes for the rate of real advance, there is no one who cannot wish that it could be pitched higher. I am sure that we all agree, whether it be 2 per cent., 2½ per cent. or 3 per cent., that there will always be good grounds for saying that more could effectively be used.

The important thing is that in this service, organised as it is and with the system of budgeting it has, we are getting the utmost return from the additional real resources which are being devoted to it. The rate at which these real resources are being devoted to the service as a whole is continuing to expand in line with our experience of previous years, and this has brought these figures to their present peak level.

However, we should not make the mistake of looking solely or mainly to increases in staff for the future improvement of the service. There must come a point—and this must increasingly be true—when it is from the modernisation of the pattern of our hospitals, their organisation, and so on, that we look for further advances in the service given to the patient. This is where the central significance of the hospital plan lies.

Hon. Members who examine the Estimates will see that the capital allocation this year—that is, the allocation for capital expenditure—has increased on a comparable basis from £36.8 million to £48 million in England and Wales. This is the next instalment of the expanding hospital programme which was placed before the country at the beginning of last year and of which the first revision was presented a month ago. That revision showed that in the first two years of the plan, 25 major schemes had been completed and that 65 others had been started, including 33 new or substantially new hospitals. In the new ten years—the ten years running to March, 1973—the assumed expenditure on the programme has risen in constant terms from £500 million to £600 million.

This programme is still expanding and marching forward, as the first revision showed. It will strain to the utmost the administrative and physical capacity of the hospital service. No method can be neglected to ensure that these large and increasing sums are fully spent and that the programme is carried forward at the rising rate which is envisaged.

Two years ago I told hospital authorities that in future I should not require to approve in detail schemes for which sketch plans had been agreed and which were within the cost limits for the various types of department laid down by my Ministry. I also told hospital authorities that, in the case of schemes not exceeding £60,000 in value, even that degree of approval would not be required for schemes within the cost limits.

I believe that I can go further now in this respect and I propose to tell hospital authorities that they have authority to carry through schemes without reference to me for approval, up to the value of £120,000 exclusive of fees and equipment; which, in practice, means that great schemes of the value of £150,000 to £160,000 each will be able to be carried through within the cost limit applied at the time, but without any paper work or cross-reference at all between the hospital authority and my Department.

Mr. K. Robinson

This is a welcome development. But what does the right hon. Gentleman mean by "within the cost limit applied at the time"?

Mr. Powell

From time to time my Department, through the building notes, indicates the cost limit for a particular type of hospital department. Now, provided that these schemes are within those limits, they can be carried through by the hospital authority without sketch plans being submitted or any other form of approval.

In the revision of the hospital plan proposed, the most important aspect to which hospital authorities had to address themselves was the consequence of the continued rise in the birth rate and, therefore, the rising demand for maternity provision. Regional hospital boards have different problems to face in this respect. The prospective increase varies very greatly between one region and another and hospital boards are still at work revising their plans in the light of the new birth rate figures. But it is already clear that many hundreds of additional maternity beds will be provided and the revised plan sets out various ways in which this will be done.

For example, for particular maternity units the starting dates will be brought forward. The Birmingham maternity hospital will start in 1964. The St. Georges, Tooting, maternity hospital will be brought forward to start in 1964 instead of 1970. The Sidcup new hospital maternity provision will be brought forward to start in 1964 instead of 1966. The South Tees-side Hospital maternity unit will be brought forward to 1967 instead of after 1971. Numerous maternity units which are in the plan will be expanded and improvements will be made at other hospitals which will enable additional beds to be used for maternity purposes.

The trend—observable not only in this country, but in other European countries—towards shorter periods of stay in maternity hospitals and the fact that a number of small maternity hospitals, with which it might otherwise be possible to dispense, can be retained in use, should, together with these increases and accelerations, provide for the welcome increase in demand for maternity provision.

But it is unrealistic to look at the developments in the hospital service in isolation. It is quite unreal to detach the care and treatment of the patient in hospital from the care which can be provided for him in the community. I am proud to have been able to place by the side of the hospital plan the Blue Book which outlines the development of community care which local health and welfare authorities throughout the country envisage during the coming ten years.

These are based on a remarkable advance in the services during the last four or five years. Over the last five years alone local authority health and welfare staffs have expanded by 20 per cent.; and the rate of increase of expenditure by 4 per cent. to 5 per cent. per annum carried on from previous years over the next decade should make possible the very large developments sketched out in the Blue Book. Local authorities have welcomed the opportunity to see their own intentions in the context of what other local authorities are doing and in a common framework. For this is the first time that the whole of health and welfare services outside the hospitals have been reviewed comprehensively, and national purposes and standards suggested.

The Report which I have to put before the Committee is that of a National Health Service which is advancing steadily and confidently upon objectives fixed for long periods ahead and constantly restudied and restated. The hospital service has the inspiration of a broadening programme which within the next decade or two will entirely modernise the fabric and the pattern of our service. Local authorities and voluntary bodies have before them the challenge of community care in its fullest and its modern sense. No nation can put beside this undertaking anything which is comparable in scope, size or vision and it is this record against which hon. Members opposite wish to align themselves in the Lobby tonight.

All I can say is that if they do so, they will show themselves totally out of touch with the spirit which exists throughout the service and the attitude of the public towards it.

5.2 p.m.

Miss Jennie Lee (Cannock)

I hoped that at some point in his speech the Minister would give an indication that a hospital presents a different aspect according to one's relationship with it If one is a patient, one looks at a hospital in a different manner from that of a friend or a relative of a patient. If one is a member of the nursing staff, or a doctor, or one who helps the nurses and doctors, the prospect is different again.

For a Minister of Health, a hospital will present another appearance. I do not say that in a critical manner. It is inevitable that when a Minister, or a senior official responsible for the Health Service, visits a hospital all the members of the hospital staff are "on their toes" and a great many of the minor and sometimes major discomforts and embarrassments which trouble the ordinary citizen would not be immediately apparent to the Minister. But I should like to think that we had a Minister of Health, who, while carrying out his high administrative duties, was rather more aware than was indicated by the right hon. Gentleman's speech of some of the present intangible problems of the Health Service.

No one in the House is not very proud that immediately after the Second World War, when countries more wealthy than our own did not dream of introducing any form of social aid so imaginative and so essential as our own scheme, we went ahead. I do not think that we should ever lose our sense of wonder at the courage and the kindness, and the hard labour, which went into getting our Health Service started. I will not nag hon. Members opposite about their part in this. I am sure that they feel ashamed of it. But we will pass on to the next stage.

Anyone who is seriously ill and needs surgical treatment, of any kind of mental or physical nursing, is served very well once they become a patient in our hospitals. I am leaving aside for the moment the minor irritations to patients and their relatives. It is very much better to be a patient in one of our great general hospitals, with the whole panoply of the hospital at the service of the patient—its machinery and its staff—than it is to be nursed in a private nursing home which simply cannot compete with the treatment provided in our great hospitals. Hon. Members on this side know that more than a decade of Conservative rule has not fundamentally undermined our Health Service—I do not know why hon. Members opposite are smiling. I should like to remind them that they did not work to start the Health Service. They did their best to make it a class service.

Let us solace ourselves by the knowledge of what we have to build on in the future, that we have this great Health Service. In addition to what is done by those suffering from serious illnesses, there is the maternity service. A young wife, who may be having her first child, may he shy and suffer embarrassment when she attends the ante-natal clinic. She may experience all kinds of irritations. She may even consider that she is being treated discourtously or brusquely because there is a lack of accommodation or a shortage of staff. But I have never heard of any mother who was not proud of the maternity service when it came to the real nursing problem, the delivery of her baby and the need to ensure that the birth took place in the best possible circumstances, and that everything was provided for herself and her child.

Hon. Members opposite must not be surprised if we on this side of the Committee take a very clear view of what is happening in our hospitals today, and for what hon. Members opposite have been responsible during the past ten years. I know that the Minister would like us to concentrate on what is to happen in the next ten years. But we think that we shall be in charge then, and not hon. Members opposite. We are in full agreement with some of the Government's proposals. Indeed, we should like the Government to go ahead faster. Obviously, it is complete nonsense that a hospital or a region should have to plan from year to year. I am glad that this point has been taken up. It is one which some of us have been urging from the beginning of the scheme. We must have long-term planning for individual hospitals and hospital groups. The Minister cannot simply turn his back on the facts. We can come much closer than in the early days of the Health Service to seeing how in spirit the Conservative Party is so reluctant: to accept it.

I ask the Minister, when he talks about the recruitment of nurses, why had our nurses to fight so hard for a modest improvement in their remuneration? Against whom were they fighting? Why has there been this cat and mouse attitude towards finance in the past ten years, giving with one hand and taking back with the oilier, an atmosphere of uncertainty and discouragement created both among the staff and the management committees? The Minister knows that to be true. Why is it that one day we find that doctors and nurses are leaving the service and that then there has to be a drive to start bringing them back again? We do not think that that is the way the Health Service should be operated.

We want to see doctors rewarded, and rewarded generously, but we think that the nurses, the ward attendants, the physiotherapists and all the contributory services are entitled to be treated with the same consideration, that there should be one law governing all of them and that that law should be predictable so that they, too, can plan their personal lives and see what the service has to offer them.

Then I come to how much we can spend on the Health Service. No one on this side of the Committee says that we can spend an indefinite amount, because we cannot. How much we spend on our hospitals must be related to our total national income, to our expanding economy and to what we are spending on education, housing and other services. What we do insist on, however, is that in fixing these priorities we should not talk about a few million pounds added one year or a few million pounds taken away another year, but that as a nation we should be planning five, ten or whatever number of years it may be ahead and whatever the percentage of our total national income it is.

If we want to get certainty into the expansion and future building programme of the hospitals, then, one, let us decide what the priority is and what percentage of the national product we are prepared to spend on hospitals. Secondly, we have to raise this money rather differently from the way in which we are doing it at present. There is no justification whatever for imposing a poll tax of 3s. 4d. a week on every man and woman who happens to be an insured worker. We want it to be widely known that a future Labour Government will end this totally unfair practice.

Of course, when the scheme was introduced many compromises were made. If there had been no compromises—[An HON. MEMBER: "Too many."] One of my hon. Friends says, "Too many". It may be that he would have been able to introduce the scheme with fewer. May be. but I am not quite certain that he would. We know perfectly well the hysterical opposition to the scheme in the early days. To get it started at all, certain compromises had to be made. They were made with our eyes open and quite deliberately, and it is the intention of the party on this side to see that those compromises which arose from the circumstances of the time are corrected at the earliest possible moment.

We have this weekly charge. That must go if we want the people to be proud of their service, to feel that they get from it what they need when sick and give to it what they can afford in relation to their income. There is no reason at all why the millionaire should be exempted from the 3s. 4d. poll tax and the worker should have to pay it. It is utterly hostile to the spirit of the scheme that anyone needing such simple things as dental treatment, dentures, spectacles and surgical aids should have to pay at the moment that they need the treatment. That, again, it must be made quite clear, is something that must go. We cannot have public opinion poisoned against the Health Service because too many people feel that they are paying for it three times over, paying for it by the weekly poll tax, paying for it when the doctor gives them a prescription and paying for teeth and spectacles.

That is expenditure which is apt to fall more heavily on the elderly than on the rest of the population. In addition to paying in these ways, the people ere paying again in income tax. I hope that no one will ask: does that mean that no one will be making a contribution at all? We have to keep the balance and realise that although some people do not pay Income Tax, no one who eats at all, drinks at all or smokes at all is exempted from taxation. Indeed, at least 10s. in the £ of our taxation is raised by these indirect methods, so that even the poorest person is making some contribution.

I hope that we shall have the dignity, as a nation, not to lend ourselves to a great deal of the crude criticism made against foreign visitors who use the Health Service. This is illiterate, and I am sure that the Minister knows precisely what I mean when I say that a great deal of this criticism is illiterate. If we had a great book-keeping system in order to keep out the foreign visitor it would cost more than giving him the advantage of the service. Just as those below Income Tax level make their contribution in other forms of taxation, so do our visitors every time they buy food, drink or tobacco or spend money generally in the country. So do not let us tarnish a very wonderful idea by that kind of niggling, petty-minded attitude about it.

I am convinced that if we can plan a steady expansion of our Health Service, if we balance that with the housing programme it will make it more possible for more of the old people to be looked after in their own homes—because the two go together—and if we can finance the scheme in this straightforward and honourable way, which I have indicated, then we shall be in a mood to tackle the two other things which I want to mention.

I have talked about the amount of our national income which we spend on the scheme, but is the Minister satisfied that we are getting value for money? I can remember the exciting developments in the early days when we were costing only dentures, artificial limbs and the rest. It was a challenge to make quite certain that the Government Departments were doing as good a job as any private enterprise could do in seeing that there was no slackness or waste—in other words, that there was value for money. The Minister knows the story of the early days.

What distresses me is that after those intervening years, about three months ago I went into the home in my constituency of an old lady of over 70 years of age who had an aural aid for the first time. She had it in her hand. It was the old-fashioned kind, not the transistor set. She was a delicate old lady and she did not know what to do with the aid. Instead of being a help to her, it was a worry and embarrassment. Her husband was a retired coal miner. They took about £60 of their limited savings so that, on the ordinary commercial market, she could be supplied with a small, neat aural aid. I ventured to say to the old couple that I thought that this was foolish, that they should have waited and that in time, no doubt, the old lady would have got a better type of aid. The fact is that these old aural aids ought not now to be supplied under the Health Service.

We want diversity in the Service. We want young and old to have a really good choice of spectacles under the Service. We do not want to say to them, "If you have National Health Service spectacles they must be the dowdy ones. If you want something smarter you must go to a private firm." We do not want to encourage advertisements saying, "If you want a really first-class aural aid you must go to private industry and pay an enormous sum for it." But these things are indicative of what is wrong with the service.

Inside the hospitals we need new wards, new equipment and new furnishings. Indeed, we need new hospitals. But if we get the spirit of the hospitals right, certain things can be dramatically improved which would not necessarily add greatly to the cost of running the Service. One thing which again is overdue is that the great specialists should make up their minds whether they want to be inside or outside the Health Service.

When the Service was introduced it was essential to keep the great teaching hospitals within the scheme. It would have been disastrous if there had been a spate of inadequate nursing homes that were a kind of refugee centre for some of our ablest doctors. It was in the interest of British medicine, of our finest doctors and of the scheme that our specialists stayed within the scheme. We had to reassure them in those days.

There were so many fears. For instance, we were told that the State would interfere between doctor and patient. We know that that was nonsense. It was never intended and could not be done. But we had to wait until time could demonstrate just how wrong and really wicked that type of propaganda was which was put out on behalf of hon. Members opposite at that time.

We have now had the scheme operating long enough for our specialists to decide either to be entirely inside or outside. I do not see that we can get the appointments system put right, that we can get the courtesies beween specialists and patient; that we want to have universally unless this is done. I hasten to use the word "universally" because I am conscious that whenever one makes criticism of the Health Service what one is saying is true of some hospitals and specialists and wholly untrue of others.

I am the first to give grateful thanks and recognition of the wonderful work that many of our great specialists are doing as well as the general practitioner in bringing healing and hope to so many people. I ask that I be not misunderstood on this point. But again I say to the Minister that no one who has experience of going into out-patients' departments, no one who has experience of waiting while those they love are being cared for in hospital, can deny that in far too many hospitals there is a brusque or inconsiderate attitude both to the comfort of the family visiting and to the time that patients have to wait when they go into out-patients' departments.

There is a great deal more I could say, but other hon. Members have many contributions to make. I conclude by saying that I get a great many letters sent to me about the Health Service. They go far beyond the confines of my constituency or of hospitals about which I can have direct personal knowledge. But these letters indicate in the most moving fashion just how grateful the vast majority of people in Great Britain are for their Health Service and just how outraged they are when they find that, in their personal experience, this great Service is often tarnished by quite unnecessary discourtesies which could be put right within the individual hospitals.

We want this Service to be truly national. I do not know whether there are class distinctions in Heaven or not. But there should be none in hospitals. Until we can make some of the amendments I have indicated, many people will be saddened, and beyond sadness will be worried, by the fear that those they love, when receiving treatment, are perhaps not getting the very best because they are Health Service patients and not private paying patients. That, above all, we on this side of the Committee must seek to remedy.

5.25 p.m.

Brigadier Sir Otho Prior-Palmer (Worthing)

It is always a pleasure to follow the hon. Lady the Member for Cannock (Miss Lee). As always, her speech was controversial, constructive and charming. She is always worth listening to, but I hope that she will forgive me if I do not comment on many of the things she said. Hon. Members opposite say that they will make this thing or that thing free. Would they give us an idea of what they consider should be the ceiling cost of the National Health Service? We all know that they got the figure very seriously wrong once before. It would be interesting to know their estimate now.

I do not believe that anybody on either side of the Committee who has read the White Paper, the various pamphlets and the Blue Book, can fail to be impressed by the vast size and scope of these ten-year plans, amounting, as they do. to about £1,000 million, with a further £700 million to follow beyond that on the hospitals alone. I was glad to hear my right hon. Friend stress the contents of the Blue Book, because there are, as he knows, areas like my constituency where the care of the old outside hospitals in cottages and homes is even more vital and important, and is, I regret to say, lacking so dreadfully in some things. We must congratulate the Minister on his power and his vision with regard to this great and enlightened scheme.

It is suggested that as a basis there should be 600 to 800 hospital beds per 100,000 population. This is all very well and good. But it may be—indeed, this often happens—that in working out all the details on the lower level of a great scheme like this people slip up, and slip up badly. I am sorry to have to say that already there are signs that the local planning is not matching up to the size and scope of the overall scheme. It is the duty of individual Members, borough councillors and others to keep a sharp and vigilant eye to see that things do not go dreadfully wrong. I make no apology for doing just this. I am glad my hon. Friend the Joint Parliamentary Secretary has arrived, because I have had considerable correspondence with him on this subject.

My right hon. Friend has put forward the idea of placing more responsibility on to the local authorities for looking after mental health. Administratively, this is a sound idea. But I wonder whether he realises what would be the effect. It would have an effect on the rates—and, goodness knows, my constituency, which has been harder hit than any other in the country, because it has no industry, really cannot take any further rate burden.

I do not want to take this aspect too far, because I shall be brought up with a jerk if I do. But I have said before that to continue the out-of-date system of rating by taxing the sort of house a person lives in, and not his ability to pay, is becoming quite ridiculous. If this matter had been tackled in the way that I suggested four years ago we would not have been running into the troubles we are now.

As long ago as 1960 I drew the attention of the Minister to the woeful situation in my constituency regarding Worthing Hospital. I make no apology for making what is virtually a constituency speech, because this matter really must be looked into. I first raised it in May, 1960, and then again in July, 1960—when there were two columns of HANSARD about it.

But discussions on this hospital were actually begun in February, 1956. A year later, nothing had happened. Further meetings took place in 1960, four years later. Still nothing had been done. Then the Ministry decided that it could not look at Worthing's hospital programme in isolation. That was four years later, and yet another year passed before anything else happened. A meeting was held which the hospital management committee only heard about afterwards. But now, at long last, we have a plan.

I suggest, and I hope to show, that although this plan is comprehensive it ignores very largely the local conditions and needs. The long promised development of Worthing Hospital in a modified way will take place at an indefinite date. Now there are 157 acute beds and this total is to be raised to 358—some time. No definite date has been given as to when the work is even likely to start.

At the same time, however, seven miles away and across a river, and removed from any bus route, Southlands Hospital is being enormously enlarged. This hospital is to serve Worthing. But this is completely cock-eyed planning. The reason put by the Ministry is that Southlands Hospital must serve Shoreham as well—it is practically in Shoreham—and that is reasonable, but it also has to serve Littlehampton, which is seven miles on the other side of Worthing.

Worthing is the geometrical and geographic centre of this area. Why, therefore, should not Worthing Hospital receive expenditure to a far greater extent than is visualised? At present, the hospital deals with 55,000 out-patients and casualty patients a year. It has no less than 600 operations outstanding. The waiting time of out-patients for only a consultation is it) to 12 weeks.

Mr. Denis Howell

The hon. and gallant Gentleman's constituents are lucky.

Sir O. Prior-Palmer

Let the hon. Gentleman tell my people that. Worthing has twice the national average of old people. I have had almost continuous correspondence with my right hon. Friend, and we can get nothing but the vaguest possible assurances.

It must be realised that most of the relatives of patients in Southlands Hos- pital will not be able to visit them. There are no communications whatever. It is much too far away. Further, the doctors say that this is most inconvenient. They wonder how they will be able to manage.

I quote from one of my hon. Friend's letters: The Board naturally have taken into account such matters as the distribution of population a Id transport facilities. That is precisely what the board has not done. It has not taken into account the population. Worthing now has a population of 80,000. This will shortly increase to 100,000. On the basis of the White Paper, we should have, or be working up to, 800 beds. Three hundred and fifty-nine beds are visualised in the dim and distant future.

This project, which is part and parcel of the great scheme, has been looked at by somebody on what I suppose is a tidy paper basis with no regard whatever to the human aspect, which is, after all, the basis of any hospital. I am very glad that my right hon. Friend the Minister is here, because I do not suppose that he has heard anything about this. I hope that he will accede to my appeal that a meeting should take place on this subject between a representative of the Ministry, a representative of the regional hospital board, a representative of the hospital management committee, the Press, representatives of the local borough council, which is extremely angry about this, and some of the doctors.

Let us thrash it out round the table and see whether we can work out something more sensible. It would be a very great pity to spoil this great scheme by getting it all wrong at the lower level at its inception.

5.37 p.m.

Mr. Llywelyn Williams (Abertillery)

I find myself in complete agreement with the remarks made in the moving speech of my hon. Friend the Member for Cannock (Miss Lee). Like her, I am not a flag-waving Jingo, but I believe that our National Health Service is the finest health service in the whole world, despite incursions made into it by the Conservative Government during the last ten years. Other countries—Germany, Switzerland, New Zealand and France—may have better social insurance schemes than ours. They probably have a finer family allowance system than we have, but we can still legitimately claim to have the finest health service in the world.

My hon. Friend said that there must be obvious limitations at some stage or other to the capital which is injected into the Service. This goes without saying. Every reasonable person knows that there must be a limit at some time. The Minister will appreciate the aptness of a quotation from one of Robert Browning's poems: Ah, but a man's reach should exceed his grasp, Or what's a Heaven for? Perhaps the spirit of Robert Browning will allow me to transpose one word: Ah, but a man's reach should exceed his grasp, Or what's an Opposition for? That is the nub of some of the discussion which has already taken place this afternoon.

Inevitably, there must be a gap between proposals suggested to the Minister in terms of capital and maintenance expenditure and the actual allocations made to regional hospital boards and, from regional hospital boards, to hospital management committees. This principle must operate all down the line. In all sorts of societies there must be a differential. Politically speaking, that is what the argument is about, whether the gap between what is asked for and what the Minister is prepared to give should be as wide as it is or whether the gap should be considerably narrowed.

The Minister has suggested the figure of 2 per cent. Some of us would have different ideas about an expanding hospital service. We would suggest that 2 per cent. is the wrong figure to represent the gap between the proposals made and the allocations made. The Opposition do not live in a fool's paradise. We know that when, after the next election, my hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) becomes Minister of Health, he will not be in a position to turn all the financial taps on at full speed. If all Ministers turned the financial taps on at full speed, Whitehall would be drowned. We know that there must be limitations. Sometimes we are entitled to ask whether these differentials are justified in all instances.

Teaching hospitals receive a grant for research purposes. An award has been made for better salary scales for laboratory technicians. Therefore, if the grants for research remain stationary, there must obviously be a cutting back on research work. This would be very unfortunate. I do not know how the Minister feels about this he must know about it.

I know from my observation that many of our top research men, not only in medicine, but in science generally, in London particularly—I am sure that this is equally true in the provinces—spend an absurdly large amount of their time running round to various foundations trying to get donations and grants to enable them to carry on with their research work. In a sense, they are seeking to justify themselves and the projects on which they are engaged. These are eminent men. They are men of exceptional ability who are doing tremendously important research work. It is infra dig that men of this calibre should be competing one with the other, running to the Ford Foundation, or the Rockefeller Foundation, or some other foundation, almost cap in hand, begging for new or additional grants to enable them to carry on their research work.

The Minister must take cognisance of this unfortunate feature of our Health Service. I sometimes speak with some of these eminent men from the London teaching hospitals. Some of their remarks reveal an unhappy mood of cynicism. I was speaking to one the other day. He seriously suggested that we might well have to follow the example of Ireland and Australia and have a State lottery to finance our hospitals. It seems that this is the only way to provide them with the large sums they require. It is regrettable that people of such eminence feel compelled even to think on such lines. I would regard it as a terribly retrogressive way of raising the necessary money to finance our hospitals if we had to intensify the gambling fever which, in all conscience, is already too prevalent in this country.

I have heard some of these eminent men speak with envy of the wonderful new hospitals in countries which we normally regard as very backward compared with Britain. Spain has built 39 hospitals in the last five years. Wonderful new hospitals are being erected in the Iron Curtain countries—for instance, in East Germany and Czechoslovakia. I heard remarks to the effect that it is sometimes doubtful who won the last war, since countries ordinarily regarded as backward countries are able to take such progressive steps in the construction of new hospitals.

My hon. Friend the Member for St. Pancras, North, directed the Minister's attention, I think rightly, to the dangers of postponing maintenance work so as to deal with urgent and unavoidable commitments. The Minister should at least be warned against cuts which, in the end, prove to be uneconomic and unbusinesslike. I base this remark on the old adage, "Penny wise, pound foolish". For instance, I believe that we are still paying very dearly for the almost idiotic recommendation of the Willink Committee to cut down by 10 per cent. the intake of medical students. That was regarded possibly as an economic operation, but I think that its effect has been very deleterious.

I know of a case in which Ministry sanction was necessary for the provision of nurses' accommodation. Probably because of the economic pressures which obtained in those days, there was an unconscionable delay in giving approval for this project, with the result that the project was in practical terms dashed to the ground. The would-be seller discovered another customer. As a result, the hospital concerned has to pay twice the original sum for accommodation very similar to the initial accommodation sought. By cheese-paring economy in maintenance there is obviously the danger that in the final analysis the economy will prove to be very false.

I have been studying some of the financial statements of the Welsh Regional Hospital Board. I think that I may be the only Welsh Member to be called to speak today. I notice that the board is very concerned, as all hospital boards are, with the differentials between their proposals and the allocations. I apologise to the hon. arid learned Member for Montgomery (Mr. Hooson). I was referring to Welsh Labour representation in the House, of course. (have no doubt that the hon. and learned Member will also speak for Wales, if he catches the eye of the Chair.

I welcome the change in the estimates procedure contained in the Ministry Circular of September, 1961, based on the review conducted by a departmental working party. The circular stressed the need for a forward look for several years ahead which will enable plans for the immediate future to be viewed as a phase in a longer course of development, possibly as much as five years ahead. I have been studying the forward-look revenue estimates for 1963–64 and 1964–65 in an analysis of probable additional expenditure of the Welsh Regional Board and hospital management committees. It can be summed up in one sentence: The additional amount of £793,800 for 1963–64 represents an increase of 3.2 per cent. over 1962–63, whilst the amount of £341,900 for 1964–65 shows an increase of 1.3 per cent. In the light of the circumstances, I would not call these increases very extravagant or exciting.

The Minister recommended that the rate of growth of total expenditure in 1962–63 should, in real terms, be about 2 per cent., but Mr. T. W. Jeffreys, treasurer of the Welsh Hospital Board, has said: This means, in effect, that increments, general increases in prices, and new developments coming into operation next year will have to be contained within this sum. I repeat, I do not regard this as a wildly exciting increase.

All the departments want money, and the establishment of true priorities must inevitably mean some cuts—those are concomitants, I am sure—but does the Minister feel happy about same of the cuts? I hear an hon. Friend call them niggling, and that is a very apt description. In a Written Answer to my hon. Friend the Member for Wrexham (Mr. Idwal Jones) on 25th March last, the Minister said that at the Denbigh Mental Hospital there had recently been a cut in pocket money of £800, and a cut in cinema shows of £540. Does the Minister feel very happy about miserable cuts like that affecting people whose lives are already darkened and bewildered?

The right hon. Gentleman also stated, and I am rather surprised at it, that … margarine is a normal item of diet."—[OFFICIAL REPORT, 25th March, 1963; Vol. 674. c. 112.1 The Welsh people have not been brought up on margarine, but on butter. The Minister knows nothing at all about the ordinary Welsh peasant folk, the stock from which I come, if he believes that margarine is the stable item of their diet. I ask him to investigate this matter.

An investigation carried out recently by the National Union of Public Employees revealed that under many hospital management committees there has been considerable pruning of staffs. Auxiliary workers are usually rather far down the wage scale, but they have had their overtime reduced. That will be a strong disincentive to workers on low rates of pay, because it is the overtime that makes that employment satisfying. Others have been declared redundant. If there is a shortage of these workers their duties devolve on the nurses and that, in turn, will act as a disincentive to the recruitment of nurses. Nurses do not enter the profession to scrub floors—

Mr. John Baird (Wolverhampton, North-East)

I do not know whether I understood my hon. Friend correctly, but was he suggesting that medical auxiliaries should have overtime? I believe, as all good trade unionists should, that we have to push up the basic wage and do without overtime.

Mr. Williams

That is a very searching question. I can only say that a report by a very reputable trade union shows a sense of grievance that kitchen workers, gardners and ancillary workers are able to get a fairly reasonable wage packet only by working overtime. That was my point.

Nurses should, in theory, be working only 44 hours a week but, being human like the rest of us, they take a dim view of working in some areas for considerably longer hours than that without receiving anything in the way of overtime. Representations on that point have been made to me. We should not take advantage of those who have entered such a noble profession as nursing, which many enter from a sense of vocation.

The Minister may like to hear a word of praise. I think very highly of the ideas contained in Circular 8/63—Report on Accident and Emergency Services based on the Report of the Sub-Committee of the Central Health Services Council Standing Medical Advisory Committee. What a mouthful! I refer particularly to paragraph 2—Sections 3 and 4 of the circular—based on paragraph 106 of the Report, which states: The Minister agrees that co-operation between hospitals and the ambulance services is important, and that every effort should be made to achieve perfect co-ordination particularly in regard to

  1. (a) arrangements for providing the hospital with a warning of numbers and types of injured persons by radio direct from the scene of the accident;
  2. (b) arrangements also for enabling the hospital staff to report to a medical officer on the cause of injuries and condition of the patient,"
In these days of slaughter on the roads, and carnage which seems likely to increase in the years ahead—a frightful thought—the Minister will do well to implement as soon as possible the more important of the excellent recommendations of Sir Harry Platt's Committee.

I confess, however, that I am rather staggered by Recommendation 11, which states: An accident and emergency unit should have at least, 50 accident beds. That is a tall order, and as things are now it would more or less rule out Wales altogether. There axe not hospitals in Wales that could possibly meet that qualification.

Speaking of Wales, I want to refer to the shortage of hospital beds for expectant mothers. There is something very slap-happy about the present arrangements, as was brought out at the last meeting of the Newport and East Monmouthshire Hospital Management Committee. It seems that the deciding criterion now operating for entry into !hospital is not the condition of the mother in terms of possible difficulties and complications during the birth of the child, but the date of application for entry to the hospital. In this type of case, such a criterion is absurd. A Caesarean operation is not postponable for five or six months, like a hernia operation.

I cannot understand this. More and more expectant mothers wish to have their confinements in hospital so more and more beds must be made available.

In the Panteg Hospital in Monmouthshire, 100 mothers are admitted each month, but 250 applications are received. Mr. J. M. Bowen, the gynaecologist in the area, has said that a number of those admitted were perfectly capable of having their babies at home, but were getting hospital beds merely because they had booked much earlier. That does not make much sense at all. Some sort of panel should investigate these conditions.

Like my hon. Friend the Member for St. Pancras, North, I commend the Minister for the exciting potentialities—at this stage, I can only call them potentialities—inherent in his proposals set out in the Plans for the Health and Welfare Services of the Local Authorities in England and Wales. All power to him to carry out, with and through local authorities, those imaginative proposals, but the local authorities must have the tools to carry out the job. They cannot possibly bring this scheme to fruition unless the Ministry gives them much more substantial financial help.

In the Sunday Citizen, last Sunday, there was a very stimulating article on the drug industry by Mr. George Pollock, who had some very heart-searching things lo say. The Health Service's drug bill has gone up by £3 million over the previous year, bringing it up to £100 million. I know that these drugs have saved literally thousands of lives—we could rival each other in paying tribute to the life-saving character of some of them—hut it has become a big business, with a turnover of £220 million a year and an export contribution of £50 million a year. It is spending £10 million a year on research. Forty firms show an average return on invested capital of 24 per cent.—a pretty good profit margin by any standards.

The point that Mr. Pollock makes is that the industry should never have been allowed to function in an atmosphere of free enterprise. We should not talk of drugs in terms of free competition, buttressed by advertisements, by high pressure on doctors and by free samples ad lib. to the extent of £800,000 in one year. This is too important a part of the Health Service for it to be freely at the whim and caprice of big business. I certainly support my hon. Friend the Member for St. Pancras, North, when he spoke of a statutory check. Lord Cohen's Com- mittee turned down 247 drugs as being of no use at all, and said that seven were particularly harmful, but we want something much stronger than a recommending, committee. We need one on the lines suggested by my hon. Friend.

The Minister has a wonderful heritage. By the fluctuations of political fortune, he has been allowed to administer something of which I feel proudest in the life of Britain—and I say that quite honestly and truthfully. Because of the vicissitudes of politics he may not have the opportunity to administer it much longer but, in the time at his disposal, I beg him to strengthen and expand the Health Service. It may be the best in the world, but it will not remain so unless it is an expanding service. It must expand, and I hope that the Minister will take "expansion" as his watchword for the future.

6.4 p.m.

Sir David Robertson (Caithness and Sutherland)

It is always pleasant to follow a Welsh Member, and I am happy on this occasion to follow the hon. Member for Abertillery (Mr. Ll. Williams). I feel that lam a brother Celt. I am most appreciative of what the Welsh Group have done for their country in this House during the twenty-four years I have been here.

I enjoyed the speech of the hon. Lady the Member for Cannock (Miss Lee). I confess to her that I am one of the guilty men—not the young men behind me—who, in my generation, were rather proud of their charity health service. Now, we have something very much better. I have said publicly before, and I say it again, that I am ashamed of having voted against the National. Health Service at every stage because I have learned how good it is and what a wonderful service it gives to all the people. It was fitting that the hon. Lady should be the first speaker from the Opposition back benches. As we all have I have wonderful memories of her husband and the work which he did in founding the Service.

I compliment my right hon. Friend the Minister of Health on the very fine report which he gave to the House today. When I was a London Member, for eleven years, I used to take part in these debates, but, since I became a Highland Member, I have not done so because so frequently they have related to England and Wales, and not Scotland, and I have become a very parochial Member. The points I wish to make now concern the Highlands.

Our fine National Health Service works very unequally. Constituents of mine are being ordered to Inverness and, occasionally, to Edinburgh and Glasgow for treatment. They are expected to pay all their expenses. Other citizens in the populous areas enjoy the full benefit of the Health Service and frequently they have a hospital just round the corner, or not very far away. My constituency, as my right hon. Friend knows, is very different; the journey from the north coast to Inverness is about 160 or 180 miles. Frequently, it involves a journey to a railway station of six or seven miles, then a long and weary train journey, and, of course, it causes a great deal of expense.

It is wrong that the great majority of the people should have the Service free while people in my area have to face journeys like that. I know that it is the Government's wish that we should continue to occupy the more distant parts of the country. We cannot all crowd into the monsters of London and the South-East, Birmingham, Coventry and the West Midlands—very unpleasant places to live in because of the travelling difficulties, and so on.

I urge my right hon. Friend to give very serious thought to the problem in my constituency. Highland people generally are proud people. They have never applied for National Assistance. They do not like to be compelled to go to the National Assistance Board to recover the fares and, of course, it is a matter of pounds to them. Moreover, if a child has to make the journey for a tonsil operation, the mother or the father, sometimes both, have to stay overnight. A few days ago, I asked a Question about a poor, semi-blind woman who, although so frail, had to make the journey from Castletown to Inverness and back. When he investigates that case a little further, my right hon. Friend will realise how strongly I am entitled to feel about it.

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

I intervene to ask the hon. Gentleman to remember that, when the Act was implemented in 1948, there was provision made for the cost of travelling and, if necessary, the expenses of a friend to accompany the patient and stay overnight.

Sir D. Robertson

I remember that; the hon. Gentleman is quite right. But, of course, the background to all this tightness of money is that poor old Britain is always doing too much. She is doing too much now in finding money for defence and all the other things.

Why cannot we have equal treatment in Caithness, Sutherland and Ross-shire? We have very fine doctors and surgeons there. This practice of sending more and more people long journeys seems to be fundamentally wrong. Could the reason be that our hospitals are hopelessly out of date? There is nothing wrong with the personnel—medical staff. surgical staff or nurses. Something must be causing it. Is it that the consultants and specialists in Inverness do not want to make the journey to the patients? That would be a much more sensible thing to do once a week or once a month.

The fundamental reason, I believe, is that our hospitals are obsolete and out of date. There are two in Caithness. One is in an old house, formerly the house of the Tory Member for the County of Caithness in the days where there were three constituencies in the area which I now represent. It was given to the community at about the beginning of this century. I do not know how long the other hospital in Thurso has been there. I should not be surprised if it were seventy-five or a hundred years old.

Caithness is the only Highland county which has had an increase in population in the last decade. Before the last election, it was up by 20 per cent., thanks to Dounreay. Thurso has now a population of about 10,000 compared with about 2,500 in 1950. Yet no provision has been made and our two ancient hospitals still have to deal with the community there. It is not good enough.

I have pressed for years for a new hospital. In November, 1959, I received a letter from the then Secretary of State for Scotland, who said: The Northern Regional Hospital Board have for some time had in mind the provision of a centralised hospital for Caithness as one of the larger building projects to be undertaken in their region, and although they have not yet finally decided on the size of this proposed new hospital or on the use to be made in the future of existing hospitals, the project now occupies a high position on their priority list. That was 1959.

The next day, I sent a reply to the then Secretary of State, in which I said: I have no doubt that the Northern Regional Hospital Board have for some time had in mind the provision of a centralised hospital for Caithness and I am absolutely certain that they will still have it in mind for a very long time before any building takes place". It is sixteen years since the National Health Service was founded, but we in the far North of Scotland till have those two ancient hospital buildings in action. Yet that was the view of the active Northern Regional Hospital Board.

If I had anything to do with that board, should sack the lot and find a new one. Unwittingly, perhaps—it is so polite and kind to many people—it has, I fear, become the "stooge" of the Treasury. Someone at the top of the table says that the project cannot be undertaken because of something or other—nuclear weapons, or whatever it may be—and that is the end of it. However, we are not standing for any more of it. The people are getting very upset. I urge my right hon. Friend to press on with a centralised hospital for Caithness.

Once again, I say how proud I am of the National Health Service, irrespective of the parochial difficulties which beset my constituents. Hon. Members opposite, of course, have greater reason to be proud of it, because they fought so courageously to bring it in, and I congratulate them on doing so, but I hope that they will always bear in mind that we have today a great Minister of Health. Every fair-minded man will agree that my right hon. Friend the Member for Wolverhampton, South-West (Mr. Powell) is doing the very best that he can.

Mr. Charles Loughlin (Gloucestershire, West)

He is sometimes misguided.

Sir D. Robertson

That is just a different point of view. No one would really challenge that my right hon. Friend is an outstanding Minister.

6.13 p.m.

Mr. William Hamilton (Fife, West)

The hon. Member for Caithness and Sutherland (Sir D. Robertson) always treats us to a very robust speech and always speaks eloquently about the problems of the Highlands. The problems of the Highlands today are nothing compared with that they will be when Dr. Beeching's proposals are carried out. After Dr. Beeching has done his dirty work in the Highlands, I shall be coming to the House to complain about maternity cases having to go to hospital on horseback.

Always, during these debates, we have expressions of fine sentiment and the production of ambitious plans for the future development of the Service. The nearer we come to an election, the greater is the spate of documents, plans and proposals. We have had from the two Health Departments their ten-year Hospital Plans. In recent days, we have had the production of the health and welfare plans of the Minister in England, though not in Scotland, for the next ten years. Occasionally, however, after we have digested the Reports and fine plans projected into the future, we, as Members of Parliament, are brought back to earth. We are made to face the hard facts which every Member knows to exist in the Service. Undoubtedly, every Member knows that the Health Service is suffering grievously from a chronic lack of funds. Anyone who goes about his constituency with his eyes open knows this to be true.

Why is this? Briefly, the answer is that the approach to the financing of the Health Service is entirely different from the approach to the financing of other services. In. passing, I refer to the way in which this country was committed to expenditure of £300 million or £400 million by the Prime Minister going to Nassau and signing on the dotted line, without let or hindrance by this House. We do not know what the cost of that agreement will be, but we can be sure that it will be four or five times as much as the total cost of the ten-year development programme for hospitals in Scotland. It was accepted without any kind of debate, with the minimum of information being given by the Government. Yet everyone will, surely, admit that our health services are at least as important in defence as the Army, the Navy, or the Air Force. A very good Health Service is part of our defence system.

I shall give one or two illustrations of the meanness of the Government in their financing of these services. When the Minister at the Dispatch Box gives us a welter of statistics, he fails to understand the problem. It would be amazing if, twenty years after a world war, he could not tell us that the Service had expanded. The question is, has the expansion been adequate for the needs of the time? Has it had its fair allocation of national resources? The answer must be a resounding "No".

I take up a point raised by my hon. Friends the Members for Abertillery (Mr. Ll. Williams) and for Cannock (Miss Lee), about which I have spoken in the House before. The nurses were some of the first victims of the Government's ill-advised wage freeze, an attack which was concentrated on the most helpless and most dedicated sections of the community, the nurses, the teachers, the probation officers, and the rest. After an enormous campaign, they eventually got a 7½ per cent. increase on what were already miserably inadequate salaries. There was no doubt about the direction in which the sympathies of the public lay at that time.

I wish to call attention to a speech made by a Minister who is still in office, the Parliamentary Secretary to the Ministry of Transport. He was quoted in The Times on 2nd June last year as having referred to the nurses' increases in these terms: The most striking feature of that claim by far is what I can only describe as a conspiracy on the part of the Press, the radio, and all normal methods of public information to conceal from the public the full facts. He went on to talk about what the cost of the demand of the nurses would be—one Polaris submarine. That is what it would have cost. He went on to say that, after paying for their board and lodging, nurses had money left which was really pocket money. This is the Government's attitude to people who are giving the most dedicated service that this country has ever known.

I turn to the recent Industrial Court award of 27th April which reveals the same crazy, mean attitude. The results of that are that the first-year student nurse gets a pay increase of £4 a year, but her board and lodging go up £7 a year.

Therefore, the net increase is minus £3. What applies to the student nurse applies to the nursing auxiliaries, the State-enrolled nurses and all the junior staff. They will get less money under this award.

Of course, there are gains at the top, and no doubt that is why the Royal College of Nursing has welcomed the award as being a reward for experience. It says that it improves career prospects. That attitude may be understandable, but I think that it is very short-sighted, if not selfish, because the future efficiency of the service obviously depends on the attraction of more and more recruits to it who must start at the bottom.

Lord Balniel

I understood that the award was welcomed by the Student Nurses Association on the ground that the remission of board and lodging charges for periods of 48 hours or more away from hospital more than offset the small increase in board and lodging charges for a shorter period.

Mr. Hamilton

That is the sort of attitude that we get from hon. Members opposite. Why do not the Government have the courage to say, "These people are doing a job which over the years has been consistently underpaid. They are being consistently exploited by this country. This will not do." I do not care what the student nurses say or what the Royal College of Nursing says. We in the House of Commons shall decide what they are worth. How on earth anyone can defend a wage award which results in people receiving less, I do not know.

However, the award has this advantage from the Government's point of view: it might divide the profession. This is a familiar pattern. The Minister of Education did exactly the same with the teachers by readjusting a negotiated award and increasing differentials in one part of the profession as against another. It may be that that is the intention here. Of course, this award must go to the Whitley Council. I hope that it will turn it out with the contempt which it deserves.

What is the next step for the nurses? I think that what my hon. Friend the Member for Abertillery said was right. These people do an awful lot of overtime and extra duty, and are expected to do it, for which they get no overtime pay whatever. This extra duty is unavoidable in the nature of the profession. I think that the time has come when the House should say that they ought to be paid for overtime. They should be paid extra for weekend duties, night duty, bank holidays, and the rest. This has been accepted for almost all workers in nearly every other trade and profession, and I see no reason why the nurses should be singled out any longer.

If we look at the way in which the Government have treated the doctors, a vastly different story emerges. Here there is a powerful trade union not unwilling to use the threat of the strike weapon if need be. Fellows like Ted Hill, Frank Cousins and Will Carron are like meek and mild choir boys compared with the British Medical Association. The result is that the doctors had a 12½ per cent. increase in 1959–60 and a 14 per cent. increase in 1963–64, making a total increase of 26½ per cent. in the last five years. Why was not the recent 14 per cent. increase referred to the National Incomes Commission? Will the nurses' award be so referred? What is the reason for the distinction between Scottish plumbers and Scottish doctors?

Unless we can obtain and hold an efficient, well qualified, well paid and contented staff, all the grandiose schemes which the Minister of Health and the Secretary of State for Scotland continually put before us for new buildings and for the extension of community care will count for nought. The Minister knows better than anybody.he tremendous shortages in the Health Service. They were pinpointed by the Young-husband Report, and very little has happened since then to overcome them.

I turn to the specific Scottish question that I wish to raise. There is a £70 million Hospital Plan for Scotland over ten years. I have sought to put this £70 million in its perspective, although the White Paper makes clear that it is not a firm commitment. One of the plan's major objectives is adequate maternity bed accommodation. It admits, however, that in many places that accommodation at the moment is woefully inadequate, not least in Fife. The County of Fife is thoroughly dissatisfied with the treatment that it has had from the Minister.

Before I develop that point, I want to quote a letter which puts the matter in perspective. It came from a lady in Perthshire who has a daughter in the new town of Glenrothes. She says: I am wondering if you can do anything at all for mothers-to-be in Glenrothes. Fife. There are at least five new churches and no hospitals. They are taken to Craigtown, 25 miles away, or Netherlea, which is over 30 miles from Glenrothes. As it is a community of young married couples, this condition of affairs should no longer be allowed to continue. My daughter who lives there had to go to Craigtown for her first baby and now has to go to Netherlea in Newport. It is bad enough not having a hospital nearer, but to go 30 miles under present road conditions is ridiculous. Also the ambulance that takes these mothers only has a driver. I wrote to Dr. Mercer of East Fife Hospital Board and `his reply was that this was quite usual. Imagine an expectant mother leaving Glenrothes far a 30-mile journey sitting beside the driver. When she got to Cupar she asked the driver to stop as she needed to lie down so that the poor girl was alone in the ambulance while the driver drove like hell to get her to Newport. Surely one of the first things when planning a new town is a hospital. I had to write back to her and tell her that the Government were too busy allowing bingo halls and betting shops to provide adequate hospital facilities, which we now do not have in Fife. There is no provision in the ten-year plan for any additional maternity beds in Fife, although I understand that after great pressure the regional hospital board has promised seventy more by 1970. The Secretary of State has refused to meet a deputation on the matter and the whole of Fife, irrespective of party affiliations, is outraged by his arrogant contempt for this vital issue.

I could go on about other shortcomings in the Service, not only in Fife but in other parts of the country. The right hon. Gentleman knows very well of the inadequacy of the provision for geriatrics. Indeed, the inadequacy in Fife in this respect is even worse than it is for maternity beds. We should welcome the challenge of old age as one to be gladly and boldly taken up, and there is no reason why it should not be solved, provided that we devote to it the resources which we all want to devote to it.

When the Minister produced his plan for the development of community care. he produced certain figures of costs and so on. I do not think that the plan says how much of this will be borne by the local authorities. It simply says that a large part of it will be taken care of by the general grant proposals, but certain it is that there will be a greatly increased burden on the already overburdened local authorities. This will re-emphasise the need for refashioning the financial structure of local government.

When does the Secretary of State for Scotland intend to produce his plan for community care? It is probably true that in this respect the position in Scotland is worse than that in England, but in any case we have the right to know exactly what the problem is and how the right hon. Gentleman and the local authorities hope to meet it, not only in a paper plan, but how he intends to get the additional staff and the additional auxiliaries who will no doubt be needed.

I promised to make a fairly short speech, and I want to say this in conclusion. When he spoke this afternoon, the Minister, as he always does, gave us a highly efficient, polished and informed speech. There was an enormous measure of what I would call cold complacency in it, bolstered up by a mass of statistics. My own view, and I think that it would be the view of the Committee, is that plans and planners, especially in health matters, must not be carried away by statistical information, but must be enormously imbued with humanity. This the Minister is singularly lacking.

As I go round the hospitals in my constituency, as other Members go around theirs, I cannot but be appalled on occasions by the amount of work still remaining to be done. In other directions, one can see equally appalling waste with what seem to be grossly inadequate returns for the expenditure of the money. One is bound to question the priorities of our society. We have to devote much more of our national and human resources to this worth-while work in the provision of hospital services and the provision by local authorities and to the co-ordination of the three great partners in this highly-civilised venture on which we are now embarking.

6.36 p.m.

Sir Samuel Storey (Stretford)

As one of those who in the voluntary hospital days took an active part in their first efforts to co-ordinate their individual efforts into a complementary whole, as one who throughout the Beveridge de- bates constantly advocated a National Health Service, and as one who was not in the House in 1948, I have no need to apologise for having voted against the National Health Service, as my hon. Friend the Member for Caithness and Sutherland (Sir D. Robertson) did. Anyone who appreciates the need for this country to increase its productivity and develop its exports must appreciate that ill health is something which we cannot afford. Even if conscience allowed us to neglect the ill and disabled, the provision of a National Health Service to keep people fit, to restore them when ill and to enable them to play their full part in the economy is an investment paying high dividends. I therefore listened with interest to what my right hon. Friend had to say about the progress already made and his plans for the future. I am sure we all feel that he has done a magnificent job and hope that he will long be able to continue with his plans.

The real purpose of my intervening in this debate is to raise the question of the availability of nursing staff in some parts of the country. My right hon. Friend has told us that whole-time and student nurses were reaching a record number. That sounds strange to some of us who like yourself, Mr. Royle, come from the north of England, particularly those who have experience of the West Manchester hospital district. In my constituency, in one hospital alone, 80 out of 415 beds are out of action, most of them in two wards which have recently been rewired and renovated but which are out of action because of shortage of nursing staff.

Every effort to recruit has been made, by advertising in many parts of the country as well as the rural areas and the development districts—where the demand for women workers is not so great—by keeping in touch with careers mistresses and senior girls in the schools and by close co-operation with the youth employment authorities, but it has not been possible to recruit either fully trained nurses, or the student nurses who become the trained nurses of the future.

This failure presents two questions. The first is whether the vocational call to nurse is losing its appeal; the other is whether the conditions of pay and service in the industrial areas are such as to overcome the attraction of the five-day week arid the higher wages offered by industry.

These questions call for a full inquiry and an early answer followed by prompt action, for without an adequate nursing staff the programme of hospital service expansion is useless, and without an adequately staffed hospital service we shall not be able to make the best use of our manpower. I hope, therefore, that my right hon. Friend or whoever replies will tell the Committee what steps are being taken to ease the present staffing situation in the areas where there is a real shortage.

6.40 p.m.

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

I have noticed a great similarity between the two sides of the Committee in this debate. Every hon. Member who has spoken has referred to shortcomings and grievances, and, as the hon. Member for Stretford (Sir S. Storey) did just now, to the shortage of nurses. There is, however, one difference between the two sides of the Committee. Whereas hon. Members on both sides put forward grievances and grumble about the present situation, hon. Gentlemen opposite join one another in congratulating the Minister on his achievements.

Much of the Minister's speech, perhaps quite rightly, was devoted to tie hospital service, and in passing he mentioned the ten-year plan for the improvement of local authority services. Not a word has been said today about the general practitioner. I am told that he is doing all right, but I should like to analyse the present position to see whether this is in fact so. I cannot understand why there is no ten-year plan to help general practitioners who form the pivot of the Service.

There are 22,000 general practitioners, and they ought to be given some consideration and included in our thoughts. The total cost of the domiciliary service for England, Wales and Scotland is about £90 million. This represents about 11 per cent. of the total cost of the National Health Service, and it is estimated that about 95 per cent. of the medical care is provided out of this sum. It may not always be very well provided, but it is, nevertheless, provided out of that figure.

Also out of this figure of £90 million the general practitioner must pay for his premises and for the staff he employs. If he does not employ staff to assist him he suffers, and so do his patients. He may be too greedy or too poor to employ staff to assist him, but if he does, whether they be nurses or secretaries, he must pay their salaries. He has to buy all his surgical instruments. He has to pay his own telephone bills.

Mr. W. Hamilton

He is worse off than a Member of Parliament.

Dr. Stross

I have figures to prove that the general practitioner is, in fact, in some respects worse off than a Member of Parliament. Certainly the mortality rate is higher among G.P.s than it is among M.P.s and that is saying something.

Out of the general practitioners' per capita fee of 19s. 6d. it is thought that 12s. should represent his net gain, and 7s. 6d. his expenses. This is a disincentive to a general practitioner providing proper amenities for his patients and looking after himself properly, because it means that the less he spends out of his so-called national allowance for expenses, the more he puts in his pocket. The better his practice, the better the premises he provides and the more he gives his patients, the more he is compelled to put his hand in his pocket and pay out of his own money to keep his practice going. This is not the right way to encourage people to do the right thing, and I hope that the Minister agrees with me about this. Practices differ considerably. Some are excellent, and some are bad. Between the two extremes one finds a great variety, but it all comes down to the fact that the fewer the facilities provided by the doctor for his patients, the better off he is financially.

The general practitioner is a self-employed man. All the other workers in the Service have contracts of service. The general practitioner is the last remnant of the rugged individualist, and he pays heavily for this privilege. The price he pays is that, first, workers in other parts of the Service live ten years longer than he does. Secondly, he tends to get his first attack of coronary thrombosis in the early fifties. This happens to about one in five G.Ps. and there is one chance in fourteen that the attack will prove fatal. I speak with some feeling about this because my partner died from coronary thrombosis at the age of 46. I had my first attack when I was 51. I had been out of practice and in this House for six years, and I think that I would have died from my first attack had I still been in practice. I am sure that my hon. Friend the Member for Batley and Morley (Dr. Broughton) will confirm what I have said.

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

Dr. Stross

I am glad that my hon. Friend agrees with me.

How does the general practitioner try to remedy the situation in which he finds himself? He does it in two ways. First, by working in a partnership. The majority of partnerships are between two people. This is better than working in isolation, but it means that if one doctors goes off duty the other has to do a double stint. It is therefore far better to have a partnership of three or four doctors.

The second method is to have a group practice. If three or more doctors are working together, preferably from one set of premises, life begins to be much more normal, but even these group practices cannot compare with a proper system of working from health centres, and I think that today there are about fifteen of these centres. The Health Service has been in operation for fifteen or sixteen years and we have fifteen centres. Two are in Stoke-on-Trent, one of which is in my constituency.

Mr. Laurence Pavitt (Willesden, West)

There are seventeen centres.

Dr. Stross

My hon. Friend tells me that there are seventeen. I am sure that they are not all satisfactory. I am sure that they have not all solved the problem of co-operation and co-ordination between the medical and other staff who work in them. The questions that we have to ask ourselves are what has gone wrong, and why they are not popular? I think the answer is that general practitioners, who are paid per capita fees, are unable to co-operate among themselves, let alone co-operate with workers in the welfare services. This is because the general practitioner is self-employed, while the people working with him are public employees.

This creates a special difficulty. I therefore suggest that we need to carry out an experiment. Certain parts of Scotland would lend themselves very well to this. It may be that it is already being done there; I am not conversant with the techniques adopted in Scotland. What we should do is to set up a number of health centres to serve the whole population within agreed areas. They would be staffed with doctors, nurses, health visitors, social workers and therapists, who would co-operate as a team and set out to practise not only curative but preventive medicine, in its true sense.

Centres of this type might solve the problem, which has not yet been properly solved. If we could ensure the evolution of teams doing this work, we would be able to show that the general practitioner gains freedom rather than loses it. In those circumstances, for the first time he would be able to make the fullest use of the technique that he learned at his medical school, and he would be able to prove that he is in the front line, and is really the pivot of the Service. Even if he lost some so-called freedom by doing this he would gain enormously in the power to provide help—and it would be worth his giving up some freedom if he could gain the power to assist his fellowmen. If, at the same time, he was able to live a longer life and then enjoy a year or two in retirement, I am sure that society would not begrudge it him.

I ask the Minister of Health and his colleagues on the Front Bench whether they have noted the editorial in the British Medical Journal this week, which referred to the food poisoning cases which have arisen from imported Chinese frozen eggs. It is a forthright editorial and I refer to it because we are obviously asked to answer a question which the editor puts, namely, why has no action been taken to protect the public? Last year, in the Minister's report to the nation, we were told that there had been 22 deaths from food poisoning, and that 20 of these were from salmonella infection. Chinese eggs have also been responsible for salmonella infection.

In short, the article asks why we have not forbidden the importation of this material, which, every year, has been responsible for outbreaks of food poisoning and which has so far caused four outbreaks this year—one in Edinburgh, one in Yorkshire, one in Northamptonshire and one in Surrey. The Yorkshire one is going on at this moment, and we do not know how many more outbreaks we shall get. An instruction should be given that the Chinese must pasteurise this material. They are quite well able to do this, and if they were given time to do it I am sure that they would not object. I ask the Secretary of State for Scotland to say that this point will be considered, and that something will be done.

6.53 p.m.

Lord Balniel (Hertford)

The hon. Member for Stoke-on-Trent, Central (Dr. Stross) began his speech by saying, rightly, that Members had taken the opportunity to raise individual grievances. Although this is a quite appropriate procedure, it has slightly surprised me. I was rather surprised by the speech made by the hon. Member for St. Pancras, North (Mr. K. Robinson)—to whom we always listen with respect, because he has great experience in health matters—because, instead of surveying the broad picture of the National Health Service he almost went out of his way to take a microscope in order to select one or two issues, which although important, are isolated and limited as compared with the broad spectrum of the Health Service.

This was the more surprising because this debate provides the first occasion in the history of the National Health Service when the whole jigsaw of the framework of the Service has been put together, with the publication of the twin major plans—the Hospital Plan and the plan produced by the health and welfare authorities. Instead of taking within their remit the whole jigsaw and interlocking pattern, however, the hon. Member for St. Pancras, North and other hon. Members isolated one or two items for attention.

I regard this as a missed opportunity on their part. This is the first time that the Committee has had the opportunity to cast its eyes forward—not in a figurative sense, or in the sense dreaming dreams and conjuring up visions, but in purely statistical terms—in order to see what will be the future pattern of our health services, be they hospital services, health and welfare services, or the general practitioner service, to which the hon. Member referred. The doctors are the linchpin of the Health Service. It is an impressive fact, which we should not allow the debate to pass without referring to, that during the next ten years the expenditure on building work alone in the Health Service will amount to over £1,000 million.

The publication of these two Reports provides the House with a magnificent vantage point from which to observe the way in which the Health Service has developed, and to try to mould it as we want to see it moulded in the future. Everybody associated with the National Health Service, be he doctor or nurse, the pharmaceutical companies; local health authority or the Government—is entitled to take a great deal of credit for what has been achieved in the past ten years.

The hon. Member for Stoke-on-Trent, Central talked about the life expectancy of general practitioners. We were worried to hear that it was very much shorter than that of politicians. We wish the hon. Member a long and happy life in the occupation that he has chosen in the latter part of his life. But it is not unreasonable for us to comment that during the past ten years life expectancy over the whole population has increased by three years—for men from 66 to 69 years and for women from 71 to 74 years. This is not a picture of a health service which is contracting it is one that is bringing material benefits to our people.

The hon. Member for Fife, West (Mr. W. Hamilton) and the hon. Member for St. Pancras, North referred to nurses' salaries. The proof of the pudding—the question whether nursing conditions are improving or deteriorating—is in the eating. During the last ten years the number of full-time nurses has not diminished; it has increased by 25 per cent. In the same period the number of part-time nurses has increased by 140 per cent.

Mr. W. Hamilton

If this argument is carried to its logical conclusion, the corollary would surely be that, if there were an enormous increase in supply, the Minister would take steps to reduce salaries, which is absolutely ridiculous.

Lord Balniel

I also come from the Kingdom of Fife, and in Scotland we are taught to bring logic to our arguments. I am completely defeated by the logic of the hon. Gentleman's argument, but perhaps we could argue the point out quietly at some time in his constituency.

I do not want to refer too much to the past except to give one other figure. The publication of these two plans gives us the advantage of looking back to the past and on to the future. During the last ten years, the number of new beds in hospitals has increased by 40,000, which is the equivalent to the building of sixty substantial, new hospitals in this country. I believe that through the efforts of Governments of both parties since the war we have now developed a Health Service which is without parallel in quality in the world.

We now, I feel, should concentrate our attention not so much on recrimination about the past but as to how much the Health Service should develop in the future. I think that we on this side of the Committee are entitled to express a sense of pride that whereas when we came into office the total capital building programme of hospitals was £9 million, we are during the next ten years proposing to spend £550 million. I cannot understand how the hon. Member for St. Pancras, North can possibly describe this as being a contracting Health Service. I do not in any way say this with a sense of complacency. To me these plans that have been published are no more than a point of new departure because I fully realise that, even when all this work has been undertaken in ten years' time, more than half of the patients in mental hospitals will still be in old hospitals. To me these plans are a basis on which we can build, and also, I believe, a challenge to my right hon. Friend and to ourselves.

I want to say a word on the subject of psychiatric services. The total number of beds for the mentally sick range from 2.3 per 1,000 of the population in some parts of the country to 7.2 per 1,000 in other parts of the country. The aim of the hospital plan is to reduce this ratio so that throughout the country there will be 1.8 beds per 1,000 of the population for the mentally sick.

The figure of 1.8 per 1,000 has in fact been very vigorously challenged by the P.E.P. pamphlet Psychiatric Services in 1975. Quite honestly, I do not think that the revision of the Hospital Plan which was published in April of this year entirely meets the argument which was advanced against this figure of 1.8 per 1,000. This revision of the Hospital Plan merely reiterates the statement that all the trends indicate that by 1975 there will be 1.8 beds per 1,000 of the population. I have no doubt myself that the trends will result in this ratio. But the argument advanced in the P.E.P. pamphlet is as follows: The crucial question is not whether the proposed changes are possible in practice, but whether they are desirable in principle. it goes on: The quantitative forecast"— that is, in the Hospital Plan— is of the most rudimentary kind; it is a simple projection of recent trends and takes no account of the many clinical, social and administrative factors which have influenced these trends. The statisticians have taken as their criterion "usage", and to me "usage" is no criterion at all as to the merits or demerits of the trends.

I am not pretending that I can judge the merits of these arguments. All I say is that the House of Commons, in a way, is a jury, and the argument which is advanced with considerable force by the P.E.P. pamphlet has not been answered in the revision of the Hospital Plan. I hope that before we embark on colossal national investment my right hon. Friend may see his way to undertaking some fairly fundamental research into whether this figure of 1.8 per 1,000 is something which we should aim at in our plans.

There is one other matter to which I wish to refer. It is the point raised by the hon. Member for St. Pancras, North when he referred to the Report of the Joint Sub-Committee on the Safety of Drugs. I find myself in a very considerable measure of agreement with him. I find this Report, which is issued by a joint sub-committee of the Standing Medical Advisory Committee, an equivocal document and one which, is to my mind, rather astonishing coming from this body. The first and more important of the terms of reference of the Committee were to advise the Minister of Health and the Secretary of State for Scotland on what measures are needed to secure adequate pharmacological and safety testing and clinical trials of new drugs before their release for general use. It seems to me that with those terms of reference the Committee could have come to three conclusions. It could have decided that the status quo was all right, and that the responsibility should rest fair and square on the pharmaceutical companies and on the doctors when prescribing. It could have come to the conclusion that some kind of voluntary advisory body would be desirable, a body with which manufacturers and doctors might or might not co-operate—but a body which would command considerable local authority. Or it could have come to the conclusion that there should be a body with statutory powers, a body with legislative sanctions behind it.

So far as I understand this Report, the Committee recommends that there should be a body with legislative sanctions behind it. It says: Our concern is with arrangements for ascertaining the effects of drugs and we make recommendations accordingly. These arrangements themselves would obviously be more effective with legislative sanction than without and we are satisfied that legislation on the whole subject is urgently required. No interim measures should be regarded as a justification for delaying this essential task. It goes on to say that it recognises that legislation would take some time Yet there is a specially urgent need to take whatever steps are immediately possible to improve the safety testing of drugs. From that moment onwards, having said that a body with legislative sanction behind it is urgently necessary—and it produces no shred of evidence to show that it is—the Committee goes on to advise the setting up of a voluntary body. The logic of its own argument seems to me to fall entirely in favour of the minority Report signed by my hon. Friend the Member for Putney (Sir H. Linstead). I think that the failure to pursue the logic of its case is a serious failure on the part of the Advisory Committee. I personally, however, neither agree with my hon. Friend, nor with the Advisory Committee. I should like to see responsibility rest solely with the pharmaceutical companies and the doctors.

I think that the Committee's failure lies in its interpretation of the terms of reference. Paragraph 6 of the Report states: We have interpreted, our remit as requiring us to advise on measures which … secondly, will re-assure the public that all possible steps are being taken to prevent the marketing of new drugs which have not been the subject of adequate safety testing and clinical trial … I do not believe that that is the responsibility of a medical advisory committee. Its responsibility is to give medical advice. Reassurance to the public is a political responsibility which falls upon the Minister of Health. I wish to make quite clear that my criticisms are in no way directed. to the Minister of Health. My criticisms are that in considering this matter the Medical Advisory Committee's joint stab-committee has taken upon itself a political decision which I do not think lies within its responsibility.

Returning to the two plans, it is a matter of congratulation that now, at long last, we have the basis for the development of the health services. We have our hospital plans. We have the health and welfare services plan. We can see in terms of capital investment how the Health Service will develop over the next ten years. I should like to see my right hon. Friend, and indeed the Government in general, take one further step in the fairly close future. The health and welfare services of the local authorities deal primarily, or in many respects, with the care of elderly people. My impression is that, in spite of the dedicated work undertaken by many voluntary organisations and many local authority servants in health and welfare, there are problems involving the care of our elderly people which are falling between many of these services.

This is occurring with the health services, the meals on wheels, home helps and residential care for the elderly. They are also falling between various Ministries—the Ministry of Housing and Local Government, with its responsibility for the housing of the elderly, and the Ministry of Pensions and National Insurance, with its responsibility for pensions and National Assistance. The time has come when we should look again at the care of the elderly and place overall responsibility for supervising the work of voluntary organisations and local authority health and welfare services, the housing of the elderly, and pensions and National Assistance on the shoulders of my right hon. Friend the Minister of Health.

7.14 p.m.

Mr. Emlyn Hooson (Montgomery)

I share the disquiet which the noble Lord the Member for Hertford (Lord Balniel) has expressed concerning the recommendations of the Cohen Report. No doubt the Minister of Health will take legal advice on the question which the noble Lord raised with the Minister—whether or not if a manufacturing firm produced a drug which passed the Committee's tests, but thereafter proved deleterious and caused damage, the firm when sued for damages could rely on the fact that the drug had passed the Committee's tests as negativing responsibility on the firm's part for negligence.

I shall not follow the noble Lord in his approach to this subject, valuable though his contribution proved, because it seems to me that his approach was characteristic of that generally adopted today—that is, looking at the Health Service from the top. This is perhaps an inevitable approach for a Minister. A Minister's view is very much like a bird's-eye view. It is naturally from the top. Perhaps we tend to forget that the Health Service is concerned primarily with the man at the bottom, the patient.

My approach is to detain the Committee with certain views which I have formed from the patient's point of view. It is only from the patient's point of view that I have any authority to speak, since I have no other experience which justifies my venturing into this field. It seems to me that the patient may be the least considered functionary in the organisation although he is the man who is there to use the service. There is a great danger in a purely statistical approach. Great tribute has been paid to the Health Service and its benefits to our people, and this, of all services, is the one where we can least afford to have a purely statistical approach.

The hon. Member for Abertillery (Mr. LI. Williams) referred to a Question which had been asked of the Minister concerning Denbigh mental hospital, namely, whether margarine had replaced butter there as part of the meals. The Minister had answered that margarine had replaced butter as part of the diet. From the Ministerial, statistical point of view, this provision of margarine was an economy in diet, but from the patients' point of view this was part of his food. The patients are in hospital and they have to eat it, and it is a question of whether their stay in hospital is more or less happy according to what they eat. This shows the difference in approach between the top and the bottom.

Again, looking at this subject from the patient's point of view, I believe that the average patient identifies the Health Service with the general practitioner. I am glad that the hon. Member for Stoke-on-Trent, Central (Dr. Stross) raised the question of the position of the general practitioner. When a man is ill he goes to see his doctor, who very often knows a good deal about the man's family and background. If the man needs further treatment, or needs any of the welfare services, it is generally the doctor who suggests it. If he has to have hospital treatment or consultative treatment at a later stage it is the doctor who arranges it. It seems to me, therefore, that only the general practitioner is in a position to co-ordinate and connect what otherwise would be entirely divorced individual items of attention. He, therefore, is the keystone of the whole structure.

There is cause for great anxiety today about the position of the general practitioner in the National Health Service. Undoubtedly many pressures are acting upon him. Let hon. Members consider for a moment the isolation of the general practitioner. He tends to be isolated from hospitals, and this is increasing. and isolated from his fellow doctors. As has been pointed out already, there is little incentive for him to improve his premises and he often works in rather sordid conditions. There is little incentive for him to improve his knowledge by post-graduate work or investigations of 'that nature. He has few facilities, few amenities and little ancillary help. He has little secretarial help, and no welfare service is under his control or direction.

Our Health Service has not been going many years, but there is no doubt that these pressures are giving rise to a state of affairs which will mean that eventually recruitment into the Service will be affected. Eminent medical gentlemen who are involved in the recruitment of medical students into medical schools in London have expressed great concern to me not about the intellectual or academic attainments of applicants but about their suitability in character and personality for medical work.

It is important to remember that the general practice of all branches of medicine needs men interested in healing; that is, men interested in medicine. There is a great danger of our making the general practitioner an overworked rubber stamp, dividing the people who need aspirins from those who need hospital treatment. It will be a sad day if we turn him into that. We should consider just what the rôle of the general practitioner should be in the Health Service today. What function should he perform? I suggest that he should be, and should be regarded as, the leader of a welfare team—the best qualified and the man with expert knowledge who is able to coordinate and lead a team of welfare workers

The present set-up tends to act against this idea. Consider, for example, the maternity services. An expectant mother today will go to a local health clinic run by the local authority, will attend her general practitioner. If anything is abnormal about the pregnancy she will go to a consultant and, after all this, the child might be delivered by a midwife in the mother's home.

The woman may be visited by a health visitor. Yet none of these people may have had real contact with each other. They are all giving advice, often conflicting advice, in complete isolation and I regard this as a reprehensible state of affairs. There is a crying need for coordination of the various services affecting the patient in his or her home. I would go as far as saying that all the services having anything to do with patients in their homes should be integrated.

There is a danger—and I have come across examples of this several times—for one person, perhaps a health visitor, genuinely to give advice, although that advice is in complete conflict with advice that the patient has already received from the general practitioner. It often happens that one of the advisers is not in contact with, and is not aware of, the advice given by the other.

As well as being critical I wish to make some suggestions and I hope that the Minister will find them constructive and of assistance to him in improving the services about which I have spoken. I believe that it is highly desirable, in uncomplicated births, that the practice of the mother having the child at home should continue. However, local emergency services should be readily available under the leadership of the general practitioner. We need what might be called "delivery centres" in some areas, particularly the more remote ones. I appreciate that the number of beds for maternity cases will be increased in. the general district hospitals, but they might be needed for the more complicated births.

We need delivery centres for cases where it might not be suitable or practicable for the mother to have her child at home, but where there is no complication about the birth. Some local hospitals have been threatened with closure and many of these could, I believe, be used for this purpose. The general practitioner, midwives and district nurses would have their respective co-ordinated parts to play in these delivery centres.

I welcome the ten-year Hospital Plan in general, although too much concern or preoccupation seems to have been placed on the closure of local hospitals. It could be that we are suffering from too urban au approach to this problem, and some of us who represent rural constituencies take a different view from that of the Government. I believe that the general practitioner must be brought mare closely in touch with the hospitals. There is considerable scope for more part-time clinical assistantships and there should be more general practitioner beds in hospitals.

The district hospital is the only answer when the whole range of specialist services must be provided. However, in my district of Llanidloes, in Montgomery, we have a small cottage hospital, staffed by general practitioners, which has, so far, provided all the services needed for the district, save for the complicated cases which have been sent elsewhere. It is now proposed to close this hospital and to move patients to the general hospital at Aberystwyth, 30 miles away.

During January and February of this year the road between the two places was completely closed. There is no railway and no public transport could get through. A few private motorists managed to complete the journey, although many were involved in collisions. This example illustrates the difficulties of the rural areas. It also shows that there is scope for preserving hospitals of this type to deal with the non-complicated medical cases and as maternity delivery centres and for geriatrics. The general practitioner could thereby be brought more closely into hospital work and he would have a closer liaison with the specialist services. There has been far too much of an urban approach by the Ministry of Health to the problems of the medical services in the rural areas.

Hon. Members must be concerned with the recruitment of doctors, especially into general practice. I am sure that the Minister will agree that the 10 per cent. Willink cut was disastrous because many areas of the country are still grossly under-doctored. It is, therefore, necessary both to restore that cut and to go above it. It is equally important not only to expand the medical schools, but to develop new ones, either in or near the areas which are under-doctored, especially in the new universities.

The Minister, who seems to be fond of statistics, is probably aware that doctors tend to settle in or near the areas where they have been to university. This, apparently, is recognised by the profession and is one of the reasons for the under-doctoring of the parts of the country where medical schools are not available.

Mr. Powell

I will give the hon. and learned Member another statistic. The intake into medical schools last autumn was 16 per cent. above the figure recommended by Willink.

Mr. Hooson

I am pleased to hear that, although I am sure that the right hon. Gentleman will bear in mind the anxiety that has been expressed about the quality of some of the entrants. I am not speaking of their academic attainments, but their personality, their aptitude for the job, and so on.

The Minister might also consider making financial provision for refresher courses to be given to married women who have been out of medical practice for a considerable time so that they can return to the service. He might also investigate the school medical service to see whether or not a great deal of overlapping occurs. Perhaps because of the National Health Service, the school medical service is not now necessary to fulfil the task that was originally intended for it and is more of a statistics-obtaining service than a preventive medicine one.

Another matter which greatly affects general practitioners is the problem of equipment. The hon. Member for Stoke-on-Trent, Central was right when he pointed to the division of the remuneration of general practitioners between that portion representing recoupment for expenses and equipment, and so on, and that portion regarded as net income as a disincentive. The Ministry's interest-free scheme for doctors in group practice to provide their own modernised surgeries has been very helpful.

I know of one practice where three young doctors, who are particularly and wholeheartedly interested in medicine, set up their own surgery at a cost of about £10,000. They decided that as they would be spending the rest of their lives in that practice, they wanted to work under the best possible conditions. They employ their own receptionist and they have their own dispenser and dispensary. I am glad to say that a local authority health visitor has been allocated to them. By and large, however, there is no incentive for doctors to do this sort of thing. The number of practices where this has been done is a small proportion of those where it could be done. because there is no financial or other incentive for doctors to do it. I should like the Minister to look at that matter.

This experiment of attaching local authority health visitors to particular practices is one to be greatly encouraged and extended. As a result of the information which is obtainable, I hope that it may be possible to consider basing midwives, district nurses, health visitors and other welfare workers on individual or group practices so that there is a co-ordinated medical scheme, with a doctor acting as the leader. The lack of such arrangements constitutes one of the great gaps in the service. There should not be this tripartite division between the general practitioner, the local authority and the hospital. Somehow, this problem must be solved.

There is much to be said for health centres in some areas, as was mentioned by the hon. Member for Stoke-on-Trent, Central. But I hope that the Minister will not consider it possible to provide a uniform solution. In many areas health centres would be a great help. But in other areas a group practice would seem to be the answer. In rural areas where the population is dispersed, the individual practitioner provides not only the best, but the only possible answer. I should, therefore, like the Minister to avoid the uniform approach which has characterised one or two of the speeches from hon. Members on this side of the Committee.

I have adverted to the fact that the administration of the National Health Service is difficult because of the tripartite administrative division between the general practitioner, the local authority and the hospital. It is a difficult matter to overcome and we are bound to get areas where health and welfare services merge, as it were, with purely medical services. I am greatly in favour of the idea of area health boards to co-ordinate services as was suggested in the Porritt Report. I should prefer the boards to follow the present local authority division rather than have new divisions, cutting across the local authority divisions, set up as areas for these boards.

I should particularly like the Minister to give his attention to a matter which affects only a minority of people, but which causes great distress. I refer not to the old chronic sick, but to the young chronic sick. I have particularly in mind cases of sclerosis which have been brought to my attention. In one case the wife has disseminated sclerosis and apparently no help has been possible under the National Health Service. There are relatively few of these cases and it has been suggested that they should go into wards with older people who are chronically sick, but surely something can be done to help specially these young people.

I know of a case where a wife, aged 40, is in one of the Cheshire homes, at a great financial expense to the husband, who cannot really afford it. He has had to sell his home. His son lives with him in a flat, but his daughter is being cared for by the family. There have been communications with the Department about this case, lot t apparently nothing can be done under the National Health Service to give this unfortunate lady the kind of assistance which she needs.

I have spoken for longer than I intended, but I wish to mention two other matters and one is the question of the prison medical service. I suggest that it is time that the prison medical services were brought under the control of the Ministry of Health. That would be a good thing for the staff and for the prisoners. Integration would ensure cooperation with other medical authorities. It would be far healthier and better if the medical services in the prisons came directly under the Ministry of Health.

The Temporary Chairman (Mr. C. Royle)

Order. I am not certain whether the hon. and learned Member is right to deal with this matter. Perhaps the Minister can assist me. I think that the prison services come under the Home Office and not the Ministry of Health.

Mr. Powell

With respect, Mr. Royle, I do not think that there is a prison Vote under discussion.

The Temporary Chairman

That is exactly what I thought. I hope that the hon. and learned Gentleman will move to his next point.

Mr. Hooson

I am grateful for your Ruling, Mr. Royle. I simply indicated the matter for the Minister's consideration.

When we have a ten-year policy for the development of hospitals it is essential, in my view, that there should also be a policy for the staff, during the same period. It is a great mistake to think that any medical service depends essentially on bricks arid mortar. It does not. It depends on the quality of the people in the service and the training they receive. One would like to see a staff development plan thought out carefully to cover this period.

I am sure that privately, if not even in his Ministerial capacity, the Minister would agree that many people on hospital staffs are still grossly underpaid. Take, for example, radiographers who are rarely vocal about this matter. I came across a case at an important hospital where the head radiographer was paid less than the head porter. There is a great need to ensure the development of a plan, complementary to the hospital plan, for staffing hospitals adequately. Surely the foundation for a proper national incomes policy would be a fair and just reward for those in the public service.

7.39 p.m.

Mr. John Eden (Bournemouth, West)

Many hon. Members opposite have used rather exaggerated phrases during this debate. They have abused my right hon. Friend. Yet the criticisms which they have sought to bring to the attention of the Committee have proved to be transparently weak. I appreciate the dilemma in which many hon. Members opposite must find themselves. They wish to glorify the Service of which, with scant justice, they claim sole authorship, without hinting in any way that its continued expansion has anything to do with the Government of the past twelve years.

The fact remains that the plans we have before us indicate not only great hopes for the future but prove the soundness of the management in the immediate past. My noble Friend the Member for Hertford (Lord Balniel) rightly drew attention to the fact that for the first time we are given a clear, forward look at the future programme of the Health Service as a whole.

Here, for the first time, the pattern for the future is set before us for the consideration of the country. The hospital and the health and welfare plans provide a comprehensive and masterly survey of future trends and needs of the Service. For this, my right hon. Friend must earn a great deal of credit from both sides of the Committee. Yet many hon. Members opposite have criticised him for what they call his statistical approach.

The hon. and learned Member for Montgomery (Mr. Hooson), in an extremely interesting speech, did exactly the same thing, as though this were something to be condemned. Hon. Members bring this criticism forward with a slanting reference to what they would have the country believe to be the lack of humanity of my right hon. Friend. How wrong they are. As in so many other things, they are totally wrong in this. Are they going to base all their plans for future expansion on emotion? We have to have a statistical approach. Statistics are necessary on which to base plans for future development.

Mr. Hooson

I am sure that the hon. Gentleman would not want to misquote me. I said that there was danger in a purely statistical approach.

Mr. Eden

Statistics are pure, otherwise they are of little value. We must have statistics on which to plan for future developments. One can have no other secure or sound basis for planning for the future. I agree that later, when the plans take shape, humanity has to be breathed into them to give them life and warmth and spirit. But before we get to that stage we must have the facts and figures, as near as can be deduced or conjectured, on which to base the plans, costs and estimates for the future.

This Committee, dealing as we are with a very sizeable portion of the national expenditure, may be grateful for the fact that our country's economy is in the hands of sound management today. At the very least, the statistics give a very good indication of the extent of the requirements likely to be placed on the National Health Service in future.

As a Bournemouth Member, I am particularly glad of the fact that the first revision of the Hospital Plan indicates that Bournemouth will have before long a new hospital for the area. My right hon. Friend has visited the Royal Victoria Hospital and I know that a former Parliamentary Secretary and many senior members of the Department have taken a great interest in the needs of the area for hospital provision.

I want to take this first opportunity I have of welcoming this new projected development, which is very necessary, for, as my right hon. Friend will know, the older the building the greater the current running cost. This is not the only reason why, in the first revision, Bournemouth is to have a new hospital, but it is a very important reason when we are considering these Estimates.

I am glad also that Bournemouth features so prominently in the Blue Book on health and welfare. I want to give an illustration of the work done in Bournemouth in part of the field covered by the Blue Book. But, first, we must understand the proper background on the national level to see what it is that the nation as a whole is seeking to do. In the chapter dealing with the care of elderly people, it is clearly indicated that the proportion of old people in the population will steadily increase over the next twenty years. Of those aged 65 and over, there is likely to be in twenty years' time an increase of nearly 2 million, which is 32.5 per cent. One interesting sidelight on this development is the fact that in the second of the two decades to come there will be a greater proportionate increase of those over 75 compared with those between 65 and 75.

In 1961, persons aged 65 and over comprised about 12 per cent. of the total population. It is conjectured that this percentage will grow to about 14 per cent. by the end of the two decades, even allowing, obviously, for the increase of population as a whole. But the Report says that there are very wide margins in different county boroughs. Paragraph 46 mentions that in 1961 the margin varied between 8 per cent. and 22 per cent. in different county boroughs.

In Bournemouth, the proportion is very high and I make no apology for telling the Committee something of how the local authority tackles its responsibilities. This is not regarded by anyone in Bournemouth as a burden or a problem but as a first obligation which they are happy to do their best to meet. Compared with the national figure of 12 per cent. of the total population aged 65 and over, in Bournemouth in 1962 the proportion was 22 per cent.

To put this in perspective I quote figures from other places. In Cardiff the figure was 10.6 per cent.; in Chester, 11.5 per cent.; Oxford, 13.6 per cent.; Bath, 15.7 per cent., and in Brighton, 17.5 per cent. In Bournemouth, by 1972—which is the end of the first decade of the two which are generally being considered now—it is expected that the proportion will increase from 22 per cent. to about 24 per cent.

I am sure that hon. Members can well understand the very big impact that these figures have on the housing programmes and on plans for home help and the provision of residential accommodation. It is a very big task for a county borough to meet these commitments honourably and adequately in the context of the figures such as I have presented today. I want to give some idea of how this is being tackled.

On the housing front, in the provision of single bedroomed flatlets, bed-sitting rooms and bungalows for the old, about 623—

The Temporary Chairman

Order. We are discussing the Estimates with regard to the Ministry of Health, not the Ministry of Housing and Local Government.

Mr. Eden

With respect, Mr. Royle, these matters come under the welfare services. These are most important aspects. I thought that it would be relevant at least to discuss some aspects of the health and welfare plans as mentioned in Cmnd. 1973.

The Temporary Chairman

When the bon. Gentleman proceeds to give figures of housing in a particular town, I would not regard that as coming under what we are discussing.

Mr. Eden

I am not deliberately arguing with the Chair, for that is the last thing I should wish, Mr. Royle, but in the chapter in the Blue Book dealing with the elderly there is an important part about housing for the elderly, and that is primarily promoted by the Welfare Services Department. I think that this is a terribly important aspect of the work being done to try to help the health of elderly people.

The Temporary Chairman

It may be very important, but it is not in the Votes we are discussing.

Dr. Dickson Mabon

Further to that point of order, Mr. Royle. Surely the Minister himself referred to this Blue Book. Although I admit that perhaps details may not be desirable at this stage, surely the argument of the hon. Member for Bournemouth, West (Mr. Eden) is valid, since the Minister himself has already brought it into our discussion.

The Temporary Chairman

It does not follow that because of a change in the occupancy of the Chair I shall not decide what is in order and what is not.

Mr. Eden

I am grateful to the hon. Member for Greenock (Dr. Dickson Mabon) for coming to my rescue. This is a dilemma we frequently face. It is the sort of point my noble Friend the Member for Hertford complained about. It is impossible to discuss comprehensively the needs of elderly people without trespassing across a number of Votes and a number of Departments. It is approaching the point of lunacy, with respect, Mr. Royle, if I cannot at least refer in passing to the sort of provision which is being made in Bournemouth.

The Temporary Chairman

I have no objection to the hon. Gentleman referring to anything in passing, but I must ask him to stick to the Votes in his general speech.

Mr. Eden

I am grateful, Mr. Royle. I will refer only briefly in passing to this subject because the picture is incomplete without it.

Altogether, 13 per cent, of the Corporation of Bournemouth's house-building programme is devoted to the needs of elderly people. This is an important aspect of the work done on the preventive side, and therefore it bears very materially on the cost of the National Health Service as a whole, for unless there is adequate provision for elderly people, designed to meet their particular needs, they will become a liability on the National Health Service Vote.

There is other work on the preventive side which is being done very actively indeed. This includes home nursing, home help, home visiting and all the miscellaneous services. But I want to draw particular attention to the work being done by the W.V.S. with the meals-on-wheels service, for this is an outstanding service which was of particular value during the cold spell and was tremendously appreciated. In Bournemouth also we have a plan—

Mr. Denis Howell

Tell us about Boscombe.

Mr. Eden

This also embraces Boscombe.

In Bournemouth we also have a plan, under the general ten-year plan, for day centres for old people. This is a new development. It is the provision of a hail, with anterooms, kitchen, baths, and other facilities, which becomes, in effect, a sort of club for the elderly people to which they can go by day and which again is designed to bring to them the general companionship of the community, which is so essential. Unfortunately, the day centre which it was proposed to begin this year has had to be postponed because of the likely heavy impact on the rates. A new mental health home has recently been opened for the area. There is another under construction. Four are planned over the next decade.

All these matters, to which I have referred in passing, are relieving the hospitals, quite rightly, of a considerable pressure which would otherwise have come their way. Whilst it does this, it also considerably adds to the total rate burden in the borough. Already all the services administered by the corporation cost about 11s. 7d. in the £, of which about ls. is spent on health and welfare. Schemes of this kind have a great impact on an area such as that which I represent, where a special and peculiar need is placed on us because of the large numbers of elderly people who, quite properly, come to spend their declining years in Bournemouth. I hope that my right hon. Friend the Minister will have a word with his right hon. Friend the Minister of Housing and Local Government with a view to seeing if something can be done by means of the general grant to assist us over this difficult period.

The fact remains, however, that since much of this work is being financed through rate contribution as well as under the Votes we are now considering, local administration can take full account of local needs. This is what we are doing. There are plans to double the expenditure on health and welfare in Bournemouth in the next ten years, which will go some way towards meeting the increased pressure which will arise from the demands in the area.

As a number of hon. Members opposite have sought to show that under Conservative management the health services have been neglected, although the complete opposite is the truth, I am forced to rub this fact home: the active work being done in my constituency and the great programme planned for the future development of the services there are being carried out under a Conservative council and have largely been inspired by a Conservative Minister of Health.

My noble friend the Member for Hertford referred to the need for closer co-ordination of the services, particularly in so far as they are designed to meet the needs of elderly people. Again, Bournemouth is well blessed in this respect. We have an extremely imaginative and able chief officer of welfare services. He works in the closest possible co-operation with the chief medical officer of health and the housing manager. I think I am justified in claiming that at that level there is the closest permissible cooperation. I stress the word "permissible", because I think that the higher up the scale one gets the less interdepartmental co-operation one gets.

Therefore, I support my noble Friend in making this plea. At Ministerial level there should be a greater effort to try to cut out the obstacles to securing the greatest degree of co-operation between departments in caring for elderly people. This has been begun already, and I know that my right hon. Friend the Minister has sent out a circular on this subject. In an area such as mine, where the need is acute and where the requirements are very great indeed, it could not possibly be tackled or met without having the closest possible practical and active cooperation at local level, and I should like to see this reflected more actively higher up the scale.

I come to the most important thought of all. When we are considering Estimates in this Committee we generally tend to call for further increases in expenditure. It is right to remember that we should consider how we are to finance some of these programmes which we have outlined before us. Any hon. Member who has looked at the summary of the Vote under Class VI will realise the tremendous size and scope of this problem. The sum of £2,826 million is the gross total involved in Class VI. We cannot lightly pass this by without any consideration of its implications, not only for us but for generations to come.

In the Health Service there is a partnership between the State, the local authority and the individual. The proportions within this partnership have got slightly out of scale. The State tends to provide a greater part in proportion than it should be required to do in days of increasing affluence and prosperity. I do not hesitate strongly to disagree with the many views put forward by hon. Members opposite who protest against anybody contributing anything towards the cost of the services they get. I yield to no hon. Member in my desire that those who are in need should get as much assistance as we can give them, but I do not agree that in days of increasing prosperity, when the annual wage packet is steadily growing, no account should be taken of the possibility that the individual citizen can himself contribute to a greater degree than he has been doing, and is now doing, towards the cost of the services which he uses and from which he benefits. It is important that we give consideration to this aspect, which concerns not only the Health Service, but, also inevitably, other services and which may lead us on to a complete reshaping of our social services generally. In looking forward over the neat twenty years I think that it would be quite wrong if we were simply to examine the future in terms of bricks or mortar, or even in terms of expanding the services, without also closely examining the methods by which we are proposing to finance them.

Mr. Loughlin

Before the hon. Gentleman sits down, can I ask him to let the Committee know—

The Deputy-Chairman (Sir Robert Grimston)

Order. The hon. Gentleman is putting a question before the hon. Member for Bournemouth, West (Mr. Eden) sits down. The hon. Member got in in time, but I hope that he will be quick, in the interest of other hon. Members.

Mr. Loughlin

I am at a loss to understand what this is all about, Sir Robert. If I am in order, why am I pulled up? May I now ask the hon. Gentleman to let the Committee know precisely what charges he thinks that the patient under the Health Service should bear? What are the charges to which he refers when he says that people ought to be prepared to bear some of the charges?

8.5 p.m.

Mr. John Baird (Wolverhampton, North-East)

I have listened to most of this debate. Hon. Members on both sides have made some very valuable points—points about local problems and points of administration, but apart from my hon. Friend the Member for Cannock (Miss Lee), I do not think that anyone has dealt with the fundamentals of the scheme as we have it today and as we introduced it in 1948.

I have been in the House of Commons for eighteen years, but I do not think I have ever heard an hon. Member take so long to say so little as the hon. Member for Bournemouth, West (Mr. Eden) has just done. He paid a great compliment to the Minister. He talked about our expanding Health Service. Anyone who knows anything about it knows that it is not expanding but is contracting. The hon. Gentleman said that we now have a new ten-year plan. But it is only on paper, issued just before another General Election. This is 1963. Why was not this plan introduced in 1953 if the Conservatives really believe in it?

The Minister smothered us with statistics. The hon. Gentleman defended him. It has been said that figures can be made to prove anything. Those of us who are associated with the National Health Service know that it is nothing like the service it was in 1948. I am glad that I caught your eye, Sir Robert, because I think that I am the only dental surgeon in the House and I want to deal with dental matters. I here declare my interest. I am glad I caught your eye, for the further reason that I was one of those who assisted at the birth of the National Health Service. I sat all through the Committee stage of the 1948 Bill and helped to formulate it. At that time it was a free health service—at least, free at time of need. The Labour Party was very proud of that service, which was perhaps the most revolutionary aspect of the Labour Government's term of office.

I want to speak about one or two dental aspects. There is a controversial point, but it is not a political one. We have recently taken a great step forward in the care of children's teeth by the introduction of fluoride into our water supplies. Caries in children's teeth has been rampant. The position today is better than it was, but it is still very serious. By the introduction of fluoride I believe that we can revolutionise the treatment of children's teeth. I advocated this measure in Parliament fifteen or sixteen years ago. I do not want any hon. Member to think that when I talk about adding fluorides I am seeking to justify fluoride in toothpaste. That can have no therapeutic value, and is simply a sales gimmick.

I cannot understand why some of my hon. Friends are opposed to the use of fluoride. They probably do not realise its medical implications and the medical advance it represents. Every responsible medical authority has welcomed it. I hope that local authorities will use it as soon as possible and will not be put aside by cranks, some of whom are among my friends.

The present Leader of the House built up his reputation by a vicious attack on my friend, the late Aneurin Bevan. He said that the school dental service had failed and that the Tory Party would put it right. There has not been much improvement in the service since 1948–49, but there has been an improvement in children's teeth. A large number of children now go to the family dentist for treatment. I should say that one-third of my patients are school children, yet I must admit that it would be much better if they could get the treatment within the school service.

Although I am a general dental practitioner, I also attend to the teeth of the children at a fairly large private school. When those children come, as they do, in groups of six or eight, they have much more courage—and they are away from their mothers. When they come with their mothers, they are apt to show off, and become a little temperamental. It would be much better if, at certain ages, they could be treated at a clinic rather than come to the family dentist. The trouble is that the school dental services are under the local authorities, and some local authorities are progressive, and others are not.

Why does not the Minister see whether the school dental service could be brought under the Ministry of Health? We should then get a standard basis instead of having one authority pushing ahead with its dental services and another neglecting them. The education authority would still provide the clinics, but the Ministry would provide the dentists and see to the development of the school service—

Mr. A. E. Cooper ( Ilford, South)

I am a member of the Select Committee on Estimates, and the recommendation the hon. Member now makes to my right hon. Friend is one of the recommendations made by the Select Committee in its Report to the House.

Mr. Baird

The hon. Gentleman is quite right in saying that the Select Committee has made that recommendation, but I made it ten years ago. I have been making it ever since, and I shall go on making it until it is adopted.

There is the question of salaries. We hear a Tot about Tory planning working. In June last year, the Ministry cut dental incomes by between 15 per cent. and 20 per cent. gross. The Minister will perhaps not accept that figure, but I worked it out in my own practice. That was in June, 1962, but in April, 1963, the Ministry tells us that it will give us an increase of 12 per cent. from 1st April—though we have not got it yet.

I admit that in 1948–50, and on to 1952, dental incomes were far too high, but the Committee should now recognise that dentists are the only profession or group of workers that has had no increase, but a reduction, in income since 1948. Dentists may have been making big money in the early days, but it is not so today.

The Minister should also bear in mind that the scale of fees is completely unbalanced. I am in favour of a fully-salaried service, but we have payment by scale of fees, and I say that it is unbalanced. In 1948, we deliberately reduced the price of dentures and pushed up the price for conservative dental treatment because, at that time, a large number of dentists were practising what we called "blood-and-vulcanite" dentistry—extracting teeth and supplying vulcanite dentures. It was to stop that practice that we acted as we did. That has remained, yet labour charges today are almost doubled.

There is no incentive to give good, high-quality work in the National Health Service now. I apologise for being technical for a moment, but if a dentist fits a synthetic crown on to the root of a tooth his fee is £2 17s. 6d. My mechanics charge me £1 15s. I sometimes have three visits to do my side of the work, and they can do theirs in an hour. The scale of fees for bridge work is completely unbalanced. It can no longer be done under the Health Service and, of course, far too much bureaucracy is growing up.

The cost of administration is growing, as the hon. Member for Ilford, South (Mr. Cooper) must know. I have been told by people whom I respect that members of the Select Committee of this House went to the Dental Estimates Board at Eastbourne, the administrative centre of the dental service. They arrived in the morning, and were given sherry by the chairman—an old gentleman of well over 70. The mayor of the town, who was on the stag of the Dental Estimates Board—and, I think, was still being paid while he was mayor, though I am not quite sure—then rushed them off for lunch, and they got the next train back to London. They never spoke to a single dental mem3er of the Board's staff.

How can the Select Committee possibly get at the facts if its members just see the officials who are running the show? I may be wrong—

Mr. Cooper

I think that the hon. Gentleman is wrong. I did not go to Eastbourne with the other members of the Select Committee, but the object of that visit was not to get the detailed information that we normally get when members of the profession appear before us. Those members of the Select Committee visited the Dental Estimates Board to see exactly what went on there. Throughout the Session, we on the Select Committee interviewed very many members of the staff from Eastbourne, and I really believe that the Report submitted to the House was a very detailed, factual and accurate account of the conditions obtaining in the Health Service today.

Mr. Baird

All I can say is that between twenty and thirty dental members are employed on salary at the Board and, to the best of my knowledge, not one of them has been interviewed. I asked certain members of the Select Committee that some of these people should be allowed to give evidence, even in London, but I do not think that anyone was invited. Administrative members of the staff may have been interviewed, but none of the dental members, who are the key to the whole service.

I do not want to take up too much time on dental matters, but will deal with the real fundamental problems of the medical service. Many of us are very worried by the drastic changes that have taken place in the Service under a Tory Government. Amenity beds are diminishing and private beds are increasing. This is all done in favour of the fee-paying patient, and the ordinary patient has to suffer as a result. The same kind of thing goes on with consultants.

There has been an attack on the principles of the National Health Service. The Minister and his predecessors have encouraged part-time consultants paid on a sessional basis, and have destroyed the whole-time consultant service. It is true that in 1948 we allowed a certain number of part-time consultants, but we were also building up a fine team of full-time consultants. Our ultimate aim was to do away with the part-time consultant, and to make this a full-time service. As my hon. Friend the Member for Cannock has said, we had to compromise at that time. To be quite frank, we were afraid of a black market in nursing homes, and in order to get the consultants in we had to offer some of them part-time service.

I am not by any means attacking our consultants. Let no one think that I blame them. I have had too much illness recently, and have been in hospital too much. to do other than pay a sincere compliment to the consultants. It is the Ministry and the Government that are encouraging this part-time service; they are to blame—not the consultants. We are going back to the bad old days of a two-class system of medicine—one for the wealthy and another for the ordinary folk. If hon. Members opposite call that an expanding service, I do not. It is expanding in some ways, but not to the satisfaction of the ordinary people.

Never have I heard so much humbug as in our Health Service debates over the years. Listening to lion. Members opposite one would think that it was their Health Service nowadays. but I have been in the House long enough to remember that the Health Service Bill was opposed at every stage by the Tories—even its Third Reading. Now they talk about an expanding service—on paper. It is humbug. Let us cut out this kind of cant. We shall be back in power soon now, and one of our first objectives must be to rebuild the free National Health Service that has been destroyed by the party opposite.

8.25 p.m.

Sir Hugh Linstead (Putney)

With only one short part of the speech of the hon. Member for Wolverhampton, North-East (Mr. Baird) have I any sympathy. This was his reference to the fluoridation of water. I was very glad that he took the opportunity to draw attention, with his specialised knowledge, to the fact that this process is one of the safest and most effective courses open to the local authorities for checking the development of dental caries. Like him, I am amazed that, in this year of grace, there are still members of the public who find that the widespread experience of the advantages of fluoridation, gained all over the world, is not conclusive as to its value.

I shall confine myself to one section of the large field open to us for discussion, although, had there been more time, I should have preferred to touch on several other points as well. I wish to draw particular attention to the Report of the Committee on the Safety of Drugs, to which several references have been made, and to explain why and one of my colleagues on the Committee responsible for the Report found it necessary to dissent from the majority view. I have to tell my right hon. Friend that, with considerable regret, I shall not find it possible tonight to support him in the Lobby.

The genesis of that Committee has been dealt with during the debate. My noble Friend the Member for Hertford (Lord Balniel) has explained in some detail what the objectives put before the Committee were. The Committee was invited to propose methods of testing new drugs for toxicity, for approving clinical trials before a drug was released for general use, for devising an early warning system which would enable unexpected results from new drugs to be noticed and, finally, to suggest a scheme for notifying the medical profession of the adverse effects of new drugs.

One of the lessons which the thalidomide tragedies brought home is that it is doubtful today whether there is any such thing as a safe drug, and that we have been all too ready to assume that drugs can be carried about and can be taken as and when our momentary condition seems to require tranquillising, invigorating, or whatever it may be.

The thalidomide tragedies brought home to us also that the effects of a new drug on whole populations very often cannot be discovered until the drug has been given to a whole population. Only then are the idiosyncrasies or unexpected results thrown up. Whatever scheme of control and protection is devised, we can be certain that, from time to time, nature will get the better of us and there will in future be, as there has been in the past, "thalidomide tragedies" which no scientific foresight or system of control can avoid.

From those lessons one or two general principles emerge. In the handling and marketing of drugs ordinary commercial rules cannot be allowed to apply. We cannot just say, "caveat emptor"—let the purchaser read the advertisement, buy the drug, try it and see what happens. Also, even the physician, with his highly-specialised knowledge today, cannot be expected to keep up with the immense advances of medical science and with the unexpected results which the distribution of new drugs may produce in a community.

It is quite clear that we need today safeguards against crude toxicity—these, I think, are fairly good—and safeguards to ensure that drugs are effective for the purposes for which claims are made, and I doubt that these safeguards are effective at the moment. We also need the safeguard of a warning system against unexpected side-effects.

The difference between the view of my colleague Mr. Grosse and myself and that of the other members of the Committee resides din our belief that two of those three safeguards can be secured effectively only if there are statutory sanctions behind them. I received only yesterday morning from the president of a pharmaceutical manufacturing company in America who had read our Note of Dissent a letter from which the following is an extract: As I understand it you are taking the position that the control of animal and human testing of new drugs (as well as old drugs for new uses) should he under some Government agency responsible to the Health Ministers rather than be controlled on some voluntary system. Our experience in various States as well as the Federal Government here would tend to support your argument; the more ethical manufacturers of drugs will police their own efforts very well, but the smaller and less reliable groups may not be trusted too much". He sums it up by saying: It is this 5 per cent. of the industry that causes us 95 per cent. of the difficulties in the enforcement of any drug control action. That, coming from the United States, with all its traditions of free enterprise, is, I suggest, a warning worthy to be borne in mind.

The majority Report of the Committee proposes that the voluntary committee be divided into three sub-committees, one to deal with toxicity, one to deal with clinical trials, and one to supervise the early warning system. My right hon. Friend has now named chairmen of the mair. committee and of the three sub-committees. No one could quarrel with or criticise in any way the choice. I am sure that their names will give great confidence, but it is just because the membership of the committees will give confidence that a certain danger exists. A sense of security will be created in the public mind beyond what it is possible for any voluntary committee or scheme to ensure. I fear that we shall have the appearance of security without reality and that there will be a real likelihood of the postponement of needed legislation because of this sense of security.

I do not want to go through the details of the scheme, because they are clearly set out in the Report, but I want to refer to some of the deficiencies. I have already said that the leading firms can be completely relied on. I think that we have in this country some of the finest pharmaceutical manufacturers in the world, whose reputation is the greatest safeguard that the public could possibly have. I am much more concerned about the smaller firms, and about the agents for small foreign firms, and about those who may say, "If I can import a new drug which has been tested in a foreign country and, relying on those tests, can get a lead of six months or a year over my British competitors, I am prepared to take the risk". That is not unlikely to happen.

It surely cannot be overlooked that there is no other country known to me of a scientific and industrial development comparable with our own which has not found it necessary to have some statutory control over new drugs. One of the most important principles to be applied in any control of new drugs is that the new drug should be regarded as guilty until it has proved itself innocent. At present, we work on the basis that all new drugs are innocent until there has been a series of poisonings, whereupon they can be scheduled and controlled. I do not think that we can afford to do that in future.

Under a voluntary scheme, it will not be possible to restrict new drugs to medical prescription until such time as they prove themselves to be safe and, therefore, available for general distribution. If the job is to be done properly, we must establish the principle that every drug shall be labelled with its own scientific name in addition to the trade mark of the manufacturer. I think that we must have labelling requirements which give the necessary warnings to the public and to the medical profession. It may be a warning about an antidote or about a dose, or it may be a warning that after a certain date it is necessary to reject the package concerned.

From the point of view of the manufacturers themselves, it is important that our requirements in this country should be co-ordinated internationally through the World Health Organisation in such a way that a drug passed as safe for marketing in this country and labelled in accordance with the statutory requirements in this country shall be acceptable automatically for sale in other countries. If there could be such co-ordination, it would be of enormous advantage to the British industry. It would greatly help the recognition of British drugs in other countries. I am very surprised that the industry is unwilling to accept some sort of statutory control on a national basis which could be adapted fairly readily to international needs.

I understand the problem with which my right hon. Friend was faced. Legislation takes time, and my right hon. Friend was, and perhaps still is, entitled to say, "I cannot guarantee that by this time next year there will be legislation on this matter passing through the House of Commons". Nevertheless, I feel that there would not have been any grave public danger in a delay, say, of a year for legislation, if a delay of a year had had to take place, because at present everybody is alerted by what has happened with thalidomide and the manufacturers and agents and doctors and pharmacists and the public are all greatly concerned about the possible dangers of new drugs. We could safely have waited for a year, if it had been a year we had to wait.

The timetable which I should have liked my right hon. Friend to adopt would have been the publication of a White Paper in July, or October at the latest. I am sure that in the Ministry there is all the information needed collected by the Working Party, which has already been mentioned, which would enable my right hon. Friend to publish a White Paper indicating the sort of legislative procedure which the Government had in mind. If that had been published by October at the latest, it could have been criticised between October and the end of the year, and by the spring, or earlier, next year, there could have been a Bill. I still ask my right hon. Friend whether he cannot tell us that there will be a White Paper, indicating the sort of legislation which, as the majority as well as the minority report and he himself have said, is urgent.

I must have regard to the wishes of other hon. Members to take part in the debate, so I will conclude by saying that the present machinery for the provision of the manufacture and the distribution of drugs and medicines in this country is in a state of complete chaos. As the secretary of the Pharmaceutical Society, I have lived with this for thirty years of my professional life. I am appalled by the way in which six or seven different authorities acting under six or seven different Acts are inefficiently trying to handle this problem. If there was ever a jungle of administration which needed clearing up and tidying, it is this.

For all those reasons, I hope that my right hon. Friend will use the opportunity which his Working Party's Report has given him to clear up this administrative jungle and come to the House with proposals, first, in a White Paper and then in legislation, as soon as possible, to put the matter on a rational basis.

8.44 p.m.

Mr. James Boyden (Bishop Auckland)

The arguments of the hon. Member for Putney (Sir H. Linstead), backed by his very great experience, ought to make the Minister reconsider his action on the Cohen Report. I could only embroider the hon. Member's case and not advance it, and so I propose to turn to the point which the hon. Member for Hertford (Lord Balniel) made about statistics.

I was astonished at the way in which the right hon. Gentleman interrupted the hon. and learned Member for Montgomery (Mr. Hooson) about the figures for entries into medical schools. The right hon. Gentleman did it so smugly. He knows enough about the shortage of doctors to know that it was quite wrong to imply that the 16 per cent. increase in intake was a great achievement. For years he and his predecessors held back the entry into medical schools, along the lines of the Willink Report. From this side of the Committee we plagued him with questions asking him to revise the figures, and when he did he merely brought them up to their previous level. Now he makes great capital about adding a further 5 per cent.

What is the position in medical schools now? There is a backlog of about five years of people who ought to have been in but who are not. Schools are overcrowded. University lecturers are doing research in holes and corners. It takes super-women to get into medical school. Our dental research lags far behind that of other countries, and even the University Grants Committee has drawn attention to the lack of money and facilities devoted to dental research. The school medical service is short handed. The school dental service is even worse.

The Porritt Report on medical aid to overseas countries makes a disparaging reference to our post-graduate education in non-teaching regional hospitals. In the event of a conflict between India and Pakistan—and one hopes that this will not happen—the right hon. Gentleman knows that the hospital service might collapse because of junior medical officers being called home. It is therefore quite wrong of the Minister to give the impression, as he did this afternoon, that 16 per cent. represents a great achievement.

I want to follow up the statement made by the hon. Member for Hertford that what the Minister does, even when he gives accurate statistics—and that is not very often—is to measure the existing situation. The right hon. Gentleman knows that medical and scientific knowledge is doubling every ten years, and therefore the pace of the advance in the hospital service and in the medical field ought to be very much greater than the miserable figures that he gave the Committee.

My hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) referred to the increasing complexity of medical techniques and to new techniques that have been brought about through the advance of scientific knowledge. These advances call for an increase not only in the number of doctors but in the number of those people who stand behind the doctors, and I do not mean the nurses. I mean the technical auxiliaries and the professions ancillary to medicine in which the right hon. Gentleman not long ago gave a good example of his misleading statistics.

I hope that the Committee will forgive me if I take up the Minister's reply to my written Questions of 11th March, which was a perfectly reasonable set of Questions. I asked how many vacancies there were in the different aspects of supplementary professions. The Parliamentary Secretary replied: This information is not collated centrally,"—[OFFICIAL. REPORT, 1101 March, 1963; Vol. 673, c. 112–113.] The hon. Gentleman then inspired a question by one of his hon. Friends to show how much better the situation had become since 1957, but he could easily have turned to a publication of his own, namely, the green Digest which I receive monthly, and which, on page 87 of No. 2 of last year carries the shortages of these grades of staff, and says that the Association of Hospital Management Committees circulated to all the hospital management committees in the country a request to be told the shortages that existed. Of the 379 committees circulated, 376 replied and gave the number of vacancies.

The Parliamentary Secretary could easily have taken this figure if the Ministry did not have it. I very much doubt whether the Ministry did not have the figure, because it receives many returns from regional hospital boards and many statistics of this kind. I am sure that if the hon. Gentleman had applied his mind to it he could have answered my Question accurately. But even if he could not have done so, he could have obtained these figures which were produced by the Association and done the percentage arithmetic, that is, the 4 per cent. or 5 per cent. increase over 1961, and given that as an approximate answer.

What I propose to do is to put to the right hon. Gentleman the figures that the Association gave, my arithmetic of what the increase in numbers would have been since the Association collected the figures and my estimate of the total deficiency in these categories today. If the right hon. Gentleman does not agree with what I say, I hope that he will contradict me.

Taking the categories referred to in the Parliamentary Secretary's Answer of 11th March, the total number of almoners on the staffs of hospital boards at 30th September, 1962, was 1,022. The shortages given in the Association's report on 31st March, 1961, amounted to 218. According to the Answer by the Parliamentary Secretary, since 1957 there had been a 5 per cent. increase in the number of almoners, and since 1961 a 2 per cent. increase. I therefore calculate—and I hope that the hon. Member will challenge me if he thinks that I am wrong—that the present total deficiency of almoners in the National Health Service is about 20 per cent.

On 30th September, 1962, there were 471 psychiatric social workers. The number of shortages, according to the Association, was 125. According to the Parliamentary Secretary's figures there was an increase of 3 per cent. from 1961 to 1962. From that it would appear that there is at present a 25 per cent. deficiency in psychiatric social workers. In the interests of speed I will not refer to my further calculations, which are based on the same method; I will just state what the deficiencies are. In the case of therapeutic dietitians there is a deficiency of 40 per cent. One knows from experience that, in fact, there is not a therapeutic dietitian service. Even if the vacancies as set out in the hon. Member's Written Answer related to what is regarded as the desirable figure, the fact is that there never has been a positive approach to diet in hospitals. It has been hamstrung all the time by false economies. Even if these figures are correct, they represent a very poor contribution to diet in the hospital service.

There is a deficiency of 16 per cent. in pharmacists; a deficiency of 25 per cent. in orthoptists; a deficiency of 20 per cent. in speech therapists; a 10 per cent. deficiency in hearing aid technicians and a small deficiency in supervisers of schools in hospitals for the mentally subnormal. In this case there has been a considerable increase in the number of staff. In the case of radiographers I make the deficiency about one-third, and in the follow-up services—which can make a great difference to rehabilitation—there is a deficiency of 25 per cent. in occupational therapists and about one-third in remedial gymnasts. In the case of physiotherapists the deficiency is about 25 per cent.

The shocking thing is that the work of the doctors could be greatly assisted by this category of workers, and the recovery of patients could be made much more effective. The numbers involved are relatively small. The total number of deficiencies in March, 1961, was less than 3,000, according to the Association's report. It is therefore clear that the hospital service is being spoiled for the sake of a ha'p'orth of tar. Far more efficiency could be produced from our very skilled consultants and doctors. Why does not the Minister make more vigorous efforts to recruit, and to solve the problem? It is almost entirely a matter of money.

A month ago I stood in for my hon. Friend the Member for St. Pancras, North at a meeting in Great Yarmouth of hospital administrators. I put to them the figures that I have just given the House. They agreed with my estimate, although they thought it was a little conservative. I asked them what was the reason for the shortages and they said that it was entirely a matter of pay. The salaries of these people are undervalued in relation to the work they do. This is true in the "Opportunity State" that hon. Members opposite so frequently talk about. The social contributions of teachers and nurses and these grades are underrated. This is one reason why, so often, even when modern buildings are erected the subsequent development does not accord with the amount of capital invested in the building.

I now want to refer to something which never seems to cross the Minister's mind. What are the yardsticks for a good National Health Service? I want to quote a complacent utterance of the Minister of Housing and Local Government on 2nd May, because it typifies the attitude of the Treasury and of the Minister of Health. He said: …the healthy phenomenon of a rapidly rising population … which causes us, like Alice, to have to run fast to overtake the need, let alone to eliminate it."—[OFFICIAL REPORT, 2nd May, 1963; Vol. 676, c. 1434.] Hon. Gentlemen opposite are content with running on the same spot, or perhaps with making a tiny amount of progress. One of the things that they ought to do in relation to measurements in the Health Service is to devise a yardstick of improvement.

For example, medical science is expanding at enormous rates, shall we say doubling in ten years. The medical weight of the population is shifting very considerably. We have a torrent of young children and babies, which I always thought demanded rather more medical attention than people in middle life, and a great number of aged people who also demand extra special medical attention. But to measure the situation as it has been in the past in the medical health service is not to evolve the scientific administrative control which is necessary to evaluate the position.

The right hon. Gentleman ought to get his statisticians, like N.E.D.C., to try to work out what should be the needs of medical care in the., present situation because it is a situation entirely different from what it was even seven or eight years ago and certainly pre-war. One of the arguments one could level very forcibly against most of the present administration is that the people with the skill, doctors, nurses and the ancillary professions are not backed up by adequate capital investment. The right hon. Gentleman is just coming to that. It is a truism in economics that the more horse-power a worker has behind his elbow, the more efficient he is and the more productive. In medical terms, this is equally true of hospitals. The better the hospital and the better the plant and equipment, the more efficient it will be, and the scarce resources of doctors and nurses will be better employed.

I was staggered to see the other day that the capital investment per worker, as it were, has varied between 5 per cent. and 8 per cent. over the years of Tory administration whereas in 1938 it was 20 per cent. These figures can be argued about, but certainly there is a very great difference in the last ten years in the technical aids which medical workers require to enable them to do their job more efficiently.

We see this, of course, in the figures for the investigations which my hon. Friend the Member for St. Pancras, North referred to. The number of investigations in the pathology departments in 1958 was 15.9 million and in 1961 20.6 million. There is the degree of extra scientific work which is needed merely to stand still. In radiological investigations the figure has risen from 18.2 million in 1953 to 22.5 million in 1961. The very sort of people who are needed to do this job are the people of whom there is the largest deficiency in numbers.

8.59 p.m.

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

I think that the Minister of Health can count himself fortunate tonight that he has been saved by the gong, because I understand that I have only two or three minutes in which to make one or two points, and I want to launch a very scathing attack on the administration of his Department. I think that he has been let off very lightly this afternoon in some of the criticisms that have been made and which could have been far more virulent in their attack on his administration.

I was rather surprised by my hon. Friend the Member for Bishop Auckland (Mr. Boyden) when he expressed surprise that the Minister should represent 16 per cent. intake of student doctors as a great achievement. I made a note when the Minister was speaking this afternoon and was tripping out the figures in the hope that the.Committee would assimilate them. I believe that this Minister could prove with figures or percentages why the Devil went to hell instead of heaven. He would prove that he was 10 per cent. below the required standard for the heavenly abode. The right hon. Gentleman's whole attitude of mind revolves round figures and statistics. It is high time that he started to think in terms of human need and what we require in the hospital services if people are to be given proper attention.

I have time to make two further points only, and very quickly. The right hon. Gentleman attacked my hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) about figures given twelve months ago dealing with the nursing situation, and he found his own figures to show that the situation today was improving rapidly and that there was now no really urgent problem.

I have here a report which is only a month old about the maternity service, on which I had wanted to say a great deal. This report states: The staffing had been frozen owing to the limited financial allocation and therefore the staffing ratio was not up to the required establishment for the maternity department, apart from the excessive intake and to cope with the present problem pending alternative arrangements being made by the Regional Hospital Board. It was essential that the staff be brought up to strength. The report added that a certain person: emphasised that this was imperative if there was not to be a breakdown in the health of the staff which was already becoming evident.…. I made inquiries and found that these girls are almost at the point of exhaustion, largely owing to the intake of emergency maternity cases. We have had to listen to a great deal of nonsense today about the staffing position among nurses being all right.

I see that my hon. Friend the Member for Greenock (Dr. Dickson Mabon) is becoming agitated, but I wanted to say a great deal about the new private health service which is growing up within the Service. This method of buying privilege, and these new associations which invite people to belong to them because they can help to finance private consultant services in private consulting rooms is designed to be a passport to some priority treatment in hospital, otherwise there is no point in it. It will ultimately destroy the National Health Service if it goes much further. It will destroy it for the simple reason that if almost every- one starts to enter this kind of service these people will no longer be able to guarantee the privileged position which they are now able to guarantee. I see again that my hon. Friend the Member for Greenock is very anxious. I will stop there; the rest will keep.

9.2 p.m.

Dr. J. Dickson Mabon (Greenock)

I am grateful to my hon. Friend the Member for Bristol, South (Mr. Wilkins) for allowing me to begin my speech now. I realise what irritation he must feel at not being able to put many of his points. There are a number of hon. Members on this side of the Committee, but, unfortunately, not on the other, who have been anxious to speak in the debate and it might be argued that we should have had a two-day debate. There is certainly an argument for having another day to discuss the Minister's health and welfare plans for the development of community care.

I cannot possibly refer to all the subjects which have been discussed today. They have been interesting, and most of the speeches have been commendable and to the point. I want to deal with the biggest issue, which is the question of the control of drugs and the Minister's decision on it. It is fair to say that we have pushed the right hon. Gentleman from not doing anything from November, 1961, to June, 1962, into doing something. I can remember the debates and the reply of the previous Parliamentary Secretary to the Ministry of Health in June, 1962, refusing any inquiry or any consideration of some kind of control over new drugs. This has now been conceded, and we have driven the Minister to accept a voluntary system.

Now the Minister today has added new provisos which we must study before we can fully appreciate their meaning. They seem to be regulatory and to change what is, in theory, a voluntary scheme into a compulsory scheme in practice. The right hon. Gentleman's words were ominous. I am sure that doctors will read them with apprehension, for he warned that without fear of serious consequence no consultants could use a drug which had not gone through the voluntary system and that no manufacturer could market such a drug. It is a strange voluntary system which has these admonitions, with a finger pointed at both the doctors and the manufacturers.

If we can keep pressing the right hon. Gentleman, perhaps we can persuade him to have legislative reform to clear what the hon. Member for Putney (Sir H. Linstead) described as the administrative jungle in drugs control and to introduce a compulsory system of registration and statutory assessment. It will be interesting to read the Minister's remarks in the OFFICIAL REPORT tomorrow about those countries which, he said, despite their control over drugs, did not prevent the thalidomide tragedy occurring in their lands. It would be interesting to look at the systems such as be insisted were comparable, to see why they were so defective.

We have always conceded that there is no system of drug control which can be absolutely safe. As long as medicine is experimenting into human disease and health generally we are bound to have tragedies and mistakes. Nevertheless, these mistakes must be qualitative and not quantitative. There may be some errors, but we must recognise them quickly to ensure that they are discovered before more errors occur. If we cannot have absolute safety, the mistakes must be qualitative; and this is what my hon. Friends and I seek. We want to have a system which is as good, if not better, than that possessed by any other country, based on experience as it evolves.

We insist on a statutory authority answerable to this House through the Minister of Health. We believe that this is fundamental. This is the position of the Labour Party which I am stating tonight and I am glad that some hon. Members opposite share that point of view. In time, the whole House will share it. The effectiveness of drugs is another matter. My hon. Friend the Member for Abertillery (Mr. Ll. Williams) mentioned the bill for drugs, the element of advertising in it, and so on. We spend £100 million on drugs for the Health Service, slightly over £5.5 million on advertising, sales representatives, free samples, and so on, to the medical profession.

Lord Cohen of Birkenhead was right when he commented that this was the most common way by which doctors got to know about new drugs. At best, he said, the information they received was biassed and, at worst, unreliable. That is a very damning indictment of a system of com- munications—yet the Minister said today that he is to impose on the doctor the decision about the use of new drugs. It means that a doctor will have to hesitate before using them; that is, unless they carry the voluntary system's imprint.

Let us be fair to the Minister of Health. He is struggling hard to battle with the great American giants. I cannot refer to certain cases because they are sub judice, but I wish the right hon. Gentleman well in his battle with these big drug companies. He has, for a Conservative Minister, started a remarkable affair in the central agencies for buying drugs, because I understand that he used individual agencies to buy drugs from abroad.

I have had experience of this and I suppose that, in this connection, I should declare an interest. I am a visiting physician at the Manor House Hospital, which is owned by the Industrial Orthopaedic Society, a charitable, nonprofit making body which is not in the Health Service. I am sure that some of the difficulties it has experienced apply to other hospitals, not necessarily those in the Health Service—I am thinking of private nursing homes and the like. My experience will help to prove to hon. Members opposite what is happening. While I know that my hon. Friends are aware of this difficulty, my illustration will help them to realise it even more keenly, for everyone should be aware of the price arrangements by which drugs are bought and sold.

There is a certain United States subsidiary company in this country which will sell a hospital antibiotic tablets at £63 per 1,000. If it is a Health Service hospital using the Minister's mechanism, the same drugs—admittedly, manufactured in another country but pharmacologically as good—can be got for £7 15s. per 1,000. If the hospital is not in the Health Service, like the one I visit, one must pay £42 per 1,000 tablets. I can never understand how the drug companies can justify these differentials. The whole thing seems incredible to me. The Government have encouraged this single buying agency with which the Minister is in contact and after furtheii7 negotiation Manor House Hospital has been able to obtain the tablets for £25 per 1,000, substantially less than it would cost to buy them from the American firm in Britain. But is this good enough?

After the discussions and conversations I have had, on the telephone and in other ways, about this matter I am left wondering whether we are doing as much as we ought to do. Does the Minister buy these antibiotics and other drugs—over which he is trying to fight the great United States firms—for the chemists, for the G.P.s? I do not think so. But I should be delighted if the Secretary of State for Scotland—who, as we are told by Conservative Members from time to time, administers a very expensive service in Scotland—would tell us.

Do Scottish chemists pay the retail price for antibiotics, or do they get them cheaper by buying from abroad, as we have done by invoking Section 46 of the Patents Act? That interests me. It would help to reduce the drug bill as a whole in a quite legitimate manner, and it would also reduce the prescribing costs of doctors—that nightmare which pursues the conscientious physician, ever anxious to know whether the local prescribing committee will come down on him like a ton of bricks because he has been trying to give patients what he thought were the best drugs for them.

In my opinion, the time is long overdue for an inquiry into the economics of the drug industry. There are some firms which do excellent work and take modest profits. There are others, particularly non-British firms, which take huge profits from this island. We should inquire into them. The party opposite has allowed this to go on. One or two hon. Members opposite are openly identified with United States subsidiaries. This penetration into our Health Service drug market by American companies is, to my mind, a very undesirable thing, because of the way it has developed. The party opposite has encouraged it, as they sold out Trinidad Oil and Ford's. It might be said that now the motto of the Prime Minister is "Americanisation before nationalisation".

Lord Balniel

I do not disagree with the point which the hon. Gentleman is making. But there are sections of the industry in my constituency which are American-owned pharmaceutical companies, and before he makes these general allegations I think that it would be preferable if he specified the companies to which he is referring. There are, of course, some bad companies. But these general allegations tend to damage the respectable companies.

Dr. Mabon

I do not wish to damage any respectable company. I do not propose to mention names. But let us appoint a referee to find out which are the bad and which are the good companies, since both the hon. Member and I seem to be agreed that there are bad and good. If we were to set up a committee of inquiry to examine the drug industry, I think that the results would be interesting.

I wish to refer to another item of substance in this debate. There were many interesting items. But obviously I can deal only with the principal ones, and I wish to refer to the relationship of the hospital plan—which has been revised for the second time officially and perhaps in fact for the third time—with the health and welfare Blue Book which the Minister took great joy in mentioning. With the Hospital Plan on the one side and this Blue Book on the other, the problem is to strike the right balance between hospital, residential and domiciliary services as they affect the elderly and the chronic sick. I suggest that that problem has not been studied, never mind solved.

The hon. Member for Bournemouth, West (Mr. Eden), in a good speech—I tried to defend the hon. Gentleman against the Chair on one occasion—called for more statistics. I agree with him. That is the whole point. There is an appalling lack of statistics in a book like this which has such a great potential for being the key for the future "march forward" to that glorious vision to which the Minister referred as lying ahead in the 1970s. It is remarkable how gloriously irresponsible the Government were last year in talking about the Hospital Plan, which was a completely baseless assessment of the number and categories of hospital beds. Only sporadic surveys were carried out. There was no research and no inquiries, and the revision which was published contained no information of substance as to how these beds were calculated. I mention specifically geriatric, mental and maternity beds. According to the figures for Scotland, we do not even have geriatric beds officially.

But we have an excellent and terrible example of what is happening here. These geriatric beds are intimately connected with health and welfare. They all stand or fall together. Here I want to quote from the sober, respectable, too often Conservate, sometimes a little Liberal, but never Labour, Scotsman. Its headline on 23rd March, 1963, said: Aged die waiting for beds". The first sentence of the story read: There are 377 old people on the waiting list for geriatric beds in the Edinburgh region and it is understood that last year almost 250 died while on the waiting list Never did a "yellow" Press tabloid scream out more sensational headlines than that one. But it is accurate. This statement is backed up by a letter from five consultants in the geriatric service who have been in correspondence with the Secretary of State about this. Edinburgh is not at all the least prosperous area in Scotland. Indeed, it is often considered to be the most bourgeois city and the wealthiest in Scotland. If that is true, what must it be like elsewhere?

Has any assessment of the need for geriatric beds been made properly? Is there any understanding of what is needed? The Secretary of State has not even revised his plan. The Minister of Health can be excused, because he has at least made another wild guess about what he should do in 1962. The Secretary of State has not even done that. Perhaps, however, he is more sensible and is waiting for more evidence. Perhaps he should be commended for not publishing a Scottish Blue Book and has made no attempt to try to match the Minister of Health's wild guesses in this affair.

The idea of having these beds and of building up community services is to discharge patients. The ideal is, "Get the mentally sick and deficient out of hospital; get the physically chronically sick, who should be in half-way houses, out of hospital; let us get domiciliary services built up and get people out of hospital". But how can one get them out of hospital when there is nowhere for them to go?

The assessment has not been properly made. The Minister talked today of the plans being within a national framework of national purpose and national standards. I can go with him in what he says about national framework and national purpose, because those words are meaningless, but what about national standards? The fact is that there are no common standards applicable to all local authorities in this group. In fact, this is but a hotchpotch of arrangements which each local authority proposes without any idea of what the national guidance should be. Not a single piece of advice is offered.

How many home helps do we need? Let us first take the basic criticism of the Blue Book. It refers to per 1,000 of population. But It should be talking, as the hon. Member for Bournemouth, West did, about per 1,000 of the population aged 65 and over. That is the point. The Blue Book at least gives acknowledgment to the fact that the elderly population will increase and it gives various statistics on population projections until 1972. But there is no attempt at an assessment of the staff required per 1,000 of this 65 and over age group.

For example, the hon. Member for Bournemouth, West talked about home helps and how Bournemouth was anxious to do all this, although his plea was, "Please do not raise the rates". I do not know how he managed to combine these two aspects. His was a remarkable speech. He asked us to do so many things, but told us that we should not raise the rates. He believes that we should get it all through general grants. But the total cost of these services he was referring to would be about £200 million, so at least £80 million must go on the rates unless there are special Exchequer grants of which no lint has been given.

Is there any attempt to suggest how many home helps per,000 of the population aged 65 and over are needed? There is none. But one or two social scientists have suggested that perhaps the figure should be 15. The only indication we have from the Government was contained in the Ministry of Health's Report for 1961. On page 56 are listed some local variations. For instance, the number of persons helped in this way in a year varies between 1.5 and 12 per 1,000 of the population. The net cost of a home help per 1,000 of population varied between £10 and £450. I have with me a huge list which I will not embarrass the Committee by reading. It deals with all the boroughs of England and Wales and their populations of people aged 65 and over. It shows the vast difference there is between the home help service in one area compared with another. The only local authority coming anywhere near the ideal of 15 home helps per 1,000 of the population 65 and over is Oldham.

The ratio in Bournemouth is 1.8 per 1,000. By 1972, despite all the wonderful schemes of the Minister—produced by Bournemouth, of course—the ratio will still only be 4.8. Yet the figure recommended by these social scientists is 15 per 1,000. Do not we realise how inadequate this programme is? It is founded on unwarranted assumptions. Not a single piece of scientific social inquiry has been done.

One can go through these plans and find wonderful and pious phrases about how the Government will see about one thing and how further study is needed in another—and so on, and so on. This is, after all, supposed to be praised as a great example of the Minister's intellect. But the right hon. Gentleman is really struggling between the Dr. Jekyll and Mr. Hyde within him—the intellectual Jekyll who wants to do the right thing and the Conservative Research Centre politician Hyde struggling to do the propaganda thing. And so the struggle goes on.

Now I turn to residential homes. How many should there be per 1,000 of the population aged 65 and over in any given area? The Minister does not know. He said on one occasion in this Blue Book that there is no evidence for suggesting a possible range, but later that 18 to 22 places per 1,000 might be a good idea.

We want to see more elderly people in flatlets, integrated into the community with domiciliary services to help. The hon. Member for Bournemouth, West, to whom I am thoroughly indebted for his speech, referred to this. Until last year 3,400 such flatlets were constructed, which is 0.6 per 1,000 of the population aged 65 and over.

What is the target figure here? Does the Minister know? Again, the only people we can go to are a few social scientists, whose opinion is that it should be 50—not 0.6—per 1,000 persons aged 65 and over. The hon. Member for Bournemouth, West said that this was a comprehensive and masterly analysis. Was there ever such a damning of a document? That was irony of the first order. There is one thing about the Scots. At least, we had the good sense to start a national morbidity survey. We have not got the answer.

The previous Secretary of State for Scotland thought, "Let us find out what the extent of the problem is. Let us find out exactly what the problem will be. Let us try to project it in figures of disease as well as of life expectancy". The Minister on the other hand has not even started this yet. He has spent £29,000 inquiring into morbidity of inpatients in certain hospitals. We must have the overall figures. We must have a summary of the national morbidity pattern as well as other population assessments which are made before we can talk in extravagant terms of 1972 and 1982, as the Minister does. It is a most unscientific approach not to proceed into these realms of prediction and difficult assessment without all the facts which one can command and all the inquiries which can possibly be conducted.

These two Blue Books, "Hospital Plan" and "Health and Welfare Services", must be followed by a third book, "Development of General Practice". In this Blue Book they refer to the fact that we have 21 health centres and by 1972 the Minister, God bless him, will give us 47. That is massive marching on. That is a rallying call! This is great Utopia. There will be 47 health centres in a country with a population of more millions than that. It is utterly farcical.

The hon. and gallant Member for Worthing (Sir 0. Prior-Palmer) told us about the way in which his constituents had bean frustrated. He waved the letters before us. He told us that for five years he had been arguing for a better hospital for Worthing. Then the Minister came along with his Hospital Plan. What happened then? The hon. and gallant Gentleman in effect said this, "Now I am told that we will get a hospital one-third of the size of the one we wanted, perhaps in about 1982 Or perhaps in 1977, but not for some time". This is what has happened in many constituencies with many hospitals. Those of us, of whom I am one, who have been agitating for hospitals in our own area have seen our hospital programme move back because of the ten-year plan. I have a list showing that I was getting an extension in my constituency for maternity beds and outpatient departments in 1962—just gone—and 1963. still with us. This is now postponed again. We shall get it in 1967, if we are lucky.

This Hospital Plan and these Health and Welfare Services can have only two effects on hon. Gentlemen opposite. Either hon. Members opposite believe it to be true and are absolutely mesmerised by their own propaganda, or they do not believe that and realise that this is a trick to deceive the electorate. It must be one or the other. Perhaps they are not reading the books at all but merely believing everything the Minister says.

We were told by the Minister, when he introduced his savage cuts in 1960, that the hospital building programme would be financed by the new health taxes. These health taxes have raised in each full year a sum in excess of £68 million. Yet the hospital building programme for England and Wales was £31 million in 1961–62, £37 million in 1962–63 and may be £48 million in 1963–64. This is a net profit of a considerable number of millions, and in the present year £20 million. The expenditure will never rise above an average of £70 million a year, so the Minister will still make a good bargain out of this manoeuvre.

It is fair to say that when the Minister talks about the future he is the most generout of men. He has built more paper hospitals than any Minister of Health ever did before. He has more blueprint community centres than were ever dreamed of by the most Utopian social scientist. That is all he will be remembered for after the three long hard years that we have had him at this Ministry. He is supposed to be the Prime Minister's propagandist to show the country that in fact the Tory party really believed in the Health Service. As a propagandist, he is a dead loss. Despite his years in the Conservative Research Centre, he has not done very well as a propagandist. The country sees this. Even the working man knows pie in the sky when he sees it, and this is very much pie in the sky. But I will say this for the Minister. As a Treasury hatchet man he is first-class.

9.28 p.m.

The Secretary of State for Scotland (Mr. Michael Noble)

I am sure the Committee has listened with interest to the whole course of the debate and particularly to the speech of the hon. Member for Greenock (Dr. Dickson Mabon). He has on many occasions in the past made this attack about paper hospitals. This is a very easy one to make, though not perhaps a very suitable one to come from the Opposition. None the less, it is a fact which anybody can see in bricks and mortar that the hospitals are in fact going up and they are going up steadily at a faster rate. {An HON. MEMBER: "Where?" I will give the hon. Member a list in a moment, if he wants it. The work in Scotland has kept up with the estimates we made. I think that the regional hospital boards deserve great credit for the skill and energy they have put into keeping these new and difficult first stages of their hospital building plans going.

I have been asked where this is happening. I can tell the hon. Member that in Scotland in the Northern Region hospitals at Fort William and Broadford in Skye are well under way. The hospital at Portree is starting next month. In the North-East Region a major extension to the Royal Infirmary at Aberdeen is just about to start. In the Eastern Region, the contract is going out this year for the first of the new big teaching hospitals—the £10 million project at Ninewells. In the South-Eastern Region, the Victoria Hospital at Kirkcaldy is making steady progress, and that is a £2½ million project. In the Western Region, the Yorkhill Hospital is finishing this year, and the hospital at Dunoon, in my own constituency, is well under way. They may be on paper, but they look very solid to me.

The problem of the old people has been referred to once or twice in this debate, and is one of very considerable importance. As far as we are able to discover from the latest figures from the Registrar-General on population trends, it is estimated that by 1970 there will be about 80,000 more people over the age of 65 than there are today. The hon. Gentleman may call that a guess, but it is estimated on the same sort of evidence that we have today, and it means that we will have to find about 4.000 more places either in homes or hospitals.

The Committee has had a good many statistics today, but it is right to record the work that both local authorities and other people have done in this sphere. Local authorities in Scotland are at present running about 170 homes, providing places for rather more than 7,000 old people. In addition, 128 homes are run by various voluntary organizations—the Church of Scotland, and other religious denominations—which provide homes for about 4,500 people. Therefore, in residential homes at the moment, we have places for about 12,000 of these older people who require it. The estimate of an increase of 4,000 old people over the next seven or eight years is, therefore, not very difficult to achieve if we continue with the policy we have been carrying out.

Over and above this problem of homes—

Mr. William Ross (Kilmarnock)

Can the Secretary of State tell me what the waiting list is at each of these homes—or at all of them?

Mr. Noble

I cannot tell the hon. Gentleman that, but I can tell him that the number of places has been increasing steadily. I am afraid that I have not the figures for the total number of people waiting—

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

Not enough.

Mr. Noble

Of course there are not enough places, or enough of anything that anybody in the world wants. The fact is that the problem is being tackled—and not only just in homes, and so on.

There has been a tremendous increase, and I am glad to see it, of services like meals on wheels. I am sure that the Committee appreciates the great work done by the W.V.S. in this realm. Its members in Scotland served very nearly a quarter of a million meals last year to elderly people in their homes. In addition, the district nurses paid over 1½ million visits to 50,000 old people, and the home helps assisted nearly 17,000 households. That does not seem to me to give a picture of neglect and despair at all. It is a picture of very good co-operation between local authorities and other bodies that are doing their best to tackle an extremely difficult job, and doing it well.

The hon. Gentleman said that the Hospital Plan provides no extra beds for the elderly and the long-term sick. This is not true. It provides beds for an extra 800 or 900 people in Scotland, and further beds will be found, as they have been in the past, by the conversion of existing buildings as new hospitals take their place—

Dr. Dickson Mabon

I said that in the Hospital Plan for Scotland—Cmnd. 1602—there is no reference, unlike the English Command Paper, to geriatric beds—unless, of course, the Secretary of State intends to publish a new White Paper on hospital work.

Mr. Noble

I can give the hon. Gentleman the information that these beds are planned—

Mr. Willis

Not enough.

Mr. Noble

It is not right for the hon. Gentleman to keep on saying "Not enough" on every single point—

Mr. Willis rose>

Mr. Noble

No, I shall not give way.

In the last few years we have increased the beds for these old people from 3,000 to 6,000 but, quite apart from the actual numbers, important though those are, the quality of nursing and the quality of the care for the old people is equally important. We are doing our best to increase the number of consultants on this side of the service. In fact, the number has doubled in the last three years, and I think that the Committee would want to pay a tribute to the nurses who staff these homes and hospitals, because their task is particularly arduous, and not always the most rewarding of the various nursing jobs.

Various hon. Members, particularly the hon. Member for Fife, West (Mr. W. Hamilton), talked about the maternity position in Scotland. The position is that although we are up to the 75 per cent. hospital confinement rate that was recommended by the Montgomery Committee. there are, obviously, still places where the position needs improving. This is not particularly so in Fife, West, because the hon. Member's constituency is up to the 75 per cent. in fact, the County of Fife is getting a greater share of hospital building than any other area in Scotland—

Mr. W. Hamilton

I cannot allow that statement to go unchallenged. The reason is, and the right hon. Gentleman knows it very well, the enormous backlog that has had to be made up, and the only consideration that the regional hospital board allowed the West Fife people seventy extra maternity beds between now and 1970.

Mr. Noble

The hon. Gentleman has made his point. I have made mine, that Fife is already receiving more money than any other county in Scotland.

There seems to be some difference of opinion in the Committee about nursing recruitment. On the one hand, the hon. Member for St. Pancras, North (Mr. K. Robinson) tells us that hospitals are turning away tens of thousands of nurses who want to come in, while, on the other hand, other hon. Members say that there are no nurses available at all. I believe that the truth is somewhere between those two. Certainly, in Scotland there is not a great number of nurses being turned away. Recruiting has been going up satisfactorily, and the pattern of staffing is getting better, not worse, because the number of trained nurses is increasing and not declining, and it is essential that the special skill of the trained nurse should not be dissipated in jobs which can be done by auxiliaries and others.

I come now to the points which have raised during the debate. The hon. Lady the Member for Cannock (Miss Lee) spoke of the different views of the hospital as seen through the eyes of the patient, the doctor, the nurse or whoever it might be. I agree very much with what the hon. Lady said about the need for humanity—she specified the sort of problems which some patients occasionally find or even some people who go in for pre-natal treatment may come across. Both my right hon. Friend and I have taken a direct and personal interest in this problem and have done everything we can to see that the different viewpoints of the hospital become one viewpoint. Clearly, whatever the statistics may prove, if we want an efficient health service it must be based on the fact that the patient in hospital is happy and not agitated, worried and fussed. I agree very much with what the hon. Lady said about this. She emphasised, as I would emphasise, that this problem of the lack of humanity is not a problem which affects all hospitals; it affects only certain hospitals and, perhaps, certain individual people in them. On the whole, our hospital service is looking after its patients with great care and humanity.

The hon. Lady asked how much we can spend, and she suggested that we should fix amounts and stick to them. I can agree with her wholeheartedly in this because it is exactly what we are trying to dc. If it is a question of how much we can spend, we have our figure. If she, in due course, cares to give hers—she said that it was very difficult to calculate in advance—we shall listen to it with interest.

I took her point, though I ought not to expand on it now because it is slightly outside the scope of the debate, about the importance of housing for old people.

My hon. and gallant Friend the Member for Worthing (Sir O. Prior-Palmer), who made a powerful speech about the problems in his constituency, will probably forgive me if I do not discuss them in great detail because he is already in correspondence with my right hon. Friend. My constituents would, I think, be delighted to have so many hospitals close to them as my hon. and gallant Friend seems to have in Worthing, but I know that in different places different considerations apply.

The hon. Member for Abertillery (Mr. Ll. Williams) produced one of the nicest phrases of the debate when he slightly changed the words of Browning and said that a man's reach should exceed his grasp, else what is an Opposition for? We have noticed this from these benches fairly consistently, and occasionally, I think, the general public notices it, too. The hon. Gentleman had half a point when he spoke about the problems of research, bat he was not quite right in saying that, if in a hospital higher pay has to be given in salaries for research, the amount of research has to be cut back to allow for the extra cost. This is not so. If there is an increase in salaries, it will be taken into consideration in calculating the extra money given each year to the hospitals.

I agree that it can be extremely bad business to make cuts in hospital maintenance programmes which then pile up over the years and then, perhaps, lead to a much bigger bill in the end. But, if this is being done—I am not saying that it is-it is part and parcel of the task of the hospital authority to make up its own mind, within the allocation of money which it receives, about the priorities necessary in the spending of the money. I do not believe that hospital authorities deliberately cut back on maintenance knowing that, in a year or two, it will cost them a great deal more, unless there is something very urgent which they need more and which, probably, would cost them even a greater amount in the future. We believe that this sort of decision should be left to the hospital authorities and, on the whole, they are perfectly capable of making such decisions.

The hon. Gentleman spoke also, as others did, about the problem of nurses working a great deal of overtime. Having listened to many different speeches on this point, I am not quite sure that I have understood it clearly. There seems to be a confusion between two ideas. The first was that nurses should work for 44 hours a week only, or an 88-hour fortnight. The other suggestion was that they were working much longer hours in the fortnight. In my experience in Scotland, there may be odd instances of longer hours, but this is not by any means usual.

The other part of the same argument was whether working within the framework of the 88-hour fortnight, they should be paid overtime rates for working during Sundays or during the night. The profession of nursing—and the nurses are very proud of the fact that they are a profession—would, I think, be entirely undermined if we started paying overtime rates, because no other profession in the country pays overtime rates. I think that the nurses would lose something if we went on to that system. [Laughter.] The hon. Member for Dunbartonshire, East (Mr. Bence) laughs, but that is true.

My hon. Friend the Member for Caithness and Sutherland (Sir D. Robertson) spoke about the problems of the Highlands. It is certainly true, as every Highland Member knows, that it is very much more expensive to be ill in the Highlands than in the towns because of the great distances involved in getting to and from hospital. My hon. Friend said that he had not previously taken part in health debates, but he made a useful contribution to this one. He is not in his place at the moment. Had he been there I should have been pleased to tell him that the hospital which he is keen to get in Wick is on the drawing board and, with luck, should be started within a very short time—a year or so. He seemed to think that it might well be ten or more years before he got it.

Mr. Ross

It could be, too.

Mr. Noble

The hon. Member for Fife, West asked why the nurses' award had not been referred to the National Incomes Commission. The main point here is that this was an arbitrated award by an independent body. The hon. Gentleman also asked about the question of board and lodging for student and junior nurses. I do not think it would be right for me to comment on the problem of the recent award, because it has not yet gone before the Whitley Council. I do not think it would be courteous to comment on it in this Chamber until the Council has considered it.

The hon. Member for Fife, West also asked what our plan was for community care. In Scotland, our staffing arrangements are rather better in one or two important respects than they are in England. The local authorities agreed with my Department that we should tackle our problem in a way different from the English one. We have set up, with their collaboration and help, various study groups on things like the dental services, school health and home nursing. As we get information about these problems we will take the steps necessary to correct them.

My hon. Friend the Member for Stretford (Sir S. Storey) referred particularly to the problems of staffing in a local hospital. I do not think I can give my hon. Friend any useful information on that. He asked whether or not there had been some lack of appeal in the calling—in the profession—of nursing. I do not believe there is any evidence of this in the numbers of people coming forward today to join this service.

The hon. Member for Stoke-on-Trent, Central (Dr. Stross) asked whether we might carry out an experiment in health centres in Scotland. I am delighted to be able to tell him that another of our health centres in Scotland is being opened at Cumbernauld tomorrow. In England, the Standing Medical Advisory Committee is reporting this year on the whole problem of health centres and group centres and so on for general practitioners. On the problem of the Chinese eggs; I am told that the arrangements for pasteurisation are now in satisfactory form, and I hope very much that we shall have no more trouble from this source.

My noble Friend the Member for Hertford (Lord Balniel) referred to an estimated requirement of 1.8 mental beds per l,000 of the population in 1975 and the arguments advanced in a recent P.E.P. pamphlet. My right hon. Friend will certainly continue not only to watch the trends in demand for psychiatric beds, but to take into account the results of research into mental illness and mental treatment. I should, however, make it clear that the capital building programme does not commit my right hon. Friend to the l.8 ratio.

The new building in England and Wales will be in the form of psychiatric units associated with general hospitals. The need for these is not in question. For the rest, my right hon. Friend is concerned only with the rate at which and the extent to which existing provision in the mental hospitals will become redundant so that it can be dispensed with. In Scotland our circumstances are rather different, because most of our mental hospitals are already located in the centres of population.

My hon. Friend the Member for Bournemouth, West (Mr. Eden) made what was clearly a very important speech, because he provided almost all the material for the hon. Member for Greenock to make his impassioned speech. It makes me extremely sorry that I happened to be out of the Chamber when my hon. Friend was making this speech, because I clearly missed a great event; but I hope that the publicity which has been given to my hon. Friend by the hon. Member opposite will make up for my [pt being able to say very much myself.

The hon. Member for Wolverhampton, North-East (Mr. Baird) raised three subjects. The first was the subject of children's teeth. I was very glad to hear that he supported the fluoridation of water supplies, as did my hon. Friend the Member for Putney (Sir H. Linstead). The second matter he raised was the decline of amenity beds and the increase in private beds. I have made some inquiries about this and I believe that he is absolutely wrong and that the position is the reverse of what he stated.

Mr. Baird

Can the right hon. Gentleman give figures for private and amenity beds?

Mr. Noble

I do not have the exact figures, but I believe that our experience is exactly the reverse of what the hon. Member stated. His third question was about consultants and the increase in their part-time service. Again our evidence is that consultants are tending to give more and more of their time to the Health Service and more are becoming whole lime in the Service.

I do not want to follow my hon. Friend the Member for Putney into very deep waters on the question of drugs. I thought that he put his case very clearly. I thought that my right hon. Friend put the Government's case equally clearly and concisely at the beginning 4 the debate. The hon. Member for Greenock specifically asked whether my right hon. Friend or I could buy drugs for chemists under the existing arrangements. Unfortunately—or perhaps fortunately—we cannot do this, because it is only for the purposes of the service of the Crown that my right hon. Friend and I are able to use Section 46 of the Patents Act to buy these drugs for hospitals. As this case is still sub judice, perhaps I had better not say any more about it.

The hon. Member for Bristol, South (Mr. Wilkins) in a very short speech—and that was not his fault—said that the tone of this debate had been much too quiet. I am sure that the Committee would have been delighted if the hon. Gentleman had been fortunate enough to catch the eye of the Chair earlier and had developed with some ferocity the various points that he wanted to make. But having listened to most of the debate, my impression is that if it was too quiet, it was too quiet because the points about which hon. Members felt strongly were mostly smaller points of detail and not the great points.

The picture which has been represented quite frequently while I have been on my feet is that not enough has been done. We all want more of any good service that is going, but I believe that judged on the basis of staff, whether they be doctors, or nurses, or any other form of staff in the Service, all of which have been increasing, judged on the volume of treatment which the Service is giving, judged on the modernisation and better organisation of existing hospitals, and on the new hospitals which are being built, and judged on the general health of our nation, our National Health Service,

Division No. 108.] AYES 9.58 p.m.
Ainsley, William Grlffiths, W. (Exchange) Moody, A. B.
Awbery, Stan (Bristol, Central) Grimond, Rt. Hon. J. Mulley, Frederick
Bacon, Miss Alice Gunter, Ray Neal, Harold
Baird, John Hamilton, William (West Fife) Noel-Baker, Francis (Swindon)
Barnett, Guy Harper, Joseph Noel-Baker,Rt.Hn.Phllip(Derby,S.)
Beaney, Alan Hart, Mrs. Judith Orem, A. E.
Bellenger, Rt. Hon. F. J. Hayman, F. H. Oswald, Thomas
Bence, Cyril Healey, Denis Padley, W. E.
Bennett, J. (Glasgow, Bridgeton) Henderson,Rt.Hn.Arthur(RwlyRegis) Paget, R. T.
Benson, Sir George Herbison, Miss Margaret Pargiter, G. A.
Blackburn, F. Hill, J. (Midlothian) Parker, John
Blyton, William Hilton, A. V. Parkln, B. T.
Boardman, H. Holman, Percy Paton, John
Bottomley, Rt. Hon. A. G. Hooson, H. E, Pavltt, Laurent.
Bowden, Rt. Hn. H, W. (Leics,S.W.) Houghton, Douglas Pearson, Arthur (Pontypridd)
Bowles, Frank Howell, Denis (Small Heath) Pentland, Norman
Boyden, James Hoy, James H. Popplewell, Ernest
Bradley, Tom Hughes, Cledwyn (Anglesey) Prentice, R. E.
Bray, Dr. Jeremy Hughes, Emrya (S. Ayrshire) Price, J. T. (Westhoughton)
Brockway, A. Fenner Hunter, A. E. Probert, Arthur
Broughton, Dr. A. D. D. Janner, Sir Barnett Proctor, W. T.
Butler, Herbert (Hackney, C.) Jay, Rt. Hon. Douglas Pursey, Cmdr. Harry
Carmichael, Neil Jeger, George Randall, Harry
Chapman, Donald Jenkins, Roy (8techford) Rankin, John
Collick, Percy Jones, Elwyn (Wear Ham, S.) Redhead, E. C.
Corbet, Mrs. Freda Jones, J. I[...]dwal (Wlexham) Reid, William
Craddock, George (Bradford, 8.) Jones, T. W. (Merloneth) Reynolds, G. W.
Crosland, Anthony Kenyon, Clifford Rhodes, H.
Grossman, R. H. S. Key, Rt. Hon. C. W. Roberts, Albert (Normanton)
Cullen, Mrs. Alice Lawson, George Roberts, Goronwy (Caernarvon)
Dalyell, Tam Ledger, Ron Robertson, John (Paisley)
Deer, George Lee, Frederick (Newton) Robinson, Kenneth (St. Pancras, N.)
Delargy, Hugh Lee, Miss Jennie (Cannock) Rogers, G. H. R. (Kensington, N.)
Dempsey, James Lewis, Arthur (West Ham, N.) Ross, William
Diamond, John Lipton, Marcus Short, Edward
Donnelly, Desmond Loughlin, Charles Silverman, Julius (Aston)
Driberg, Tom Lubbock, Erie Slater, Joseph (Sedgefield)
Ede, Rt. Hon. C. Mabon, Dr. J. Dickson Small, William
Edwarde,Rt. Hon. Ness (Caerphilly) McBride, N. Snow, Julian
Edwards, Robert (Bilston) MacColl, James Soskice, Rt. Hon. Sir Frank
Edwards, Walter (Stepney) MacDermot, Niall Steele, Thomas
Fernyhough, E. McKay, John (Wallsend) Stones, William
Fitch, Alan Mackie, John (Enfield, East) Strachey, Rt. Hon. John
Foot, Dingle (Ipswich) McLeavy, Frank Stross,Dr.Barnett(Stoke-on-Trent,C.)
Foot, Michael (Ebbw Vale) Mallalieu, J.P.W. (Huddersfield, E.) Taylor, Bernard (Mansfield)
Forman, J. C. Manuel, Archie Thomas, George (Cardiff, W.)
Fraser, Thomas (Hamilton) Mapp, Charles Thompson, Dr. Alan (Dunfermline)
Galpern, Sir Myer Mason, Roy Thomson, G. M. (Dundee, E.)
Ginsburg, David Mayhew, Christopher Thornton, Ernest
Grey, Charles Millan, Bruce Wade, Donald
Griffiths, David (Rother Valley) Mitchison, G. R. Wainwright, Edwin
Griffiths, Rt. Hon. James (Llanelly) Monslow, Walter Warbey, William

which, as the hon. Lady the Member for Cannock, said is the best in the world, is expanding and improving steadily and that the Committee and the country knows it well.

Mr. K. Robinson

I invited the Secretary of State for Scotland to contradict the figure of 7 per cent. which I quoted. As the right hon. Gentleman has not done so, I assume that the figure is correct.

In view of the failure of the Government to reply to our criticisms, and because of the appalling complacency of Ministers with regard to the Health Service, I beg to move, That Item Class VI, Vote 13 (Ministry of Health), be reduced by £5.

Question put:—

The Committee divided: Ayes 170, Noes 229.

Watkins, Tudor Williams, D. J. (Neath) Woof, Robert
Weitzman, David Williams, LI. (Abertillery) Yates, Victor (Ladywood)
Wells, William (Walsall, N.) Williams, W.R. (Openshaw)
White, Mrs. Eirene Williams, W. T. (Warrington) TELLERS FOR THE AYES:
Wilkins, W. A. Willis, E. G. (Edinburgh, E.) Mr. McCann and Mr. Whitlock.
Willey, Frederick Winterbottom, F. E.
Agnew, Sir Peter Gibson-Watt, David Mawby, Ray
Alliken W.T Gilmour, Ian (Norfolk, Central) Maxwell-Hyslop, R. J.
Allan, Robert (Paddington, S.) Gilmour, Sir John (East Fife) Mills, Stratton
Allason, James Glover, Sir Douglas Miscampbell, Norman
Arbuthnot, John Glyn, Dr. Alan (Clapham) Montgomery, Fergus
Atkins, Humphrey Glyn, Sir Richard (Dorset, N.) Morgan, William
Awdry, Daniel (Chippenham) Goodhew, Victor Morrison, John
Balniel, Lord Gough, Frederick Mott-Radclyffe, Sir Charles
Barter, John Gower, Raymond Nabarro, Sir Gerald
Batsford, Brian Grosvenor, Lt.Col. R. G. Noive, Airey
Beamish, Col. Sir Tufton Gurden, Harold Nicholls, Sir Harmar
Bennett, F. M. (Torquay) Hall, John (Wycombe) Noble, Rt. Hon. Michael
Bennett, Dr. Reginald (Gos & Fhm) Hamilton, Michael (Wellingborough) Nugent, Rt. Hon. Sir Richard
Biffen, John Harris, Frederic (Croydon, N.W.) Oakshott, Sir Hendrie
Biggs Davison, John Harris, Reader (Heston) Orr, Capt. L. P. S.
Bingham, R. M. Harrison, Col. Sir Harwood (Eye) Orr-Ewing, C. Ian
Birch, Rt. Hon. Nigel Harvey, Sir Arthur Vere (Macclesf'd) Osborn, John (Hallam)
Black, Sir Cyril Harvey, John (Walthamstow, E.) Osborne, Sir Cyril (Louth)
Bourne-Arton, A. Hastings, Stephen Page, Graham (Crosby)
Boyd-Carpenter, lit. Hon. John Heald, Rt. Hon. Sir Lionel Partridge, E.
Brains, Bernard Henderson, John (Cathcart) Pearson, Frank (ClItheroe)
Bromley-Davenport,Lt.-Col.S1rWalter Hicks Beach, Maj. W. Percival, Ian
Brooman-White, R. Hiley, Joseph Peyton, John
Brown, Alan (Tottenham) Hill, Dr. Rt. Hon. Charles (Luton) Plckthern, Sir Kenneth
Browne, Percy (Torrington) Hill, Mrs. Eveline (Wythenshawe) Pitt, Dame Edith
Bryan, Paul Hirst, Geoffrey Pott, Percivall
Buck, Antony Hobson, Sir John Powell, Rt. Hon. J. Enoch
Bullard, Denys Hocking, Philip N. Price, David (Eastleigh)
Bulk's, Wing Commander Eric N. Holland, Philip Prior-Palmer, Brig. Sir Otho
Burden, F. A. Hollingworth, John Pym, Francis
Campbell,Rr. Hon.SIrD.(Belfast,S.) Hope, Rt. Hon. Lord John Quennell, Miss J. M.
Campbell, Gordon (Moray & Nairn) Hopkins, Alan Redmayne, Rt. Hon. Martin
Carr, Robert (Mitcham) Hornby, R, P. Rees, Hugh
Channon, H. P. G. Hornsby-Smith, Rt. Hon. Dame P. Rees-Davies, W. R.
Chataway, Christopher Howard, Hon. G. R. (St. Ives) Renton, Rt. Hon. David
Clark, William (Nottingham, S.) Howard, John (Southampton, Test) Ridsdale, Julian
Clarke, Brig. Terence (Portemth,W.) Hughes-Hallett, Vice-Admiral John Robinson, Rt. Ho. Sir F. (B'pool, S.)
Cleaver, Leonard Hughes-Young, Michael Roots, William
Cole, Norman Hulbert, Sir Norman Reamer, Col. Sir Leonard
Cooke, Robert Hurd, Sir Anthony Scott-HopkIns, James
Cooper, A. E. Hutchison, Michael Clark Seymour, Leslie
Cooper-Key, Sir Neill James, David Shaw, M.
Cordeaux, Lt Col. J. K. Jenkins, Robert (Dulwich) Skeet, T. H. H.
Onstain, A. P. Jennings, J. C. Smith, Dudley (Br'ntf'd & Chiswick)
Craddock, Sir Beresford (Sperthorne) Johnson, Dr. Donald (Carlisle) Smyth, Rt. Hon. Brig. Sir Joseph
Crawley, Aidan Johnson, Eric (Blackley) Spearman, Sir Alexander
Crosthwaite-Eyre, Col. Sir Oliver Johnson Smith, Geoffrey Stanley, Hon. Richard
Crowder, F. P. Jones, Arthur (Northants, S.) Stevens, Geoffrey
Currie, G. B. H. Jones, Rt. Hn. Aubrey (Hall Green) Steward, Harold (Stockport, S.)
Dalkeith, Earl of Kaberry, Sir Donald Stodart, J. A.
Dance, James Kerby, Capt. Henry Stoddart-Scott, Col. Sir Malcolm
d'Avigdor-Goidsmid, Sir Henry Kershaw, Anthony Storey, Sir Samuel
Derides, Rt. Hon. W. F. Kimball, Marcus Studhoime, Sir Henry
Digby, Simon Wingfield Langford-Holt, Sir John Summers, Sir Spencer
Donaldson, Crmir. C. E. M. Leather, Sir Edwin Taylor, Frank (Wah'srr, Moss Side)
Doughty, Charles Legge-Bourke, Slr Harry Taylor, Sir William (Bradford, N.)
Drayson, G. B. Lewis, Kenneth (Rutland) Teeling, Sir William
du Cann, Edward Lindsay, Sir Martin Thomas, Peter (Conway)
Duncan, Sir James Litchfield, Capt. John Thompson, Sir Richard (Croydon, S.)
Eden, John Lloyd,Rt.Hn.Geoffrey(SutMC'dfield) Thornton-Kemsley, Sir Colin
Elliot, Capt. Walter (Carahalton) Longden, Gilbert Tiley, Arthur (Bradford, W.)
EllioR,R.W.(Newc'tile-upon-Tyne,N.) Loveys, Walter H. Touche, Rt. Hon. Sir Gordon
Emery, Peter Lucas-Tooth, Sir Hugh Turner, Colin
Farr, John Madden, Sir Stephen Tweedsmuir, Lady
Fell, Anthony MacArthur, lan Van Straubenzee, W. R.
Fisher, Nigel McLaren, Martin Vane, W. M. F.
Fletcher-Cooke, Charles Maclean,SirFitzroy(Bute&N.Ayrs) Vaughan-Morgan, Rt. Hon. Sir John
Forrest, George Macleod, Rt. Hn. lain (Enfield, W.) Wakefield, Sir Waveli
Foster, John McMaster, Stanley R. Walder, David
Fraser, Ian (Plymouth, Sutton) Maddan, Martin Walker, Peter
Freeth, Denril Maitland, Sir John Walker-Smith, Rt. Hon. Sir Derek
Galbraith, Hon. T. G. D. Markham, Major Sir Frank Wells, John (Maldstone)
Gammans, Lady Marshall, Douglas Whitelaw, william
Gardner, Edward Matthews, Gordon (Meriden) Whitelaw, William
Williams, Dudley (Exeter)
Williams, Paul (Sunderland, S.) Wise, A. R TELLERS FOR THE NOES:
Wills, Sir Gerald (Bridgwater) Wolrige-Gordon, Patrick Mr. Chichester-Clark and
Wilson, Geoffrey (Truro) Worsley, Marcus Mr. Finlay.

Original Question again proposed.

Sir Stephen McAdden (Southend, East) rose

It being after Ten o'clock, The CHAIRMAN left the Chair to report Progress and ask leave to sit again.

Committee report Progress; to sit again Tomorrow.

Back to