PRIVATE HEALTH INSURANCE

HC Deb 10 December 1969 vol 793 cc451-510

Mr. Speaker

May I announce that I have selected the Amendments in the names of the Prime Minister and his right hon. Friends to each of the two Motions of the Opposition on the Order Paper.

4.15 p.m.

Mr. Maurice Macmillan (Farnham)

I beg to move, That this House welcomes the development of schemes for private health insurance. I take the opposite view on this subject to that taken by the Secretary of State for Social Services in his pamphlet which has recently been the subject of a good deal of publicity, and I quarrel, therefore, with the spirit of the Amendment, however similar the wording has been made at least to seem to that of the Motion.

First, may I regret the absence of the Secretary of State and, still more, the illness which I understand is its cause. I hope that he will soon be better. I think, however, that he must be improving, for I detect his rather devious mind in the subtleties of semantics of the Government's Amendment, which is, of course, literally true; but how true depends on the meaning one attaches to the words "adequate alternative", and whether they imply "sole". The omission from the Amendment of the phrase of welcome in the Motion totally reverses the implication of the wording of the Motion.

We have a more than adequate substitute in the right hon. Gentleman the Secretary of State for Wales. He may not have quite the same capacity for obscuring the issue behind analytical skill and force of destructive criticism, but he is certainly equal in wit and charm, and I have no doubt that he will be just as successful in his attempts to divert the House from the realities of the problems, and will have the same capacity to avoid awkward facts and unanswered questions.

I hope that he can be firm and definite on the Government's attitude to private practice in general. Any doubts which may have been expressed about the growth of private insurance schemes can be doubts only about the rôle of private practice in the care of the nation's health. We on this side of the House have no doubt about this, and I recall the words of the late Aneurin Bevan: If people wish to pay for additional amenities, or something to which they attach value, like privacy in a single ward, we ought to aim at providing such facilities for everyone who wants them. There are many reasons why people wish for this extra convenience. They may wish to choose more nearly the time of an operation which may require medical urgency; and I hope that the House would reject the idea that such priorities should be given to people solely because of the alleged importance of their standing or status in the world, official or otherwise. Surely the reasons which were valid in 1946 are still more valid now when, private insurance schemes have enabled more people who want additional amenities to get them. In 1946, a relatively small number of people could afford, either directly or through insurance, expenditure on medical care. That number is now growing, and we welcome it.

The Secretary of State for Social Services has said, and we have no reason to doubt his accuracy, that about 60 per cent. of private patients use National Health Service hospitals. There is evidence of growing demand for these additional amenities which people value. Yet in 1967 the review of pay-beds in National Health Service hospitals reduced them from 5,764 to 4,370. This was despite the provisions of the Health Services and Public Health Act, 1968, which made more effective use of beds by altering the arrangements by which previously they were set aside for specialities, anti despite the absolute rule that such pay beds should be allocated for medical priority if there was any medical need over-riding the amenity need.

Private practice, as well as being of great service to the patient, is a service to the profession. Again, I would quote the late Aneurin Bevan, when he said in the House: Specialists in hospitals will be allowed to have fee-paying patients. I know this is criticised and I sympathise with some of the reasons for the criticism, but we are driven inevitably to this fact, that unless we permit some fee-paying patients into public hospitals there will be a rash of nursing homes all over the country."—[OFFICIAL REPORT, 30th April, 1946; Vol. 422, c. 57.] I have no doubt of the value of private practice not only to the pockets and standard of living of the profession, but also to their general conditions of service and way of life.

Britain, rightly, is regarded as a centre of medical advance. Our teaching hospitals are unrivalled and large numbers of people come here from abroad, most of them as private patients. I cannot help feeling that they not only add to our invisible earnings, but also to our reputation and to the experience and capacity of our doctors to serve our own people.

Perhaps the most important side of private practice so far as it concerns the medical profession is that without private practice the career structure and rewards for doctors and surgeons and specialists is lamentable. The British Medical Journal, as far back as May, 1967, in a supplement reprinting the annual report of the council, said, in the first paragraph: Never before have hospital doctors been so disenchanted with conditions of practice… No one can pretend that those conditions have improved since, or that that disenchantment has lifted. This can be seen in the emigration figures, with 350 doctors leaving the country every year.

The Times, in an article on 1st December, said: If private fees persuade a doctor who would otherwise have gone overseas to continue in practice here, everyone gains… That proposition cannot be seriously contradicted. If the alternative of the medical profession to the encouragement of private practice is, as the only possible alternative must be, the establishment of a purely State-salaried service, it has as something to look forward to the situation of teachers and nurses. The State, alas, has not a reputation either for paying its servants well or for developing the best career structures.

The Secretary of State, in his pamphlet "Paying for the Social Services", said, on page 8: In an organised service like our National Health Service priorities of medical need can be made to over-ride the priorities of the market place and costs can be kept within the capacity of the nation to pay. That does not provide much cheer to doctors and consultations if it means, as the hon. Member for Bosworth (Mr. Wyatt) said in a recent article, that we are getting doctors on the cheap.

Finally, private practice has given help on a considerable scale to the National Health Service. This is shown by the number of hospitals and institutions of one sort or another, amounting to 152, in the Association of Independent Hospitals, which provides over 10,000 beds for in-patients, caters for the treatment of 370,000 patients, and was responsible for six general nursing-training schools, three psychiatric nursing-training schools and three enrolled nurse-training schools. This relates to 1966, the last year for which I could obtain accurate figures.

This effort can be said to make a significant contribution to the health care of the nation, but cannot be said to be causing a rising diversion of resources. In fact, half the Health Service resources are required for the terminal care of patients and care of long-stay patients. This is not an area in which the types of institutions I have mentioned trespass at all. Private insurance is concerned mostly with the acute side of health care. The more private resources devoted to this the more is available from the taxpayer to improve what must always be, and can only be, taxed finance devoted to the care of long-stay patients, the mentally subnormal, the mentally sick and terminal cases.

Some changes have taken place over the past years. It is true to say that the size, scope and range in which private practice and private health insurance operates within the nation's health care has increased to an extent which perhaps might be worrying the Secretary of State for Social Services and some of his Friends. In the old days these facilities were open to only a few, but the private insurance schemes have opened the door to many more people to obtain the amenities they want and the amenities they value at a relatively low cost to themselves.

In the light of this contribution I am moving this Motion. We reject the Secretary of State's idea that the unplanned growth of private pension schemes is a disturbing element within the Health Service. This idea has the implication that the growth of these schemes, and the schemes themselves, should be controlled or limited and hence, by inference, so should private practice rather than, as I would suggest, that they must be taken into account as an element in the development of health care. In this attitude the Secretary of State and the Government show a negative point of view similar to that which they have developed over charges.

Mr. John Mendelson (Penistone)

The hon. Gentleman misrepresents the attitude of us who are concerned about this matter. We are not worried about the larger number of people getting something they want. We are concerned that this might have a bad effect on the Health Service.

Mr. Macmillan

The hon. Gentleman will be able to make his own points, later, perhaps. Our time has already been grossly reduced, and I should like to make my own points in my own way.

This negative attitude is seen in the use of charges to prevent the growth of demand rather than to increase the amount of resources available. Incidentally, the Secretary of State, in his pamphlet, justified the charges on teeth and spectacles on the ground that they would be paid by people who would be in work and earning. So are the B.U.P.A. contributions and, indeed, all forms of insurance which are of great value to ordinary people.

It would be fair to say that the analysis of the great problem of the Health Service, which is one of paying for the Service, is valid, and, so far as it goes, accurate. Of course, it is true that the Service creates the demand. Of course, one can say that in tracing price rises and other costs there are many reasons why its cost goes up. It is because of greater activity, but also because of big advances and because doctors can do more for people than they could do before.

The Secretary of State is also right in saying that savings which can be got from greater efficiency are not enough. The faster we build new hospitals the greater are the running costs because of the better service which they can give. This problem of an open-ended demand and limited resources is not confined to the Health Service alone. We have it in pensions, in houses and in education. Yet the Health Service is the only one where the partnership of public and private effort is criticised both directly and, even more, by implication.

It is the Health Service which perhaps is in the greatest need of extra funds—about another £500 million a year if we are to keep the standard to what it should be. The increase in the last 10 years in private schemes shows the scale of the problem and the size of the demand. Nearly 2 million people are now covered by private insurance schemes, and possibly another 2 million actually use private practice without being insured. It is absurd to suggest that this presents a serious diversion of resources from the Health Service. At the very most it is under 8 per cent. of the population.

It is equally absurd to suggest that this presents a fear for the future. It does so only if we have given up hope of getting more resources into the Health Service and if we are to be content to run the service permanently starved of resources. I think that this aspect is worrying, especially with reference to capital development. Figures show that about 25 per cent. of total Government spending is on capital development and 75 per cent. on current, but in the Health Service it is only about 6¼ per cent. Perhaps that is why we have such a great need for new hospitals, particularly for long-stay patients.

The Government have no proposals to make, except patching-up proposals. They appear to have no ideas. We have not yet heard from the Secretary of State about the reallocation of resources. There seems to be no fundamental thinking about the future and there is still confusion about priorities of different aspects of the social services system. Certainly, there is no suggestion as to new resources.

The Secretary of State suggested that contributions could be raised. Of course they can, but that is not a new resources; it is taxation; and a tax is still a tax, even if it is called a contribution. A contribution paid by the employers adds just as much to the price of goods as a value-added tax or any other form of indirect taxation. The Government appear to have lost faith in their 1964 panacea, the policy to improve the Health Service by the rate of growth. Figures again show that whereas from 1964–65 to 1968–69 expenditure on health and welfare went up by 3.9 per cent. a year, the forecast for 1968–69 to 1971–72 shows no change at all, except a very small drop, 0.1 per cent.

Whatever growth of the economy and whatever savings can be made in administration and the better use of resources by increased efficiency, it will not be enough. I should be out of order in developing a discussion on Health Service finance, but there is a point of the argument which is relevant because failure to comprehend it has led to misjudging the rôle of private insurance schemes.

The functions of the Health Service can be divided into two. Using the same set of people, but providing a very different service, one could describe them, first, as the healing of the sick and the restoring of those who are ill to normal productive life, and, secondly, the care of the incurable and dying. It is this last part which puts the biggest burden on the service. It reduces the number of beds available from 1 per 100 to 1 per 400. This must be a charge which is a burden on the taxpayer and it must take a higher proportion of total resources devoted to the Health Service.

It is this which provides the strongest argument for encouraging private insurance, for if the taxpayers' contribution is confined to this half of the Health Service where it is the only reasonable source of finance and to subsidising need on the other side, then normal health, the sort of thing for which to use about half the Health Service and most of the private insurance schemes, becomes an insurable burden for ordinary people.

Figures show that, on average, people spend 12s. to 14s. per week on private schemes. This ties in with the work done on possibilities of public insurance schemes which work out at roughly the same level. Private insurance is not com- prehensive, but it could be as various companies have worked out, if the number of people covered went up to 12 or 13 million. Insurance itself is not an impossible method of financing the acute side of health care, provided those in need are subsidised and those who cannot be covered by insurance remain, as now, society's responsibility and a proper burden on the taxpayer.

The premium is not by itself excessive although it could be made so by tying it to the so-called contribution, which is actually an indirect tax. It works out at the cost of about three packets of cigarettes a week. If some such scheme were developed and private insurance schemes were developed this would leave more for those who really need it in the care of the subnormal, the mentally sick and terminal illness.

It is absurd to regard the growth of private insurance schemes as a threat to the nation or to the Health Service. Even the Government's Amendment does not say that private insurance does not make any contribution, although it implies that it cannot make much more. I think that many Government supporters approve of the use of private insurance schemes. It is equally absurd to imply that these schemes will need limitation or that their growth needs control. Rather they should be used to help to increase the total resources devoted to health care and to enable the taxpayers' money to be concentrated where it is most needed.

4.40 p.m.

The Secretary of State for Wales (Mr. George Thomas)

I beg to move, to leave out from "House" to the end of the Question and to add instead thereof: 'noting the development of schemes for private health insurance, recognises that these cannot provide an adequate alternative to existing methods of financing a comprehensive health service'. My right hon. and hon. Friends are very grateful to the hon. Member for Farnham (Mr. Maurice Macmillan) for his sympathetic remarks about the Secretary of State for Social Services. But I thought that his sympathy evaporated rather quickly and I shall, therefore, concentrate on the first part of the tribute he paid to my right hon. Friend.

The hon. Gentleman is probably mindful that this is the first debate that we have had on the Health Service and its financing in which I have taken part since the Welsh Office took over responsibility for the health services in Wales. I welcome the opportunity to take part in the debate, although I know that every hon. Member will wish my right hon. Friend a speedy recovery to full health. I am sure that his one anxiety is that he is not able to answer the hon. Gentleman today.

The National Health Service touches the life of every family in the country. At some time or another everyone comes in touch with the Health Service and this debate today is, therefore, of considerable interest in the country.

The Motion proposed by the hon. Gentleman was tabled following the Herbert Morrison Memorial Lecture given by my right hon. Friend the Secretary of State for Social Services. In that lecture, he discussed the question of private health insurance and the whole question of paying for the social services. The lecture followed very closely what my right hon. Friend said on 1st July, when the House was debating the financing of the National Health Service. On that occasion there was no exception taken to what my right hon. Friend said.

In the lecture, my right hon. Friend referred to the substantial increase in the cost of the Health Service and indicated that this would continue to grow despite the original assumption that by improving the health of the nation a comprehensive service would reduce the demand for medicine.

I think that we are all agreed as to why this has not proved to be the case. The general growth of population, the higher standard of health expected by people as a result of our higher standard of living, and the fact that the making available of services creates a demand for them, are all factors to be considered.

My right hon. Friend discussed what alternatives there were to taxation to meet the cost of the Service. His conclusion was that there is no viable alternative to the present methods of financing the Service.

In the year ended 30th June, 1968, I understand that the private schemes collected £14 million and paid out £12 million in benefits. I accept the figures advanced by the hon. Gentleman about current membership, although it has not been possible for me to check them.

The advantages derived from these insurance schemes are that they enable people to pay the cost of private treatment, to be treated by the consultant of their choice at a time convenient to themselves and generally in conditions of privacy.

But supposing these private schemes were increased say, fourfold, in terms of scarce skills and scarce resources, such schemes solve nothing. They might provide a minor economy in the cost of the Health Service—£48 million if increased fourfold—out of our £1,600 million for hospitals and general medical services, but, clearly, they cannot provide an alternative to paying for the Service out of taxation.

With a limited supply of skilled manpower and resources any considerable expansion in the private sector of medicine is bound to mean that there will be less of these resources available to the Health Service. Similarly, if the private sector were to grow to such an extent that a considerable number of leading consultants, doctors and nurses were to withdraw from the Service and treat only private patients, it would no longer be possible to say that all our citizens, irrespective of means, were able to obtain the same standard of medical care, and thus the comprehensive Health Service would be effectively destroyed. This is a question of the right use of the resources within the Health Service.

Our first responsibility must be to see that there are adequate health services and that the availability of services shall be according to medical need and not according to ability to pay. The logic of the Opposition's case is that everyone able to join a private insurance scheme should do so, thus leaving only the very poor to be cared for by the Health Service. This is a philosophy and a policy which we reject completely.

The achievements of the Health Service have been substantial, and all of us who believe in it have reason to be proud. Against a 14 per cent. increase in population since the Service began and with little change in the number of beds, there has been an increase of over 70 per cent. in the number of in-patients treated each year, a 40 per cent. increase in the numbers attending accident emergency departments and a 25 per cent. increase in the number of out-patients.

At the outset of the Service about 350,000 people were employed in it, but now there are over 700,000. Capital outlay spent annually on hospital building has increased from an original £10 million to something like £100 million per year.

I can understand the hesitancy of hon. Gentlemen in talking about the running costs of a new hospital because they do not have much experience in this regard. The experience is coming because of the policy which the Government are adopting.

Mr. David Gibson-Watt (Hereford)

A good point.

Mr. Thomas

It is a good point. That is why I said it.

The hon. Gentleman the Member for Farnham paid me what I call a Dutch compliment. He said some kind words about me, and then said that I had a gift for making obscure the real facts. Now I am determined to lay before the House the truth, and nothing but the truth, so help me, which is my common policy. I listened with care to the hon. Gentle man in case he had a new contribution to make. As he was so generous to me, I do not want to be unkind to him, so the best thing that I can do is move on.

The achievements of the Health Service have been substantial, and I know that we all accept that. Complete new hospitals have been built, and improvements to old ones are going on all the time. This is not to say that everything has yet been provided, for this is a long and substantial process, and a good deal remains to be done, but not, as I think will be clear from what I have said already, through finance raised by the relatively small resources of private medical insurance. To get this into its proper perspective, the House should know chat the number of private patients treated in our hospitals is about 2 per cent. of all the patients treated. The vast majority of people prefer the Health Service.

While there is still much to be done to improve the N.H.S. in replacement of old hospitals and the more equal distribution of resources throughout the country, nevertheless the House should acknowledge that it provides a service second to none for the seriously ill patient. Urgent cases are admitted without undue delay, they receive expert attention, and all the resources of modern medicine, including recent technological developments, are at their disposal. In respect of comprehensive facilities we have a service unmatched by any other country, and certainly unmatched by anything that the private sector can offer.

But there is another side of the coin which I acknowledge. Because, as the hon. Gentleman reminded us, 52 per cent. of all admissions are urgent or emergency cases, people with non-urgent but often highly inconvenient conditions find that they often have to wait for out-patient appointments, and still longer for admission. At the end of 1968, 534,890 patients were awaiting admission. This was a small reduction over the 1967 figures. Before the noble Lord the Member for Hertford (Lord Balniel) thinks that he has something to smack his lips about, let me tell him that this was the first recorded reduction in the waiting list since 1962. Of these, 78 per cent. were surgical patients. It is for such reasons that people find it worth their while to join private health insurance schemes.

Our aim is for a steady advance in the quality of our Health Service, and no one should underestimate the tremendous achievements in its first 20 years. Hospital medical staff had risen by 81 per cent. in 1968. The number of consultants has more than doubled, and in the three years from 1965 to 1968 the number of consultants rose by just over 9 per cent.

I am glad to tell the House that the proportion of all consultants who are full time is rising gradually from 31.8 per cent. in 1965 to 33.2 per cent. in 1968. In the main, this reflects choice by consultants themselves, because few posts are advertised on the basis that the holder must be whole time. By the more intensive use of available facilities, the number of operations performed in England and Wales has increased since 1961 by more than 21 per cent.

The difference between the Opposition and ourselves is not far to seek. They have never liked the Health Service. I was a Member of the House when the Health Service was first initiated. In fact, several of my hon. Friends were here at the time, but I do not see anyone on the benches opposite who was present on that occasion.

Dr. M. P. Winstanley (Cheadle) rose—

Mr. Thomas

I hope that the hon. Gentleman will succeed in catching the eye of the Chair, because he will do greater justice to himself in a speech than in an interruption. I remember the vote against the Bill on Second Reading. We regard the service as having a major claim upon us. They believe that it is in the interests of the Health Service for us deliberately to encourage the growth of private health insurance schemes. That is the case that was advanced this afternoon. We put our emphasis on a continuing improvement in the Health Service itself.

This debate is really much ado about nothing, for I want to make it perfectly clear that no one in the Government is proposing, or has proposed, a withdrawal of the facilities at present provided for private practice.

In a leading article on this issue, the Daily Express said recently: Individual choice is a vital element in a democracy. I agree, and the Government agree, and there is no intention at all of interfering with individual choice in this matter.

I cannot help reflecting on the fact that the hon. Member for Farnham, and the noble Lord who will wind up the debate for the Opposition if he catches the eye of the Chair, as I expect he will, are both Old Etonians. It is not an offence to mention it, surely? They proudly wear the old school tie. They are rarely without it, although its influence is ever-diminishing. As they see the privilege of the old school tie disappearing in society today, it appears that their philosophy is to encourage privilege for those with the deepest purse. [An HON. MEMBER: "The right hon. Gentleman can do better than that."] I am trying very hard.

Now a kind word for the noble Lord the Member for Hertford. He is known, and I mean this most sincerely, as a man of considerable compassion and concern for old people and the poor in our community. He is constantly at that Box reminding us of it, but the greater the encouragement that he gives to the growth of private schemes the more he is likely to damage the interests of those who cannot afford to pay.

Surely our ideal is that everyone who seeks the help of the Health Service shall feel that the very best that the country can give is available on the basis of need and not on the basis of ability to pay. The Health Service is not a charitable institution, but is paid for by all our people. If we are to be a civilised society we must make it our aim that the day shall come when no one shall feel that there is any advantage to be bought by private insurance, because the Service provides all that is desirable.

While we take note of the development of schemes for private health insurance, we on this side are convinced that they cannot and will not provide an adequate alternative to the existing method, by which we maintain the best comprehensive medical service in the world.

5.2 p.m.

Mr. Victor Goodhew (St. Albans)

I always enjoy listening to the right hon. Gentleman the Secretary of State for Wales, and I did so again today, even if he did not himself write that speech. I take it from his comment that he was doing his best that he did not write it. However, when he starts talking about the "old school tie", and so on, it makes me feel that I am in the Chamber in 1919 rather than in 1969. I have never heard such a ridiculous speech, with so much tremendously biased and prejudiced old-hat stuff. Someone must have dug it out of Transport House, and shaken the dust off it that had collected since 1919 or 1920. I am sure that the right hon. Gentleman could not have believed what he was saying—[Interruption.] I am not an Old Etonian, nor am I an Old Harrovian—and do not let us go through the whole list.

The Secretary of State shuffled from one argument to another trying to be all things to all men while still coming out with this great Socialist jingoism and anti-Tory feeling. He started talking about the danger of any extension of the private sector resulting in damage to or contraction of the National Health Service. If he fears that, why did he later say that the vast majority of people preferred the service, because only 2 per cent. used private practice? If that is so, any attempts to expand private provision will fail—so what is all the fuss about? The right hon. Gentleman cannot have it both ways.

Does his party take the view that private provision of housing or pensions is equally a danger to the national provision? Are he and his colleagues coming round finally to saying that the State should provide everything for everyone? If we are being told that at the next General Election they will say that no one should be allowed to provide his own housing or pensions or education—[HON. MEMBERS: "Oh."] They must have a principle somewhere amongst them—just one. It seems to me that they just dodge about, and say that in the case of the Health Service private practice is bad but that private provision in every other sphere is good.

The Government Amendment is one of the most negative I have seen in the Order Paper during the 10 years I have been a Member. It is difficult to see its object. The Government might just as well have left our Motion as it was and voted for it. It welcomes the development of private health insurance, and I should have thought that the Government, too, would have welcomed it.

Private provision injects into the health sector £13 million a year. The Government should not be dismayed at that. If people want to inject such sums as that into the nation's health services, the Government should welcome it. It is done by people already paying their dues for the Health Service, so they are not opting out of their obligations. As a result of this private provision, hospitals are established which provide additional beds.

Many doctors and consultants who might otherwise have emigrated have remained. Did the right hon. Gentleman read the article in The Times on 1st December? My hon. Friend quoted from it, and I shall do the same. It said: Doctors are very conscious these days of being part of an international labour market. They know that there are lucrative posts available in Canada, the United States, and Australia, and the rate of emigration will naturally be influenced by medical earnings in Britain. If private fees persuade a doctor who would otherwise have gone overseas to continue in practice here, everyone gains—provided that he devotes part of his time to the National Health Service and that he treats his National Health Service patients with proper professional care. If improved facilities, purchased with private money, can also be put at the service of N.H.S. patients so much the better. The closer the partnership between private and public medical care the greater the chance of private finance flowing into the bloodstream of British medicine. That paper is not notoriously Right-wing Tory, or Monday Club, or anything like that. The majority of these doctors and consultants take their part in the Health Service as well, and there are many in the service today who would not be in it but for this private provision.

I am not as complacent about the Health Service as is the right hon. Gentleman, but we all recognise that it has achieved a great deal, though it must be realised that it also relies a great deal on this private provision. If it had to meet the requirements of those who are at present treated privately it would be under much greater strain.

The Secretary of State talked of the individual's right. What is wrong with the individual having the right to spend his own money as he wishes? My belief is that the Government should encourage private provision by tax relief—[HON. MEMBERS: "Oh."] Let them look at the whole public expenditure and see what it costs because they encourage people to lean on the State instead of providing for themselves. Tax relief for people in insurance schemes like this would cost less than providing the services that those people would otherwise use.

In any event, it is better to encourage individuals to provide for themselves than to lean on the State, because it produces a responsible society. Is the right hon. Gentleman so happy that today our society is very often seen to be somewhat irresponsible? How much of that is the result of people depending too much upon the State rather than accepting responsibility of providing for themselves and their families, and themselves having to order their own priorities of expenditure?

Right hon. and hon. Members laugh—I do not understand how they can. They are faced with expanding public expenditure in the years to come. They thank God, will probably not have to look after that themselves, but any Government must face it. And this is at a time when the balance between the relatively rich and the relatively poor has so changed that we should be looking at the whole question of the Welfare State, and asking whether the assumptions of the 'forties, based on the conditions of the 'thirties, are tenable now.

One thing is certain, that we need people today to provide for themselves those things that they can, because only the Government can provide certain other things, like defence, police, and the law courts. So any Government should be anxious to encourage people to provide for themselves.

There is nothing wrong in anyone in this country deciding that he would prefer to use his money to buy for himself or his family privacy in a hospital, or special service such as he gets in a private hospital, rather than consumer goods or leisure pursuits. Is there anything dreadful in that? Would the right hon. Gentleman challenge the right of any father to say that he would prefer to spend his money on insurance so that his children or his wife can go into private accommodation, rather than blueing it on bingo or a new car, or both, or holidays abroad?

These are the decisions which people must make about their priorities. There is nothing wrong in people prefering to buy these things for their families rather than things which they regard as less important. Would not the Chancellor be glad to see more people spending money on this than on consumer goods? The right hon. Gentleman might ask him one day. There is nothing unfair in this and it is ridiculous for hon. Gentlemen opposite to pretend that people with this sense of responsibility should be prevented from exercising it—[HON. MEMBERS: "No."]—Hon. Members may disagree, but the general tenor of their remarks is that any expansion in this field must be prevented at any cost. Anyone who prefers to spend money on health insurance, pensions, housing or education should be encouraged to do so, rather than condemned for it.

It is the party opposite who, in its whole approach to this debate, condemns people who wish to do that instead of encouraging them. This is Socialism at its worst. It is the idea, which we have heard here before, "If we cannot all afford to go to the Ritz, nobody should be allowed to do so. If some people are profligate and prefer to waste their money on less essential things and then lean on the State, we must not allow other people to provide these things for themselves for fear of showing them up".

It was Nicholas Murray Butler who wrote: False democracy shouts—Every man down to the level of the average. True democracy cries—All men up to the height of their fullest capacity for service and achievement. It is the party opposite who, in this as in practically every other matter which comes before the House, shows itself in favour of false democracy rather than true democracy. This is why, when the time comes, the electorate will reject it once more, as they have in recent by-elections.

5.15 p.m.

Mr. John Cronin (Loughborough)

I enjoyed listening to the hon. Member for St. Albans (Mr. Goodhew). His speech had a refreshingly light-hearted side to it, but I hope that he will not expect me to take it seriously or follow him too closely. In some respects, he is pushing against an open door when he says that we on this side should be more agreeable towards private practice. No one, on either side, seriously questions the right of anyone to spend money as he thinks fit, provided that it is not contrary to the public interest. Obviously, there are occasions when people require privacy, or want treatment at a special time, or have a particular desire to choose their own consultant. It is reasonable and proper that they should, therefore, spend money on this as they think fit.

Both sides of the House, and perhaps particularly my right hon. Friend, should appreciate that private practice is of some substantial advantage to the National Health Service, in that it is an additional emolument for consultants which costs public funds nothing. This should be remembered.

We should also remember that there is, in effect, an open market on consultants' services. These private insurance schemes, in effect, are concerned only with consultants' services. There are no private schemes—or hardly any—for general practitioners' services. Obviously, they would be unworkable. In terms of a market, a London hospital consultant who sees a patient privately in his rooms in Harley Street or Wimpole Street will get 10 10s. for a half-hour consultation. If he is a surgeon, that is more than he will get for operating the whole afternoon in his teaching hospital, presuming that he gets even a higher rate of pay.

So, if one accepts that there is an open market for consultants' services, there is no doubt that private practice adds massively to the emoluments of consultants at a very small cost to public funds.

Mr. Laurence Pavitt (Willesden, West)

Does my hon. Friend say that a consultant surgeon with an "A" merit award, working in a London teaching hospital, gets only £10 a session?

Mr. Cronin

Approximately in that case it could be about £15. The basic fact is that, in half an hour, he can make roughly the same amount just by seeing a private patient as by a whole afternoon's onerous and heavy work in the operating theatre. I beg my hon. Friend to beat in mind that I have been in this situation, or, rather, in similar situations, so I know at least as much as he about the economics of the situation.

Sir Brandon Rhys Williams (Kensington, South)

Would it be true that a consultant, out of his fees, must pay rent and assistants and many other things which do not apply in the other case?

Mr. Cronin

This is true, but, if one takes the net figure there is no doubt that private practice enormously increases consultants' emoluments and, therefore, is a force which keeps him working for the Health Service at what is, in effect, a reduced standard of emoluments by the service. We should also remember that this is an international market. About 20 per cent. of doctors every year go to work in the United States and the Commonwealth countries. Again, private practice is unquestionably an inducement to them to stay here.

We should be clear in our minds that private practice is not, in itself, an evil force in the treatment of health, but it can be abused. For that reason, the Secretary of State for Social Services is well advised to suggest that there should be some inquiry into the effect of private practice on the Health Service. There are various ways in which it can impinge on people. First of all, it is not an uncommon practice for a consultant to see a patient privately who needs an operation and is on a waiting list.

These waiting lists are under the control of consultants. They decide which patient shall come in first. It would be contrary to human nature if a consultant did not have some feeling of indulgence towards a person who had seen him privately, even if he takes the strictest view of a person's priorities from a medical aspect. Inquiries should be made into that matter. I do not suggest for one moment that it is a widespread abuse, but it is a potential abuse.

Mr. Keith Stainton (Sudbury and Woodbridge)

Does not the hon. Member agree that this is a relative question? In the hospitals in Suffolk the waiting lists are six months for appointments with E.N.T. specialists and four months for appointments with orthopaedic specialists—and I refer to appointments and not to operations. In considering how private practice impinges on the Health Service. we must look at the reverse, too.

Mr. Cronin

I accept the point.

The next important question concerns the extent to which a consultant's energies and time are diverted by private practice. A large proportion of consultants do a maximum number of part-time sessions and devote the rest of their time to private practice. Everyone appreciates that in the Health Service an enormous burden is placed on registrars—a much heavier burden than should be placed on them. Almost every week we read of some disagreeable happening in a Health Service hospital, and almost every time we read that no consultant appeared on the scene at all. One wonders whether private practice is causing some diversion of the consultants' time and energies and whether too large a burden is being placed on the shoulders of registrars, who often are ill-equipped to cope with the more difficult technical problems.

Thus, the use of private health services may well be causing some diversion of resources. But in terms of the total cost of the Health Service, the £12 million a year paid out on these schemes cannot be an enormous diversion and there is not much reason to fear what will happen if the private health schemes increase by, say, 50 per cent. in the next 10 years. I do not think that that would cause a serious diversion of resources from the Health Service.

Hon. and right hon. Members on both sides of the House must bear in mind that ever since 1946 there has been a steady growth in private health insurance schemes. That steady growth, which has taken place irrespective of the Government in power, must indicate beyond all doubt that a large proportion of the people are dissatisfied with the treatment which they get in the Health Service. There can be no escape from that conclusion.

At present, about 2¼ million people are covered by these private insurance schemes. That indicates that these people are prepared to divert a substantial part of their economic resources and that they want nothing to do with the Health Service. That is a criticism which we must accept.

Mr. John Mendelson

So far, I have followed my hon. Friend's argument, but he is beginning to misrepresent the case. What many people want is not to have nothing to do with the Health Service but to have all the advantages which a consultant can get them within the service.

Mr. Cronin

My hon. Friend does not grasp the point. I am talking exclusively about consultant services. When the prospective patient joins a private insurance scheme he gets his treatment entirely outside the Health Service, except that he may use a room in a hospital, and of course he pays for it at economic rates. He puts himself outside the service except in terms of renting that room.

Mr. Mendelson

And also in terms of the consultant's time. It is a case of jumping the queue.

Mr. Cronin

I take the point, but I cannot carry out a dialogue with my hon. Friend.

The situation is clear. Millions of people are voting with their pocket books to have treatment outside the Health Service. Whatever my hon. Friend says, that cannot be a compliment to the service.

Mr. Mendelson

It has nothing to do with it.

Mr. Cronin

This situation disturbs me. The Secretary of State for Wales said that the Health Service provides medical resources second to none and my hon. Friend the Member for Penistone (Mr. John Mendelson) is making interjections along similar lines. But we cannot accept the present situation. We must improve the service.

Mr. George Thomas indicated assent.

Mr. Cronin

I am glad that my right hon. Friend agrees. There is no room for complacency.

The Secretary of State said that there was no alternative to taxation in order to improve the finances of the Health Service. It must be largely a matter of additional finance for providing better buildings, better staff, more nurses, more doctors and more facilities in every way. But, while I do not want to go outside the scope of the debate, I suggest that more financial resources would be available if cost-effectiveness were introduced as a principle into the Health Service. At present, only lip-service is paid to it.

Every doctor is entitled to prescribe whatever treatment he wishes, irrespective of cost-effectiveness. In practice, general practitioners and consultants all over the country have a cheque book on the nation's finances over which no one out themselves has any control. That situation cannot make economic sense. If it were negotiated sensibly and carefully, surely some better arrangement could be made with the medical profession.

Millions of pounds are spent on drugs which are either inert or are unsuitable for the illness in question. This is largely due to the frenzied promotion by the drug manufacturers, which has a powerful psychological effect. An immense amount of treatment is given which is of dubious value. The hon. Member for Sudbury and Woodbridge (Mr. Stainton) spoke of the waiting lists for the ear, nose and throat consultants. We know that 200,000 sets of tonsils are taken out every year. In sore districts the operation is twenty times more frequent than in other districts. This shows more enthusiasm than regard for cost-effectiveness.

The same comment could be made about appliances. It is difficult for a consultant to refuse anyone who says, "I want an orthopaedic corset". He knows that if the patient does not get it he can go back to his general practitioner and say, "That consultant is no good". The consultant's reputation is then impaired in the mind of the general practitioner. There is immense room for increased cost-effectiveness on such matters in the Health Service.

The fact remains that improving the Health Service also requires some form of increased taxation. There is no escape from that. Perhaps it could be an increased contribution levied on employers or on employers and employees. But the Health Service cannot continue to be efficient on the rather beggarly finances it is receiving at present.

I do not wish to speak longer, because many hon. Members want to take part in the debate, but I wholly deplore the Opposition Motion, which can make sense, as the closing part of the speech of the hon. Member for Farnham (Mr. Maurice Macmillan) underlined, only in terms of increasing the insurance aspect of the Health Service. That is contrary to the whole idea of a free, comprehensive Health Service—an idea which has the overwhelming support of the country. The hon. Member did not come completely out into the open, but he made it fairly clear that the Opposition are basically opposed to the humane and popular idea of good, comprehensive, free treatment under the Health Service.

Several Hon. Members rose—

Mr. Deputy Speaker (Mr. Harry Gourlay)

Order. I must remind hon. Members that this is a brief debate. Perhaps they will keep their speeches brief.

5.30 p.m.

Mr. John Pardoe (Cornwall, North)

I am puzzled by the Motion because it asks us to welcome the development of private health insurance schemes and any welcome that one would give them would depend very much on the reasons for the development. If the development is due to inadequacies of the National Health Service, I admit that I do not welcome those inadequacies and, therefore, I do not welcome this development. If the welcome is given in the belief that this development can somehow solve the problems, I admit again that I do not welcome it.

As has already been said, the development of private health insurance cannot create new resources in the sphere of health in this country. They are limited by under-investment in the past and by bad planning. I listened with great interest to a Conservative Party broadcast on the radio two nights ago when we were told how much the previous Conservative Government had cut taxation. In fact it is not true, because the total of taxation went up by many thousands of millions of £s, but in so far as the Conservative Government were successful in cutting back the proportion of the gross national product which went into taxation, they were also successful in reducing the resources which went into the National Health Service.

When, the following day after the broadcast, I read about the condemnation of the children's ward in Paddington Hospital as unsuitable, I thought that the chickens had really come home to roost and that this was precisely the price which the nation had to pay for having under-invested in health resources in the past. The damage was done, of course; I have no brief for this Government, but it was not done by this Government. It may be true that the present Government do not have adequate plans for the future of the National Health Service, as the hon. Member for Farnham (Mr. Maurice Macmillan) maintained. But where are the plans of his party? Where were their plans in the 1950s when they could have been laying down the foundations for hospitals in which children would not have to die in inadequate children's wards?

In fact, I regard the provision of private health insurance as something of a red herring if one is considering it in the totality of the National Health Service. If we compare it with the size of the problem, we find that it is just spitting in the ocean. The cost has more than doubled, from £830 million to £1,720 million in 10 years. Taking the figures for 1967–68, we find that charges were £31 million, which was only 2.1 per cent., and contributions were £141 million, which was 9½ per cent. So the £12 million spent by the private insurance schemes last year is a very small amount even if it is compared with the small amount which came in from charges and contributions. It is indeed hardly worth making such a fuss about, as the Secretary of State seemed to do or as the Motion seeks to do.

I see no reason at all for abolishing private health insurance. The Secretary of State speaks in his pamphlet of unplanned growth, and I am bound to ask what that means. Was it growth, or lack of growth, which was responsible for the lack of hospital expenditure in the 1950s? If it was lack of growth, was it planned or unplanned? I suggest that it was planned and that planning has led to the present chaos.

Should private facilities be limited? Should they be discouraged, or should they, as the Secretary of State is aiming to do, be merely discouraged by threatening them vaguely in the hope that a degree of uncertainty about their provision in the future will prevent further growth? This seems to be another piece of government by kite-flying.

I am not insured privately at present, but I suspect that I shortly will be. I have not been insured with private insurance schemes primarily for political reasons. I make that quite clear. I have a political objection to taking advantage in this way, and I have had this objection for many years. I do not want private health schemes to undermine the National Health Service. But I must say that I have waited long enough for the National Health Service to catch up with the standards that I require. When a company with which I am associated suggested that we might have a company scheme by which one gets substantial reductions, the temptation has become fairly strong and one has to ask oneself a series of questions.

For instance, how long does one have to wait if one wants an appointment at an out-patients' department of a hospital, or as an in-patient? One has to wait a very considerable time indeed, as I know to my own cost from recent experience. If money is not available to provide the facilities that I require in the National Health Service, this is because other people are not prepared to pay as much for their health as I am prepared to pay. Do I as an individual have to hold back from paying this money if others prefer, perhaps, colour television, or a second car, or perhaps a new car every other year instead of every four or five years?

The basic problem that faces us is a shortage of resources. Therefore, we have a need for rationing. I certainly do not wish rationing by the purse. That is the last thing in my political philosophy. Inevitably, one gets a certain degree of queue jumping. One sees cases of it in one's constituency all the time. It is simply paying on the side to get services that one would not otherwise have. This is nothing more than a black market in medical resources, and I accept that this is so. Of course, queue jumping takes place.

I have one or two illustrations which I should like to mention. I have a letter from a constituent who wrote in June about a friend as follows: This lady has a daughter who has had very acute tonsilitis three times in very quick succession and the child was very ill this last week. Her doctor advised her that an operation for tonsilectomy was imperative and that she should be seen by a specialist at the earliest moment. This had to be done in spite of the girl's acute condition as the doctor wanted him to see for himself the state that she was in. The specialist agreed that an operation was absolutely essential if the girl was not to deteriorate further but that there would be a wait of at least two to three months. This he said could be overcome if she agreed to her daughter being taken in as a private patient and would be attended to immediately the acute condition had subsided, but the cost would be about £60. This is quite blatant blackmail.

Lord Balniel (Hertford)

This, I agree, seems to be utterly wrong, but surely the position is that under Section 5 of the 1946 Act if any individual is in urgent need of medical attention a pay bed must be made available. Surely that is the case.

Mr. Pardoe

I will come on to this problem of what various individuals regard as medical priority because it is a matter of definition.

I have a letter from a Methodist minister in Cornwall who sent me a resolution passed by his Methodist circuit, the members of which were concerned about the waiting list and the extension of the practice of private insurance. He said: The fact remains that if it is possible to see a consultant within a few days by paying the fee as an alternative to several months waiting as an out-patient, then admission to hospital is accelerated by precisely that period. Recently I was speaking to a man with a painful condition who was told that the waiting list for a consultant was eleven weeks. As a young working man with a family he could not face that, so he opted for a private consultation which was arranged within two days. He thus got admission to a hospital nearly eleven weeks sooner than he otherwise would have done. These are two cases which have come to my notice, and I have many more. This is clearly queue jumping which is inexcusable and ought not to be necessary.

The really sick will always get treatment under the National Health Service—I accept this—but the problem is that medical priority is a subjective matter in the mind of the patient and is an objective matter in the mind of the consultant or the doctor. There are no absolute methods of measuring medical priority. It depends, too, on which part of the country one happens to live, to a large extent. Therefore, if the patient wants to be sure of getting treatment where he wants it, he must pay for it.

What are the reasons why many of us consider insuring privately? Let me make it clear that the cost is not considerable. For a family of two adults and three children it amounts to £50 a year, or roughly £1 a week, less than a packet of cigarettes a day—and I do not smoke—less than the additional cost of renting a colour television instead of my present black and white set, and very much less than the cost of running a second car.

The first reason is privacy, and to some people this is more valuable than it is to others. Some people are naturally gregarious and do not mind going into a hospital ward with many others. Having spent some time at a boarding school, not that attended by the noble Lord, in dormitories and then, in National Service, in barracks, I have had enough of gregarious getting together in wards. The next time I am ill I should very much like to be in a private ward.

I do not think that I shall wake from unconsciousness, as the hon. Member for Ebbw Vale (Mr. Michael Foot) is alleged to have done, very nobly, and say that I want to go into a public ward. It may not be a commendation for the future, but Loyola founded the Jesuits because he had a long period on his back in solitary confinement where he could think. We would never have had the Jesuits if he had been in a public ward, because one cannot think there. Many of us may come to dying in a ward, and I must admit that I should prefer to die in privacy than having to keep up a front before everyone else.

The second main reason for paying private insurance is that one can have the treatment when one wants it. I recently had to make four visits within four or five weeks to an out-patient clinic. Each appointment took only about a quarter of an hour, which made a total of one hour. Leaving aside travelling time, I was never there for less than one and a half hours, even though there was allegedly an appointments system and in the four visits that is a total of six or seven hours. Time is valuable to most people and it is worth paying something for it and it is legitimate to want to do so.

A third major reason is that one may have the specialist of one's choice. That is not very important to me. I do not know the medical profession well enough to know who I want to operate on me when the time comes and I do not think that I would care very much.

The fourth major reason, which I believe to be the most important, is disgust with the services offered by the National Health Service. I think that this disgust is increasing and I am not surprised that there should be an increase in a desire for private insurance to try to by-pass the agonies which one has to suffer in some sectors of the Health Service. Every hon. Member knows that he is besieged by letters from constituents who have had to wait long periods to go into hospital.

Mr. Albert Booth (Barrow-in-Furness)

If what the hon. Member is now alleging is true, and I dispute it, would it not be an argument for a general improvement in the standards of the Health Service and not an argument for permitting those who can afford to do so to purchase something better?

Mr. Pardoe

I entirely agree. I do not think that the hon. Gentleman was present when I said that the problem was that many people were simply not prepared to pay for the Health Service. That is blatantly true. Neither the Labour Government nor the Tories are prepared to pay for a decent Health Service. If they are not prepared to pay, am I not allowed to opt out of their decision—their decision, not mine?

Part of my constituency is in the Plymouth clinical area, which has 17 people on the waiting list for every 1,000 population. This is a very high figure compared with many other areas. The figure for Devon and Exeter, for instance, is 10 per 1,000. It is not surprising that I am submerged by requests to speed up the process, and doctors do not like their patients to contact Members of Parliament—one has grave reservations about delving into this jungle at all.

As a result of the lack of resources in the Health Service, there is an increasing tendency to centralise services in larger units. This is leading to great inequalities in different parts of the country, particularly between urban and rural areas. There is no doubt that rural areas are getting a raw deal. Cornwall now has a second-class health service. It may be said that it costs more to provide a Health Service for a rural community than for an urban community and that therefore Cornwall can be afforded only a second-class Health Service, but if we are to have a second-class service, we ought to pay only a second-class price.

There is nothing in the Act which brought the Health Service into being—and, incidentally, we had a health service in 1911, long before the date mentioned by the right hon. Gentleman—which says that some citizens should have worse services simply because they live in rural areas. We legislated on the principle, which I regard as a noble principle, that poor people should have as good a service as the rich. Yet, apparently, we happily accept the principle that people in rural areas should have an infinitely worse service than those who live in urban areas, and there is no doubt from the figures that that is so. A modest request for physiotherapy out-patient treatment in Launceston and Stratton, two small hospitals—

Mr. Deputy Speaker (Mr. Harry Gourlay)

The hon. Member must come a little more precisely to the Motion time is getting on.

Mr. Pardoe

I accept your guidance, of course, Mr. Deputy Speaker, but the Motion welcomes the development of private health insurance and I am arguing that the reason for the development of such schemes is disgust with the Health Service. I have had to recommend some of my constituents to go into private health insurance simply because of this factor. If hon. Members opposite think that the Health Service is satisfactory, that is their opinion and they are entitled to it. But I maintain that there is an increasing lack of confidence in the Health Service and that that lack of confidence is brought about by lack of resources and that that is the main reason why people are moving into private insurance.

One of the great advantages of having a national health service should be that one could rely on an adequate system of public inquiry if the system falls down in an individual's case. We have already had an Adjournment debate on the case of Guy Alderson. The assurances which I have received from the Secretary of State in this matter are quite inadequate to give the father of Guy Alderson, who died as a result of a mishap in Guy's Hospital, any confidence in the Health Service and I would have thought in his position that the answer was to seek a way out of it. I hope that the Parliamentary Secretary will have another look at this case about which I have written to his right hon. Friend in the last few days.

It would be wrong to discourage the development of private insurance schemes. I believe that they offer people a way of buying privacy and of buying certain facilities that are not necessarily strictly health facilities. I am aware that right hon. and hon. Members opposite will defend the National Health Service to their dying day. I support it as much as they do, but I also defend the right of people to go on paying for privacy and other side facilities if they want to do so.

Mr. Deputy Speaker

I hope that hon Members will bear in mind the appeal which the Chair has already made for short speeches.

5.50 p.m.

Mr. Laurence Pavitt (Willesden, West)

We have just listened to a weird speech from the hon. Member for Cornwall, North (Mr. Pardoe). It contained practically everything. I congratulate the hon. Gentleman on his analysis of the neglect in the past. There are still many things to be done, and I admired him for his logic when he decided that these insurance schemes do undermine the National Health Service. Then he spent a lot of time telling us why he was prepared to join one. He then destroyed his own logic. The hon. Gentleman said that the reason for the growth of these schemes was the general disgust with the Health Service. This is absolute nonsense.

Mr. John Mendelson

Demagogic nonsense.

Mr. Pavitt

The hon. Gentleman himself demonstrated that one of the reasons why there has been a growth in insurance provisions is because of the large number of companies offering participation in group schemes at cheaper rates as a bargain. If a person joins with a group he gets special facilities, and we all like bargains. My great regret is that in this House, which is under Government control—and the Government are not in favour of these schemes—one can see advertisements aimed at Parliament's employees for group schemes downstairs, and in most of the Ministries in Whitehall civil servants are invited to join in such schemes. I find this contradictory.

The Secretary of State for Social Services has said that these schemes are not to the advantage of the N.H.S., and I congratulate the Opposition upon getting us another debate on the Health Service on the strength of that statement. I also thank hon. Gentlemen who have taken part so far for making it so wide that we have been able to discuss almost the whole N.H.S. The Fabian Society is possibly the only society which could publish a pamphlet which makes the Opposition hold a debate in the House of Commons within ten days of its publication. Here I must declare an interest as a member of the Fabian Society. The hon. Member for Farnham (Mr. Maurice Macmillan) said that 60 per cent. of people engaged in these schemes are using the National Health Service. What he is saying is that this is a piggy-back sector which the rest of us carry as a weight on the shoulders of us all.

The hon. Member for Cornwall, North was quite right when he said that we all pay for the National Health Service. We pay about £1 a week for each wage earner. Through our mutual efforts we provide a wide variety of services and on our backs we have the additional weight of those with the power to pay collectively in insurance schemes, or privately, to use the whole of the services which I and others have provided. Of course there is freedom of choice—it is the choice to use the services that I have paid for. I object very much to this, which is all part and parcel of the idea that the power of the purse is all. It runs contrary to the basic concept of the National Health Service, that medical need should be the only deciding factor.

It is not just a question of beds or privacy. Everyone who goes to hospital as an out-patient or an in-patient knows that when a person goes as a private patient his files, which go through all the departments, physiotherapy, radiography and any others, are marked at the top "P.P."—private patient. It is all very well to say that the answer is to get rid of the waiting system. What do we do? Are we to organise illness as we would organise a production line, so that people get ill at regular intervals and do not have influenza epidemics when hospital beds are full?

The inevitable consequence of any health service is that there will be waiting time. But if people can jump the queue by paying it is unfair upon those who cannot. The hon. Member for Cornwall, North was lucky to be quoted the price of £60 for an admission. Hospitalisation in a London teaching hospital is nearer to £80 a week.

Dealing with the number of beds, only 2 per cent. of our beds are pay beds. I gave these figures in a letter to The Times some time ago. In 1964 the number of pay beds available in the whole of the country was 4,033 and the occupancy rate was 1,916. In 1966 it was 4,030 with 1,928 occupied which is 47 per cent. of the pay beds being used. The rest were not occupied by paying patients.

In Scotland it is even worse. From a total of 571 available only 231, 40.5 per cent., were used by fee-paying patients. I have to give credit to some consultants. It is true that people can sometimes jump the queue with the help of consultants. I can cite the case of a consultant in a teaching hospital not far from here. A friend of mine had the problem of cancer of the breast and was extremely worried about it. A date had been arranged for an emergency operation within a fortnight. My friend felt that it was not possible to wait that long and went to see the same consultant in his Harley Street practice who said: You can come privately but you cannot get in for six weeks. I can take you in 14 days under the National Health Service. A large number of consultants do take these ethical considerations into account.

No one wants to go into hospital, and when they do they cannot help it, and want to make the best of it. If we have the private schemes as well, we will create a first and second-class tier in the service. The more the private schemes are successful the more downgrading there will be of the N.H.S. We create the incentive for people to obtain these advantages and not the incentive to raise the whole standard of the health service. The hon. Member for Farnham has given us the figures for the private schemes, £14 million with £12 million paid out in benefits. I can think of many ways in which this money could have been spent on the National Health Service. I would much prefer it to go to the nurses. It would be put to far better use than using it for the additional comforts of self-interest. As hon. Gentlemen may know a sister in charge of a ward at a teaching hospital in London receives 18s. 6d. for working an extra day, on a Sunday, after a full week's work.

Of course there are still things to do in the National Health Service, but for the Opposition to use one of their Supply Days on this kind of Motion is deplorable. Perhaps they hope that it will appeal to the snob instincts of some of their supporters, or that they will appear to be holding the banner of freedom—allowing people freedom to jump the queue. I congratulate the hon. Member for Farnham because he hardly touched insurance but went a little more seriously into the subject of the N.H.S. and dealt with other, more important issues.

Like so many debates in which I have taken part over the last ten years, this one has rehearsed a good many of the points that we are continually making about the Health Service. A comprehensive service can only be paid for comprehensively, and if we are all paying for it, we must control it. If we control it we must have the facilities. I accept the hon. Gentleman for Cornwall, North's point that there should be a spread of facilities and that the urban area should have no advantage over the rural area. This is all within the planning possibilities of the Health Service, but this 2 per cent. peripheral matter of insurance is not important. The nightmare that was raised for me by the right hon. Gentleman the Member for Farnham opposite was that he felt it was important. If the door opened by the small insurance schemes like B.U.P.A. widened further, there could be a tremendous "killing" in terms of profits by much bigger fish in the insurance world. I had the privilege of seeing the Blue Cross and Blue Shield schemes in the United States. Lord preserve us from getting into a situation like that in which a father must decide how much cover he dare put into insurance for his family and be constantly anxious in case it is not enough.

I hope that the House will reject the Motion. I agreed to this slight extent with the hon. Member for St. Albans (Mr. Goodhew), that if I had framed the Government Amendment, I would have made it much more harsh and firm and much more anti the private insurance scheme. I hope that the Green Paper will give us greater democratic control over the Health Service, and if people want to participate and exercise free choice they will do so inside the National Health Service. These peripheral schemes divert our attention from the real things which need to be done.

There has been reference to the case concerning the hospital at Paddington in which a child died and which serves my constituents. I asked a Question of the Minister yesterday on this subject. Nobody chose that that child should die, but he died, because we had not the moral courage ten years ago to do the right thing for paediatrics. We had not the courage to say, "There must be more public expenditure. If you want hospitals, nurses and paediatricians and 'kids' not to die in hospital, you must be prepared to pay the bill". To suggest that we can solve the problem by means of peripheral private schemes is so much nonsense that I regret that we have not a full House to hear this debate.

6.2 p.m.

Mr. David Waddington (Nelson and Colne)

I should perhaps straight away declare an interest. I am a member of the Private Patients Plan. But I hasten to add that, strangely enough, when I had to go into hospital some years ago, I swiftly moved to a public ward for the company which was afforded me there.

I listened with the greatest interest to the debate. I was particularly interested in what the hon. Member for Loughborough (Mr. Cronin) said. He stated that none of his hon. Friends seriously questioned the right of people to spend their own money in their own way or the virtues of private practice. I noticed that his remarks fell on stony ground. They certainly did not seem to bring much of a response from his hon. Friends. The truth is that the right of people to spend their money in their own way is seriously questioned by hon. Members opposite. If it were not seriously questioned by them there would have been no Amendment tabled to our totally unexceptionable Motion. One could scarcely imagine a Motion more difficult to quarrel with. I remind the House of its terms: That this House welcomes the development of schemes for private health insurance. Who, with his hand on his heart, could not welcome such a development?

I wish to put two points to the House. First, every hon. Member recognises that it is highly unlikely that in the years to come the Treasury will be able to provide all the money which will be needed for the treatment of illness and disease. The demand is almost inexhaustible. When one thinks of the amount of money needed for the provision of kidney machines—and that is only one small need—we know that the Treasury will always put obstacles in the path of spending more public money.

Mr. Pavitt

We started with £1 million for the provision of kidney machines. The Treasury has now sanctioned £15 million to be spent on kidney machines alone.

Mr. Waddington

That is a glorious irrelevance. It is highly unlikely that in the coming years the Treasury will shell out all the money required for the Health Service.

Secondly, it is likely that we are close to the limit of what the public is prepared to pay by way of taxation and the National Insurance contribution. I listened with some amazement to what the hon. Member for Loughborough said on that score. We have only to experience in the constituencies the growing resistance to ever-increasing taxation and the reaction against the latest increase in the National Insurance contribution to realise that the day is fast coming when the public will not be prepared to provide the necessary funds if there is to be the expansion of the facilities for the treatment of disease which is needed. It is obvious that if we can encourage people to invest voluntarily in better medical care we should give three cheers, having increased the proportion of the national wealth spent on the treatment of illness and disease in a way in which it would be unlikely to be increased through taxation.

There is a wider issue of principle. I was horrified at the recent statement by the National Union of Teachers and their call for the abolition of private education in the interests, not, as I saw it, of education, but of egalitarianism. If the State insists on taking an ever larger proportion of the individual's income in taxation, the least that it can do is to allow the individual, who has paid his fair share of the State schemes for education and health, to spend what is left to him on taking off the backs of the State the responsibility for looking after himself and his children. If he is prepared to do that, the State should again give three cheers.

It is disturbing, to say the least, to see the distortion of values fostered by some hon. Members opposite and even more members of the Labour Party not of this House. Their philosophy seems to be that if a person "blows" his savings on a holiday in Bermuda or buys an expensive car, even an expensive foreign car, that is all right. But if he exercises his inalienable right, which is recognised by international convention, to educate his children as he wishes, he is an antisocial scoundrel who is buying privilege. We must not allow this sort of distortion of values to creep into the subject of health.

I will not embark on the arguments advanced about queue jumping because time is short. If private practice were abolished tomorrow—and it would be abolished effectively if we took from people all the privileges which come from having private treatment—it by no means follows that the man in the street would be treated any more quickly. If private fees were abolished, even more doctors would leave the country as soon as they had completed their training. It is a sobering thought that 20 per cent. of all doctors trained in this country in recent years have emigrated permanently and almost immediately after completing their training. The one thing which we would ensure if we put fetters on private practice is that even more doctors would leave this country, which would be of no assistance to the Health Service or to the poorer members of the community who are unable to enter private health insurance schemes.

There is far too little encouragement of self-reliance in this country. I look on private health insurance schemes as performing a most valuable social function in that they remind people that there is still room for private endeavour and a place in the community for the person who says, "I can afford to look after myself, and I am prepared to do so, and to take some of the burden off the State".

6.10 p.m.

Mr. George Wallace (Norwich, North)

I have heard quite a number of the speeches from the Opposition benches, including that of the Liberal representative. In every case there has been a direct or implied attack upon the National Health Service.

My experience of the House goes back to the time when it passed the National Health Service Act, when the Opposition party, the same party as are now in opposition, voted against it at every stage and when, above the clock in another place, where we were then meeting, sat an owlish figure representing the British Medical Association, opposed entirely to the Health Service. That attack on the service is emerging again today.

I have had 32 years' experience of public life and fighting for one objective: that was, a decent service of hospital treatment in the district in which I live. My first election was in 1937. At no time during that 32 years can I say that the Tory Party has been of any significant assistance. They made no constructive move towards the hospital the last stage of which is now being built, thanks to the present Government, who made sure that the regional board had the money with which to build it. I refer to Queen Mary's Hospital, Sidcup. But for the present Government, we should not be able to look forward to a better standard of service with the new hospital.

I am a member of many years' standing of the hospital management committee. We have a large number of hospitals, including some which are hutted and not up to modern standards. The objective of that committee, of every nurse, every doctor and every lay administrator, is to give service to the patient, and that is what we give. We get very few complaints and the standard of service given by the nurses and doctors, particularly under bad conditions, gives me the greatest admiration.

I am not against private insurance as such. Let us face the fact, however, that excessive charges for private beds and private rooms can cause difficult problems, especially for those administering the finances of the service at hospital management level.

The hon. Member for Farnham (Mr. Maurice Macmillan) inferred, if lie did not directly say, that he wanted additional amenities to be provided because of the increased demand for a private insurance scheme and for more private beds—and this at a time when our concentration should be on ridding ourselves of the old Victorian and other substandard hospitals. Let us give the proper standard of hospital service first. It is a question of priority, not of privilege, but of need.

The expansion of private practice in itself means more private beds. There is no denying that fact. I am not against a measure of private practice where it is possible, but my experience, with that of my colleagues, in trying to ensure a decent standard of service for the great mass of people in the Health Service leads me to the belief that any provision of additional amenities and services for private patients at this time would have to be at the expense of the rest of the patients in the hospitals.

There is a supposition throughout the whole of this debate that fee-paying patients can get a higher degree of skilled treatment than others. [HON. MEMBERS: "No."] That is the impression which I have had. If that is not the feeling of hon. Members opposite, it is the impression one gets that it is possible to buy a better doctor under private insurance.

Mr. pardoe

No.

Mr. Wallace

Well, that is the impression that some people have. I am not saying that it is necessarily the Opposition's view, but it is true. That is what the average person thinks.

We get a flood of advertisements nowadays on this very subject. Not only do hon. Member get pamphlets, but the newspapers carry a great spread of publicity for the scheme. I have a shrewd suspicion that that is why the Tory Party have come in on this, to cash in on it. Their Motion is badly timed, because it adds to some extent to people's anxieties, remembering the unfortunate minority of cases which are receiving attention in the Press.

I put this direct question to the Opposition spokesman who will be replying for his party. What is behind the Opposition Motion? What is behind Tory thinking on this issue? I have heard and seen statements made by individuals outside that charges should be made for stays in hospital, that a general charge should be levied in the same way as we unfortunately have prescription charges. Is this pressure by the Opposition to provide greater private insurance schemes? Have they in mind the advancing of a theory later, possibly after an election, and not before, that there should be charges for all beds in hospitals? Then, of course, the private scheme would come to their salvation and help to pay the cost of the charges for people who have insured. If that is the case, we are going right back to the conditions which prevail in certain other countries, far more wealthy than we are, where everyone who is ill has to pay.

Hon. Members opposite have talked about going to Bermuda and elsewhere. What do we do when we go on delegations abroad? One of the first things that any sensible hon. Member does is to make sure that he is fully insured against medical expenses. There is hardly another country where illness is not an expensive item, whereas in this country, at least we have the principle that anybody, irrespective of means, can receive adequate treatment.

One day, unfortunately, I was a sudden casualty and was whipped off to Westminster Hospital. I did not go into a private ward. I suppose that I was not a sufficiently important back bencher for that. I had all the treatment under the sun, as is available on the same basis for every other patient. The only additional treatment I got was that the hospital secretary had to deal with the Press, who seemed to be more interested in my passing out than in my recovery, perhaps because of the size of my majority. We all know that this happens.

Unfortunately, there was a large battery of photographers outside the House when I was taken into the ambulance. They were waiting, I think, for somebody more important, but the passage of a Member hors de combat on a stretcher was something beyond price to Press photographers. Fortunately, my wife threatened to sue them for libel and my photograph never got into the papers.

Apart from that kind of thing, most of us have been in ordinary wards and have seen the treatment that is given. We have experienced the treatment. There is no doubt that, in most cases, in the majority of our hospitals private insurance cannot mean additional skilled treatment because, thank goodness, the majority of hospital staff—doctors, nurses and lay administrators—have only one thing in mind, which is rammed home to us every time we have a meeting: the welfare of the patient is their first priority. Thank God that that principle still applies in the National Health Service today.

6.20 p.m.

Lord Balniel (Hertford)

We all found it very pleasant that the debate was opened by the Secretary of State for Wales, although I am bound to add that whilst it was very nice to have him here his speech was totally irrelevant to the Motion which we have moved, although it may have been relevant to his Amendment.

I think that, perhaps, as a Scotsman, I dare not refer to his Welsh-ness in view of the complexity of the law on the subject at the moment, but he did venture to say that both my hon. Friend the Member for Farnham (Mr. Maurice Macmillan) and I had been educated at Eton. Perhaps the House will allow me, with some academic loyalty to my school, to say how much better it might have been if the Secretary of State for Social Services had been an Old Etonian rather than an old Wykehamist. I think that it would have been of considerable value to the well-being of the country.

However, the question which we are debating today, as was brought out very forcefully by my hon. Friends the Member for St. Albans (Mr. Goodhew) and Nelson and Colne (Mr. Waddington), is really a very basic question indeed. It is whether people should be allowed to make decisions for themselves, or whether all decisions should be made for them by the State. We can certainly argue about the effect of expanding private provision on the State health services, and I shall refer to this matter during my remarks.

This is, however, subsidiary to the main question which we are discussing. We have moved a Motion welcoming the development of private health insurance because we believe it is right that people should be free to insure themselves if they wish to do so. We have noted that the Government's Amendment quite deliberately refuses to join us in welcoming this development and that it is designed to obliterate our Motion with a froth of plantitudinous words, words which are quite innocuous in themselves although in spirit which has motivated the Government's action is clear to everybody who has taken part in this debate.

The hon. Gentleman the Member for Norwich, North (Mr. Wallace) asked why we had proposed this Motion now. The reason is that it is becoming increasingly apparent that the Government, just as they have curbed home ownership, and just as they are now attacking private occupational pension schemes, are now paving the way for an attack on our right to choose whether to use the State services or to make out own arrangements.

The Labour Party's document entitled, "Labour's Social Strategy" says: We must be alive to the danger of a growth in private health and welfare provision which is now gathering momentum. I could make many other quotations from the same document along the same line of thinking.

We have the Secretary of State for Social Services using very much the same language. He says: The unplanned growth of these private insurance schemes is a disturbing element within the Health Service. I am not quite sure what he means by "unplanned growth", but certainly I planned my insurance scheme very carefully indeed, and I review it every year. I believe that the registrations, which cover 2 million persons in private health insurance, were very carefully planned, also. What the Secretary of State really means is that this instinctive human demand for freedom of choice cannot be controlled by the Government, and he wishes to control it. I must confess my own wicked involvement in these schemes. I belong to B.U.P.A. I hardly dare acknowledge the fact to hon. Gentlemen opposite, but not only have I insured myself but I have insured my wife and my four children.

I know that all of us, all 2 million of us, should crawl and cringe and blush with shame in front of the Government. Our hideous crime is that we have decided that, over and above taxation and the contributions which we pay towards the Health Service, we will cut back on some aspect of our personal spending so as to insure ourselves and pay our doctors' bills. We in the House can, of course, laugh at the absurdity of a Government who think it dangerous for people voluntarily to put aside some of their earnings for health insurance. But we have no sympathy at all with their desire to stamp on private choice.

We have no sympathy with the view that a man's or woman's free choice is less important than politicians' plans.

Indeed, the development of the Government's attack on private health insurance, like their attack on private occupational pension schemes, is an attack on a fundamental freedom. People should be free in as wide a sphere as possible to make their own choice as to how they spend their own savings.

I shall return to this point of principle, but I should like just to look at two of the arguments which have been developed fairly fully in the debate against private provision against ill-health. The first argument is that it enables people to jump the queue. The second is that it draws resources away from the public service. I shall take the queue jumping argument first.

The Government know that in the case of pay-beds provided under Section 5 of the 1946 Act it is expressly stated that a pay-bed can be used for any patient who urgently needs it. Exactly similar provision exists for amenity beds under Section 4 of the 1946 Act. Therefore, there should be no question of any National Health Service patient who urgently needs a pay bed on medical grounds being refused one.

That is why I thought the case which was referred to by the hon. Member for Cornwall, North (Mr. Pardoe) must be illegal under the 1946 Act. However, that is, of course, a matter which he himself will be studying, to see the rights and wrongs of the case. But I would say to the Minister that if he has any evidence of that kind of queue jumping I hope that he will disclose the facts to the House and tell us what appropriate action he intends to take.

What private health insurance, like B.U.P.A., or like the Private Patients Plan to which my hon. Friend belongs, or the Western Provident Association, does is, it enables people, through their insurance, to buy privacy, to choose the time of their non-urgent operations. If people want these fairly elementary facilities like privacy, like the timing of their non-urgent medical operations, and they want to pay for it, why should they not have the right to do so? Timing of operations is very important to the staffs of businesses, and it is interesting to note that 70 per cent. of the membership of the private health insurance is of staff and professional groups.

After all, leading members of the Labour Party take advantage of the Manor House Hospital outside the Health Service, supported by the trade union movement. By the Government's definition, this is queue jumping. So, presumably, are the civil servants who belong to the Civil Service Medical Association, with 20,000 members.

The Government's case rests, so far as I can see, upon no point of principle at all. They are quite prepared to tolerate arranging medical treatment at a time to suit the patients provided that not too many people do it. Their case, a rather bad case, I think, is that a few elite should be allowed this privilege, but that on no account must it be extended to the general public.

I want to see an increasing number of the general public able to have their hospital treatment at a time convenient to themselves, subject always to the proviso that this must not ever stand in the way of anyone needing urgent medical attention.

I will turn now to the other objection which has been raised, the question of resources. About 60 per cent. of those who pay are in pay-beds in Health Service hospitals. I suppose it can be argued that it is marginally more time-consuming for staff to have pay-beds rather than for everyone to be in the public wards. Against this is the fact that these beds bring to hospitals valuable revenue which would otherwise be lost to the Health Service.

In addition to pay-beds, there are those who pay for treatment in about 150 hospitals, convalescent homes and nursing homes. These are run by B.U.P.A. and by a wide variety of voluntary and religious organisations. Some of them are profit-making and some nonprofit-making. The subscription income for B.U.P.A. is £14 million; for Private Patients Plan £2½ million; and for Western Provident Association £½ million. All this is extra money which is brought into the sector of health. The Nuffield Nursing Homes Trust runs 14 small hospitals with 466 beds. Next year, a new medical centre will be established with a fully automated laboratory. The Health Service is completely relieved of the cost of all these services which otherwise would fall on the taxpayer.

Is the Health Service so flush with money that the Government can haughtily reject these contributions voluntarily made by the public? One has only to walk around the geriatric wards of our hospitals, visit the mental subnormality hospitals, witness the understaffed general district hospitals or see the overworked, underpaid medical staff in these hospitals to realise the absolute folly of scorning the contribution which can be made by voluntary health insurance.

It may be argued that these doctors and nurses would be working in the Health Service if there were no private facilities. Perhaps some would. I accept that but I believe that there would be many more who would join their colleagues who have already emigrated from this country. If there were no private provision in this country, it is certain, without any "ifs" or "buts", that many doctors and consultants who now have a base of private practice, but who also do invaluable work in the National Health Service, would pack up and go. Nurses and doctors belong to one of the greatest professions in the world, and there is a worldwide demand for their services in rich countries like Canada, South Africa, Australia and the United States.

Even today, the Government should be deeply concerned that so many of our best young doctors are leaving the country, so that we have to draw on doctors from the under-developed countries where they are so desperately needed.

Mr. Leslie Spriggs (St. Helens)

Is the hon. Gentleman suggesting that surgeons and members of the medical profession practising privately put profit before their profession?

Lord Balniel

I believe that the medical profession, like every other profession, is entitled to a good remuneration. The remuneration offered in the Health Service is not good and that is why so many of our good doctors, particularly the young doctors, are leaving the country. That is exactly the point which the hon. Member for Loughborough (Mr. Cronin), who has great experience in this matter, made in his valuable contribution to the debate.

I return to the general issue of principle. These attacks by the Government on private health insurance stem from two motives. They are partly a sop to the egalitarian principles of the Left wing of the Labour Party. They are also partly because the Government are desperately anxious to distract attention from their failure to get to grips with the real problems of social welfare, to distract attention from the cut-back in the growth of the local community services on which old people depend, to distract attention from the inadequate provision for the mentally ill and from their failure to switch additional resources from one sector of the health service into this starved sector.

How foolish the Government are, for political purposes, to attack private provision, instead of concentrating every effort on bringing State help to the sick, the disabled and the elderly who cannot look after themselves. How foolish can a party be which writes in "Labour's Social Strategy" the words which I quoted at the beginning of my speech about the danger of a growth in private health and welfare which is now gathering momentum. What an incredible attitude of mind which makes them think that it is dangerous for more people to want to make more provision for their own health and welfare and that of their children. Apparently, this is a danger to the nation and the Socialist Government must stamp it out.

We warn the Government to keep their hands of occupational pension schemes, to keep their hands off the freedom of choice which men and women want and to keep their hands off private health insurance. We want a society where people are free to invest, save and insure and where the resources of the State are used to improve the conditions of our hospitals and the other services which can be provided only by the State. The Government, in their Amendment have gone out of their way to seek to amend our Motion welcoming the development of private health insurance. They are trying to obliterate the words and the spirit of the Motion, and I would advise the House to vote against their folly.

6.38 p.m.

The Joint Under-Secretary of State for the Department of Health and Social Security (Dr. John Dunwoody)

I have been impressed by the nature of the debate, which has been useful and important, although I thought the hon. Member for Hertford (Lord Balniel) made a speech which bore little or no relevance to the excellent speech of my right hon. Friend the Secretary of State for Wales. The hon. Member for Hertford continuously repeated the word "attack". I have listened most carefully to the whole debate, and I have heard no attack on private health insurance schemes or on private practice.

The problem of getting the best and most appropriate care and treatment for each and every patient is of paramount importance the solution to which cuts across all consideration of finance. My right hon. Friend made the point that if one is in urgent need of treatment our hospital service responds at once, and I know that I can safely say that nowhere else in the world is better treatment more readily available to the entire community when urgent medical or surgical help is needed than in this country under the National Health Service.

Our hospital services are organised so that any patient in real need can be admitted at once and receive the devoted care of doctors, nurses and all the other hospital staff, without the question of payment for the care provided. As medical knowledge has expanded and scientific know-how increased, facilities have been made available in hospitals which are at the service of all, irrespective of financial status, race, creed or any other considerations except those of medical need and the relief of suffering, pain and distress.

The advent of antibiotics and all the other new wonder drugs and our immunisation programmes have played a very large part in controlling and curing many of the acute infections so lethal in the past. Mortality in the younger age groups has been greatly reduced, for example, one of the main scourges of earlier days, tuberculosis, has been almost eliminated. On the other hand, better medical care and improved social services mean that much larger numbers of people are now living on to middle and old age arid, at one stage or another, requiring medical care for chronic degenerative and debilitating disorders, for cancer, for heart diseases, and for a host of other conditions.

New and sophisticated techniques which not only diagnose more accurately the disease process, but also improve the success of treatment, have become increasingly available. This, along with improved surgical and anaesthetic techniques, has made surgery far safer. This brings in its train problems. For example, the previously untreatable and fatal congenital abnormality has now become not only a surgical problem, but one whose solution may result in a rehabilitation and medical care commitment for the rest of the patient's life.

Sir Stephen McAdden (Southend, East)

On a point of order. I am sorry to raise a point of order which I have raised in the case of other Ministers, Mr. Speaker, but it is becoming intolerable that Ministers get up and read their speeches word for word.

Mr. Speaker

The hon. Gentleman has called attention to this phenomenon before but the Chair has often had to rule that a Minister may use copious notes when addressing the House.

Dr. Dunwoody

As I was saying, increasing sophistication means that the traditional specialities are increasingly being subdivided into smaller specialities in order to develop expertise, new skills and to concentrate resources. Thus, costly methods of treatment compete for priority with all the other demands on available resources. A progressive and more enlightened attitude—which is something we would all welcome—towards the mentally ill, the subnormal, the geriatric, the disabled, and the chronic sick brings all these patients, more than ever before, to the forefront of our thinking and planning.

As many of those who have contributed to the debate have said, the picture is not always so satisfactory for patients who are not suffering from an urgent condition, but who are waiting for surgical treatment for a non-urgent disability. Waiting lists vary greatly up and down the country, but it is clear that there are some areas and specialties where the waiting times are long and where the sum of discomfort, unhappiness and reduced effectiveness at work and in everyday life must be considerable.

As my right hon. Friend has said, the number of patients awaiting admission at the end of last year was over half a million. The vast majority of these were waiting for surgical treatment, but I am glad to say that for the second year running general surgery, the largest discipline, showed a small reduction in the numbers waiting. Other specialties showing a decrease in that year were tonsillectomy ophthalmology, urology, plastic and thoracic surgery. The waiting list for tonsillectomy was 18 per cent. of the surgical total. As hon. Members know, there is controversy over the indications for this operation and this particular part of the waiting list should be looked at in the light of this fact. Again, in gynaecology there was a small decrease for the second year running.

Mr. Peter Emery (Honiton)

But would the Minister not agree that the Health Service waiting lists would be very much larger if a large number of tonsillectomies were not done under private health insurance schemes? Would the hon. Gentleman now turn his mind to the Motion and say whether he is in favour of private health insurance, if he is not attacking it?

Dr. Dunwoody

It is unfortunate that the hon. Gentleman has not been in the Chamber for some time, and particularly since he did not hear my right hon. Friend speak earlier in the debate. So far as waiting time for admission is concerned, as my right hon. Friend has said, urgent cases are admitted without delay. The great majority of patients on waiting lists are those booked for non-urgent elective surgery. Examples of the median waiting time—the waiting time of the middle patients in a group distributed in order of waiting time, and the largest proportion of those waiting fall around this point—were, in 1967, 8½ weeks for hernia, 7½ weeks for haemorrhoidectomy, 12 weeks for uterine prolapse, and 14 weeks for varicose veins.

It is clear from these figures why some patients prefer to take advantage of private facilities to cut short the wait. This is understandable, and it could be argued to be justified in terms of the convenience of the individual. But more can and must be done to remedy the situation within the Health Service itself. There are still hospitals where the organisation of the facilities for outpatient attendances, for admissions and for operating lists fail to make the best use of available resources. This is something which only the doctors themselves, in consultation with nursing, other professional and administrative colleagues can put right. In many areas the medical and nursing staff concerned are organising themselves to solve just this problem. I hope that organisation will steadily improve so that we will see, at least, waiting lists will no longer be increased by shortcomings in organisation.

But it is not simply a matter of logistics. There are not unlimited supplies of manpower, medical, nursing and other skilled fields, and whatever is done either in the private or the public sector can only be done within the limit of the resources available at any one time, including, of course, financial resources.

Hon. Members opposite have made the point that there are other ways, in their opinion, than financing the Health Service largely through Exchequer funds. They ask why cannot private medical insurance be substantially expanded? Then we are sometimes asked, why cannot patients be called upon to pay a boarding charge for their hospital treatment, or to pay a charge per visit to their general practitioners?

A thoughtful commentary on some of these suggestions was made in a leading article in The Lancet of 6th December. It is worth referring specifically to some of the important points it makes. In the first place, the article agrees with my right hon. Friend's contention that the idea that charges can be a substitute for taxes as the main source of National Health Service revenue can be dismissed out of hand". It mentions that a £4 a week charge for hospital patients and a fee of 2s. 6d. for each visit to a general practitioner would yield only £60 million, leaving aside the need for refunds and exemptions, and that this sum would make very little impression on the total budget of £1,600 million for hospital and family practitioner and allied services in Great Britain.

The article continues: About 800,000 people are registered with a private insurance scheme to provide varying degrees of cover against hospital bills for private treatment, fees for general-practitioner consultations, and the cost of drugs. Many people think that increased reliance on schemes such as these would lessen the burden on the State; but this seems a very doubtful proposition… The Lancet then goes on to say that my right hon. Friend did not stress the point which has long concerned those with an eye to what has happened to medical care in the United States—namely, that insurance can never be comprehensive, so the National Health Service will retain responsibility for the expensive items such as mental illness and chronic sickness and for those with a poor medical history. After all, what middle-aged man could afford to cover himself against the need for intensive care if he had a history of myocardial infection? The article refers also to the possibilities of increased Health Service contributions, but it concludes, in regard to all the possible ways of raising money for health, as follows: These alternatives are the same as they have always been, and we can find nothing in this pamphlet to alter the view that the only way to pay for a comprehensive, free Health Service is out of general taxation. This represents a point of view which is doubtless shared by very many of the medical profession as well as by Her Majesty's Government.

There were, however, a number of points raised by hon. Members in the debate with which I should like to attempt to deal in the short time at my disposal before summing up our conclusions on the place of private medical insurance in the pattern of health care.

I wish to take up a point which was made by the hon. Member for Farnham (Mr. Maurice Macmillan), when he opened the debate. I understood him to say that expenditure in the years ahead in health and welfare not only were not planned to rise, but might fall marginally. He quoted the figure of 0.1 per cent. increase per annum. If he will look at the White Paper, "Public Expenditure from 1968–69 to 1973–74", he will find that we plan an increase of 3.8 per cent. in expenditure per year between 1968–69 and 1971–72 at constant prices.

This is a figure for the country as a whole. The effect of considering the figure per capita will be marginal, because the increase in the population of this country, which is taking place steadily every year, is a very small percentage in any one year and the figures I quoted were for two or three years.

Lord Balniel

The hon. Gentleman was quoting a figure of increase in expenditure on health and welfare of 3.8 per cent. from 1968–69 to 1971–72, but there was an increase of 3.9 per cent. from 1964–65 to 1968–69, so there is a dropping in the rate of increase.

Dr. Dunwoody

The noble Lord will remember that his colleague said that, far from there being an increase or a drop in the increase, there would be a cut in years to come. I have tried to explain that this is not so and that we plan to improve the services as rapidly as possible.

Hon. Members have referred to the possibility of queue jumping by private patients. It is, of course, true that if a patient is referred by his general practitioner to a consultant privately for advice on a non-urgent condition he may thereby be seen at an earlier date than would be possible if he had been referred under the Health Service for a hospital out-patient appointment. Any priority in the queue should, however, stop there.

The hon. Member for Cornwall, North (Mr. Pardoe) instanced an urgent case of a patient who had to wait a long time before a bed was available. That should be catered for by the procedure of hospitals whereby urgent requests for beds jump the queue for out-patient appointments. I can speak from experience. It is almost invariably the case that urgent cases can be seen quite rapidly and the long period of waiting which urgent cases have to endure is not necessary.

Some years ago an agreement was reached with the medical profession to check the possibility of jumping the queue for a Health Service bed by having a consultation on a private basis. This was to the effect that if a patient has been seen by a consultant privately, and required admission as a non-paying patient, he would either have to attend the outpatient department, or the consultant would pass to the hospital an ordinary out-patient record or his notes and the patient would then be admitted, according to his medical priority, from the general waiting list.

There have been other allegations that priority in operating time is secured for the private patient, and there are understandable anxieties about this. The situation is further complicated in some places as operating theatre space is limited and my right hon. Friend is satisfied that more theatres are needed in these places. More are being built, but even theatres have to take their place in order of priority with other essential hospital building. The vital consideration is to ensure that the facilities which are already available should be used to full advantage.

Following the Report on the Organisation of Medical Work in Hospitals, more and more of the surgical staffs in hospital are organising their work with a view to achieving the objective of the maximum number of patients treated in the shortest time having regard to the professional and ancillary staff and other facilities available. I pay tribute to the work done in many hospitals by medical and nursing staff to achieve this desirable end.

Other hon. Members have raised various points about bed occupancy. Why are pay-beds under-occupied? Could we not have more amenity beds? The short answer to these points is that pay-beds should be and are used by Health Service patients who require them on medical grounds. As for amenity beds, there is little room for much expansion since many single rooms or small wards in old hospitals are rightly used for patients whose medical condition demands their use. In new hospital, there is a much higher proportion of single rooms and very few large wards. Most patients would not find it necessary to pay to secure extra amenity in these new hospitals.

Another quite different point has been raised by hon. Members on both sides of the House—the interaction between private practice and Health Service practice and the contribution made by one to the other. It is quite true that in some areas of the service the two are in parternship. In certain places for example the Health Service contracts to pay for beds in private hospitals and nursing homes—this is sometimes necessary for geographical reasons—though the number is decreasing with the pro- vision of new or extended Health Service hospital facilities. We think it right, in this situation, that the Health Service should contract to use certain beds in these units of the community as a whole, at least as a stop-gap until we have been able to improve the service to fulfil the needs of the community.

On the other hand, the Health Service supplies such things as blood and laboratory services to these private units. While this is possible on a small scale it would be quite impracticable to meet unforeseen demands from a much larger private sector. Conversely, the private sector would find great difficulty in providing and manning the vast sophisticated diagnostic services which are an essential part of a modern comprehensive service.

Finally, some hon. Members who may not contemplate a service wholly based on private insurance, have asked why a modest increase in private insurance could not be encouraged. The Lancet article to which I referred earlier makes the comment that very little is known about how private practice works… and indeed, despite all the discussion of private practice, nowhere have all the facts been brought together. It has been striking that in this debate very different figures have been quoted by hon. Members on either side of the House. I do not think it is anything more than an indication that we do not know all the facts.

Because of this uncertainty, my right hon. Friend thinks that it would be most helpful to hon. Members on both sides to have an independent and objective study of the scale, the scope and the rate of growth of private practice, and to this end he is exploring with P.E.P. the preparation of a study of this kind. It is important that it should be an independent study, because this is not an area where it is appropriate that my Department should initiate or conduct the work.

It is thus difficult at present to say what would be the effect of modest changes in scale of private practice. However, in any event, private practice is inevitably limited in scope, dealing mainly with the therapeutic aspects of a particular illness occurring in the patient. I have already made plain it is not in a position to cover the comprehensive range of services provided by general practioners, the local authority and the hospital which span the lifetime of the individual from cradle to grave and make available preventive medicine, rehabilitation, and health education, together with such social, medical and welfare services as may be required by the patient.

Her Majesty's Government have a responsibility to provide the whole range of services across the community, and I repeat what I said earlier, that there is nowhere in the world where better treat-

ment is more readily available to the entire community when urgent medical help is needed than in Britain today. Private practice plays a part, and it is highly desirable that we should be better placed to assess the actual contribution which private practice is making towards the total health care of our community.

Question put, That the Amendment be made:—

The House divided: Ayes 296, Noes 225.

Division No. 32.]	AYES	[7.0 p.m.
Abse, Leo	Dickens, James	Hughes, Hector (Aberdeen, N.)
Albu, Austen	Dobson, Ray	Hughes, Roy (Newport)
Allaun, Frank (Salford, E.)	Doig, Peter	Hunter, Adam
Alldritt, Walter	Driberg, Tom	Hynd, John
Allen, Scholofield	Dunn, James A.	Jackson, Colin (B'h'se & Spenb'gh)
Ashley, Jack	Dunwoody, Mrs. Gwyneth (Exeter)	Jackson, Peter M. (High Peak)
Atkins, Ronald (Preston, N.)	Dunwoody, Dr. John (F'th & C'b'e)	Jay, Rt. Hn. Douglas
Atkinson, Norman (Tottenham)	Eadie, Alex	Jeger, George (Goole)
Bacon, Rt. Hn. Alice	Ellis, John	Jenkins, Hugh (Putney)
Bagier, Gordon A. T.	English, Michael	Johnson, Carol (Lewisham, S.)
Barnes, Michael	Ennals, David	Johnson, James (K'ston-on-HuIl, W.)
Barnett, Joel	Ensor, David	Johnston, Russell (Inverness)
Baxter, William	Evans, Albert (Islington, S. W.)	Jones, Dan (Burnley)
Beaney, Alan	Evans, Fred (Caerphilly)	Jones, Rt. Hn. Sir Elwyn (W. Ham, S.)
Bence, Cyril	Evans, Ioan L. (Birm'h'm, Yardley)	Jones, J. Idwal (Wrexham)
Benn, Rt, Hn. Anthony Wedgwood	Ewing, Mrs. Winifred	Jones, T. Alec (Rhondda, West)
Bennett, lames (G'gow, Bridgeton)	Faulds, Andrew	Kelley, Richard
Bessell, Peter	Femyhough, E.	Kenyon, Clifford
Bidwell, Sydney	Finch, Harold	Kerr, Dr. David (W'worth, Central)
Binns, John	Fitch, Alan (Wigan)	Latham, Arthur
Bishop, E. S.	Fletcher, Rt. Hn. Sir Eric (lslington, E.)	Lawler, Wallace
Blenkinsop, Arthur	Fletcher, Ted (Darlington)	Lawson, George
Boardman, H. (Leigh)	Foot, Rt. Hn. Sir Dingle (Ipswich)	Leadbitter, Ted
Booth, Albert	Foot, Michael (Ebbw Vale)	Ledger, Ron
Boston, Terence	Ford, Ben	Lee, Rt. Hn. Jennie (Cannock)
Boyden, James	Forrester, John	Lee, John (Reading)
Bradley, Tom	Fowler, Gerry	Lestor, Miss Joan
Bray, Dr. Jeremy	Frascr, John (Norwood)	Lever, Rt. Hn. Harold (Cheetham)
Broughton, Sir Alfred	Freeson, Reginald	Lewis, Ron (Carlisle)
Brown, Hugh D. (G'gow, Provan)	Galpern, Sir Myer	Lomas, Kenneth
Brown,Bob(N'c'tie-upon-Tyne,W.)	Gardner, Tony	Loughlin, Charles
Brown, R. W. (Shoreditch & F'bury)	Garrett, W. E.	Luard, Evan
Buchan, Norman	Ginsburg, David	Lubbock, Eric
Buchanan, Richard (G'gow, Sp'burn)	Colding, John	Lyon, Alexander W. (York)
Butler, Herbert (Hackney, C.)	Gordon Walker, Rt. Hn. P. C.	Lyons, Edward (Bradford, E.)
Butler, Mrs. Joyce (Wood Green)	Gray, Dr. Hugh (Yarmouth)	Mabon, Dr. J. Dickson
Callaghan, Rt. Hn. James	Greenwood, Rt. Hn. Anthony	McBride, Neil
Cant, R. B.	Gregory, Arnold	McCann, John
Carmichael, Neil	Grey, Charles (Durham)	MacColl, James
Carter-jones, Lewis	Griffiths, Eddie (Brightside)	MacDermot, Niall
Castle, Rt. Hn. Barbara	Grimond, Rt. Hn. J.	Macdonald, A. H.
Concannon, J. D.	Gunter, Rt. Hn. R. J.	McElhone, Frank
Conlan, Bernard	Hamilton, William (Fife, W.)	McGuire, Michael
Corbet, Mrs. Freda	Hamling, William	McKay, Mrs. Margaret
Craddock, George (Bradford, S.)	Hannan, William	Mackenzie, Alasdair (Ross&Crom'ty)
Crawshaw, Richard	Harper, Joseph	Mackenzie, Gregor (Rutherglen)
Cronin, John	Hart, Rt. Hn. Judith	Mackie, John
Crosland, Rt. Hn. Anthony	Haseldine, Norman	Mackintosh, John P.
Daiyell, Tam	Hazell, Bert	MacMillan, Malcolm (Western Isles)
Darling, Rt. Hn. George	Healey, Rt. Hn. Denis	McMillan, Tom (Glasgow, C.)
Davidson, Arthur (Accrington)	Heffer, Eric S.	McNamara, J. Kevin
Davidson, James(Aberdeenshire, W.)	Henig, Stanley	MacPherson, Malcolm
Davies, G Eifed (Rhondda, E.)	Hilton, W. S.	Mahon, Peter (Preston, S.)
Davies, Dr. Ernest (Stretford)	Hobden, Dennis	Mahon, Simon (Bootle)
Davies, Rt. Hn. Harold (Leek)	Hooley, Frank	Mallalieu, E. L. (Brigg)
Davies, Ifor (Gower)	Hooson, Emlyn	Mallalieu, J. P. W. (Huddersfield, E.)
Davies, S. O. (Merthyr)	Horner, John	Manuel, Archie
Deiargy, Hugh	Houghton, Rt. Hn. Douglas	Mapp, Charles
Dell, Edmund	Howarth, Robert (Bolton, E.)	Marks, Kenneth
Dempsey, James	Howie, W.	Marquand, David
Dewar, Donald	Hoy, Rt. Hn. James	Marsh, Rt. Hn. Richard
Diamond, Rt. Hn. John	Hughes, Rt. Hn. Cledwyn (Anglesey)	Mason, Rt. Hn. Roy
Maxwell, Robert	Pentland, Norman	Strauss, Rt. Hn. G. R.
Mayhew, Christopher	Perry, Ernest G. (Battersea, S.)	Swain, Thomas
Mellish, Rt. Hn. Robert	Perry, George H. (Nottingham, S.)	Traverne, Dick
Mendclson, John	Prentice, Rt. Hn. Reg	Thomas, Rt. Hn. George
Millar), Bruce	Price, Christopher (Perry Bar)	Thomson, Rt. Hn. George
Miller, Dr. M. S.	Price, William (Rugby)	Thornton, Ernest
Milne, Edward (Blyth)	Probert, Arthur	Tinn, James
Mitchell, R. C. (S'th'pton, Test)	Pursey, Cmdr. Harry	Tomney, Frank
Molloy, William	Randall, Harry	Tuck, Raphael
Morgan, Elystan (Cardiganshire)	Rankin, John	Urwin, T. W.
Morris, Alfred (Wythenshawe)	Rees, Merlyn	Varley, Eric G.
Morris, Charles R. (Openshaw)	Richard, Ivor	Wainwright, Edwin (Dearne Valley)
Morris, John (Aberavon)	Roberts, Albert (Normanton)	Walker, Harold (Doncaster)
Mulley, Rt. Hn. Frederick	Roberts, Rt. Hn. Goronwy	Wallace, George
Murray, Albert	Roberts, Gwilym (Bedfordshire, S.)	Watkins, David (Consett)
Neat, Harold	Robertson, John (Paisley)	Watkins, Tudor (Brecon & Radnor)
Newens, Stan	Robinson, Rt.Hn.Kenneth(St.P'c'as)	Weitzman, David
Norwood, Christopher	Rodgers, William (Stockton)	Wellbeloved, James
Oakes, Gordon	Roebuck, Roy	Wells, William (Walsall, N.)
Ogden, Eric	Rogers, George (Kensington, N.)	Whitaker, Ben
O'Halloran, Michael	Rose, Paul	White, Mrs. Eirene
O'Malley, Brian	Ross, Rt. Hn. William	Whitlock, William
Oram, Albert E.	Rowlands, E.	Wilkins, W. A.
Orbach, Maurice	Shaw, Arnold (Ilford, S.)	Willey, Rt. Hn. Frederick
Orme, Stanley	Sheldon, Robert	Williams, Alan (Swansea, W.)
Oswald, Thomas	Shinwell, Rt. Hn. E.	Williams, Clifford (Abertillery)
Owen, Will (Morpeth)	Shore, Rt. Hn. Peter (Stepney)	Williams, Mrs. Shirley (Hitchin)
Padley, Walter	snort, Mrs. Renée(W'nampton,N.E.)	Willis, Rt. Hn. George
Paget, R. T.	Silkin, Rt. Hn. John (Deptford)	Wilson, Rt. Hn. Harold (Huyton)
Palmer, Arthur	Silverman, Julius	Winnick, David
Pannell, Rt. Hn. Charles	Skeffington, Arthur	Winstanley, Dr. M. P.
Pardoe, John	Slater, Joseph	Woodburn, Rt. Hn. A.
Park, Trevor	Small, William	Woof, Robert
Parker, John (Dagenham)	Snow, Julian	Wyatt, Woodrow
Parkyn, Brian (Bedford)	Spriggs, Leslie
Pavitt, Laurence	Steel, David (Roxburgh)	TELLERS FOR THE AYES:
Pearson, Arthur (Pontypridd)	Steele, Thomas (Dunbartonshire, W.)	Mr. Ernest Armstrong and
Peart, Rt. Hn. Fred	Stonehouse, Rt. Hn. John	Mr. William Hamling.
NOES
Alison, Michael (Barkston Ash)	Chichester-Clark, R.	Hall-Davis, A. G. F.
Allason, James (Hemel Hempstead)	Clegg, Walter	Hamilton, Lord (Fermanagh)
Amery, Rt. Hn. Julian	Cooke, Robert	Hamilton, Michael (Salisbury)
Archer, Jeffrey (Louth)	Cordie, John	Harris, Reader (Heston)
Astor, John	Corfield, F. V.	Harrison, Brian (Maldon)
Atkins, Humphrey (M't'n & M'd'n)	Costain, A. P.	Harrison, Col. Sir Harwood (Eye)
Baker, Kenneth (Acton)	Crouch, David	Harvie Anderson, Miss
Baker, W. H. K. (Banff)	Cunningham, Sir Knox	Hawkins, Paul
Balniel, Lord	Dalkeith, Earl of	Hay, John
Barber, Rt. Hn. Anthony	Dance, James	Heald, Rt. Hn. Sir Lionel
Batsford, Brian	Dean, Paul	Heath, Rt. Hn. Edward
Beamish, Col. Sir Tufton	Dodds-Parker, Douglas	Heseltine, Michael
Bell, Ronald	Douglas-Home, Rt. Hn. Sir Alec	Higgins, Terence L.
Bennett, Sir Frederic (Torquay)	Drayson, G. B.	Hiley, Joseph
Bennett, Dr. Reginald (Gos. & Fhm)	du Cann, Rt. Hn. Edward	Hill, J. E. B.
Berry, Hn. Anthony	Eden, Sir John	Hirst, Geoffrey
Biffen, John	Elliot, Capt. Walter (Carshalton)	Hogg, Rt. Hn. Quintin
Biggs-Davison, John	Emery, Peter	Holland, Philip
Birch, Rt. Hn. Nigel	Errington, Sir Eric	Hordern, Peter
Black, Sir Cyril	Eyre, Reginald	Hornby, Richard
Blaker, Peter	Farr, John	Howell, David (Guildford)
Boardman, Tom (Leicester, S.W.)	Fisher, Nigel	Hunt, John
Body, Richard	Fletcher-Cooke, Charles	Hutchison, Michael Clark
Bossom, Sir Clive	Fortescue, Tim	Iremonger, T. L.
Boyd-Carpenter, Rt. Hn. John	Foster, Sir John	Irvine, Bryant Godman (Rye)
Boyle, Rt. Hn. Sir Edward	Fraser,Rt.Hn.Hugh(St'fford & Stone)	Jenkin, Patrick (Woodford)
Brewis, John	Fry, Peter	Jennings, J. C. (Burton)
Brinton, Sir Tatton	Galbraith, Hn. T. G.	Johnson Smith, G. (E. Grinstead)
Bromley-Davenport,Lt.-Col.SirWalter	Gibson-Watt, David	Jones, Arthur (Northants, S.)
Brown, Sir Edward (Bath)	Gilmour, Ian (Norfolk, C.)	Jopling, Michael
Bryan, Paul	Gilmour, Sir John (Fife, E.)	Joseph, Rt. Hn. Sir Keith
Buchanan-Smith, Alick(Angus, N&M)	Glyn, Sir Richard	Kaberry, Sir Donald
Buck, Antony (Colchester)	Godber, Rt. Hn. J. B.	Kerby, Capt. Henry
Bullus, Sir Eric	Goodhart, Philip	Kershaw, Anthony
Burden, F. A.	Goodhew, Victor	Kimball, Marcus
Campbell, B. (Oldham, W.)	Gower, Raymond	King, Evelyn (Dorset, S.)
Campbell, Gordon (Moray & Nairn)	Grant, Anthony	Kitson, Timothy
Carlisle, Mark	Grant-Ferris, Sir Robert	Lambton, Viscount
Carr, Rt. Hn. Robert	Gresham Cooke, R.	Lane, David
Cary, Sir Robert	Grieve, Percy	Langford-Holt, Sir John
Channon, H. P. G.	Gurden, Harold	Legge-Bourke, Sir Harry
Chataway, Christopher	Hall, John (Wycombe)	Lewis, Kenneth (Rutland)

Lloyd,Rt.Hn.Geoffrey(Sut'nC'dfield)	Orr-Ewing, Sir Ian	Stoddart-Scott, Col. Sir M.
Lloyd, Rt. Hn. Selwyn (Wirral)	Osborn, John (Hallam)	Summers, Sir Spencer
Longden, Gilbert	Page, Graham (Crosby)	Tapsell, Peter
McAdden, Sir Stephen	Page, John (Harrow, W.)	Taylor, Sir Charles (Eastbourne)
MacArthur, Ian	Pearson, Sir Frank (Clitheroe)	Taylor,Edward M.(G'gow,Cathcart)
Maclean, Sir Fitzroy	Percival, Ian	Taylor, Frank (Moss Side)
Macleod, Rt. Hn. Iain	Pike, Miss Mervyn	Temple, John M.
McMaster, Stanley	Pink, R. Bonner	Thatcher, Mrs. Margaret
Macmillan, Maurice (Farnham)	Pounder, Rafton	Tilney, John
McNair-Wilson, Michael	Powell, Rt. Hn. J. Enoch	Turton, Rt. Hn. R. H.
McNair-Wilson, Patrick (NewForest)	Price, David (Eastleigh)	van Straubenzee, W. R.
Maddan, Martin	Prior, J. M. L.	Vaughan-Morgan, Rt. Hn. Sir John
Marples, Rt. Hn. Ernest	Pym, Francis	Waddington, David
Marten, Neil	Quennell, Miss J. M.	Walker, Peter (Worcester)
Maudling, Rt. Hn. Reginald	Ramsden, Rt. Hn. James	Walker-Smith, Rt. Hn. Sir Derek
Mawby, Ray	Rawlinson, Rt. Hn. Sir Peter	Wall, Patrick
Maxwell-Hyslop, R. J.	Renton, Rt. Hn. Sir David	Walters, Dennis
Maydon, Lt.-Cmdr. S. L. C.	Rhys Williams, Sir Brandon	Ward, Dame Irene (Tynemouth)
Mills, Peter (Torrington)	Ridley, Hn. Nicholas	Weatherill, Bernard
Mills, Stritton (Belfast, N.)	Ridsdale, Julian	Wells, John (Maidstone)
Miscampbell, Norman	Robson Brown, Sir William	Whitelaw, Rt. Hn. William
Monro, Hector	Rossi, Hugh (Hornsey)	Wiggin, A. W.
Montgomery, Fergus	Royle, Anthony	Williams, Donald (Dudley)
Morgan-Giles, Rear-Adm.	Russell, Sir Ronald	Wilson, Geoffrey (Truro)
Morrison, Charles (Devizes)	Scott, Nicholas	Wolrige-Gordon, Patrick
Mott-Radclyffe, Sir Charles	Scott-Hopkins, James	Wood, Rt. Hn. Richard
Munro-Lucas-Tooth, Sir Hugh	Shaw, Michael (Sc'b'gh & Whitby)	Woodnutt, Mark
Murton, Oscar	Silvester, Frederick	Worsley, Marcus
Nabarro, Sir Gerald	Sinclair, Sir George	Wylie, N. R.
Neave, Airey	Smith, Dudley (W'wick & L'mington)	Younger, Hn. George
Nicholls, Sir Harmar	Smith, John (London & W'minster)
Noble, Rt. Hn. Michael	Speed, Keith	TELLERS FOR THE NOES:
Nott, John	stainton, Keith	Mr. R. W. Elliott and
Onslow, Cranley	Stodart, Anthony	Mr. Jasper More.
Orr, Capt. L P. S.

Main Question, as amended, agreed to.

Resolved,

That this House, noting the development of schemes for private health insurance, recognises that these cannot provide an adequate alternative to existing methods of financing a comprehensive health service.