HC Deb 08 May 1967 vol 746 cc985-1009

11.0 a.m.

Mr. W. F. Deedes (Ashford)

I beg to move Amendment No. 1, in page 2, line 17, to leave out from 'to' to 'and' in line 19 and to insert 'the General Medical Council'.

Mr. Speaker

I think that it will be for the convenience of the House if we take all the Amendments on the Notice Paper together, as they all deal with the one point entitled "Advisory Bodies". That includes the new Schedule.

Mr. Deedes

Thank you, Mr. Speaker. I agree that all the Amendments are consequential and in similar terms. They are not intended to obstruct the progress of the Bill—I think the Minister will realise that—nor are they likely to do so. They are not, moreover, likely to find acceptance by the Minister, though I can conceive of circumstances in which he might feel that if he could he would approach the problem in this way.

The Amendments are designed to emphasise the conviction held by at least some of us that this is the form which the Bill should take, that this is the right way to go about it, and to emphasise the protest which some of us made in earlier proceedings on the Bill that we had been brought to doing what we want to do in this way.

The Amendments are much closer to the proposals which Lord Brain and his colleagues made in their Second Report than the Bill. Lord Brain recognised that the Minister would be responsible for changing the law, which indeed he becomes under the Bill, but Lord Brain also thought that enforcement of the law should as far as possible be the responsibility of members of the medical profession through their own body, the General Medical Council.

It remains our view, and we hold it strongly, that the medical profession ought to retain real responsibility here. There is no disposition, which the Minister has accepted and he is asking us to accept, for the hierarchy of the medical profession to wash its hands of this business; to say, in the immortal phrase of Samuel Goldwyn, "include us out". I do not accept that. It may be said that a great proportion of the medical profession is unaffected by the Bill, and in a sense this is true. We know that only a handful are prescribing heroin, and that what the Minister does with the Bill and with the Regulations will bite on only half a dozen or more, but I have a feeling—and I would like the Minister to consider this—that it may not for ever be quit as simple as this.

The time may come when we shall have to decide, for good reasons, not just to limit the prescription of the drugs which I foresee will be included in the Regulations which the Minister will be tabling sooner or later, but perhaps some other drugs as well. I do not think that I am stretching a point when I say that we may reach the stage when we want to limit the prescription of Drinamyl There are some members of the medical profession who have no use for this drug and will not prescribe it, but what then? Under the Bill as it stands the Minister could become responsible for enforcement and control over not six doctors, but perhaps sixty or 600, or even more, and I am not sure that that would be a desirable state of affairs. It would be said, and I think fairly, that the medical profession would be put in an intolerable position of subordination to the Minister, and then it would be too late to make the change which we are suggesting with the Amendments.

I think that there is a considerable matter of principle involved, the principle being the right, I think the duty, of professional bodies to regulate their own affairs wherever this is possible, and the Minister ought to give us more information of the reasons for this proposed solution. Why has the G.M.C. felt unable to comply with the recommendation made by Lord Brain and his very knowledgeable colleagues who must have known what is, and what is not, possible in the medical profession, and who produced another kind of solution? Did the Council feel it was too difficult, that it was unworkable, or did it feel, and possibly it had every right to feel this, that the principle of restricting prescribing was something with which it did not want to be associated?

Without pressing the Minister to the point where confidential discussions become imperilled, I hope that he will give us a little guidance on this, because I do not part with the Bill at all happily about the path it is moving along in this direction. In rejecting the Amendments, as I feel pretty certain he will do, I hope that he will give us a little more to understand why they are unacceptable. I think the time might come, perhaps sooner than the right hon. Gentleman thinks, when he will have been glad to put on record his own position, and it is really with his interests in mind that I have moved the Amendment.

Mr. Bernard Braine (Essex, South-East)

I am somewhat torn on this occasion. There is a great deal in the arguments adduced by my right hon. Friend the Member for Ashford (Mr. Deedes), especially as they are supported by the powerful recommendations of the Brain Committee, but, with respect, I think that the circumstances which led that Committee to its conclusions are not quite the same as those which face us in the Bill.

The Brain Committee was faced with the appalling problem of doctors who, by any standards, over-subscribed to quite a fantastic degree, but there were only six of them in the whole of the Kingdom. In 1962 one of these had prescribed almost 600,000 tablets of heroin—6 kilograms—for addicts. The evidence set out in their Report shows that not more than six doctors had prescribed these large amounts of dangerous drugs for individual patients, and that they had acted within the law, and according to their professional judgment. In fact, some of the doctors concerned had said that they embarked on the treatment of addicts under a sense of duty because they felt that the treatment facilities elsewhere were inadequate.

One could describe such conduct as foolish or irresponsible, and perhaps even as infamous, but it would be stretching matters excessively to describe it as criminal—although its effects, both socially and upon the individuals concerned, were highly dangerous. This was a case of professional judgment going completely haywire, and it ought to have been possible for such doctors to have been dealt with by their colleagues for infamous conduct. But this lies in the past.

The Bill creates a new kind of offence. We are giving the Secretary of State power to prohibit a practitioner altogether from prescribing, administering and supplying drugs listed in the Schedule of the principal Act. This is not a matter of exercising professional judgment; it is straightforward prohibition, except in the sense that a doctor will, I understand, still be permitted to prescribe one of the listed drugs for the relief of pain. Thus, there is no intrinsic difference between the new offence and the ordinary criminal offences under the principal Act.

My first reaction to the elaborate procedural machinery laid down in the Bill was to ask myself why the General Medical Council could not deal with these matters. The medical profession is a self-governing one. On other legislation I have constantly argued that we should do everything possible to safeguard the position of the medical profession in this regard. Here we have a self-governing profession with a very high standard of professional ethics. Why cannot it deal with a situation like this?

The General Medical Council blue book, which sets out functions, procedure and disciplinary jurisdiction, lays down what can be done by the Council in this connection—but this is against a background of doctors having the right to prescribe for their patients in cases where they think it medically necessary. The Bill removes that right in cases where a doctor has reason to believe or suspect that a patient may be an addict.

I do not altogether agree with Government policy in this matter. The Minister has tacitly admitted that there is a difficulty in the establishment of adequate treatment centres straight away. He has given us an assurance that until adequate treatment centres are available the Regulations which were are empowering him to make under the Bill will not be brought into force. But I can think of at least three good reasons why the G.M.C. did not accept the Brain recommendation and why it has agreed to the Minister's proposal for special tribunal arrangements under the Bill. The G.M.C. deals with professional and not criminal offences. True, contravention of the Regulations under the Bill is not strictly a criminal offence, whatever we may think of it. If it were, the Bill would have stated so quite plainly.

On the other hand, the penalties available to the Council, such as removal from the register, are inappropriate to deal with this kind of offence. There is no intrinsic difference between the new offence and the ordinary criminal offences under the principal Act. In my view, any person charged with such an offence should be entitled—subject to the ordinary rights relating to minor offences in magistrates courts—be tried by a jury.

I cannot agree, therefore, with the Amendments, although I am very grateful —as I am sure the Minister is—that my right hon. Friend has put them down. When we are dealing with an honourable profession, such as the medical profession, it is surely important, to be clear what we are seeking to do. It is essential that the Minister should give a detailed explanation why the Brain recommendation was rejected. I take it that this was not solely because the medical profession said, "We do not like this, the G.M.C. should not deal with it." I take it that the Minister himself has firm ideas on the subject. My right hon. Friend has provided him with an opportunity to give us an explanation, and I now invite the Minister to do so.

11.15 a.m.

The Minister of Health (Mr. Kenneth Robinson)

I appreciate the motives of the right hon. Member for Ashford (Mr. Deedes) in moving the Amendment. To the extent that his motives in doing so include the provision of an opportunity for me to explain the Government's position, I welcome his action. In Committee we had a general discussion on the enforcement machinery, but time was short. The right hon. Gentleman will probably agree that that discussion was a little untidy and confused.

The Amendments deal squarely with the position of the General Medical Council. In Committee some hard words were said about the Council. There was an understandable wish that the problem of enforcement should be left to the profession, but there was also a feeling—expressed by Members on both sides of the Committee—that the arrangements provided for by the Bill were somewhat elaborate and cumbersome. It may be that the criticisms expressed tended to become reflections on the Council. I hope to show that such reflections are unjustified.

In Committee, the most extreme view seemed to be that the profession should deal with the problem of over-prescribing to addicts through the Council's normal disciplinary procedure. Reference was made to the American practice which, we were told, appears to work without any regulations. If such a system were possible here there would be no need for the Bill, but such a simple solution is out of the question.

First, the American system of dealing with drug addicts is quite different from ours. Doctors there are prohibited from giving heroin to addicts; indeed, heroin cannot be prescribed to any patient. It is therefore easier for the American Medical Association and other bodies concerned to exercise control over doctors who transgress without bringing in State enforcement. The British system has hitherto allowed doctors to prescribe dangerous drugs for addicts. The Brain Committee's recommendations represent radical changes in respect of the responsibility of doctors in connection with addicts and dangerous drugs.

It is quite out of the question to think that self-regulation by the profession could achieve compulsory notification of addicts and the surrendering of most doctors' rights to prescribe for addicts.

Mr. Deedes

It is very important to be sure that we are both talking about the same thing. I do not question the Minister's statement that the Government must legislate to produce a new situation, but the Brain Committee's recommendation was that the medical profession should do the actual enforcement.

Mr. Robinson

I was trying to lead up to that by stages. It is the view of the Government—and, I believe, the view of the House—that we could not have achieved this through self-regulation by the profession. For that reason Clause I is necessary.

The question then arises how the new statutory obligations are to be enforced. The Brain Committee dealt with these matters in paragraphs 31 to 36 of its Report. The Committee did not, in turn, suggest how notification should be enforced. I mention this because it is fair to say, with all respect to the Committee, that its proposals for enforcement were drawn in outline rather than in detail, and they left open some difficult questions for discussion between the Departments and the profession.

First, the Committee visualised that contravention of the new obligation would be an offence. It used this phrase specifically in paragraph 31. It went on to give its view that the matters to be judged in any case of a contravention of the new requirements would be inappropriate for determination in a court of law because they were primarily concerned with professional judgment and conduct.

The Committee suggested that any doctor whose conduct in respect of the new obligations seemed unsatisfactory should come before a tribunal of his professional colleagues and justify his action. It suggested that the Disciplinary Committee of the General Medical Council would be the appropriate tribunal for this purpose because, to quote paragraph 35: Already this body deals with questions of professional conduct, and the over-prescribing of restricted dangerous drugs, we think, comes into this category. Finally, the Committee visualised that if the Disciplinary Committee found the facts proved there would be provision for the doctor's authority to prescribe certain dangerous drugs to be withdrawn.

The Committee did not take evidence from the G.M.C. on this proposition, and when the Council's views were invited on the report the Council drew attention to a number of points which, in its view, made it quite inappropriate for it to play any formal part in the procedure, as suggested by the Committee.

As is well known, the G.M.C, through its Disciplinary Committee, has a long-established tradition of dealing with cases of "infamous conduct in any professional respect". I will not go into the type of cases which are dealt with by the Council in which a serious breach of medical ethics is alleged. Infamous conduct of the kind with which the Council deals is not necessarily the conduct with which we are concerned in this Bill. In order to prevent over-prescribing, we have to take account of a number of possibilities in relation to the prescribing doctor. The scale may range from questions of professional judgment and discretion, through carelessness of whatever degree, to what is tantamount to "in-famous conduct" in the accepted sense.

The motives of doctors may vary similarily. A doctor may genuinely believe that it is better for his patient to get a generous supply of drugs, because this may make him more stable in behaviour and build up his confidence. Accordingly, the kind of control that we need has to assume, not that the doctor is a potential wrongdoer, but that, acting sincerely, he may none the less, by his action, help to complicate and magnify the general addiction problem.

This proposition does not fit in with the G.M.C.'s established functions. It is not the Council's responsibility to deal with contraventions of statutory obligations or offences. It is not the Council's responsibility to intervene in matters of professional judgment or medical treatment. If a doctor has a private theory of medicine, it is not for the Council to step in and prevent him from practising in his chosen way. It will be clear that neither the G.M.C. nor the Disciplinary Committee were ready-made bodies for tackling the enforcement of the Regulations under the Bill.

It would have been convenient for the Government to have been able to graft some new machinery of enforcement on to the G.M.C. The Council has the established authority, experience and administrative resources. Setting up a new ad hoc body is never easy, and as the provisions of the Bill show, is likely to be complicated. It is clear, however, that the Brain Committee's proposals could not be implemented through the G.M.C, except by legislation, and in paragraph 36 the Committee said that legislation would be necessary to enable the Council to assume this responsibility.

It has been said that the G.M.C. declined to take on this responsibility. That is not strictly accurate. The Council explained to us why the new responsibility could not be assumed under its existing machinery. The Government accepted that advice. The Council informally suggested alternative machinery, and we took this as a starting point for the scheme in the Bill.

I should now like to mention one or two other considerations which led the Government readily to accept that it would be more appropriate to establish a new tribunal than to try to introduce machinery within the ambit of the G.M.C. First of all, the penalty proposed by the Brain Committee of withdrawal of a doctor's licence, necessarily involves action on the part of my right hon. Friend the Secretary of State for the Home Department. The right hon. Gentleman's Amendment would have the effect of making the G.M.C. adviser to the Secretary of State on such action. This is a long way from what is required by the profession.

On the other hand, it would not be appropriate, as the Council feels, to lay on it the onus for withdrawing the authority to supply drugs, initially conferred on the doctor by the Secretary of State. On all those considerations the Council felt overwhelming doubt about the merits of the Brain Committee's proposal—a doubt in some measure shared by the B.M.A. The Government accepted the Council's view.

I hope that I have made clear to the House that this proposal of the Brain Committee was not fully thought through. The Government's task was simply to determine, in consultation with the profession, the form of a completely new tribunal. We admit that the provisions in the Bill are somewhat complicated, and we believe that a scheme of this nature is required if we are properly to protect the interests of all parties, not least those of the practitioner.

It is quite clear that any legislation to give the G.M.C. a new responsibility would have been no less complicated and, we think, rather less satisfactory. I hope that in the light of that explanation the right hon. Gentleman will ask the leave of the House to withdraw his Amendment.

Mr. Deedes

I am grateful for what the Minister has thought fit to say about the Amendment. I hope that he will agree that a great deal of what he has said ought to be on the record. In that sense I am glad that we have been able to have this short discussion, and in the light of what he has said, I beg to ask leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

11.25 a.m.

The Minister of State, Home Office (Miss Alice Bacon)

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

After the wide-ranging discussions that we have had on the Brain Committee's proposals, and the proposals for enforcement, both in Committee and this morning, there is no need for me to say very much in commending this Bill to the House. It opens the door to great changes in the treatment of addicts. I want to emphasise that the Bill is not a Bill against doctors, it is a Bill to help those who have already become addicted to dangerous drugs, and to prevent others from becoming addicted.

The Government are glad to acknowledge the ready support which the medical profession has given to its principles. For reasons which are well understood, much of the detail of the new restrictions is not yet visible in the Regulations. Some of the administrative organisation is not yet developed, but we intend to push forward as quickly as possible to fill in the missing pieces of the picture.

We shall have the fullest consultations with the medical profession and other interests. We all realise the tremendous possibilities for good and evil that are at stake, along with the future of many of our young people.

In conclusion I should like to thank all hon. Members, especially hon. Members opposite, for their co-operation in giving the Bill a swift passage. The Government have rightly been pressed to explain, not only how the Bill fits in with the wider plan, but also how the measures to be taken under it will affect doctors and addicts and others involved. The Government believe that the information which we have given about the drug situation, and our strategy for dealing with it, is accepted by the House as being realistic. I ask hon. Members to give the Bill an unopposed Third Reading.

11.29 a.m.

Mr. Deedes

Without prejudice to anything that my hon. Friends may wish to say further, I would intervene only to tell the right hon. Lady that we accept the necessity of the Bill and, subject to the reservations which we have expressed about the methods, we wish it well, and we shall give it all possible support. She has appositely said that it opens the door to great changes.

In view of the urgency of this Measure we on these benches may be considered to have been relatively compliant, all things considered. The Ministers have had a pretty easy run. They have asked us to take a lot for granted, both in terms of the regulations and the administration. Of the Regulations, which will be much more important even than the Bill, we are still without any knowledge. We do not know what they will contain, when they will be in operation or when they will be ready.

I regret the insistence of the Minister—I will explain why—that the Regulations are to be produced by the negative procedure. That means that when the Regulations are produced, if we on this side wish to discuss them, as, I am sure, we shall, we shall have to move to annul them. That procedure is acceptable in many instances, but in urgent matters of this kind dealing with drug addiction it is unfortunate that the Opposition should be put in the position of having to move to annul Regulations for the purpose of discussing them. For that reason, I enter a modest protest at the refusal at an earlier stage of our proceedings to make the Regulations subject to the affirmative procedure. If we find it necessary to move to annul the Regulations, I hope that our position will be clear.

As to administration, we know even less than we know about the Regulations. The right hon. Lady has just said that parts of the administration have not yet been developed. Many people who are about to become involved in these matters are markedly uneasy. A great many people who will have an important part in these affairs, members of the medical profession and others, are expressing doubt about whether the Government Departments principally concerned are in the right gear about all this.

I am not referring to opinion among those who are already in this field, among whom, I accept, there is probably a degree of, if not resentment, at least reluctance. What they have to say about the future course is of interest, but I would not use it as evidence against the Ministry or the Home Office. What is more disquieting, however, is a current feeling among those in hospitals and elsewhere who are about to be brought into all this. At this point of time, it is a little disquieting how little they know about what the administration is to be in any sort of detail. I have talked to a good number of these people and the impression which I get compels me to say that the Ministry is leaving much too much to chance.

Official people have been told quite recently, for example—I do not think that they have been misinformed—that the regulations will depend on the passage of the Bill and, after that, they will be discussed with members of the medical profession. I add in parenthesis the hope that this round of discussions will be less protracted than the last.

Why is not all the work on the Regulations running concurrently with the Bill? The Bill can have Royal Assent within a matter of weeks—a month or less—and the Regulations could be tabled soon afterwards. I would like to feel that we should get the Regulations through before we rise for the Summer Recess. The right hon. Lady has said that there will be consultations, but what has prevented consultations taking place during the weeks of preparing the Bill and its course through this House?

We are now operating at a distance of two years since the Brain Committee reported and we know well that the numbers of people who have been caught up on drugs since that Report was published have been alarming. I know that both the Home Office and the Ministry of Health are exceedingly busy, but even so, this subject should have a higher priority in terms of administrative speed than it has been given. I suggest to the Minister that he should apply a little bit of a spur. That is not simply my view, and I am not being politically critical. That view is held by doctors, psychiatrists and others who will have heavy responsibilities but are not clear what shape those responsibilities will take.

Last week, I had occasion to visit a large psychiatric hospital well outside London. The people there had been visited by officials and had been asked in general terms about the future contribution which they might make. In effect, they were asked whether they could deal with a small number of in-patients in the area and also with some out-patients. In passing, I am not sure whether those two should go together in the same establishment, but I will not dwell on that.

The doctor in charge of that large psychiatric hospital asked me a number of questions, to none of which I could supply the answers. The most important question he said, was what sort of liaison he was likely to have with other establishments involved in the same business. He wanted to know whether he could be sure of being able to contact the central authority all round the clock when he was approached by an addict and it was necessary to know the credentials of the addict. Why could not the local general hospital deal with out-patients, leaving him at the psychiatric hospital to deal with the in-patients? How was he to assess quickly the needs of those who came to his door? Those were important questions. The Minister is not the only one who should know the answers. Some of the answers should be known by now if we are to get these arrangements into operation within a reasonable time.

What, I think, the Departments are failing to grasp is not that this will be a difficult transition period, although it will be. It will involve discarding a small number of people, who have been working closely towards all this business, and turning their work over to a greater number of people with relatively little experience in this direction, people who, I find in discussion with them, are only too conscious of and frank about their own deficiencies in terms of experience.

I exonerate the Minister, but I get a strong impression that in some official quarters this is all regarded as a very tiresome, troublesome business which must not be allowed to delay other important matters. It is very tiresome and it is also very dangerous. I suggest that after two years we ought to move a little faster than we are moving. We are dealing with a small virulent plague which is being tackled in many places at walking pace. There can be no argument about this because it is now two years since Lord Brain recommended certain action, and we have yet to get it moving.

Only last week we had an example—it just comes within the terms of the Bill—of what I would call lack of administrative concern in education. When I recently asked the Minister responsible what was happening, he said that instructions were being reviewed. He added, quite rightly, that it was important in educating people not to arouse curiorsity. Now—this is an example of where the administration is not all that it might be— instructions are going out to London schools. Was this done on the authority of the Secretary of State? I have no complaint if it was, but, if it was, why only London?

As the Bill indicates, London is not the only place where these dangers arise. Will there be nation-wide instruction? If London is being catered for, why not all the rest of the country? This is an example of how administration is not moving with the confidence which some people who are deeply anxious about these matters feel that they should be getting from those in authority.

I give notice that we on this side are a little restive about the pace of official action and that we shall make ourselves increasingly troublesome if there is not an improvement. The Minister knows that we accept the Bill as bi-partisan policy, but bipartisan policy must not be taken as unconditional acceptance of administration which we do not regard as being altogether satisfactory.

Therefore, I beg the Minister, when he gets the Bill, as he is about to do, to persuade all concerned to pull out the stops just a little bit quicker. The right hon. Gentleman will reply that everyone is doing his best and that he slightly resents what I have said. I do not mind that as long as he marks what I have said and others do the same. We make it a condition of giving our consent to the Bill that this disagreeable and rather dangerous business must be taken seriously in all quarters.

11.40 a.m.

Mr. Eldon Griffiths (Bury St. Edmunds)

Like my right hon. Friend the Member for Ashford (Mr. Deedes), to whom I pay tribute for all the work which he has done in illuminating the drug problem in our country, I welcome this small and limited Bill and I hope that the House will give it the Third Reading which it so richly deserves. I join with my right hon. Friend in saying that it is a Bill when the affirmative procedure would be much more satisfactory to the House of Commons.

The Bill enables the Government to make a wide variety of Orders. Some of its language is very vague, necessarily vague, as I understand, but when I read in Clause l(1,a) that the Minister may make regulations, including the power to require a medical practitioner to furnish, to such authority as may be specified by the regulations, such particulars with respect to that person as may be so specified then I must say that these are very wide powers of delegation and that when the Government seek such powers, it is right that the affirmative procedure should be operated before such powers are given. As I was not a member of the Standing Committee which considered the Bill, I hope that the Minister will say this morning why it is necessary not to have the affirmative procedure.

I welcome the Bill, but I am bound to say that against the background of drugs in our midst it is a late and half-baked Measure. It is half-baked because it puts the Minister in a position of trying to deal with a large problem with a very small Measure. He might be likened to a man trying to keep out the sea with a whisk broom.

Reading through the OFFICIAL REPORT of the debate in Committee, I have been interested to see the number of occasions on which both sides of the Committee—perhaps there was only one on this occasion—referred to the American experience. Certainly my right hon. Friend the Member for Ashford knows a great deal about this. I, too, have seen a good deal of this problem in the United States and, sadly, it has a bearing on our growing experience in this country. One sees a network of gambling, prostitution, drugs and then violent crime, the crime of the "enforcer", of the paid assassin, all working together, and as I see what is happening in London and Glasgow and the other big cities, I have no doubt that this same pattern of violent crime, in which drugs are an important element, is increasing in Britain at a speed which the Bill does nothing to tackle.

I said that the Bill was half-baked and I say that mostly because of the many things which it leaves out and also because at least some of the assumptions on which it is based now appear to be quite out of date. In many instances it appears to will the end without willing the necessary means.

As for the things which are left out, I notice that there is nothing—

Mr. Deputy Speaker (Sir Eric Fletcher)

I am sure that the hon. Gentleman will appreciate that on Third Reading we cannot discuss matters which are left out of the Bill. We can discuss only what is in the Bill.

Mr. Griffiths

In that case, I will confine myself to making that general comment and pass to my second criticism which is concerned with the change of assumptions on which the Bill is based.

When the Bill was first promulgated, it stood on the findings of the Brain Committee. I have read those findings, which were frequently mentioned in Committee, and I am sure that the Minister would acknowledge that the Bill is based on those recommendations. The Bill contains the assumption that at the moment there is not a very large illicit drug traffic in this country. I dispute that. I believe that there is, and I am sorry that the Bill does not deal with it.

The Brain Committee assumed that the main problem was over-prescription by doctors. That is an erroneous assumption. The provision of drugs to addicts and others does not arise solely from over-prescription, but in many cases from pilfering, theft and forgery.

The Bill is unfortunate in that it wills the end without willing the means. For example, the Minister has not yet made adequate arrangements to provide and finance the treatment centres which will be necessary. These are an absolute prerequisite to any legislation banning doctors from prescribing drugs. Whether the hospital service will be able to cope is very much open to question. Is there enough staff? Are the accommodation and finance available? These are the questions which need to be answered against the background of the Minister willing the end without willing the means.

I want to raise one specific matter, namely, the drugs which will continue to be prescribed and administered whether to addicts or others, for the relief of the pain. I take it that there is nothing in the Bill which would prevent a doctor from prescribing or administering drugs, whether to addicts or to others, if the person concerned had been in an accident or was in pain for some other reason. As a substantial quantity of drugs is still likely—at all events, one supposes so—to be available on that account, I want to ask two specific questions about the control of the drugs which will still be available. First, can the Minister say how he visualises effective control between the wholesaler and the retailer?

The second question is concerned with control between the retailer, the chemist, and the patient or addict. I have looked into this matter in some detail and I have recently spoken to a number of police officers who have been extremely worried about this aspect. As I understand it, the present practice is that a comparatively senior police officer goes round to chemists' shops from time to time and examines the registers of dangerous drugs. He then looks up the prescriptions and matches the prescriptions against the names on the register. He is entitled to ask to look at the stock to see whether the stock held by the chemist and prescriptions which the chemist has dispensed and the names in the registers tally. If there are changes in the register, he must inform Her Majesty's Chief Inspector of Drugs.

When the police officer informs the Chief Inspector of Drugs that there is some marked change in the levels of prescriptions, or that there is some new name in the register, will there be as many delays as there now sometimes are?

Mr. Deputy Speaker

I do not want to interrupt the hon. Gentleman again, but it is not obvious to me how this matter arises on the Bill.

Mr. Griffiths

Even under the Bill considerable quantities of drugs will continue to be dispensed to addicts and others when that is necessary to combat pain and chemists will continue to dispense them against doctors' prescriptions. I was simply asking for an assurance that when the police do their duty of reporting what is in the register to the Chief Inspector, there will be speedy answers to their queries about whether the changes in amount, or in the names on the register, are legitimate; in other words, whether they are approved.

Whether or not the Minister feels that the enforcement should be done by lay members of the police force, many police officers feel that they are professionally not able to judge—are not trained to judge—whether the little white tablets they may see in the stock a chemist carries are the drugs in question or not. With a lay background, they are placed in a most invidious position when asked to make a professional judgment. It has been suggested that the Minister might take up this point with the pharmaceutical industry and the Pharmaceutical Society. Has the right hon. Gentleman discussed this matter either with the Society or with individual members of the police force to see how this practical administration is done at the shopkeeper's level?

11.50 a.m.

Mr. Braine

I shall speak briefly, Mr. Deputy Speaker, because I am as anxious as anyone to see that the Bill has a swift passage. My hon. Friend the Member for Bury St. Edmunds (Mr. Eldon Griffiths) described the Bill as half-baked and unfortunate. I think that he was a little less than just because, as I understand it, the Bill is only part of a series of Measures which the Government are devising to deal with the scourge of drug abuse.

In passing, I am very encouraged at the signs, albeit belated, of activity in this sphere. I refer in particular to the advice given by the Education Officer of the Inner London Education Authority to 300 secondary school head teachers in London about the need to watch for signs of drug abuse among school children. The fact that this step has had to be taken shows just how grave the general situation is.

The Bill is absolutely crucial, as the right hon. Lady the Minister of State said, to success in the drive to help those already addicted to hard drugs or who may become so addicted. The success of the Measure itself will depend entirely on the speed with which really adequate treatment centres are provided. During the Committee stage, we voiced certain anxieties on this score, and were relieved to hear that the Regulations which the Bill empowers the Minister to introduce would not be implemented until adequate treatment centres were made available. But we were given no clue as to when this might be, although it is quite clear that the Government, the medical profession and all those who have taken an interest in the matter are seized of the dire urgency of introducing these treatment centres as soon as possible.

I think that the real difficulty is that the right hon. Gentleman has pinned his hopes and faith to treatment only in treatment centres and has thereby imposed upon himself a very considerable limitation. He knows as well as I do that there is an acute shortage of psychiatrists, and that there are difficulties with the hospitals over accommodation and staff. As my right hon. Friend the Member for Ashford (Mr. Deedes) made clear, there are a great many people in the medical profession who are markedly uneasy—I think that those were my right hon. Friend's words—about the possibilities of bringing adequate treatment centres into operation at an early date. The right hon. Lady said that discussions would continue with the medical profession on this and related matters, but my present purpose is to ask the Minister whether, if he encounters difficulties in this respect, he will consider licensing additional doctors outside the treatment centres that he has in mind.

I should have liked to have seen provision to this effect in the Bill. Indeed, there is nothing in the Bill to prevent it. There is nothing in the Bill to prevent the Minister when making the Regulations, the content of which we at present know nothing, including some sort of transitional arrangements. What is needed is a great deal more flexibility in approach than the Minister has tended to show thus far. I hope that he will assure us this morning that his mind is not closed to making some transitional arrangements if he finds, after all his labours, after the consultations he is having with hospital authorities and the medical profession, that it is not possible to establish adequate treatment centres at an early date and he is therefore unable to implement the Regulations.

11.55 a.m.

Mr. James Dance (Bromsgrove)

Like my hon. Friend the Member for Essex, South-East (Mr. Braine) I support the Bill, and will not speak for long because I sincerely hope that it will get its Third Reading. Despite all the publicity at present being given to the drug menace, I do not believe that there are all those people in the country who fully appreciate the appalling danger of these drugs. I do not believe that they are quite aware of the dreadful habit-forming effect these drugs have on people, and particularly on young people. There is no doubt that there is an immense addiction.

To illustrate this, I should like to quote a case that was brought to my notice not very long ago. A certain youth served 18 months in prison for stealing 1,000 grains of heroin and 1,000 grains of morphia. At the end of 18 months it was considered that he had been cured of his addiction, and he was released from the prison in the Isle of Wight—Camp Hill, to be exact—and travelled by train to New Street Station, Birmingham.

There is in my constituency a rehabilitation centre, because the authorities believe that even though a youth like this may have been thought to have been cured, a further year working in the open air on a farm may possibly confirm that a cure has been effected.

The youth was met at New Street by a very excellent gentleman who does much of this work voluntarily, and who was horrified to see that the youth was absolutely full of drugs. It is quite impossible to take him to the rehabilitation centre as it would probably have undermined much of the good work being done there. The voluntary worker felt very sorry for the youth so he took him to his own home and interrogated him.

The youth said—and I fully appreciate that this has subsequently been denied by the right hon. Lady the Minister of State—that on leaving prison he was given back four grains of heroin that had been taken from him when he went in, plus his hypodermic syringe and three needles. I repeat that it was denied that he was handed back the heroin, but there is no doubt that he was handed back the hypodermic syringe and the three needles. So great was his addiction that, somehow, on the journey between the Isle of Wight and New Street, Birmingham, he managed to get hold of some more heroin—I gather that it was heroin he was found to have taken—and gave himself a shot in the cloakroom at Waterloo Station.

I told the Home Office that I thought that it was rather like handing a potential suicide a revolver—it might not have any bullets in it but it could put the idea into the person's mind that he might use it at some time. The Home Office showed very great wisdom. Lord Stonham wrote to me fairly recently saying that he had given instructions to prison governors not to hand back hypodermic syringes, and the like, to these people on discharge. The next point I want to come to is the question of peddling drugs, because that is the most serious. Some years ago my own son—

Mr. Deputy Speaker

Order. There is nothing about peddling drugs in the Bill. It may be very important, but it does not arise under the Bill.

Mr. Dance

With respect, Mr. Deputy Speaker, we should try to find out where these people get the drugs from.

Mr. Deputy Speaker

That is no doubt a very important subject, but debate on the Third Reading of a Bill is very limited. I have already allowed hon. Members to exceed the limited scope of the Bill. We are on Third Reading, and this is not a Committee Stage. I must ask the hon. Member to confine his observations to the desirability or otherwise of the House giving the Bill a Third Reading.

Mr. Dance

I beg your pardon, Mr. Deputy Speaker. I was just trying to refer to the danger of peddling.

One final point—if it is not out of order—is that I am not happy about the security in some of the manufacturing chemists—

Mr. Deputy Speaker

I am afraid that that is also out of order.

Mr. Dance

It is all most unfortunate, Mr. Deputy Speaker, because this is such a very important matter and I feel that these points should be aired at present. As my hon. Friend said, one might hope that this is only one of the Measures being taken to try to combat this terrible affliction.

Mr. Deputy Speaker

It is precisely because this is only one of the Measures that we can, on this Third Reading, deal only with it and not with any other.

Mr. Dance

I apologise if I have been out of order. That was not my intention. I was not trying to be unhelpful, as I think the Ministers will agree, but merely to put forward some suggestions. As I have been out of order, I am pre- pared to sit down now and say only that I wish the Bill a good passage.

12.2 p.m.

Mr. K. Robinson

I should like to reply briefly to the points raised by hon. Members opposite.

The right hon. Member for Ashford (Mr. Deedes) again expressed the misgiving about the Regulations under the Bill not being subject to the affirmative procedure. We explained in Committee why the procedure in the Bill has been adopted and I think that I should be out of order if I went through those arguments again on Third Reading. I could not take the right hon. Gentleman very seriously when he said that there would be some reluctance on the part of the Opposition to move to annul the Regulations. They managed to bring themselves to move to annul the Regulations on new payments to general practitioners without any fear that they would be misunderstood by the medical profession, and I think that the right hon. Gentleman will manage to get over the difficulty in this case. I only said that in passing—

Mr. Braine

And, I hope, in fun too.

Mr. Robinson

Entirely.

The right hon. Gentleman said that the current feeling amongst those in hospitals who will have to deal with this problem is that they know very little about the administration. This will be a new subject for a number of practitioners in hospitals. They will come to it fresh and until the new Regulations have been published and there have been further discussions I can well understand that some of them would like to know a bit more.

The right hon. Gentleman asked why we did not discuss the Regulations before the Bill was passed—why did we not get on with them. We are getting on with them. There have been discussions, and consultation with the profession is continuous in this respect. He quoted a doctor with whom he had been discussing the problem who asked why the general hospital should not deal with out-patients, leaving psychiatric hospitals to deal with in-patients. That will happen in certain areas, but we want to try a mixture of arrangements. It is necessary that there should be a close liaison between in-patient and out-patient facilities. In some cases they will be in the same hospital. Provision for out-patients in London will be mainly at the London teaching hospitals with the in-patient provision at psychiatric hospitals. It is most important that we do not try to adopt too rigid a pattern in this new experiment on which we are embarking.

I can assure the right hon. Gentleman that there is no lack of urgency in either my right hon. Friend's Department or my Department about this. We have no doubt about the seriousness of the problem or of the importance of getting the right solution.

A specific point mentioned by the right hon. Gentleman concerned advice to schools. I understand that the circular sent out was on the authority of the Inner London Education authority. It is designed to discover whether there is a problem in the London schools. Any further extension of that sort of inquiry would be a matter for my right hon. Friend the Secretary of State for Education and Science, and I am sure that he has it very much in mind.

Mr. Deedes

I know that the right hon. Gentleman accepts that this is an interdependent problem as far as the three Ministries are concerned. If this was not done with the Secretary of State's authority, in the light of what we have been told in the past it is a very extraordinary thing to have happened.

Mr. Robinson

I did not say that it was done without his authority. I have not been able to discover what discussions there were between the I.L.E.A. and the Department of Education. The move by London has not so far been paralleled in other areas.

Mr. Braine

Is the right hon. Gentleman correct about that? I understand that schools in Birmingham have been aware of this for some time. The complaint of many doctors in London is that the London education authorities were unaware of what was going on under their very noses. I hope that the right hon. Gentleman will get the situation correct.

Mr. Robinson

I do not think that the hon. Gentleman has contradicted any- thing I said. I understand that his right hon. Friend was talking about a communication which has just gone out to London schools.

Mr. Deedes

indicated assent.

Mr. Robinson

It is a communication which was sent out by the Inner London Education Authority, what Birmingham did before in a different sense or context I do not know, and that was not the question I was asked.

The hon. Member for Bury St. Edmunds (Mr. Eldon Griffiths) said that we were trying to deal with a very large problem with a very small Measure. I beg him and the House not to get the problem out of proportion. It is serious, but, thank heavens, it is not yet a very large problem. Under the Bill we are following the best advice we can get from expert opinion as to the best method of containing and, I hope, reducing the size of the problem.

The hon. Member dealt with a number of questions about control and also asked about illicit trading. I think that I should be out of order if I went into detail on that, but I assure him that my right hon. Friend the Secretary of State for the Home Department already has fully adequate powers to deal with illicit trading. What the Bill deals with is over-prescribing by doctors.

On the question of security of drugs in pharmacies, I can tell the hon. Gentleman that a deputation from the Pharmaceutical Society of Great Britain and the National Pharmaceutical Union is meeting officials of the Home Office today to discuss proposals for improved security. I am sure that the question of inspection will be included in the discussion.

The hon. Member for Essex, South-East (Mr. Braine) once again asked whether I or my right hon. Friend would consider licensing doctors outside treatment centres if we encountered difficulties. He said correctly that the Bill would not prevent this, but I can only repeat what I have told him before, that it is not the Government's present intention to license doctors outside treatment centres.

I echo the thanks of my right hon. Friend the Minister of State to right hon. and hon. Members opposite for the fair wind they have given to the Bill, which I commend to the House.

Question put and agreed to.

Bill accordingly read the Third time and passed.